CMS Moves the Goalposts for Five Star Ratings

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

ezPBJ – the newest Briggs family member – posted guidance late last week based on the recent updating of the Five Star rating system used with Nursing Home Compare. QSO-19-08-NH – issued March 5, 2019 and effective April 24, 2019 – outlines what will change next week. [I blogged on this as well as another guidance document that day; also blogged on the changes to Five Star the day before.]

I encourage you/your team to review the information posted by ezPBJ as well as the S&C notice of March 5, 2019 (links to those posts provided in previous paragraph).

Here’s some details provided by ezPBJ staff:

  • Many facilities will lose a Staffing star due to how CMS increased emphasis on RNs in the Staffing Five Star ratings.
  • Monitor the impact of these two changes when the new PBJ Five-Star ratings are published next week (late April):

    (1) Daily RN Coverage Rule Tightened
    Currently, SNFs can trigger an automatic one star for staffing if they report seven (7) or more days with zero (0) RN hours in a quarter. Beginning with the next PBJ submission, this threshold is now just four (4) or more days. ezPBJ’s error checker has already been updated to this new rule.

    (2) Five Star Cut Points and Weighting Shifted
    Less obvious is the shift in RN cut points and stars in the Staffing Five Star table. The focus on RN staffing comes from:
    – A major shift in RN cut points – from 18% to 31% higher HPRD per star level
    – Change in Star levels emphasizing RN’s (see image)


  • These changes are RETROACTIVE. The Oct 1 to Dec 31 PBJ report (submitted by Feb 14th) will be the first to use these new cut points when the Staffing Five Star ratings comes out next week.
  • We recommend you assess your staffing levels and use ezPBJ to monitor your real-time Hours Per Resident Day metrics. Knowing what’s coming enables you to plan your staffing to respond to the latest focus on RNs.
  • Check out their Five Star Projection details.