CMS Care Compare SNF Star Ratings
The Centers for Medicare and Medicaid Services (CMS) created the Five-Star Skilled Nursing Home Star Rating System in 2008. This 5 star methodology was intended to provide residents and their families with a simple snap shot in time of three dimensions of skilled nursing facility (SNF) quality of care compliance: health inspection results, staffing data, and quality measure data. Medicare star ratings for long term care are made available to the public on CMS Care Compare and they are updated on a monthly basis.
Over the past 15 years, CMS Star Ratings have been refined, and now not only hold a special significance for residents and their families, but also for SNF financial stakeholders who invest or do business in the senior care sector. Its also not surprising that the covid pandemic has significantly heightened nursing home quality of care scruitny. As a result, its increasingly common for the department of health (DOH) inspectors, newspaper reporters, LTC advocacy groups, nursing home lawyers and politians to reference CMS star ratings data. This is why its necessary for all SNF stakeholders to understand how the star ratings are calculated, and even more crucial for nursing home executives to ensure that their public star ratings performance reflects their committment to providing the highest level of quality of care.
Click Here to read more about the importance of CMS Star Ratings
How the Overall Star Rating is Calculated
The Overall Star Rating represents the facility’s high-level performance across several areas, and the chart below shows how the Overall Rating comes together.
The Health Inspection (also called Survey) rating, which CMS views as the most important, forms the basis. Facilities then have the opportunity to earn “bonus stars” for high ratings in both Staffing and Quality, but they may also be assessed “penalty stars” for poor performance. Their rating can also be capped if they’re a special focus facility, or “not rated” if they’re too new, or are missing other ratings.
Our guide provides an overview, but for detailed information, please see the detailed documentation from CMS.
Survey (Health Inspection)
Nursing homes are subject to unannounced annual on-site health inspections or surveys. Surveyors are looking for health and safety problems within the facility, and they issue deficiencies based on their findings. The Survey star rating is based on the number, scope, and severity of the deficiencies.
Read more about Survey
Staffing
Several studies have shown that higher Staffing levels and more engaged staff lead to better patient outcomes. As such, the Staffing star rating is based on both the number of hours logged by nurses each day and how well the home retains its staff.
- Earn a Bonus Star + 1 if the facility is 5 stars in Staffing and the Staffing Rating higher than the Survey Rating
- Incur a Penalty Star - 1 if the facility is 1 star in Staffing
Quality
The Quality star rating is based on a facility's performance in more than a dozen measures of patient health and well being, covering both long-stay and short-stay (rehab) residents.
- Earn a Bonus Star + 1 if the facility is 5 stars in Quality
- Incur a Penalty Star - 1 if the facility is 1 star in Quality
Exceptions
Facilities that have had a history of severe abuse citations have their Survey Rating capped at 2.
Sometimes, facilities are too new to have a Survey Rating. In that case, they will not receive an Overall Rating.
Similarly, some facilities have been designated as Special Focus Facilities (SFFs) due to historical issues on their surveys. SFFs also do not receive an Overall Rating.
Read more about SFFs