What Are CMS Nursing Home Star Ratings?
CMS nursing home star ratings are a 1–5 rating system used to evaluate nursing home performance based on health inspections, staffing levels, and quality measures.
How Are CMS Nursing Home Star Ratings Calculated?
CMS calculates nursing home star ratings using three domains: health inspections, staffing, and quality measures. Each domain is scored separately and then combined into an overall rating, with adjustments for penalties or bonuses.
Medicare Star Rating Overview
The CMS Nursing Home Five-Star Rating System assigns each facility a rating from 1 to 5 stars based on performance in health inspections, staffing, and quality measures.
CMS introduced the Five-Star system to make nursing home performance easier to compare. CMS introduced this system to make nursing home performance easier to compare across facilities and is now widely used by regulators, lenders, investors, and operators.
What the CMS Star Ratings Measure
Health inspections (survey results and deficiencies)
Staffing levels (hours and turnover)
Quality measures (resident outcomes and care indicators)
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.
Step 1 - Health Inspection (Survey)
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.
Step 2 - 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
Note: Facilities that are 1 star in Survey can only earn one of the two "bonus" stars available.
Step 3 - 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
Note: A facility cannot achieve a star rating higher than 5 or lower than 1.
Step 4 - 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.