Five-Star Quality Rating System
The Five-Star Quality Rating System is CMS's public quality scoring system for nursing homes, composed of three domain ratings — Health Inspections, Staffing, and Quality Measures — that directly affect consumer choice, census, referral patterns, and reimbursement in some states.
What is the Five-Star Quality Rating?
The CMS Five-Star Quality Rating System assigns nursing homes an overall 1–5 star rating derived from three domain-specific ratings. The Health Inspections star is based on state survey deficiency citations — frequency, scope, and severity of citations from the most recent three annual surveys plus any complaint investigations — and is updated monthly. The Staffing star is calculated from Payroll-Based Journal (PBJ) staffing data submitted directly to CMS, measuring registered nurse (RN) hours per resident day, total nurse hours per resident day, and — since 2023 — weekend staffing levels reported separately. The Quality Measures star is derived from MDS data submitted for long-stay and short-stay residents and encompasses 15 long-stay quality measures (including prevalence of high pain, pressure injuries, antipsychotic medication use, falls with major injury, and low-risk residents with loss of bowel or bladder control) and 5 short-stay measures. CMS designates facilities with a persistent history of serious survey problems as Special Focus Facilities (SFF), subjecting them to enhanced oversight and potential termination from Medicare and Medicaid participation. The financial impact of the star rating is substantial: four- and five-star facilities maintain 8% higher occupancy than one- and two-star facilities on average, hospital discharge planners routinely restrict referrals to four-star-and-above facilities, and some state Medicaid programs provide supplemental quality incentive payments tied to Five-Star performance.
Why It Matters for Healthcare Analytics
Star rating improvement requires understanding exactly which quality measures are dragging the composite score and how far each metric is from the national distribution cutoff for the next star tier. A facility at 3 stars may need improvement in only one or two specific MDS-derived quality measures — or a staffing data submission correction — to cross the threshold into 4 stars.
How Vizier Tracks Five-Star Ratings
Upload your MDS and PBJ staffing data, then ask "Which quality measures are keeping our Quality Measures domain star below 4, and how close are we to the next tier threshold?" — Vizier benchmarks all 20 quality measures against national and state distributions and identifies the specific measures with the shortest path to star rating improvement.