Impact of PDPM-Acuity and 90-Day Turnover Definition on Five-Star Ratings

On July 31, CMS released updated Five-Star ratings that incorporated the following changes related to QSO-24-14-NH:

• Revised the PBJ turnover definition to 90-days from 60-days, and
• Switched from Resource Utilization Groups (RUGs) to a PDPM-based acuity adjustment for Hours per Resident Day (HPRD) measures.

Five-Star Ratings Mostly Did Not Change: Approximately 55% of nursing facilities in the nation saw no change to their Staffing Ratings. Of those nursing facilities whose ratings changed, 23% had a higher star rating and 22% had a lower rating. The overall Five-Star Ratings also did not change for 74% of centers. With the change to the new 90-day definition, there was a decrease in national average turnover rates (3 to 6% for each measure). Total nurse average case-mix adjusted HPRD levels increased (1.3% change), while average RN case-mix HPRD decreased (-2.5% change).

These PowerPoint slides have visuals and details on all the changes including updates to the risk-adjustment of readmission measures and the posting of facility-level resident characteristic data. The attached Excel document provides state-level summary data on the Five-Star impact.