• Innovation in Action

Dec 19, 2019

How the Medicare Total Quality Score Affects Your Star Rating—and what you can do about it


Your total quality score directly affects your star rating and with it the ranking that influences hospital referrals and whether families choose your facility for loved ones. Getting a handle on your Total Quality Score is essential; read more and we will show you how.

The Five-Star Quality Rating System is made up of three domains that are scored, weighted and summed to produce a total that corresponds to a specific number of stars:

  1. Total Quality Score
  2. State survey results
  3. Staffing levels

Fifteen key measures of resident care make up your Total Quality Score, including the pressure ulcer rate and urinary tract infection rate. The Centers for Medicare & Medicaid Services (CMS) assigns points to each measure based on your facility’s results relative to those of other nursing homes nationwide. After the state survey, your Total Quality Score generally has the most influence on your star rating. You can read more here about CMS’ latest scoring changes, which became effective in October 2019.

While you can’t control when an inspector shows up or when staff call in sick, you can elevate your facility’s quality performance. By providing the right tools, training and subject matter expertise, the Health Quality Innovation Network (HQIN) can help you improve your Total Quality Score and even your star rating.

HQIN breaks down improvement into smaller, achievable steps. You will learn to integrate new data-driven approaches into daily activities to make a positive impact on resident care. As quality steadily climbs, you and your team will be building the confidence and skills to take on even bigger quality improvement challenges.

Get started today by completing our online participation agreement. Review our nursing home fact sheet to learn more.

Next week read how one of HQIN’s Quality Measure Tip Sheets spotlights MDS coding steps. This example, which looks at coding Urinary Tract Infections (Long Stay), is one of more than 10 of these types of tip sheets offered by HQIN. We’ll also introduce another easy-to-share tool called “Think 2 for UTI’s,” which highlights UTI MDS coding guidelines.