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.

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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.