SIGNIFICANT CMS Updates to Care Compare and your 5-Star Rating System

The Centers for Medicare & Medicaid Services (CMS) has issued QSO-25-20-NH, outlining substantial updates to the Nursing Home Care Compare website and the Five-Star Quality Rating System, effective beginning July 30, 2025. These changes mark a strategic move toward greater transparency, accuracy, and accountability in the assessment of nursing home performance and ownership.

These updates, far more than routine tweaks, reflect CMS’s shift toward modernized quality reporting that incorporates payer diversity, recent performance, and consumer-friendly ownership data.

Here’s what’s changing and why it matters.

Chain-Level Performance Reporting- Effective July 30, 2025

CMS will begin displaying performance information for nursing home ownership groups, also referred to as "chains" or "affiliated entities," directly on the Nursing Home Care Compare site. This builds upon CMS’s 2022 and 2023 initiatives to publish ownership and chain-level performance data on data.cms.gov, now transitioning that information into a format more accessible to consumers.

What Care Compare will now show

1. Average overall star rating
2. Health inspection ratings
3. Staffing ratings
4. Quality measure ratings

This transparency initiative enables families and referral sources to evaluate the performance of entire corporate entities, not just individual facilities, facilitating more informed decision-making.

 Updated Health Inspection Rating Methodology- Effective July 2025

CMS will discontinue the use of the third cycle (oldest) standard health inspection in the Five-Star rating calculation. Previously, three cycles were used—each up to 15 months long. However, due to survey backlogs, some third-cycle inspections are now over 45 months old, no longer representing current facility performance.

What is changing?

1. Only the two most recent standard surveys will be used.
2. Weights will prioritize the most recent cycle (75% weight).
3. Complaint and infection control surveys will still be considered over a three-year lookback.

This change will reward facilities that have improved and more accurately reflect current conditions. CMS anticipates that about 20% of facilities may see a shift in their inspection rating, while the majority (~80%) will not be affected.

 Updated Long-Stay Antipsychotic Use Measure

Effective October 29, 2025, in response to long-standing concerns from the Office of Inspector General (OIG) and other stakeholders about underreporting in the MDS, CMS is revising how it calculates the long-stay antipsychotic use quality measure.

 The new methodology will incorporate:

• Medicare Fee-for-Service (FFS) claims
• Medicaid claims
• Medicare Advantage (MA) encounter data

These data will supplement the MDS, enabling CMS to more accurately capture antipsychotic use, particularly for prescriptions not falling within the MDS’s 7-day lookback window. Claims data will also validate exclusion diagnoses (e.g., schizophrenia), addressing the trend of inappropriate exclusions.

 Key Impact:

• The national average will increase from 14.64% to 16.98%, not because of increased prescribing, but due to improved detection and data integrity.
• Cut points will shift based on provider deciles, reinforcing accountability across all payer types.

This marks the first time CMS will use Medicare Advantage data in a Five-Star measure, a move that could foreshadow broader integration of MA data in future CMS metrics, especially given that over half of Medicare beneficiaries are enrolled in MA plans.

 Removal of COVID-19 Vaccination Metrics

Effective July 30, 2025, Resident and staff COVID-19 vaccination rates will be removed from the main profile pages on Nursing Home Care Compare. While CMS originally introduced these metrics in 2021 to promote vaccine uptake during the pandemic, their removal reflects a return to more core quality indicators within the public reporting framework.

 Implications for Providers

These updates represent a fundamental shift in how CMS evaluates and presents nursing home quality:

• Chain-wide visibility may increase reputational and regulatory pressure on multi-facility operators.
• Recent performance will be emphasized, benefiting providers who have made measurable improvements.
• Payer-aware quality measurement is becoming the norm, requiring facilities to ensure complete and accurate documentation across all insurance types.
• Star rating volatility is likely for about one in five facilities, with some benefiting from the removal of outdated survey data and others exposed to more recent declines.

 What to Do Now

Providers should assess how these changes may affect their public ratings and quality performance profiles. Chain-level operators must pay close attention to aggregate performance trends, while all facilities should evaluate their antipsychotic prescribing practices and survey readiness in light of new data sources and survey weightings.

This is a pivotal moment for data strategy in post-acute care. Facilities that proactively align with CMS’s updated methodologies and transparency goals will be better positioned to protect their ratings, reputation, and resident outcomes.

https://www.cms.gov/files/document/qso-25-20-nh.pdf

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