CMS Adds New Five-Star Staffing Measures

CMS; Nursing; Quality

​​​​In July 2022, CMS updated Five-Star Ratings on Care Compare​ to include staff turnover measures. The following six Payroll-Based Journal (PBJ) staffing measures now determine Five-Star Staffing ratings): 

​Hours per Resident Day Measures (HPRD) 
1. Total nursing (RN, LPN/LVN, CNA/aide) HPRD 
2. RN nursing HPRD 
3. Total nursing (RN, LPN/LVN, CNA/aide) HPRD on the weekend *New* 

Turnover Measures 
4. Total nursing turnover *New* 
5. RN Turnover *New* 
6. Administrator Turnover *New* 

Impact on Staffing and Overall Five-Star Ratings

Staffing star ratings are determined by points earned for performance on each of the six measures. The scoring thresholds and method are outlined by CMS in the Five-Star Technical Manual. The latest Your Top-Line (2022-Q3), released on August 2 on LTC Trend Tracker​ goes through how a center’s scoring on each measure leads to its new staffing rating. 

Nationwide, 32 percent (4,824) of skilled nursing center  had a lower staffing rating with this latest release and changes. The overall rating for 25 percent (3,780) of centers also decreased. A portion of the decrease in overall ratings can be attributed to a methodological change made by CMS in how the overall rating is calculated. Under the new method, only centers with 5 stars in staffing can add a star to their overall rating. Previously, 4-star staffing facilities could add an overall star. 

To see the impact of these changes by state, region, or county, check out this AHCA/NCAL research report and follow the steps in this help guide to run the SNF Staffing Measures report on LTC Trend Tracker.​