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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.
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:
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.
The CMS five star rating system for nursing homes evaluates facilities across three domains:
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.
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:
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.
One of the key components of quality measures is your hospitalization rate. Facilities with high rates of hospital transfers may be signaling that they:
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:
Facilities that reduce their hospitalization rates by just 10% often see measurable improvements in their CMS 5-star rating for nursing homes.
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:
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%.
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:
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.
Beyond hospitalizations, antipsychotic use, and pressure ulcers, the CMS quality measures also include:
Review each of these indicators individually to identify specific improvement opportunities.
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:
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.
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:
This financial incentive makes investing in quality improvement not just good for residents, but essential for long-term business sustainability.
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.
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...