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CMS 5-Star Rating System for Nursing Homes: Complete Guide to Improving Your Facility's Quality Measures in 2025

Understanding the CMS 5-Star Rating System for Nursing Homes

Does your 5-star rating keep you up at night? You're not alone. Many nursing home administrators find the CMS (Centers for Medicare & Medicaid Services) star rating system confusing, especially when trying to determine how to improve it. While numbers aren't everything, this rating system is a benchmark to let the public know how a facility performs in three critical areas compared to regional competitors: health inspections, staffing, and quality measures.

Whether you're attracting new staff, contracting with a Medical Director, or building community trust, your rating matters. As someone who regularly consults with facilities and is asked to consider leadership roles, I always look at a facility's 5-star rating before making decisions.

How the CMS Five Star Rating Impacts Nursing Home Success

The CMS Nursing Home Compare website receives millions of visits annually from families researching care options for their loved ones. Studies show that nursing homes with higher CMS star ratings typically:

  • Experience higher occupancy rates
  • Command better reimbursement rates
  • Attract more qualified staff
  • Face fewer regulatory challenges
  • Build stronger reputations in their communities

A one-star improvement in your CMS 5-star rating can translate to a 3-5% increase in private-pay census, according to industry data. For the average 100-bed nursing home, this improvement could generate hundreds of thousands in additional annual revenue.

Breaking Down the Three Components of the CMS 5-Star Rating System

The CMS five star rating system for nursing homes evaluates facilities across three domains:

  1. Health Inspections (weighted at 60-70%): Based on outcomes from the three most recent annual inspections and complaint investigations.
  2. Staffing (weighted at 15-20%): Measures nursing staff hours per resident day, including RN, LPN, and CNA time. The staffing rating is case-mix adjusted to account for the varying needs of residents.
  3. Quality Measures (weighted at 15-25%): Evaluates 15 different clinical and physical measures for short-stay and long-stay residents.

Understanding how CMS calculates these ratings is essential for identifying targeted improvement opportunities. The CMS nursing home star ratings are updated quarterly, giving facilities regular opportunities to improve their standing.

Where to Start: Focus on Quality Measures

The best place to start when trying to boost your 5-star rating is your quality measures. This category reflects the outcomes and care standards within your facility, and small, strategic changes can lead to significant improvements. Improving your quality of care for residents while simultaneously improving your quality measures can result in better care for residents, which everyone should focus on.

The CMS quality measures for nursing homes are divided into two categories:

  • Short-stay measures: Apply to residents who spent 100 days or less in your facility
  • Long-stay measures: Apply to residents who have been in your facility for 101 days or more

Each measure is risk-adjusted and weighted differently in the overall quality score calculation, with some measures carrying up to twice the impact of others.

Why Hospitalization Rates Matter for Your CMS Star Rating

One of the key components of quality measures is your hospitalization rate. Facilities with high rates of hospital transfers may be signaling that they:

  • Struggle to manage chronic conditions effectively
  • Fail to prevent avoidable infections
  • Lack a strong fall prevention program

Lowering unnecessary hospital visits doesn't just help your rating; it's a clear sign your team is delivering competent, proactive care.

Strategies to reduce hospitalizations and improve your CMS nursing home rating:

  1. Implement INTERACT (Interventions to Reduce Acute Care Transfers) tools and protocols
  2. Develop stronger relationships with attending physicians for more responsive care
  3. Enhance staff training on early symptom recognition

Facilities that reduce their hospitalization rates by just 10% often see measurable improvements in their CMS 5-star rating for nursing homes.

Antipsychotic Prescribing: Small Change, Big Impact on CMS Five Star Rating

Antipsychotic medication use is another important factor. Unless prescribed for schizophrenia, Huntington's disease, or Tourette's Syndrome, these medications can negatively impact your quality score. Work closely with your Medical Director and consultant pharmacist to:

  • Review and justify current antipsychotic use
  • Explore non-pharmacologic interventions
  • Educate staff on behavior management

Even a modest reduction in usage can significantly boost your facility's quality score. The national average for long-stay antipsychotic use is around 14%, with 5-star facilities typically maintaining rates below 10%.

Pressure Ulcers: A Red Flag for CMS 5-Star Rating and Substandard Care

New or worsening pressure ulcers are not only painful and dangerous for residents, but they're also another care category in the quality measures. These ulcers often reflect poor staffing levels, inadequate repositioning schedules, or ineffective wound care practices.

To reduce this risk:

  • Implement a strong wound care program
  • Ensure consistent support from dietary services for healing
  • Maintain adequate staffing for regular skin assessments and repositioning

CMS particularly focuses on Stage 2-4 pressure ulcers in the five star rating calculations, making this an area where focused improvement efforts can yield significant rating gains.

Other Key Metrics to Monitor in the CMS Nursing Home Quality Measures

Beyond hospitalizations, antipsychotic use, and pressure ulcers, the CMS quality measures also include:

  • Vaccination rates (staff and residents)
  • Urinary catheter usage
  • Unplanned weight loss
  • Physical restraint use
  • Moderate to severe pain reporting
  • Fall rates with major injury
  • Functional decline measurements
  • Depression symptoms
  • Activities of daily living (ADL) dependencies

Review each of these indicators individually to identify specific improvement opportunities.

Navigating the CMS Nursing Home Compare Website

The CMS Nursing Home Compare website isn't just for consumers—it's a valuable tool for administrators seeking to improve their facility's performance. The site provides:

  • Detailed breakdowns of your facility's performance across all three rating domains
  • Comparison tools to benchmark against state and national averages
  • Historical data to track improvement trends
  • Downloadable datasets for more granular analysis

Visit medicare.gov/care-compare regularly to monitor your CMS 5-star rating and identify specific areas where your nursing home may be falling short compared to competitors.

How CMS 5-Star Ratings Affect Reimbursement for Nursing Homes

In today's healthcare landscape, your CMS 5-star rating increasingly affects your bottom line. Value-based purchasing programs often tie reimbursement rates directly to quality measures, many of which overlap with the CMS star rating metrics.

Nursing homes with higher CMS star ratings typically:

  • Qualify for preferred provider networks with hospitals and ACOs
  • Secure better contracts with Medicare Advantage plans
  • Experience lower liability insurance premiums
  • Position themselves favorably for future value-based payment models

This financial incentive makes investing in quality improvement not just good for residents, but essential for long-term business sustainability.

Change Is Possible With the Right Mindset

Improving your 5-star rating is absolutely possible, but it requires honest self-assessment, team collaboration, and a commitment to continuous improvement. The good news? Even simple, focused steps can create meaningful change, not just in your numbers, but in the daily experiences and health outcomes of your residents.

Because at the end of the day, quality care should be the true goal. The rating? That's just the reflection of how well you're delivering it.

Dr. Jean Storm Signature



CMS 5-Star Rating System for Nursing Homes: Complete Guide to Improving Your Facility's Quality Measures in 2025

CMS 5-Star Rating System for Nursing Homes: Complete Guide to Improving Your Facility's Quality Measures in 2025

Understanding the CMS 5-Star Rating System for Nursing Homes Does your 5-star rating keep you up at night? You're not alone. Many nursing home...

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