January 18, 2020

Five-Star Quality Rating System

By Donna Zoellick, Director, Advisory Services

Related Industry Healthcare

Five-Star Quality Rating System

In 2008, CMS created a Five-Star Quality Reporting System as a tool to assist consumers compare nursing facilities in their area. The system results in an overall quality rating of one to five stars (one being the lowest and five being the highest) based on a nursing home’s performance in three domains: health inspections, staffing, and quality measures. The Nursing Home Compare website provides an overall star rating as well as separate star ratings in each of the three domains, for every nursing home in the U.S.

Health Inspection Ratings

Health inspections ratings are based on the number, scope and severity of deficiencies identified during the three most recent annual inspection surveys, along with findings from the most recent 36 months of complaint investigations, as well as any repeat visits needed to verify corrections.

Staffing Ratings

Staffing ratings are based on nursing home staffing levels of RNs plus total nursing, which includes RNs, LPNs and nurse aides. The measures are derived from quarterly data submissions through the Payroll-Based Journal (PBJ) System, along with daily resident census obtained from the MDS assessments. The hours are case-mix adjusted. There is evidence of a correlation between a nursing home’s staffing levels and residents’ outcomes.

Quality Measures Ratings

Quality measures ratings are based on the performance of 17 MDS and Medicare claims-based quality measures. These include 10 long-stay measures and seven short-stay measures.

five star quality rankings chart

The Southwest region has the highest percentage of 1-star ratings, with 511 (29.8%) of its 1,713 long-term care homes receiving the lowest rating. The Pacific region has the lowest percentage of 1-star ratings, with 175 (1.1%) of 1,585 facilities receiving 1 star. The Rocky Mountain region has the highest percentage of 5-star ratings. 186 (32.5%) of the 573 homes in the Rocky Mountain region were awarded 5 stars. The Southwest has the lowest percentage of 5-star ratings. Of the 1,713 homes in the Southwest, only 198 (1.2%) received a 5-star rating.

For the nation as a whole:

  • 3,323 homes or 21.69% received a 5-star rating
  • 3,402 homes or 22.21% received a 4-star rating
  • 2,835 homes or 18.51% received a 3-star rating
  • 2,912 homes or 19.01% received a 2-star rating
  • 2,845 homes or 18.57% received a 1-star rating

Please note that the Nursing Home Compare does have some facilities with no rating; therefore, the totals mentioned above do not include 100% of the facilities in the United States.

A CMS staffing study found a direct correlation between a nursing home’s staffing ratios and its quality of care. The 5-star ratings illustrated in the graph above do support this finding. For example, as shown, the Southwest region has the highest number of 1- and 2-star rated facilities in the United States. The Southwest region also has the lowest number of nursing hours per patient day. On the other hand, the Pacific region has the lowest number of 1-star facility ratings and the second highest number of 5-star rated facilities. The staffing ratio and quality care correlation is consistent, as the Pacific region has the highest number of nursing hours per patient day.