Diving into one of the biggest shifts in the CMS Five-Star Rating System — the revised Health Inspection calculation.
This month’s “Ask Amanda” dives into one of the biggest shifts in the CMS Five-Star Rating System — the revised Health Inspection calculation. With CMS adjusting how survey results are weighted and applied, many facilities may notice unexpected changes in their star ratings. Let’s take a closer look at what’s changing, what it means for you, and how your team can stay ahead of the curve.
A New Era for Health Inspection Ratings. CMS has announced a significant change to the way Health Inspection ratings are calculated, and this shift may cause your stars to realign — for better or for worse.
The update, highlighted in CMS’s “Change in the Stars” initiative, introduces a new calculation model for the Health Inspection domain that will impact how deficiencies translate into your facility’s Five-Star rating. Understanding these changes — and preparing your team — is key to protecting your overall star performance.
What’s Changing
Historically, the Health Inspection rating was based on a three-cycle weighted average of survey outcomes — current, previous, and second prior cycles. The new methodology, however, adjusts the weighting and comparison process, emphasizing recent survey performance while phasing out older cycles faster.
In short:
- Current surveys carry more weight. Your most recent performance will have a greater impact on your rating than ever before.
- Older cycles contribute less. Facilities can recover more quickly from past poor performance — but they can also lose stability faster if recent surveys reveal new concerns.
- Complaint surveys continue to factor in, but their impact will be recalibrated to better reflect scope, severity, and timeliness of deficiencies.
The goal, according to CMS, is to create a more accurate and current reflection of facility performance while maintaining fairness across states and survey environments.
What This Means for Facilities
These changes may lead to noticeable rating shifts once the new calculations take effect. Some facilities could see star drops despite consistent care quality, simply due to timing or survey recency. Others may benefit from recent improvements that are now more heavily weighted.
For Interdisciplinary teams, this means two key things:
- Survey readiness is now a continuous process. With more emphasis on the most recent cycle, one difficult survey can have an outsized impact.
- Data and documentation alignment is critical. The MDS, care plans, and daily documentation all contribute to survey outcomes — consistency and accuracy are non-negotiable.
Practical Steps to Stay Ahead
To navigate the recalculation smoothly, facilities should:
- Strong Documentation. Documentation plays a vital role in demonstrating compliance. It provides evidence that the Interdisciplinary Team (IDT) is actively following care plans, implementing timely interventions, and maintaining organized records of staff competencies and training—ensuring employees are qualified and prepared to deliver quality care.
- Conduct proactive mock surveys. Focus on areas with repeat tags or care processes that often drive citations (infection control, pressure injuries, and unnecessary medications).
- Reinforce staff education. Surveyors increasingly focus on real-time care observations — ensure staff understand not just the “what,” but the “why” behind care standards.
- Review QAPI and audit systems. Use data-driven QA meetings to track patterns and prevent issues before they reach survey level.
- Communicate openly with your survey team. Transparency and collaboration are key to interpreting results accurately and planning next steps.
Polaris Group can be a key team member in evaluation and establishing these processes in your facility.
The Bottom Line
CMS’s new calculation model represents a philosophical shift — away from a long-term average and toward a real-time reflection of quality of care. For high-performing facilities, this means greater recognition of current excellence. For others, it’s a chance to reset and improve more rapidly.
In either case, the message is clear: survey outcomes today matter more than ever.
So, as the stars shift, stay steady in your focus — on quality, accuracy, and resident-centered care. Because no matter how CMS recalculates, excellence in care always earns its own five stars.
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