The recent Medicaid rates included new incentives for providers. These resulted in many questions from providers regarding how the measures were calculated, especially the Quality Measures incentive.
Myers & Stauffer has prepared a more detailed explanation of these and all providers should have received this explanation last week, along with an example calculation.
Now that we know how the scoring was done for these measures, where do we go from here? How do we improve these scores? The answer lies within the 5 star rating system itself.
The Myers & Stauffer document included a link to the 5 Star Rating System Technical Users Guide. See it here.
Visit this site for another less technical resource.
These should be required reading for all organizations. They gives more guidance as to what goes into all of the 5 Star Ratings and how they are determined. LeadingAge Kansas frequently gets questions about the 5 Star System and while the LeadingAge National website has some great training on the 5 Star system, the technical guide gives even more. This includes details of how your census is determined for the calculations, staffing data usage, and scoring rules.
As the 5 star ratings include more of a provider’s history and data, including the recent addition of the PBJ data, it is imperative that providers understand the methodology and how it impacts them. MDS Coordinators have a very important role to play in this, as they are sending in your data, so accuracy of that data is more important than ever. This data, along with your survey performance, determines your 5 star rating. And with the recent press regarding nursing home staffing, the accuracy of your PBJ data submission is also very important.
Finally, since this system is now affecting providers in an even more direct financial way, it is critical that providers review their 5 star report and make sure that the data used is accurate. Ongoing continuing education for MDS Coordinators and a data review procedure is a great way to address this. Support for your MDS Coordinator will pay off in the long run.
One other point to keep in mind is that the current 5 star rating system does not use survey findings for any survey after November 28, 2017. This is due to the new survey process and the time it will take for all of the homes to be inspected under the new process. Any survey performed after that date will be available on the Nursing Home Compare website, but will not be included in the 5 star rating. CMS estimates that it will take approximately one year for all homes to be inspected under the new process, after which time the new surveys will be included.
