What the 5-Star Rating System Changes Mean for Nursing Homes

Members | February 17, 2015

On Feb. 12, the Centers for Medicare and Medicaid Services (CMS) announced a new approach in the way it will calculate the scores for the Nursing Home Compare 5-Star Nursing Home Rating System, and the agency anticipates that most nursing homes will see a change in their 5-Star score.

On Feb. 12, the Centers for Medicare and Medicaid Services (CMS) announced a new approachin the way it will calculate the scores for the Nursing Home Compare, 5-Star Quality nursing home rating system. 

All nursing homes received a notice about this change from CMS on Feb. 13. Public roll-out on Nursing Home Compare will occur on Feb. 20.

5-Star Ratings: What’s Happening

The main changes include adding 2 measures on use of antipsychotic drugs to the calculation process for the 5-Star Rating System and resetting the quality measure scale to raise the standard for nursing homes to receive a high rating.  

CMS anticipates that most nursing homes will experience a change in their 5-Star rating.

There will also be some ‘minor’ adjustment to the staffing domain; CMS is making a general change to the final algorithm.  

Currently, it is possible to have a rating of 3 stars for RN and a rating of 3 stars for total staffing, but achieve a rating of 4 stars overall for staffing.  

Facilities will now have to achieve 4 stars in at least one of the RN or Total Staffing categories to attain a 4-star rating for staffing. CMS’ rationale is that a 4-star overall rating for staffing is not warranted unless 4 stars are achieved in one or both categories.

CMS intends to implement the electronic collection of payroll-based staffing data on a voluntary basis in/by the end of 2015; and for all nursing homes by the end of 2016. They are working on compatibility with all payroll systems. 

In the interim, the 671 will remain in use.


On Feb. 20, CMS will publicly release a revised Nursing Home Compare [“NH Compare 3.0”]. The public roll-out will include a press release and a press conference detailing the changes.  

On Feb. 13 all nursing homes received a private preview [via their QIES mailbox], and access to the updated Technical User’s Guide. The User’s Guide can also be requested through: BetterCare@cms.hhs.gov.

Our Comments on the 5-Star Rebasing

LeadingAge supports a consumer-friendly nursing home rating system based on reliable quality information that the public can understand. The 5-star rating system is a great idea, but was hastily and prematurely implemented. CMS continues to tweak it without addressing or correcting underlying fundamental flaws.

CMS’s latest rebasing of the 5-star formula will likely impact many LeadingAge members, who may see a one to two star drop in their total number of stars based on the new calculation.

While LeadingAge supports the addition of a calculation that measures antipsychotic use and one that revises the current way that staffing levels are determined, we are disappointed overall that CMS has not yet provided more transparency about the recalculations. 

We are concerned about how this might affect and confuse residents and their families.

We hope CMS will more aggressively pursue fixing the fundamental flaws behind 5-Star because the public deserves a tool that is easy to understand and is supported by reliable criteria. But we aren’t there yet.

How to Preview Your 5-Star Data

The data will be posted in each nursing home’s QIES mailbox, i.e., used by NHs to submit MDS data and also used by CMS for various announcements/pop-ups including the 5-star preview data.  

Every nursing home has its own password.

CMS 5-Star Rating System Preview Reports

As with previous preview information, providers can access through QIES - the umbrella site that supports MDS information, including facility submission of MDS data.

To access your 5-Star Preview Report, go to the MDS State Welcome page available on the state servers where you submit MDS data and select the CASPER Reporting link located at the bottom of the page.

To access these reports, select the CASPER Reporting link located at the top of your MDS State Welcome page. Once in the CASPER Reporting system, click on the 'Folders' button and access the 5-Star Report in your 'st LTC facid' folder, where st is the 2-digit postal code of the state in which your facility is located and facid is the state assigned facid of your facility.

Nursing Home Compare will be updated on Feb. 20, 2015.

BetterCare@cms.hhs.gov remains available for inquiries.