Home Feature Stories Oklahoma Nursing Homes Strive for High Star Ratings Amid Evolving Regulatory Atmosphere

Oklahoma Nursing Homes Strive for High Star Ratings Amid Evolving Regulatory Atmosphere


The Centers for Medicare and Medicaid Services (CMS) released data in October rating nursing homes and other long-term care facilities and skilled nursing facilities.

The ratings were released amidst an evolving regulatory environment resulting in changing data measurements and methods to quantify the quality of care rendered by Oklahoma nursing homes.

The 5-star rating is is awarded to the top 10% of facilities in each state.

The ratings are derived from a multitude of data sets, with rankings, including an Overall Ranking, compiled from three other ratings consisting of a (i) Health Inspections Rating, (ii) Staffing Rating and (iii) Quality Measures Rating.

State and federal agencies conduct unannounced inspections on nursing homes on an near annual basis.  The Health Inspections Rating results from the number, scope and severity of deficiencies charged to the facility during the annual inspections.

The Staff Rating results from the measured number of registered nurse (RN) hours per resident on a daily basis and another sum which includes the total number of daily staffing hours from RNs, licensed practical nurses (LPNs) and certified nurse aides (CNAs).  The Staffing Rating is adjusted based upon the varying levels of resident care needs.

The third rating, the Quality Measures Rating (the “QM” Rating) is based on the facility’s performance in connection with 18 quality measurements which evaluate the care of the residents. The QM Ratings are based upon the three most recent fiscal quarters for which the data is available.  As a result, CMS views the QM Ratings as an indication of how the facility is performing within the recent past.

The QM Ratings are not without critics, however.  The various QM ratings include a number of quality measurements which record, among others, (i) the percentage of short-stay residents who were re-hospitalized after a nursing home admission, (ii) the percentage of short-stay residents who have had an outpatient department visit, (iii) percentage of short-stay residents who were successfully discharged to the community, (iv) the percentage of long-stay residents whose ability to move independently worsened, and (v) the percentage of long-stay residents who received an antianxiety or hypnotic medication. Each of the foregoing QMs are adjusted by a multitude of factors involving the health and condition of the residents, with as many as 50 different factors affecting the outcome of a given measurement.

Some facilities are concerned that the QMs result in an internal policy which avoids returning residents to hospitals when complications arise that are beyond the scope of the facility — to avoid being penalized in the 5-star rating process.

Additionally, it is argued that QMs provide incentives to facilities to avoid admitting residents who have complex and severe medical disorders and treatment histories and any conditions requiring treatment by anti-anxiety or hypnotic medications. Critics argue such patients are passed by 5-star facilities and fall into care by facilities with lower ratings.

To see the various ratings of Oklahoma nursing homes, please see the following stories:

SLN SOURCES:  Medicare’s Explanation of 5-Star Rating System; Medicare’s Nursing Home Locator with 5-Star Rating for the HomeNursing Home Compare Quality Measure Technical Specification; Medicare Data Page; and New Strain on State Nursing Homes:  Keep Patients Out of Hospitals, Lisa Chedekel, Jan. 2017.