SNF Administrators Track Five-Star Quarterly. They Can't Tell Which QMs Are Dragging the Score Without Manual Spreadsheet Work.
The Five-Star Quality Rating System has three components — Health Inspections, Staffing, and Quality Measures — each scored separately with its own calculation methodology. Most SNF administrators know their composite Five-Star rating. Few know exactly which of the 18 long-stay and short-stay quality measures are pulling their Quality Measures star below what they could achieve, or how much improvement in each QM is needed to move from 3 to 4 stars on that component.
MDS (Minimum Data Set) assessments are the data foundation for LTC quality reporting. Section GG functional scores drive ADL decline quality measures. BIMS (Brief Interview for Mental Status) cognitive scores affect antipsychotic use and dementia care measures. CAA (Care Area Assessment) trigger rates identify clinical risk areas. But MDS data lives in the MDS software system — PointClickCare, MatrixCare, American HealthTech — and getting that data into a cross-functional analytics view requires technical integration work most SNFs can't afford.
PDPM (Patient-Driven Payment Model) replaced RUG-IV in 2019 and fundamentally changed SNF reimbursement. Under PDPM, payment is based on case mix group (CMG) classification driven by clinical characteristics — primary diagnosis, function score, and comorbidity adjustments — rather than therapy minutes delivered. SNFs that don't analyze their HIPPS code distribution under PDPM may be systematically under-coding for high-acuity patients.
Long-Term Care Analytics Capabilities
LTC Quality Reporting Requirements
The Nursing Home Quality Initiative (NHQI) encompasses the Five-Star Quality Rating System, the MDS-driven quality measure submission to CMS, and the CMS Care Compare public reporting platform. SNF quality measure rates are publicly available on Care Compare and directly influence referral patterns — hospital discharge planners, managed care organizations, and families all use Five-Star ratings in SNF selection. For operator groups managing multiple facilities, a 1-star difference between two comparable facilities can shift $2-4M in annual Medicare revenue.
The Nursing Home Quality Reporting Program (NH QRP) requires quarterly MDS data submission. NH QRP measures include short-stay measures (successful discharge to community, rehospitalization, ED use without hospitalization, improvement in function) and long-stay measures (pressure ulcers, falls, antipsychotic use, pain). These measures are distinct from the Five-Star QM component measures but overlap significantly — understanding which measure set applies to which reporting requirement prevents data submission errors.
Know Your Five-Star Score Before CMS Publishes It
Upload your MDS data and billing records, ask 'which quality measures are keeping our QM star at 3 instead of 4?' and get the specific measures, current rates, and threshold distances in seconds.