What is the CMS Five-Star Rating System?
Every month, the Centers for Medicare and Medicaid Services (CMS) publishes ratings on the Medicare.gov Care Compare website for each nursing home certified by Medicare and Medicaid. These ratings range from 1 star (Much Below Average) to 5 stars (Much Above Average), providing families with an objective measure of care quality when choosing a healthcare facility for their loved ones.
The rating system uses comprehensive data from multiple sources, including claims submitted to Medicare, information provided by the nursing facility, and results from annual state surveys. This data is evaluated across three critical categories that determine the overall star rating: Health Inspections, Staffing, and Quality Measures.
Health Inspections
State inspectors conduct thorough annual surveys of nursing facilities to ensure compliance with Medicare and Medicaid regulations. Additional inspections may occur in response to complaints or concerns. These inspections evaluate everything from resident care standards to infection control and prevention protocols.
The health inspection rating is based on three years of survey data. Each deficiency identified during inspections is scored and weighted according to its potential impact on residents and the severity of harm it could cause. Facilities have the opportunity to correct deficiencies to improve their scores. Only the top ten percent of nursing homes in each state receive the coveted five-star designation in this category, making it a true mark of excellence.
Staffing
Adequate staffing is essential to quality care, which is why CMS requires nursing facilities to submit staffing data quarterly. CMS calculates Hours Per Resident Day (HPRD), which represents the average amount of time nursing staff can dedicate to each resident daily. As of July 2022, CMS also evaluates nursing staff turnover and administrator turnover rates from the past year.
The staffing rating incorporates six key measures: RN Hours Per Resident Day, Total Nurse Hours Per Resident Day, Weekend Staffing Hours Per Resident Day, RN Turnover Rate, Total Nurse Turnover Rate, and Administrator Turnover. Facilities with higher staffing levels and lower turnover rates earn more stars in this category, reflecting stable, experienced care teams.
Quality Measures
Nursing facilities submit data to CMS regarding specific quality indicators, including metrics related to falls prevention, resident mobility, pain management, and other crucial aspects of care. CMS also analyzes claims data to assess rehospitalization rates and successful transitions back to community living.
Each quality measure receives a point value, and the cumulative score determines the facility’s star rating in this category. These measures provide insight into clinical outcomes and the facility’s effectiveness in helping residents maintain or improve their health and independence.
How the Overall Five-Star Rating is Calculated
CMS uses a three-step process to determine the overall star rating, with each step ensuring the rating remains between 1 and 5 stars:
- Start with the Health Inspection Rating – This serves as the foundation, as it reflects regulatory compliance and care standards.
- Adjust for Staffing – Add one star if the staffing rating is five stars; subtract one star if the staffing rating is one star.
- Adjust for Quality Measures – Add one star if the quality measures rating is five stars; subtract one star if the quality measures rating is one star.
This calculation produces the final rating published monthly on the Medicare.gov Care Compare website.
Why Does This Rating Matter?
According to CMS, the Five-Star Quality Rating System was created to “help consumers, their families, and caregivers compare nursing homes more easily.” For families searching for the right care facility for their loved ones, the star rating provides an immediate, objective assessment of a facility’s quality compared to others in the area.
This rating system offers transparency and accountability, giving families confidence in their healthcare decisions. A five-star rating signals that a facility consistently delivers exceptional care, maintains appropriate staffing levels, and achieves superior health outcomes for residents.
Alliance Community’s Commitment to Excellence
At Alliance Community Health and Rehabilitation, earning a 5-star rating from CMS is a reflection of our entire team’s dedication to providing the highest quality of compassionate, personalized care. This achievement validates our mission to be the provider of choice for health care and rehabilitative services in our community.
Our 5-star rating demonstrates our commitment to:
- Maintaining exceptional standards in all health inspections
- Ensuring adequate staffing with experienced, dedicated professionals
- Achieving superior clinical outcomes and quality measures
- Prioritizing the safety, comfort, and well-being of every resident
- Partnering with families to create personalized care plans
We invite you to visit Alliance Community and experience firsthand the difference that award-winning care makes. Our team is here to answer your questions and help you understand how our comprehensive services can meet your loved one’s unique needs.
Learn More
To view Alliance Community’s current CMS five-star rating and compare facilities in your area, visit the Medicare.gov Care Compare website.
For more information about Alliance Community Health and Rehabilitation and our specialized programs, please contact us today or schedule a tour of our facility. We look forward to welcoming you and your family.
Alliance Community Health and Rehabilitation is proud to serve the DeLand community with compassionate care and dedicated rehabilitative services. Our continuum of care approach is designed to help you regain and maintain your independence.