The Purpose of CMS Nursing Home Ratings And How They Work

how cms nursing home ratings work - 5 star calculation and statistics used

The Care Compare public reporting website provides Centers for Medicare & Medicaid Services (CMS)  quality star ratings for more than 15,000 nursing home facilities. It allows you to find and compare nursing homes around the country that are certified by Medicare and Medicaid. This helpful tool was originally created in 2008 and uses information from nursing home staff, an analysis of quality measures, and both standard and complaint health care surveys.

CMS government star ratings are based on the general performance of facilities within each individual state. Comparing facilities to each other within each state helps to control variation among states that can result from different management practices, differences in state licensing laws, and differences in state Medicaid policies.

What is the Five-Star Rating System for CMS?

It is a quality rating system that provides residents and their families with a clear and simple summary of the level of nursing home quality in three specific areas: health inspection results, staffing data, and quality measure data. 

Every nursing home in the country that participates in Medicare or Medicaid is listed along with the CMS government star rating for each facility. The Nursing Home Compare 5 Star Quality Rating System aims to define the differences for consumers between high- and low-performing facilities. It also helps nursing homes recognize and rectify any areas that need improvement. 

CMS 5 Star ratings are based on the general performance of facilities within each individual state. Comparing facilities to each other within each state helps to control variation among states that can result from different management practices, differences in state licensing laws, and differences in state Medicaid policies. For more detailed information about certification and compliance you can visit the CMS Five-Star Quality Rating System website page

How are CMS nursing home ratings calculated?

There are several steps that facilities can take to improve CMS star ratings and foster a more positive culture that includes enhancing focus on consumer perception, regularly assessing changes in data, retraining healthcare staff, and establishing better patient-provider communication. The final rating cannot be less than one star or more than five stars.

The three categories under which ratings are provided are: 

  • Health Inspections
  • Nursing Home Staffing
  • Quality Measures

Based on these three ratings, the overall 5-Star rating results are calculated by using the following five steps: 

  1. Begin with the Health Inspection 5-Star Rating. 
  2. If the Staffing rating is 4 or 5 stars and also greater than the Health Inspection Rating, one star is added to the step one total. If the Staffing rating is 1 star, one star is subtracted.
  3. If the Quality Measure Rating is 5 stars, add one star to the step 2 result. Subtract 1 star if the Quality Measure Rating is 1 star.
  4. The overall quality rating cannot be increased by more than one star based on the staffing and quality measure ratings if the health inspection rating is only one star.
  5. If the nursing home has been classified as a Special Focus Facility (SFF), the maximum overall quality rating the facility can receive is three stars.

Nursing homes that have had a history of serious quality issues or are included in a special program to implement improvements in their quality of care are considered Special Focus Facilities (SFF). The SFF program uses the same process as the health inspection domain of the 5-Star Quality Rating System to determine which facilities are eligible. Results from over three cycles in roughly three years of inspections are converted into points based on the number of deficiencies cited and the severity of those citations. The more deficiencies there are, and the more deficiencies cited at higher severity levels, the more points are assigned. The facilities who accumulate the most points in a state then become candidates for the SFF program.

Most recently, the federal government announced the completion of a plan to fold Nursing Home Compare, a consumer-focused website, into a larger database of public information on a variety of health care providers. 

When are CMS star ratings released?

CMS Star Ratings are calculated and released each year and may change from one year to the next.

No single rating system can address all of the important considerations that go into a decision about which nursing home will be the best fit for a particular individual. Other considerations include:  any specialty care that’s needed, like dementia care or specialized rehabilitation, or how easy visitation is for family members.  A residents' quality of life and quality of care, can be greatly improved by regular visits from loved ones. 

How To Find And Compare Nursing Homes Online

CMS quality ratings on the website aren’t the only information you should use when making a decision. 

The CareWindow online search and compare portal provides skilled nursing facility (nursing home) rating and review data from several data sources beyond CMS such as: Covid-19 statistics, employee & family reviews, and patient surveys. CareWindow provides consumers with a range of relevant information, beyond just the CMS rating. This makes CareWindow the best option for consumers doing online research to find the best available skilled nursing facility, nearest to their location with the desired ratings, reviews, features and amenities offered. CareWindow also offers providers the best opportunity to expand the feedback they receive regarding their facility's quality of living, and to provide valuable information to prospective senior residential living consumers.