CMS Five-Star Rating System: Five Year Report

Karen Morris in Clinical & Quality

The Nursing Home Compare Five-Star Quality Rating System: Year Five Report [Public Version] was issued on June 16, 2014.  The study was completed by Abt Associates Inc. and is the Final Report since the rating system began in 2008.  
The report provides the following conclusions based on the analyses (see page 38 of the report):

  1. Because of the design of the Five-Star Rating System, there is essentially no change in the distribution of Health Inspection ratings.  (By design, the distribution of Health Inspection Star ratings is fixed within each state so that 10 percent of nursing centers receive 5 stars, 20 percent receive 1 star, and 70 percent receive 2, 3, or 4 stars.)

  2. Over the five years, the proportion of nursing homes receiving a one-star Quality Measure (QM) rating decreased from 20.0 percent to 3.2 percent.  The proportion receiving a four- or five-star rating increased from 34.1 percent to 71 percent.  There have been large improvements in the reported QMs since July 2012, which CMS is analyzing in greater detail.
  3. From January 2009 to December 2013, the proportion of nursing homes with a one-star Staffing rating decreased from 22.9 percent to 12.1 percent.  Although there was a modest increase in the proportion of nursing homes with a five-star Staffing rating (7.2 percent to 10.5 percent), the proportion with a four-star Staffing rating increased from 30.6 percent to 42.5 percent.

  4. There were improvements in the Overall ratings during the five years examined.  In January 2009, 22.7 percent of nursing homes had a one-star rating while 35.2 percent had a four- or five-star rating.  By December 2013, the proportion with a one-star rating had declined to 10.5 percent and just over half (50.5 percent) had a rating of four or five stars.

Further, the report acknowledges it is not possible to attribute the changes in star ratings exclusively to the introduction of the Five Star Rating System.   However, using the current rating algorithm, Abt Associates did analyze health inspection, quality measure and staffing data from the 11 months just prior to the public reporting of the measures and determined that more recent changes may be at least partly attributable to the introduction of the Five Star Rating System.

Karen Morris

Director, Clinical & Quality Services
518-462-4800, ext. 15