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July 30, 2018

CMS lowered staffing level ratings for nearly 1.4K nursing homes

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    CMS on Wednesday updated its Nursing Home Compare Five-Star Quality Ratings, lowering its staffing ratings for nearly 1,400 nursing homes in the United States, according to a Kaiser Health News analysis of federal records.

    The Nursing Home Compare Five-Star Quality Ratings awards nursing home facilities up to five stars, similar to systems used to rate hotels. Providers use the ratings to help decide where to refer patients when they are discharged from hospitals. In addition, the ratings usually are the first metric investors and lenders use to help decide whether to fund a nursing home.

    The Affordable Care Act (ACA) required CMS to begin collecting and publishing payroll data on nursing homes' staffing levels, which is one metric used to calculate the facilities' star ratings. Before the ACA, CMS used unverified reports on staffing levels that nursing homes submitted themselves.

    New data show lower staffing levels

    CMS requires every nursing home to have an RN working at least eight hours daily. According to KHN, RNs are the highest-trained caregivers that CMS requires nursing homes to have on staff. The RNs supervise both nurses and aides who work at the facilities.

    According to KHN, CMS' updated nursing home ratings show that the agency lowered its rating for staffing levels for 1,387 of the 15,616 nursing homes in the United States because they either did not staff the adequate number of RNs, or failed to supply payroll data that verified they had the required number of RNs. Facilities that did not have an adequate number of RNs on staff or that did not provide the necessary payroll data received a one-star rating for staffing levels, KHN reports.

    KHN reports that payroll records from nursing homes that provided the documents showed the facilities had lower staffing levels than they had previously reported, particularly when it came to RNs.


    Katie Smith Sloan—president of LeadingAge, an association that includes 2,000 nursing homes—expressed disappointment over the lower star ratings for staffing levels, but primarily attributed the lower scores to workforce shortages. "Our members are battling on multiple fronts to recruit and retain all types of qualified staff, and nurses in particular," she said. 

    David Grabowski, a professor of health care policy at Harvard Medical School, called CMS' action "a really good start." He said it is "a real positive that [CMS is] taking the payroll-based system seriously, that [it is] using it to punish those nursing homes that either aren't reporting staffing or those that are below the federal limit" (Rau/Lucas, Kaiser Health News, 7/30).

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