The CMS Five-Star Quality Rating System plays a critical role in evaluating skilled nursing facilities, influencing public perception, referrals, and reimbursement rates. In this lesson, we’ll break down the origins, purpose, and structure of the 5-Star Rating System so you can develop a solid foundation for improving and maintaining high-quality ratings.
What You’ll Learn in This Lesson:
The history and purpose behind the 5-Star Rating System
The three key domains that determine a facility’s star rating
How to access and utilize CMS 5-Star resources for benchmarking and improvement
How to Navigate This Lesson:
Watch the Video – Get an overview of the 5-Star Rating System and its impact.
Download the Handout – Review the CMS 5-Star User Guide for a deeper dive.
Explore Additional Resources – Use the embedded link to access CMS’s official 5-Star page.
By the end of this lesson, you'll have a clear understanding of how the system works and why it matters.
Understanding how CMS calculates a facility’s Overall 5-Star Rating is essential for monitoring performance and identifying improvement opportunities. In this lesson, we’ll break down the step-by-step process used to determine a facility’s final star rating and explore key rules that impact how ratings are assigned.
What You’ll Learn in This Lesson:
The step-by-step formula for calculating the overall 5-Star Rating
The role of each domain—Health Inspections, Staffing, and Quality Measures—in determining the final score
Rules that limit upgrades and how Special Focus Facility (SFF) participants are affected
How star ratings are displayed on Care Compare
How to Navigate This Lesson:
Watch the Video – See a detailed walkthrough of the calculation process.
Download the Handout – A quick-reference guide to the 5-Star calculation formula.
Explore Care Compare – Understand how ratings appear to consumers.
By the end of this lesson, you’ll be able to accurately calculate a facility’s overall star rating and recognize factors that can influence changes.
The Health Inspection Domain is the foundation of the CMS 5-Star Rating System, serving as the starting point for calculating a facility’s overall rating. Because this domain carries significant weight, understanding how health inspection scores are calculated—and how they impact your star rating—is critical for performance improvement.
What You’ll Learn in This Lesson:
What is included in the Health Inspection rating and how it’s determined
Scoring rules and deficiency points—how survey outcomes impact your score
Weighting for repeat inspections and how missing data is handled
How ratings can change over time and the role of cut points
Special rating methodology for facilities with abuse citations
Step-by-step calculation examples to apply what you’ve learned
Setting realistic goals to improve your Health Inspection score
How to Navigate This Lesson:
Watch the Video – Get a clear breakdown of the Health Inspection domain.
Review Calculation Examples – Follow step-by-step scenarios in the slides.
Set Goals for Improvement – Learn strategies to enhance your inspection score.
By the end of this lesson, you’ll have a comprehensive understanding of how the Health Inspection Domain is scored, how it affects your 5-Star Rating, and what actions you can take to improve your facility’s performance.
Staffing levels are a key component of the CMS 5-Star Rating System, directly influencing resident outcomes and overall facility performance. This module provides a high-level overview of the staffing measures that impact your rating and the reporting periods that determine how CMS evaluates your data.
What You’ll Learn in this Module:
The six staffing measures CMS uses to assess nursing homes
How Payroll-Based Journal (PBJ) data reporting periods affect your staffing rating
This brief module lays the foundation for understanding how staffing impacts your 5-Star Rating and prepares you for the deeper dives in upcoming lessons.
Staffing plays a critical role in a facility’s 5-Star Quality Rating, directly impacting resident care, operational efficiency, and survey outcomes. In this module, we will break down the six staffing measures that contribute to the Staffing Domain rating and explore how Payroll-Based Journal (PBJ) data is used to assess staffing levels.
What You’ll Learn in This Module:
A detailed explanation of the six staffing measures and their role in the 5-Star Rating System
Overview of PBJ job codes and how different staff types are categorized
Staffing data sources and how they impact your facility’s performance
By the end of this module, you’ll have a clear understanding of how staffing measures are calculated and reported, empowering you to optimize your facility’s staffing strategy for improved quality outcomes.
Accurate census data is critical for staffing calculations and regulatory reporting. This module explores how census is determined, the role of MDS assessments in reporting staffing ratios, and best practices for validating census data to ensure compliance and accuracy.
What You’ll Learn in this Module:
How census is calculated using MDS assessments
The importance of accurate resident identification in census reporting
Common census validation reports to verify data accuracy
Understanding how census is determined allows facilities to ensure their staffing ratios reflect actual resident needs, improving both compliance and quality of care.
