CMS Makes Updates to the Nursing Home Compare Website and Five Star Quality Rating System

Quality; CMS; Regulations

The Centers for Medicare & Medicaid Services (CMS) released QSO Memo QSO-23-05-NH, which outlines how audits on erroneous Schizophrenia coding will impact Five-Star ratings. The memo also outlines how CMS displays citations under dispute on Nursing Home Compare but will not affect Five-Star until​ the disputes are resolved. 

CMS to Select and Notify Facilities of Offsite Audits on Schizophrenia Coding
The quality measure for long-stay residents who are receiving antipsychotic drugs allows for an exclusion of any residents with a diagnosis of schizophrenia, Huntington’s disease, or Tourette syndrome. CMS is concerned that facilities are erroneously coding residents as having schizophrenia, to exclude residents from counting towards the metric. CMS plans to conduct offsite audits of schizophrenia coding and, based on the results, will adjust quality measure star ratings for facilities whose audits reveal inaccurate coding. This information is in line with the White House’s Fact Sheet, which states​, “CMS will launch a new effort to identify problematic diagnoses and refocus efforts to continue to bring down the inappropriate use of antipsychotic medications.”

If, during the audit, CMS finds inaccuracies in coding, specific to residents diagnosed with schizophrenia, the facility’s QM rating will be adjusted as follows:

  • The overall QM and long stay QM ratings will be downgraded to one star for six months (this drops the facility’s overall star rating by one star).
  • The short stay QM rating will be suppressed for six months.
  • The long stay antipsychotic QM will be suppressed for 12 months.

If selected and contacted for an audit, facilities can forego the audit by admitting they have committed errors and committing to fix them. CMS will consider a lesser action related to star ratings if a facility foregoes an audit. Follow-up audits may be considered if CMS notes continued inaccuracies. Facilities are encouraged to begin working with the psychiatric providers now, and ensure appropriate diagnoses are given, and coded in the MDS.

Survey Deficiencies Under IDR/IIDR will be Posted on Nursing Home Compare but Not Impact Five-Star
Additionally, CMS plans to begin publishing survey information on Nursing Home Compare and the Quality Certification and Oversight Reports (QCOR) while facilities are still in the Informal Dispute Resolution (IDR) or Independent Informal Dispute Resolution (IIDR) process. CMS cites that this process can take up to 60 days for resolution, therefore the consumer is unaware of this information until after the process is complete. CMS also states that this will provide transparency to consumers, especially when deficiencies are identified as Immediate Jeopardy. While these citations will be publicly displayed, they will not be included in the facility’s star rating until the dispute is complete.  

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