What Are Star Ratings?
The Centers for Medicare and Medicaid Services (CMS) created the Five-Star Quality Rating System in 2008 as a way to provide residents and their families with an easy-to-understand summary of three dimensions of nursing home quality: health inspection results, staffing data, and quality measure data. These ratings were made available on Nursing Home Compare, the website CMS has created to help the public research Skilled Nursing Homes.
The Star Ratings have been refined a number of times since their inception, and now hold a special significance not only for residents and their families, but also for the folks who staff, manage, own and invest in the homes. The media constantly references Star Ratings, so it’s important for stakeholders to understand how they’re calculated, and for facilities to ensure that their ratings remain high.
Click Here to read more about the importance of 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 increased Staffing leads to better patient outcomes. As such, the Staffing star rating is based on the number of hours logged by nurses each day, adjusted for the number and clinical complexity of the residents they're caring for.
- Earn a Bonus Star + 1 if the facility is either 4 or 5 stars in Staffing and the Staffing Rating is 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 and not 1 star in Survey
- 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.
Read more about Quality
Exceptions
Facilities that have had a history of severe abuse citations have their Overall 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