The 5-Star Rating System: Care and Quality Improvement in Nursing Homes

Jul 20, 2018 | Blog

The 5-Star quality measure is so much more than another ambiguous operations metric. Achieving a 5-star rating demonstrates your team’s commitment to care and could mean an increase in new resident leads. Set by The Centers for Medicare & Medicaid Services (CMS) and given to nursing homes participating in the Medicare or Medicaid programs, quality measures for skilled nursing facilities provide residents and their families a quick and effective way to evaluate care facilities. Ratings are awarded on three measures:

  • Health inspections
  • Staffing
  • Quality measures

Researching how to improve your nursing home? Understanding the intricacies involved in earning a CMS 5-star rating is the best place to start. At HealthDirect, we know that earning your 5-star rating can feel like a complex and frustrating process.  To provide insight and encouragement on the journey to earning a 5-star rating, the HealthDirect team interviewed DJ Raux, Executive Director of Crouse Community, a 5-star care facility and HealthDirect partner. With more than 22 years of healthcare experience, here are Raux’s tips for achieving high star quality rating and how to improve care in your nursing home.

How is the CMS 5-star quality measure impacting your facility?

After having 4 stars for several years in a row, receiving our 5-star rating was a really big deal. We know that research is an important step in choosing a care facility for our residents and families. More and more families looking for nursing home care use the nursing home compare tool on the website as their primary research tool.

Upon earning 5-stars, we saw an increase in inquiries about our services – even outside of our typical service area, meaning people are willing to travel farther to see their loved ones if it means they are receiving higher quality care.

How do you work toward ensuring 5 stars in each category?

Each category has specific measures for quality improvement in nursing homes.

In the health inspection category, it is most important that every single member of your staff is prepared for survey. We provide regular team training to stay sharp on the survey process and what inspectors look for. I observe all members of my staff performing their regular duties. This includes everyone from meal service to senior nursing staff. That way, I am able to find areas of improvement before an inspector does. In addition, our HealthDirect pharmacy consultant observes our nursing staff to ensure we catch problem areas before an inspector does. They help us identify both pharmacy and non-pharmacy issues.

The staffing category is the hardest measure to control due to an industry-wide struggle with staffing and turnover. To reduce turnover, I strive to build a positive working environment, filled with regular training opportunities for professional growth and confidence building. In addition, we see the highest level of turnovers with CNAs. So, Crouse Community has doubled the number of free CNA certification courses to ensure we are properly staffed.

Also in terms of staffing, it is important to keep on top of residents’ needs. As residents’ health changes, they may require different levels of care. It is vital to address any care-level adjustments as soon as possible.

The last category, quality measures, is the most important to me because of the direct impact it has on the other categories. Because of the reporting capabilities, this category is the easiest to measure, allowing us to stay on top of it and be ready for inspection at any time.

To regularly track our quality measures, I run our CASPER report every week. This report helps me identify those residents with the care needs identified by the CMS Five-Star Quality Rating System – such as pressure ulcers and UTIs. The report also helps me flag residents whose MDSs may not be coded properly. Correct MDS coding is extremely important to both resident care and Medicare and Medicaid reimbursement. By identifying incorrect coding I am able to teach my staff the correct coding method to prevent future coding issues. Our HealthDirect pharmacy consultant has been a big help in this area, especially with antipsychotics. Our consultant ensures each medication is appropriate for the resident’s diagnosis by cross-checking the code they also make sure that we have proper monitoring measures in place.

What is the best advice you have for improving these quality measures for skilled nursing facilities?

First and foremost, review your CASPER report every week. I cannot say this enough. It is the easiest way to quickly spot any red flags. I also recommend reading and having a strong understanding of the 5-Star Rating Technical Users Guide. Also, never stop learning. There are always areas to grow for both you and your staff. Finally, enlist the help of a pharmacy services partner, such as HealthDirect. It always helps to have another expert at the table.

How has your HealthDirect team helped you?

Our HealthDirect service team has helped us earn and maintain our 5-star rating in a number of ways. Here are a few ways they have improved our nursing home quality indicators. As you can tell, their help is truly invaluable.

  • Individualized drug regimen reviews for each resident that highlight irregularities to the facility management, physicians and other care providers
  • Detailed reviews of all new residents
  • Prospective review of prescribed medication changes
  • Proactive, timely clinical consulting with onsite solutions that have led to a reduction in hospital readmissions and associated costs
  • Recommend strategies to decrease cost by simplification of drug therapy
  • Develop and recommend quality improvement plans
  • Medication storage inspection and evaluation
  • Facilitate practice survey/inspection covering
    • Dignity review
    • Med pass and infection control process review
    • IV/fluid observation
    • Insulin administration observation
    • Controlled substance administration
    • High risk drug review
    • Dosing and med interactions review
    • Antibiotic stewardship review
    • And much more

Improve your stars quality measure with HealthDirect.

As Raux has underscored, getting a 5-star CMS rating for your facility requires a lot of learning and hard work. Let HealthDirect become your trusted pharmacy partner for quality improvement in nursing homes. To learn more about a HealthDirect partnership, send us your contact information below and one of our experienced pharmacy reps will be in touch.

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Summer Hagens

As HealthDirect brand manager, Summer champions all efforts in delivering truly personalized care at the right time and every time.  

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