Quality Measures & Five-Star Rating in Skilled Nursing Facilities | Clinical Consulting Services | Richter

Skilled nursing facilities (SNFs) track dozens of clinical, financial standards and quality measures for internal benchmarking, as well as for reporting to and compliance with governmental agencies. Given the large volume of data generated by SNFs of all sizes, and the myriad ways such data could be utilized, Richter’s clinical consulting services team recently undertook a process to create performance initiatives that target five high-risk areas in the SNF setting and provide proactive mitigation of those risks.

In this blog, we highlight the ways that elevating your quality measures and Five-Star rating can assist your SNF in being a preferred provider.

Quality measures represent one of three categories in the star system used by the Centers for Medicare and Medicaid Services (CMS). A specific SNF will receive one Five-Star rating from CMS, and individual ratings for quality measures, as well as health inspections and staffing.

Quality measures shed light on an SNF’s effectiveness in caring for residents’ physical and clinical needs. They give insight into how the facility handles items like decubitus prevention, antipsychotic medication use and fall prevention, to name a few. According to CMS, quality measures come from resident assessment data that nursing homes routinely collect on the residents at specified intervals during their stay. These particular items are taken directly from the resident MDS assessment that is completed upon admission, quarterly and annually for all SNF residents. The measures assess the resident's physical and clinical conditions and abilities, as well as preferences and life care wishes. Given that so many oversight programs focus on quality measure data, it’s imperative that your SNF perform at the highest level possible.

The Five-Star quality rating system, meanwhile, is a tool created by CMS in 2008 to help consumers select and compare SNFs. The system utilizes information and data from health care surveys, quality measures and staffing.

In 2019, CMS amended the Five-Star system in an effort to improve the information consumers receive about skilled nursing care centers. The quality and overall star ratings of SNFs now reflect:

• The addition of five new measures
• Expansion of the time frame for determining the quality metric (from a three-to four-quarter average)
• Changes to scoring of the ADL measure from a state ranking to a national ranking

Increasing your Five-Star rating can assist your SNF in being a preferred provider, while improving quality measures can improve facility processes and boost resident outcomes.

Contact Richter

Do you have questions about elevating your quality measures and Five-Star rating, the five SNF target areas identified by Richter, or other clinical challenges? Read our e-book, “Optimizing Five Target Areas in Skilled Nursing Facilities – Your Key to Success” or call Richter’s skilled nursing facility consultants at 866-806-0799 to schedule a free consultation.

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