5 Ways to Improve CMS Nursing Home Ratings
The Centers for Medicare and Medicaid Services (CMS) nursing home ratings system, also referred to as five star ratings, was created to help people select a safe and high-quality nursing facility. The influence of CMS ratings of nursing homes has grown — impacting how the government, health insurance companies, lenders, and investors determine incentive payments, referrals, and financial loans. While this article focuses on nursing homes, similar versions of this rating system have extended to hospitals, home health agencies, and dialysis centers.
Your facility knows first-hand how CMS star ratings affect your reputation, success in attracting prospective residents, and your finances due to government incentives or penalties. This article will help you earn high stars by offering tips on how to improve your ratings.
CMS Nursing Home Ratings: Overview
The CMS star-based rating system is used to evaluate nursing home facilities through comprehensive criteria pulled from multiple data sources. CMS calculates your facility’s stars by considering three domains:
- State health inspections
- Staffing
- Quality measures
Each domain earns an individual score and factors into the overall CMS star ratings. Nursing homes then receive an overall score between one and five stars based on their CMS star rating data. These ratings are meant to represent the quality of services you deliver and are posted publicly on the CMS Nursing Home Compare Website. Many families and older adults seeking out a nursing home compare 5-star ratings using this site. So, in addition to helping you improve care and outcomes for your residents, maintaining a good rating is also important for promoting your business.
5 Tips to Improve Your CMS Nursing Home Ratings
Now that you have a better understanding of this system and what it’s used for, you may be wondering how you can improve your CMS ratings. Nursing homes that work to deliver higher quality care not only build a better reputation, but also help their residents achieve a higher quality of life. Here are five tips that will help you enhance your care delivery and optimize your ratings.
1. Assess Compliance
The surveyors thoroughly audit your compliance with government regulations during your facility’s health inspection. Have your healthcare administrator or director of nursing (DON) prepare by conducting an internal audit to address any issues with a well-considered plan. You’ll want to earn top marks, as this score heavily impacts the overall quality rating.
Develop an urgent corrective action plan if a recent health inspection cited any deficiencies. The surveyors will be back to assess whether you’ve resolved their concerns. Problems not resolved promptly may result in multiple visits and could hurt your score.
Example: A DON conducts an internal inspection of their facility, and notices that the fire alarms have stopped working properly. To comply with CMS life safety code requirements, the DON calls the facility engineer to fix the issue as soon as possible and double checks that all other fire safety requirements are met.
2. Address Nurse Staffing
If you didn’t score well in this area of the CMS nursing home ratings, work with your nursing leadership to address any staffing pain points. Nurses are looking for flexibility and work-life balance. If you don’t have the resources to offer staffing strategies and solutions, look for a trusted staffing partner to provide this service.
As you build up your nursing team, work together to implement a plan for decreasing burnout among nursing staff and reducing the turnover rate at your facility. This long-term investment will take time to implement; however, it will ultimately yield results that improve nursing satisfaction, patient outcomes, and resident quality of life.
Example: A DON trains and hires caregivers to help residents with activities of daily life. While they’re not authorized to do everything a CNA does, they help free up staff for more high-level tasks. This eases the workload strain on the CNAs, which helps increase job satisfaction and reduce turnover.
3. Prioritize Quality Measures
Quality measures (QMs) improve patient outcomes and quality of care. Based on the long list of QMs that CMS evaluates, it may be unclear where to begin. Start with the measures from your last visit that have the lowest scores and prioritize the QMs assigned the most points, as this will significantly impact patient outcomes and your score.
Lead your staff in a nurse hackathon, where you identify issues and problem-solve solutions impacting your QM scores as a team. Often, practical and cost-effective solutions are available by engaging your nursing experts.
Example: An administrator reviews their previous CMS ratings report and notices that their facility ranked particularly poorly on timeliness. More specifically, residents did not feel that staff came quickly when they called for help. To improve care efficiency, the administrator decides to allot more resources into hiring two additional per-diem nurses. This helps improve the nurse-to-resident ratio during busier periods.
4. Prevent Elder Abuse
Senior adults are vulnerable and at risk for abuse and neglect. Incidents of abuse and neglect can result in resident injury and significantly impact your CMS nursing home ratings. With proper training, nursing homes can prevent and reduce resident harm in their facilities, improving the health and safety of their residents. By listening to nursing staff and utilizing state resources such as your local ombudsman, you can gain insight into additional educational needs.
Example: A facility administrator conducts a survey to get employee feedback on what type of training they need to help keep residents safe. Several staff members suggest training on how to calm confused or agitated residents with dementia. The administrator acts on this feedback by implementing a comprehensive de-escalation training program. This helps prevent accidental injuries occurring from staff and resident interactions.
5. Implement Standards and Policies for Residents With Mental Illness
CMS has found that residents were incorrectly assigned schizophrenia diagnosis codes in resident MDS 3.0 assessments. As a result, coding inaccuracies for schizophrenia are now incorporated into CMS nursing home ratings. Medicare will penalize facilities for errors by suppressing or reducing QM ratings for 6 to 12 months, potentially resulting in a loss of stars.
Your facility can implement standards and processes to ensure correct mental illness diagnoses and review the use of long-standing antipsychotic medications, another CMS QM. This will enhance patient outcomes by providing proper treatment and improving the quality of care for residents.
Example: An administrator sets aside a budget to hire an in-house geriatric psychiatrist to work alongside their in-house primary care provider. This allows residents to get more individualized psychiatric care, ultimately improving the screening and treatment of mental health conditions and enhancing resident quality of life.
Interested in Learning More About Improving Quality Ratings?
Improving and maintaining high CMS nursing home ratings is an ongoing pursuit. As a healthcare leader, you constantly search for practical ways to enhance quality and outcomes. Learn more about new and innovative ideas to improve care at your facility, with insights delivered to your inbox.
IntelyCare education development nurse and writer Diana Campion, MSN, APRN, ANP-C, contributed to the writing and research for this article.