The Centers for Medicare & Medicaid Services (CMS) formally unveiled Nursing Home Compare (NHC) 3.0 to the public today, marking the third major revision to the 5-Star Quality Rating System for Nursing Homes.

Beginning today, nursing home star ratings will:

  • Incorporate 2 new quality measures related to anti psychotic medication use–one for short-stay residents when a nursing home begins use of anti-psychotics for residents without warranted diagnoses, and a second measure for their continued use. The two existing quality measures (for short stay and long stay residents) will now be part of the larger calculation for the Quality Measures star rating.
  • Reflect revised cut points for the Quality Measures category.
  • Include adjusted calculations for staffing levels. To receive a 5-star rating, facilities must meet or exceed the 5-star level for both RN and total staffing. To receive a 4-star staffing rating, facilities must receive at least a 3-star rating on both RN and total nurse staffing and must receive a rating of four or five stars on the other of those dimensions.

The re-calibrations will have an immediate impact on the star ratings for the majority of certified facilities. According to CMS, “about two thirds of nursing homes will see a decline in their quality measures rating and about one third of nursing homes will experience a decline in their Overall Five Star Rating. For example, before the re-calibration, about 80% of nursing homes received either a 4 or 5-star rating on their quality measures. Now, about 49% of nursing homes will receive a 4 or 5 stars on their quality measure rating. Also, the number of nursing homes receiving one star for their quality measures has increased from 8.5 percent to 13 percent after the re-calibration.”

More changes are on the way. CMS recently announced the planned expansion of Targeted Surveys (a report on the results of the pilot surveys completed in 2014 will be available here), and a fourth major improvement to the Nursing Home Compare website is scheduled for 2016, when CMS will implement quarterly payroll-based staffing reporting to verify staffing information.