5 Star, QMs, and PBJ Data Updates

5 Star, QM’s and PBJ data updates have been released. Last week, we shared that QRP’s were released for review. All are critical reporting which impacts our 2022 FY reimbursement and our publicly displayed information on Care Compare. There are a few small windows of time for review and correction if needed.




5 Star Ratings

  • July 19th, the Five Star Preview Reports became available for review within the CASPER reporting link located on the CMS QIES Systems for Providers page.

  • July 28th (on or around), ratings will be displayed on Care Compare.

  • Health inspection rating incorporates data reported through June 30, 2021.

  • QM time periods for each of the QM’s contributing to the 5 Star QM measure can be found in each of the QM tables in Care Compare.

  • Staffing and RN ratings are based on the payroll-based journal (PBJ) staffing data reported for the first calendar quarter of 2021.

Quality Measures (QM’s)

  • July 2021’s refresh on Care Compare reflects Q2-4 of 2020 and Q1 of 2021.

  • Four of the claims-based QMs use data based on the collection period ending December 31, 2020. The two QMs part of the SNF QRP, “Percentage of SNF residents with pressure ulcers/pressure injuries that are new or worsened” and “Rate of successful return to home and community from a SNF,” will continue to be held constant at this time.

PBJ

  • July 2021 Care Compare website updates were calculated based on staffing information for January 1, 2021 - March 31, 2021 (submitted and accepted by the May 15, 2021 deadline).

  • Expected staffing levels are based on average MDS-based resident census and resident acuity level using RUG-IV data. The 5 Star rating technical users’ guide contains a detailed explanation of the staffing rating and the case-mix adjustment methodology.

Let's Get to the Point:

This publicly displayed information accuracy is critical as the impact in regards to census through community referrals, managed care arrangements and financial penalties can be long lasting. The 5-Star preview reports are only available within the QIES system for a short amount of time. Many choose to print and save reports for future reference.
  • Accessing: Once in the CASPER reporting system, select the ‘Folder’s’ button then select ‘My Inbox’ or the Inbox beginning with ‘LTC’ and the state abbreviation followed by a facility ID.

  • The 5-Star helpline will be available July 26th through July 30th, 2021 (1-800-839-9290).