January 2015 ushers in changes to the Centers for Medicare & Medicaid Services (CMS) Five Star Quality Rating System with the focus being on staffing practices in long-term and post-acute care facilities. These changes have been brought about by recent reports stating that the 55% of nursing homes with a 4 or 5 star staffing rating have inflated their staffing level numbers to get that rating. The Centers for Public Integrity claims that 80% of skilled nursing homes might have inflated their registered nurse staffing levels.

CMS is trying to make sure that staffing level information is reliable. First they will implement a payroll based staffing report that would require the nursing home turn in quarterly electronic reports of its staffing levels which will then be verified by payroll data. It will also allow for the calculation of other quality measures such as staff turnover and retention.

Second, there will be nationwide surveys done that verify MDS coding accuracy and nursing home staffing levels in which record review, resident observation and staff/resident interviews will be done during a 2-day process to validate data. Finally CMS plans to change the way it calculates Five Star Quality ratings by placing a bigger emphasis on verifiable data from independent sources instead of self-reported data.

CMS will also increase the number and types of quality measures used at Nursing Home Compare with the first one in January 2015 measuring the extent to which antipsychotic medications are used in nursing homes. CMS will also strengthen its requirements to ensure that the states are completing inspections in a timely and accurate manner.