Improving Nursing and Long-term Care Facility Quality Ratings

Boosting Ratings & Reimbursements: How Leaders Can Maximize Quality Ratings at Skilled Nursing & Long-Term Care Facilities

Quality measurement in skilled nursing facilities (SNFs) and long-term care (LTC) facilities extends beyond patient care; it also directly impacts financial performance.

And navigating quality metrics isn’t easy.

Quality and compliance leaders at SNFs and LTC facilities face continuously evolving regulations, shifting reimbursement models, and an increasingly complex healthcare system. They must run point on tracking, improving, and ensuring adherence to quality metrics—not just to meet quality, safety, and regulatory requirements but also to protect their organization’s bottom line.

Adopting an effective strategy, supported by a robust quality management system, can streamline this process and help leaders enhance both resident care and the performance scores that impact these quality metrics.

In the following sections, we’ll explore:

• Defining and measuring quality
• Financial implications of quality measurement
• Challenges in managing quality metrics
• Quality measurement requirements for SNFs and LTC facilities
• Strategies to enhance quality in these settings

How healthcare quality is defined and measured

The Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) play significant roles in defining and measuring healthcare quality at SNFs and LTC facilities.

CMS defines quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

CMS’s current areas of focus regarding quality measurement include:

• Addressing high impact measure areas that safeguard public health
• Adopting measures that are patient-centered and meaningful to patients
• Adopting outcome-based measures where possible
• Fulfilling legislative requirements
• Minimizing burden for providers
• Identifying significant opportunities for improvement
• Addressing measure needs for population-based payment through alternative payment models
• Aligning across programs and payers (e.g., Medicare, Medicaid, and commercial payers)

According to AHRQ, there are three types of healthcare quality measures:

• Structural measures: Assess a provider’s infrastructure and capacity to deliver high-quality care (electronic medical records, staff qualifications, etc.)
• Process measures: Evaluate specific actions health care providers take to maintain or improve health (timely administration of medications, hand hygiene compliance, etc.)
• Outcome measures: Gauge the effects of health care services on patient outcomes (hospitalization rates, serious falls with injury, mortality rates, etc.)

Financial impacts of quality metrics in skilled-nursing and long-term care facilities

Leaders of SNFs and LTC facilities are well aware of the significant financial implications of CMS’s quality measures. These metrics aren’t just regulatory hoops to jump through; they directly influence financial performance via incentives, penalties, and the facility’s competitive standing in the healthcare market.

Understanding and effectively managing these measures is crucial for safeguarding revenue streams and optimizing resident care. Whether operating within a value-based, fee-for-service, or hybrid model, various quality measures—including resident outcomes, safety metrics, and CMS Star Ratings—have substantial impacts on skilled nursing and long-term facilities.

The challenges of managing multiple metrics

Leaders commonly run into issues when navigating these various quality programs and metrics. These challenges can lead to misleading reports, poor decision-making, missed deadlines, lost bonuses, and even penalties, and include:

• Issues with data accuracy and completeness
• Resource constraints
• Difficulties coordinating care across fragmented systems
• Lack of engagement and buy-in from staff
• Rapidly evolving quality measures and regulations
• Outdated quality tracking systems (paper, binders, spreadsheets, CMS templates)
• Opinion-based assessments impacting objectivity
• Failure to prioritize quality improvement initiatives

Quality measurement at SNF and LTC facilities

Skilled nursing facilities and long-term care facilities are required to meet various quality metrics, including the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) and the Five-Star Quality Rating System.

Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)

CMS requires SNFs to report data on various quality measures through the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). Key components include:

• Quality measures: To measure health, safety, and functionality; includes fall rates, community discharges, and pressure ulcers
• Data reporting: To assess care quality and program compliance
• Public reporting: To enhance transparency and aid consumer decision-making
• Payment adjustments: To adjust Medicare payments based on compliance, penalizing non-compliance in an effort to maintain high care standards
• Improvement and compliance: To provide guidelines and resources to help facilities improve and achieve better patient outcomes

Five-Star Quality Rating System

The CMS Five-Star Quality Rating System is designed to help the public compare nursing home quality. Consumers, families, and caregivers can visit the Nursing Home Compare website to see quality ratings of between 1 and 5 stars. Ratings cover:

• Overall rating: Takes into account the three ratings below
• Health inspections: Based on most recent health inspections and previous two years of inspections (food service, cleanliness, adherence to regulations)
• Staffing: Includes average hours of nursing care per resident per day
• Quality measures: Reflects clinical data on residents’ health and well-being (pressure ulcers, use of restraints, etc.)

Top three strategies for quality improvement

The SNF Quality Reporting Program and CMS Five-Star Quality Rating System are only two examples of quality measures facilities must meet. Compliance and quality leaders can navigate  complex quality requirements by investing in the right tools and by developing a strategic plan focused on improving Here are three strategies to improve quality at your facility:

1. Foster collaboration across departments.

Consider whether your quality improvement strategy keeps everyone in silos or supports collaboration across the organization:

• How do you ensure information flows smoothly between departments?
• Do you have shared quality goals and metrics across teams?
• Do members on different teams understand their individual roles in reaching the overall quality goals?
• Do your employees feel they have a safe space to share concerns about quality or ideas for improvement?
• Do you feel your team members feel valued and are invested in improving quality outcomes?
• Do they feel they have the appropriate work time allocated to accomplishing their goals?

2. Provide ongoing targeted staff training.

Next, reevaluate your training programs as they relate to improving quality. Do you have professional development opportunities in place that are specifically related to quality? To enhance care quality, could you implement or strengthen your training in:

• Resident safety
• Fall prevention
• Preventing medical errors
• Infection control
• Clinical decision-making
• Hands-on simulation
• Resident-centered communication
• Interprofessional communication
• Cultural competency
• Resident privacy and data protection
• CMS regulatory and quality compliance measures (listed in chart above)
• Accreditation standards
• Resident interaction (customer service, conflict-resolution)
• Data reporting
• Leadership and change management

3. Use the right quality management tool.

Implement a quality management tool designed to track and improve performance. The right tool can help you:

• Keep track of performance indicators
• Improve reporting accuracy
• Pull in demographic data
• Reduce reporting and assessment time from days to just hours or even minutes
• Update as your needs change
• Provide action indicators to target issues prior to audit
• Keep historical records of actions
• Document actions to show you’ve met changing regulatory requirements

Ready to work on improving your facility’s quality ratings?

Improvement can be simple with the right healthcare quality management software. HealthStream’s Quality Manager empowers leaders in SNFs and LTC facilities to pinpoint areas for improvement, make data-driven decisions, streamline compliance processes, save time and resources, enhance patient care quality, and ultimately, boost the bottom line.

Learn more