Quality Star Rating

Overview

Patient health is at the top of the priority list for any Nursing Home. The Quality Star Rating is based on 15 measures of resident health covering conditions like bed sores, key medications, and adverse occurrences like falls and ER visits.  A facility earns points for their performance in each Quality Measure or QM, and their total number of points determines their Overall Quality Rating, as well as two sub-ratings, Short Stay Quality Rating  and Long Stay Quality Rating.

 

Meet The Measures

The Quality Measures are divided into two major sections – Short Stay and Long Stay. Short Stay residents are typically in the facility briefly for rehab while Long Stay residents are expected to remain in the facility. 

In addition, QMs can be either MDS-based, or claims-based.  MDS-based measures are calculated from Minimum Data Set (MDS) Assessments, or surveys of resident health, that get submitted to CMS each quarter.  Claims-based QMs are calculated based on Medicare claim data submitted by the facility on a well after care has been delivered, so these measures often have a lag time of a year or more.

Finally, some measures are Risk Adjusted.  This means that some residents may be more or less predisposed to the condition that the QM measures.  For example, a QM measuring mobility improvement will be adjusted for the resident’s age.

All measures are calculated as percentages, with “triggering” residents serving as the numerator, and a set of qualifying residents serving as the denominator.  If the measure is Risk Adjusted, the basic (observed) percentage will be adjusted.

 

Here we see the facility percentage for a sample facility alongside the state and national average, with a history of the facility’s performance.  The numerator and denominator are also shown.  This measure is not risk adjusted, so 8.44% represents the un-adjusted numerator over the denominator (13/154).

Calculating Points

Once the percentage is calculated, it can be compared against a matrix of cutpoints to determine how many points a facility earns for each QM.  The maximum number of points is either 100 or 150, depending on the measure.

 

In the above example, the facility’s percentage of 8.44% means that the facility earns 120 points towards their total.  Although this facility is doing well on this measure, they can do better.  Addressing 2 of the 13 “triggering” residents (cases) will move the facility up a slot and earn it an additional 15 points. 

 

 

Things are slightly different with the above Short Stay measure.  Notice the point values in parentheses?  Since there are fewer Short Stay measures than Long Stay, the Short Stay measures are given an increased weighting when counting the final points.  As a result, facilities should focus in on their Short Stay measures, as they contribute 44% more points towards the Overall Star Rating.

 

 

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Calculating The Quality Star Ratings

Once the number of points has been calculated for each QM, they’re totaled, both within their individual Long Stay/Short Stay buckets, and in total, to determine the Overall Quality Rating.  Here’s that calculation for our sample facility:

Short Stay

ED Visit 135/150
Successful Community Discharge 135/150
Pressure Ulcers 100/100
Antipsychotic Medication 100/100
Functional Improvement 150/150
Hospital Readmissions 150/150
Total 770/800
After Adjustment
(Multiplied by 1150/800)
1107/1150

Long Stay

Catheter 60/100
Falls w/Injury 80/100
Antipsychotic Medication 120/150
Decline in Activities for Daily Living 135/150
Hospitalizations 150/150
ED Visits 150/150
Pressure Ulcers 150/150
UTIs 100/100
Mobility Decline 150/150
Total 1045/1150

 

Similar to Survey and Staffing, Quality also has a set of cutpoints in a matrix to determine Star Ratings:

 

 

So our sample facility is well in the 5-star range for both Short Stay and Long Stay Ratings, and with a combined total of 2152, they’re comfortably within the top tier of the Overall Quality Rating as well.

At StarPRO, we believe that visualizations do a better job of telling the story, so we add colors and easy indicators to our dashboards:

 

 

To learn more about how StarNow Quality can help operators identify quality issues and improve their Star Ratings, click below.

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