Adviser Fall 2018 Vol 1 - Page 20

19 Shooting Stars and Deadline Landmines: A Summary of the 2018 Nursing Home Compare Five-Star Quality Rating System Changes By Susan Chenail, RN, CCM, RAC-CT, senior quality improvement analyst 2018 may have brought the most comprehensive revamp of the Five-Star Quality Rating System since 2015. All three domains will be updated this year. The changes include new methodologies to calculate both the health inspection and staffing domains. The quality measure domain is due for updates before the end of the year. The changes also include a new short-stay pressure ulcer quality measure that replaces the pressure ulcer measure that used the recently discontinued Minimum Data Set (MDS) items M0800 and the annual quality measure cut point adjustment. This past spring, the methodology used to calculate the the health inspection domain clarified. Essentially, health inspection domain was was clarified. Essentially, the the Centers for Medicare Medicaid Services (CMS) Centers for Medicare and and Medicaid Services (CMS) clarified clarified how it was to the manage the “freeze.” CMS how it was going to going manage “freeze.” CMS defined defined the number of surveys used – the two most prior the number of surveys used – the two most recent recent to Nov. 28, their 2017 weighting – and their weighting to Nov. prior 28, 2017 – and factor: 60 and 40 factor: and the 40 most percent, with survey the most recent heavier. survey It percent, 60 with recent weighted weighted heavier. It also defined timeframes from also defined the timeframes from the which complaints would which complaints would used: Nov. for 28, calculation 2015 to Nov. in the be used: Nov. 28, 2015 to be Nov. 27, 2016 27, 2016 most for calculation in the second most second recent survey period, and Nov. recent 28, 2016 to Nov. survey and Nov. in 28, 2016 to recent Nov. 27, survey 2017 for 27, 2017 period, for calculation the most period. The calculation in the most survey period. CMS The anticipates aging aging of complaints has recent been discontinued. of been to discontinued. anticipates the complaints end of the has “freeze” occur in the CMS spring of 2019. the end of the “freeze” to occur in the spring of 2019. The staffing domain was also overhauled. All three calculate resident acuity. Several facilities, including those in New York, felt the effect of shooting stars. Some stars were lost, and some were gained, but most were unchanged. Summer brought the one-star penalty definitions used in the staffing domain. This is a serious penalty because scoring one star in staffing reduces a facility’s overall rating by one star, leaving some feeling as though they stepped on a landmine. There are three occasions that will cause a facility to score one star in the staffing domain: (1) if the facility fails to submit its PBJ data by the reporting deadline; (2) if the facility reports seven or more days with no Registered Nurse (RN) staffing; and (3) if the facility fails to respond to a staffing audit, or the results of the staffing audit identify significant discrepancies between the reported hours and the hours verified. An easy way to sidestep a deadline landmine is to submit PBJ data on time. To access a PBJ quick reference tool, click here. In October, the new MDS 3.0 v 1.16 item sets were put in use along with the updated RAI Manual. To go hand in hand with the new, revised and retired items, aspects included in the of this All domain The staffing domain was calculation also overhauled. three were updated: the in number of staff, of census and aspects included the calculation this domain were acuity of the resident. CMS used Payroll Based updated: number of staff, census and acuity of the Journal (PBJ) to Payroll calculate nursing hours, the resident. CMS data used Based Journal (PBJ) data MDS to calculate census and Utilization to calculate nursing hours, the Resource Groups (RUGs) IV to Adviser a publication of LeadingAge New York | Fall 2018