Medicare Five Star Rating

What is the Five-Star Rating

CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions.

The Nursing Home Compare web site features a quality rating system that gives each nursing home a rating of between 1 and 5 stars. Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average. There is one Overall 5-star rating for each nursing home, and a separate rating for each of the following three sources of information:

Health Inspections - The health inspection rating contains information from the last 3 years of onsite inspections, including both standard surveys and any complaint surveys. This information is gathered by individuals who go onsite to the nursing home and follow a specific process to determine the extent to which a nursing home has met Medicare's minimum quality requirements. The most recent survey findings are weighted more heavily than the prior two years. More than 200,000 onsite reviews are used in the health inspection scoring nationally.

Staffing- The staffing rating has information about the number of hours of care on average provided to each resident each day by nursing staff. This rating considers differences in the level of need of care of residents in different nursing homes. For example, a nursing home with residents who had more severe needs would be expected to have more nursing staff than a nursing home where the resident needs were not as high.

Quality Measures- The quality measure rating has information on 10 different physical and clinical measures for nursing home residents - for example, the prevalence of pressure sores or changes to resident's mobility. This information is collected by the nursing home for all residents.

The QMs offer information about how well nursing homes are caring for their residents' physical and clinical needs. More than 12 million assessments of the conditions of nursing home residents are used in the Five-Star rating system.

How is the Overall Five-Star Rating calculated?

The overall 5-star rating is calculated in four steps, based on the 5-star rating for the survey domain, the nurse staffing domain and the quality measure domain:

  1. Start with the survey domain 5-star rating.
  2. Add one star if the staffing rating is 4 or 5 stars and greater than the deficiency rating; subtract 1 star if staffing is 1 star.
  3. Add one star if the quality measure rating is 5 stars; subtract 1 star if the quality measure rating is 1 star.
  4. If the rating after step 3 is 4 or 5 stars, and the facility is a special focus facility, the overall rating is downgraded to 3 stars.

Note:Regardless of the math in steps 1-4, the composite rating cannot be more than 5 stars or less than 1 star. This method of determining the overall nursing home rating does not assign specific weights to the survey, staffing, and quality measure domains. The survey rating is the most important dimension in determining the overall rating, but, depending on their performance on the staffing and QM domains, a facility’s overall rating may be up to two stars higher or lower than their survey rating.