Changes will affect ratings for many Texas skilled nursing facilities

For the third time in just two years, the federal government is set to announce more changes to its Five-Star Quality Rating System for nursing homes.

The proposed changes — set to be phased in July 27 — were delayed without explanation by the Centers for Medicare & Medicaid Services (CMS), but are expected to be posted to the CMS Nursing Home Compare website sometime within the first two weeks of August.

The changes will affect the federal government’s consumer quality ratings for skilled nursing facilities, and have Texas operators scrambling to understand how they will impact their operations and their future investments.

“The federal government is moving the goalposts with these changes, and that makes it hard, but nursing home operators are accustomed to expect the unexpected and find ways to make it work. That still doesn’t make it any easier,” said Kevin Warren, president and CEO of the nonprofit Texas Health Care Association.

Warren said that the changes would affect the number of stars that many Texas nursing homes receive from the federal Five-Star Quality Rating System, but that the new ratings will be based on new measures, and just can’t be compared to previous ratings.

“If a local nursing home in your district gains or loses a star, it’s not necessarily because they have gotten better or worse; it’s because there is a new system for assessing them,” Warren said.

The federal government’s changes include adding five new quality measures. For the first time ever, CMS will use insurance claims data.

The five new quality measures being added are:

  • The percentage of short-stay residents who were successfully discharged to the community (claims-based)
  • The percentage of short-stay residents who have had an outpatient emergency department visit (claims-based)
  • The percentage of short-stay residents who were rehospitalized after a nursing center admission (claims-based)
  • The percentage of short-stay residents who made improvements in function (MDS-based)
  • The percentage of long-stay residents whose ability to move independently worsened (MDS-based)

Warren said that while the federal government’s changing standards are a challenge for nursing home operators, they are a step in the right direction.

“Texas nursing home operators are already working to raise the bar on quality of care, and these improvements to the Five-Star Quality Rating System are based on measures we are laser-focused on,” Warren said.

For more information about how the CMS Five-Star Quality Rating System may affect skilled nursing facilities in your district, contact Scot Kibbe at