Staff turnover is a key indicator of workforce stability and directly impacts quality of care. This module provides an in-depth look at turnover measures, how data is collected and calculated, and the criteria for exclusions.
What You’ll Learn in this Module:
Overview of turnover measures and their significance
Data collection periods and reporting timelines
Calculation methodology for turnover rates
Exclusion criteria and how certain staff changes impact reported data
Accurately tracking and interpreting turnover measures allows facilities to identify workforce trends, strengthen retention strategies, and improve overall staffing stability.
The staffing domain plays a significant role in the Overall 5-Star Rating, and understanding how staffing scores are calculated is essential for improving performance. This module breaks down the key factors influencing staffing ratings, including scoring rules, rating methodology, and exceptions.
What You’ll Learn in this Module:
Exclusion criteria for staffing calculations
Scoring rules and how staffing levels impact ratings
Rating methodology used to assign star ratings
Staffing score exceptions and when adjustments apply
Sample staffing data to illustrate calculations in action
By mastering the staffing score methodology, facilities can better interpret their ratings, identify areas for improvement, and implement strategies to enhance staffing performance.
Achieving and maintaining a strong staffing rating requires a strategic approach to workforce planning, labor management, and ongoing monitoring. This module provides practical steps to help facilities optimize staffing levels and enhance their 5-Star Rating.
What You’ll Learn in this Module:
Setting realistic staffing goals to improve star ratings
Effective labor management strategies to ensure staffing goals are met
Monitoring staffing hours to maintain compliance and accuracy
Tracking and adjusting staffing plans based on real-time data
A proactive staffing strategy not only strengthens 5-Star performance but also improves staff satisfaction, resident outcomes, and overall operational success.
Accurate Payroll-Based Journal (PBJ) reporting is critical for maintaining compliance and ensuring the integrity of your facility’s staffing rating. This module provides an in-depth look at the PBJ audit process, what to expect, and how to prepare.
What You’ll Learn in this Module:
PBJ audit process and the type of letter facilities may receive
Steps to comply with audit requests and avoid common pitfalls
Lessons learned from past PBJ audits to strengthen reporting practices
Key PBJ reports to review for accuracy and compliance
Proactive strategies to ensure PBJ data aligns with facility operations
By understanding the PBJ audit process and implementing best practices, facilities can minimize risks, ensure accurate reporting, and protect their staffing domain rating.
The Quality Measure (QM) Domain plays a vital role in the 5-Star Quality Rating System, assessing both short- and long-term resident outcomes through MDS-based and claims-based data. Understanding how QMs are calculated, scored, and factored into the overall facility rating is essential for improving performance and achieving a higher star rating.
What You’ll Learn in This Lesson:
Overview of the QM Domain – How QMs contribute to the Five-Star Rating, scoring methodology, and key considerations
Short-Stay MDS-Based Measures – Calculation methods, exclusions, risk adjustments, and strategies for improvement
Long-Stay MDS-Based Measures – Understanding long-stay resident outcomes, key indicators, and best practices
Claims-Based Measures – Hospitalizations, emergency department visits, and other claims-driven measures that impact performance
Each module will provide a detailed breakdown of QM calculations and scoring rules, along with practical strategies to improve your facility’s QM rating. By the end of this lesson, you’ll be equipped with the knowledge and tools to strengthen quality outcomes and elevate your 5-Star Rating.
The Quality Measures (QM) Domain plays a crucial role in a facility’s 5-Star Rating, providing insight into resident outcomes and quality of care. This module offers a comprehensive overview of the QM domain, including how measures are calculated and scored.
What You’ll Learn in this Module:
How Quality Measures are Calculated – Understanding data sources and scoring rules
Measures Included in the QM Domain – Overview of short-stay and long-stay measures
Point Calculation for Each Measure – How performance translates into QM points
Handling Missing Data & Imputation – What happens when data is incomplete
Scoring Rules & Rating Methodology – How QM scores contribute to the overall rating
Examples of QM Calculations – Practical scenarios for applying scoring rules
This module provides the foundational knowledge needed to interpret and optimize QM performance, ensuring facilities can take targeted action to improve their quality rating.
The Short-Stay MDS-Based Quality Measures provide critical insights into the care and outcomes of residents who stay in a facility for a short duration. This module will break down each measure, explain how it is calculated, and highlight key exclusions and risk adjustments.
What You’ll Learn in this Module:
Overview of Short-Stay MDS-Based Quality Measures – What they assess and why they matter
Measure Calculations & Exclusions – Understanding the methodology and who is included/excluded
Risk Adjustment Process – How resident characteristics impact QM scores
Best Practices for QM Management – Strategies to improve short-stay outcomes and boost your facility’s QM score
By the end of this module, you’ll have a clear understanding of how short-stay QMs contribute to your 5-Star Rating and actionable steps to enhance your facility’s performance.
