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CMS Announces Changes To Staffing & Overall Quality Rating Calculations

July 13, 2022 | Peter Corless


Late last week, the Centers for Medicare and Medicaid Services (CMS) announced updated staffing measures tied to the calculation of the Five-Star Staffing rating, as well as overall Five-Star Quality ratings. These changes were forewarned recently this year when CMS announced the public reporting of weekend staffing levels on the Medicare.gov Care Compare website. These changes will take effect with the July 27 refresh.

Changes to the rating system will include four (4) new measures. In addition to the current registered nurse (RN) and total nurse hours per resident per day, the new staffing rating will include the following:

  • Total nurse staffing hours per resident day on weekends—including RN, LPN and nurse aid hours)
  • Total nurse staff turnover within a given year
  • RN turnover within a given year
  • Administrator turnover within a given year

CMS specified a maximum of 100 points can be awarded for case-mix adjusted total nurse staffing and RN staff. Weekend staffing levels will account for a maximum of 50 points. Total nurse turnover and RN turnover will also account for a maximum of 50 points, with administrator turnover accounting for a maximum of 30 points, respectively.

In addition to these changes in calculation, CMS also announced they will no longer automatically award an additional star to the overall Five-Star Quality rating for those who earn a 4-star staffing rating. Those who earn a 5-star staffing rating will continue to be awarded an additional star.

According to a recent article in McKnight’s Long-Term Care News, this change could penalize an estimated 10% to 16% of long-term care providers who look to their staffing rating to boost their overall rating.

CMS notes “these changes seek to incentivize a more holistic approach to improving nursing home staffing, and ultimately aim to result in better quality and outcomes for residents.”

You can read the full Technical Users’ Guide for the Five-Star Quality Rating System at cms.gov

These changes come as long-term post-acute care providers continue to face staffing shortages. According to a recent survey conducted by OnShift, 79% of providers cite staffing shortages as their top workforce challenge, followed by finding and hiring job candidates (62%) and employee turnover (54%). As a result, more than 60% of nursing homes are limiting new admissions, according to a recent survey conducted by the American Health Care Associations (AHCA) in May.

Recruitment and retention must become a priority for providers if they want to remain competitive. Now is the time to revaluate your employee experience and implement benefits and programs to foster a culture where employees feel support, valued and heard.

For more on some of the perks providers are relying on to better attract, recruit and retain a stable workforce, download our 2022 Big Book Of Perks For Senior Care.

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About Peter Corless

Peter Corless is Executive Vice President of Enterprise Development for OnShift. Peter is a recognized HR leader in post-acute care and is well-known for his achievements at some of the country’s largest post-acute care organizations, including Kindred Healthcare and Genesis HealthCare. As an experienced, chief administrative and human resources officer within these organizations, he developed strategies that reduced turnover, improved recruiting and hiring strategies, and reduced labor costs.

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