Long-Term Care Analytics

Skilled Nursing and Long-Term Care Analytics: MDS, Five-Star, and Survey Readiness

Five-Star scores directly affect SNF census — facilities with 4+ stars have 8% higher occupancy than those with 3 or fewer stars. Vizier tells you which quality measures are dragging your composite rating and what it takes to move each star component.

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$75Bannual SNF Medicare spend across 15,000+ facilities — Five-Star score is the primary census driver
The Data Challenge in Long-Term Care

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.

Five-Star QM Score Decomposition
The 18 CMS quality measures (long-stay: pressure ulcers, falls with injury, antipsychotic use, pain management, ADL decline; short-stay: rehospitalization, improvement in function, community discharge) each contribute to the QM star. Vizier shows which measures are in the lowest national percentile and quantifies the census impact of each star change.
Staffing Star Weekend Component
CMS added weekend staffing as a separate Five-Star component in 2023. RN hours per resident day (HPRD) on weekends are scored independently of weekday staffing. Agency/pool staff ratios affect the staffing star calculation — facilities that rely heavily on registry staff score lower than those with consistent employed staffing.
Survey Deficiency Pattern Analysis
Survey deficiency patterns are predictable. Facilities that received infection control deficiencies in one survey cycle are at elevated risk for similar citations in the next. Vizier analyzes deficiency history and correlates it with current operational metrics to identify survey readiness risks.
What Vizier Tracks

Long-Term Care Analytics Capabilities

MDS Assessment Analytics
Section GG functional scores trending over assessment periods, BIMS cognitive score distribution, and CAA trigger rate analysis. Identify residents at risk of functional decline before the next MDS assessment window.
Five-Star QM Score Tracking
All 18 CMS quality measures tracked in real time — long-stay and short-stay — with national percentile benchmarking and star threshold identification. Know which QMs are dragging your composite score and by how much.
SNF Readmission (SNFRM)
30-day all-cause readmission from SNF tracked against the SNFRM measure specification. Identify which diagnoses and which receiving hospitals drive the highest readmission rates to target care transition interventions.
Staffing HPRD Analytics
RN, LPN, and CNA hours per resident day by shift and day type (weekday vs. weekend) with Five-Star staffing threshold benchmarking. Agency/pool staff ratio tracked separately from employed staff to assess staffing star impact.
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PDPM Case Mix Optimization
HIPPS code distribution by clinical group, functional impairment level, and comorbidity adjustment. Compare current case mix to pre-PDPM RUG-IV distributions to identify systematic under-coding for high-acuity short-stay residents.
Antipsychotic Use QM Tracking
Antipsychotic use without a psychosis diagnosis — one of the highest-weight long-stay quality measures and a frequent survey citation. Track by unit and by prescribing provider, with facility-to-national benchmark comparison.
Quality Programs & Reporting

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.

Quality Programs
Five-Star Quality Rating System (Health Inspections, Staffing, Quality Measures), Nursing Home Quality Reporting Program (NH QRP), CMS Care Compare public reporting
Payment Models
PDPM (Patient-Driven Payment Model) since 2019, Medicare Part A fee-for-service, managed Medicare (MA plan SNF contracts), Medicaid daily rate (state-specific)
Key MDS-Driven Measures
Section GG functional scores, BIMS cognitive assessment, pressure ulcer staging, antipsychotic medication use, fall documentation, pain assessment frequency
Survey Requirements
Annual standard survey (CMS Form 3070), complaint investigations, QAPI program documentation, infection control program evaluation, staffing documentation
Long-Term Care Analytics

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.