CMS revises methodology for calculating staffing star rating

By Jasmyne Ray

Effective with the July 2022 refresh, the Centers for Medicare & Medicaid Services (CMS) is revising the methodology for calculating the staffing star rating.

These measures, which have been posted on the CMS website for more than a decade, are used to calculate each nursing home’s star rating for the staffing section of the Nursing Home Five-Star Quality Rating System.

The new rating is based on six separate staffing measures. In a system similar to the Quality Measure (QM) rating, points are assigned based on the performance on each of these six measures. The points are then summed up, and the total staffing score is compared to staffing rating point thresholds to assign a rating of one to five stars.

The six measures, which apply to weekend staffing and staff turnover, are:

Weekend Staffing

  • Case-mix adjusted total nurse (RN, LPN/LVN, aide) staffing levels (hours per resident per day)
  • Case-mix adjusted RN staffing levels (hours per resident per day)
  • Case-mix adjusted total nurse (RN, LPN/LVN, aide) staffing levels (hours per resident per day) on the weekend

Staff Turnover

  • Total nurse turnover, defined as the percentage of nursing staff that left the nursing home over a 12-month period
  • RN turnover, defined as the percentage of RN staff that left the nursing home over a 12-month period
  • Administrator turnover, defined as the number of administrators who left the nursing home over a 12-month period

In examining the relationship between staff turnover and quality, CMS’ preliminary analysis found that homes with a lower RN, total nurse, and administrative turnover had higher Five-Star Ratings. Facilities with low administrative turnover are likely to have stable leadership, clear direction, and efficient operations, which can help staff provide more consistent care.

In 2020, the Office of the Inspector General (OIG) recommended that CMS look for ways to provide consumers with additional information on the daily staffing levels at nursing homes and their variability. The following year, the OIG, seeing the effects of the COVID-19 pandemic, further recommended that CMS report measures of nurse turnover “as soon as practicable.”

“Improving nursing home staffing is a top priority for CMS. There are many different factors that impact how nursing homes are staffed, and the PBJ program aims to help us understand these factors, how nursing homes are staffed, and how staffing relates to nursing home quality,” the memorandum stated.

“This information can then be used to inform future actions aimed at improving staffing to protect and enhance the health and safety of nursing home residents.”

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Accreditation, CMS, Quality Improvement