Five-Star Quality Measures That Can Improve Your Community

September 15, 2021

By: Roxanne Osborne


I’m sure by now anyone in long-term care has heard of the CMS (Centers for Medicare and Medicaid Services) five-star rating system. If not, as a provider it’ll be important for you to get to know about the rating system, so that you may help your organization track the components, and if necessary, implement plans to improve performance in one or more of these areas. The system provides an overall 5-star rating for each nursing home, and a separate rating for each of the following three sources of information: Health Inspections, Staffing and Quality Measures (QM).

The overall 5-Star rating has grown in importance since its inception in 2008. More and more hospitals, payers and providers are utilizing 5-star information to determine whom to include in referral networks. Additionally, patients and their families are becoming ever savvier regarding 5-star ratings and are using them to help make decisions about their post-acute choices.

So, what’s your QM rating? This question is now heard frequently in conversations in or between facilities, health providers and consumers. When it comes to marketing your community, quality rating is key. How can you make sure your QM’s are the best? How can you make your facility star rating standout? Some key processes may include:

Five-Star Rating System

    • Many of us tend to think of star ratings only at health inspection time, but really, we should be thinking about them all the time. Regularly audits and inspections of resident care are a key to identifying issues timely. It’s important to have systems and processes in place to complete investigation of causes. Investigation of the specific causal factors will help the facility determine the course of action it must take to improve quality of care and your ratings.
  • Knowledge is valuable
    • Education and training for your staff on systems and process improvement must be vigilant and ongoing. Leadership should take an important role in staff development, encouraging it by example, and supporting it in your attitude. The positive effects of employee retention, staff morale, job competency and patient satisfaction from the quality of care will only improve your performance.
  • Customer Service
    • Pay attention to staff, families and residents to avoid complaints. Communication methods are important to the success of addressing any resident care issues. People just want to be heard, remember that there is always some small truth in every complaint.
  • Correct MDS Information
    • Leadership should make sure they have minimum data set (MDS) coordinators that are always on top of their quality measures, ensuring that the MDS assessments are started on the right date, contain the correct information, are completed by the right people, and are submitted on time.
  •  Documentation
    • A lot of things that could hurt your QM star rating fall around poor or inadequate documentation. Utilize a documentation system that provides real-time, audits, if possible analytics. Documentation is a key to proving a service was provided and in measuring the effectiveness and outcomes of resident care.

Having a five-star overall rating makes a community stand out to consumers. Being a healthcare provider continues to be an ever-increasing challenge. Keeping up with clinical and regulatory developments is hard, but remaining engaged and informed is key in helping you navigate the waters ahead.

To learn more about improving the five-star score at your facility, please reach out to your Marsh McLennan Agency representative.