Five-Star Refresh: A Look at Quality Measures

With the January Five-Star refresh on Care Compare, 1/3 of nursing homes in the nation saw a drop of at least 1 Star, leading many to wonder, what’s going on?

Although fifteen measures impact the quality measure Five-Star rating, last April four measures were paused, essentially halting their impact on the quality measure rating. Three long-stay measures required realignment from Section G to Section GG Pressure Ulcer/Injury, Ability to Walk Independently Worsened, and Increased Need for ADL Assistance; and the new Discharge Function Score measure (which replaced the improvements with function measure) required data collection.

The most recent refresh reflects the inclusion of these four previously paused measures. In reviewing the data and preparing for the quarterly release, CMS lowered the point ranges for long-stay, short-stay, and overall quality measure rating star thresholds, but the impact still remains. Whether a facility saw a positive or negative outcome with this refresh, best practice strategies can be implemented to ensure consumer facing platforms appropriately reflect the quality of care within each facility.

1. 1. Access and review CASPER reports (i.e., Resident Level QM Report and Facility Level QM Report) to determine what measures were outliers and which residents triggered, or in the event of the Discharge Function Score, did not trigger for inclusion in the calculation.

1. 2. Continue to monitor CASPER reports prior to Care Compare’s quarterly refresh and review confidential feedback reports from iQIES to identify necessary corrections.

1. 3. Get to know the measures and understand the impact of Section GG data:

• • • The Discharge Function Score reflects the percentage of Medicare A residents who achieved or met an expected discharge function score. CMS uses a complex calculation from the admission MDS to calculate an “expected” discharge function score for each qualifying resident. There are 26 risk adjustors based on clinical characteristics within the Initial Medicare Assessment, but the functional levels are derived from 10 Section GG items. Then the patient’s usual performance on discharge, as documented on the discharge MDS Section GG is used to calculate a discharge function score that is compared to the expected score. Residents who met or exceed that expected score trigger for this quality measure. Again, for the discharge function score, triggering is a positive event. CMS does not publish the expected score. 
      • This measure also impacts SNF QRP compliance, and data collection now will impact the FY2027 VBP program.
    • The two measures, Need Help with ADLs Increased and Ability to Walk Independently Worsened are long-stay measures and are calculated from Section GG OBRA assessments. The late loss ADLs (Sit to Lying (GG0170B), Sit to Stand (GG0170D), Eating (GG0130A), and Toilet Transfer (GG0170F) generate the ADL measure, and Section GG item Walk 10 Feet (GG0170I) generates the ability to walk measure. The functional ability is compared to qualifying prior assessments to determine if the resident has demonstrated a decrease in ability.

1. 4. Consider training and support needs

• • • Ensure the team has a thorough understanding of the impact of Section GG.
    • Consider whether discharge GG levels align with observed patient outcomes.
    • Develop plans of care and care plans that target functional, person-centered goals.
    • Section GG is interdisciplinary and reflects usual performance. There is no “rule of 3” to guide coding, so review of all data collected is crucial.
    • Access and review quality measure reports from iQIES.

Reliant Rehabilitation team members are skilled in functional ability assessments and interventions. Support is available for analysis and training to achieve quality measure goals.