Nursing homes certified by Medicare and/or Medicaid have to meet over 180 regulatory standards intended to protect residents. In summary, nursing homes may not even be able to obtain sufficient referrals or receive Medicare and Medicaid funding in the future if they do not have at least a 3-star rating. Several other lenders and institutional investors include 5-star ratings on their underwriting checklists. They now use star ratings as a component of its risk assessment. Department of Housing and Urban Development (HUD) an important nursing home lender. These payment arrangements – some of which are mandatory – encourage hospitals, doctors, SNFs and other providers to coordinate and reduce the cost of care received by patients across an episode of care, such as heart bypass surgery or a hip replacement. To qualify for the waiver, the majority of the SNF partners in the arrangement must have a quality rating of at least 3 stars. Medicare Episodic Payments: CMS offers waivers of the required 3-day hospital stay for Medicare SNF coverage in certain “bundled” and episodic payment arrangements.Total cost of care and meet quality targets for an assigned population of patients. An ACO is a network of providers that seeks to reduce the The waiver requires that patients go to nursing homes with at least 3-star ratings. Accountable Care Organizations (ACOs): Beginning in 2017, CMS will allow waivers of the required 3-day hospital stay before Medicare will pay for skilled nursing facility (SNF) care for enrollees in certain Medicare ACOs.The 5-star Health Inspections rating and other elements of the rating system are used to determine distributions under this program. It is re-distributed to nursing homes based on measures of compliance, quality and avoidable hospital use. Nursing Home Quality Initiative: New York’s Medicaid program annually reduces nursing home reimbursement by $50 million.Taken together, these insurers control – or will soon control – the majority of nursing home revenues. Several Medicaid plans will not include nursing homes with less than 3-star ratings in their networks. Insurers: Insurers consider these ratings when setting up their service networks.Some Performing Provider Systems – the large provider networks operating throughout the State and New York’s vision for delivery system reform – are also relying on the ratings to select their network partners. Providers and practitioners: When nurses and doctors discharge patients from hospitals, they often use the ratings in referral decisions.CON applicants’ 5-star ratings are now reviewed for this purpose. Regulators: A nursing homes’ star rating could affect their ability to obtain New York State Certificate of Need (CON) approval for facility renovations, restructurings or sales/purchases.This helps these individuals to make informed decisions on which nursing homes to consider for needed services. Consumers: The CMS rating system gives patients, residents and family members a broad overview of how they assess nursing homes for quality.
The ratings are also often a first stop for lenders and investors, who consult them to decide whether a nursing home is a safe investment. These ratings are increasingly used by consumers, regulators, insurers and other payers and provider networks to select which facilities they will consider having relationships with.
Receiving a better than average 5-star rating has never been more important to nursing homes. Growing Importance of Nursing Home 5-Star Ratings
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