The Long-Stay MDS-Based Quality Measures (QMs) evaluate the quality of care and resident outcomes for individuals residing in a facility for over 100 days. These measures are a critical component of the Five-Star Quality Rating System and help facilities assess their long-term performance in areas such as functional decline, falls, pressure ulcers, and infections.
What You'll Learn in this Module:
Overview of Long-Stay MDS-Based Measures – Key indicators and their impact on the Five-Star Rating
Calculation and Exclusions – Understanding how each measure is derived and which residents are included/excluded
Risk Adjustments – How resident characteristics impact QM scores
Best Practices for QM Management – Strategies to improve long-stay measures and enhance resident care outcomes
By mastering these long-stay QMs, facilities can proactively address performance gaps, enhance resident safety, and improve their overall Quality Measure Rating.
The Claims-Based Quality Measures (QMs) are derived from Medicare Fee-for-Service (FFS) claims data rather than MDS assessments. These measures assess critical outcomes related to hospitalizations, emergency department use, and successful discharges. Since they rely on billing data, facilities cannot directly report or adjust them, making proactive care management essential.
What You'll Learn in this Module:
Overview of Claims-Based QMs – What they measure and why they matter
Measure Calculation – How CMS uses Medicare claims to determine performance
Exclusions & Risk Adjustments – Factors that impact measure scores
Strategies to Improve Performance – Best practices for reducing hospitalizations and optimizing care transitions
Understanding claims-based measures allows facilities to track care outcomes, reduce avoidable hospitalizations, and enhance their Quality Measure Rating.
Improving and maintaining a high CMS 5-Star Rating requires a proactive, data-driven approach. This lesson will guide participants through analyzing their staffing, quality measures (QM), and health inspection data to project their upcoming 5-Star Rating and create a strategic plan for improvement. By understanding scoring methodologies and key performance drivers, facilities can set realistic goals and implement targeted interventions to enhance their rating before the next CMS update.
By the end of this lesson, participants will have a clear roadmap to improve their 5-Star Rating, along with actionable steps to sustain performance over time.
Staffing levels and turnover play a critical role in the 5-Star Rating. This module will walk participants through their Payroll-Based Journal (PBJ) data, staffing measures, and rating calculations to identify trends and areas for improvement. By accurately assessing PBJ compliance risks and staffing patterns, facilities can set data-driven staffing goals to enhance their rating.
This module covers:
Reviewing facility staffing measures and their impact on 5-Star Ratings
Analyzing PBJ job codes, data accuracy, and compliance risks
Identifying trends in staffing levels and turnover
Projecting how current staffing data will impact the next rating update
Developing strategies to improve staffing scores
The Quality Measure (QM) domain is a key component of the 5-Star Rating, reflecting both short-stay and long-stay resident outcomes. This module will help facilities analyze trends in QM performance, identify high-impact measures, and forecast their QM rating for the next CMS update. Participants will also review exclusions, risk adjustments, and data completeness to ensure accurate calculations.
This module covers:
Reviewing short-stay and long-stay QM measures and their impact on 5-Star Ratings
Identifying high-impact measures that drive QM scoring
Understanding exclusions, missing data, and risk adjustments
Forecasting QM rating changes based on recent data trends
Setting measurable goals to improve QM performance
Survey outcomes significantly affect a facility’s 5-Star Rating, and understanding deficiency scoring rules, trends, and enforcement risks is essential. This module will guide participants through their past survey findings, point deductions, and trends in repeat deficiencies to identify opportunities for improvement. Participants will also explore strategies to prevent deficiencies and mitigate their impact on ratings.
This module covers:
Reviewing past survey findings and deficiency points
Understanding how repeat deficiencies impact the rating
Identifying common trends and enforcement risks
Projecting future health inspection ratings based on past performance
Developing a compliance action plan to reduce deficiencies
Once facilities have assessed their staffing, QM, and health inspection data, they must integrate their findings to project their overall 5-Star Rating and create an action plan for sustained improvement. This module will help participants understand the overall rating formula, key rating drivers, and goal-setting strategies to strengthen their rating before the next CMS update.
This module covers:
Combining projections for staffing, QM, and health inspections
Understanding how domain ratings impact the overall 5-Star Rating
Identifying key drivers for rating improvement
Developing a facility-specific action plan for sustained performance
Setting monitoring strategies and realistic improvement goals