For many skilled nursing facilities, improving Quality Measures has been the focus of quality improvement efforts for years. Effective with the July 2026 CMS Five-Star Quality Rating System refresh, earning higher Quality Measure star ratings has become more challenging for skilled nursing facilities.
The individual Quality Measure point thresholds did not change. Instead, CMS increased the total score thresholds used to assign long-stay, short-stay, and overall QM star ratings. For the July 2026 refresh, CMS increased the rating thresholds by one-half of the average improvement in QM scores measured between January 2025 and April 2026.
Per the July 2026 5-Star Users Guide, the QM rating thresholds are:
*Short-stay thresholds are based on adjusted scores after CMS applies the 1,150/800 adjustment factor to the unadjusted short-stay score.
CMS also indicates that it intends to continue increasing the QM rating thresholds every six months based on national performance improvement. As a result, maintaining the same Quality Measure performance may not always be enough to maintain the same Five-Star rating. Simply put, Five-Star has become a moving target.
A facility that maintains the same performance today could potentially earn fewer stars in the future if its improvement does not keep pace with national trends. Strong Five-Star performance begins with strong clinical systems, consistent interdisciplinary processes, and accurate documentation.
Leadership Strategies to Optimize Quality Measure Performance:
Review the new July 2026 QM star thresholds and identify the facility's current position within its star range.
Evaluate long-stay and short-stay QM performance separately rather than focusing only on the overall QM rating.
Identify the QMs contributing the fewest points to the facility's score.
Trend measures over time to identify early movement before a decline is reflected in the star rating.
Compare MDS coding with the supporting clinical record to ensure the resident's story is accurately represented.
Review claims-based measures alongside MDS-based measures and evaluate the clinical systems contributing to hospitalizations and ED utilization.
Use QAPI to develop targeted performance improvement plans for priority measures.
Bring QM trends into Clinical Risk, QAPI, and interdisciplinary meetings so the team understands how daily care processes connect to facility outcomes.
Establish accountability for follow-up, auditing, and sustained improvement.
Understanding your Quality Measure score provides a much clearer picture than looking at the star rating alone.
Quality Measures reflect resident outcomes not just MDS coding. Falls, pressure injuries, hospitalizations, antipsychotic use, functional decline, infections, and successful community discharge are all influenced by the daily work of the interdisciplinary team. While accurate MDS coding is essential, sustained Five-Star performance depends on consistent clinical practices and effective interdisciplinary collaboration.
The July 2026 update serves as an important reminder that quality improvement is not a destination. Five-Star performance is a moving target. Facilities that routinely review their Quality Measure scores, monitor trends, and address opportunities before they affect outcomes will be best positioned to maintain and improve their Five-Star ratings.
At Polaris Group, we help skilled nursing facilities look beyond the star rating by identifying the clinical, documentation, and operational processes driving Quality Measure performance. Through comprehensive clinical reviews, mock surveys, MDS and reimbursement consulting, Quality Measure analytics, and leadership education, our consultants partner with facility teams to identify risk, strengthen clinical systems, improve regulatory compliance, and achieve sustainable quality outcomes before they impact Five-Star ratings.
For many skilled nursing facilities, improving Quality Measures has been the focus of quality improvement efforts for years. Effective with the July 2026 CMS Five-Star Quality Rating System refresh, earning higher Quality Measure star ratings has become more challenging for skilled nursing facilities.
The individual Quality Measure point thresholds did not change. Instead, CMS increased the total score thresholds used to assign long-stay, short-stay, and overall QM star ratings. For the July 2026 refresh, CMS increased the rating thresholds by one-half of the average improvement in QM scores measured between January 2025 and April 2026.
Per the July 2026 5-Star Users Guide, the QM rating thresholds are:
*Short-stay thresholds are based on adjusted scores after CMS applies the 1,150/800 adjustment factor to the unadjusted short-stay score.
CMS also indicates that it intends to continue increasing the QM rating thresholds every six months based on national performance improvement. As a result, maintaining the same Quality Measure performance may not always be enough to maintain the same Five-Star rating. Simply put, Five-Star has become a moving target.
A facility that maintains the same performance today could potentially earn fewer stars in the future if its improvement does not keep pace with national trends. Strong Five-Star performance begins with strong clinical systems, consistent interdisciplinary processes, and accurate documentation.
Leadership Strategies to Optimize Quality Measure Performance:
Review the new July 2026 QM star thresholds and identify the facility's current position within its star range.
Evaluate long-stay and short-stay QM performance separately rather than focusing only on the overall QM rating.
Identify the QMs contributing the fewest points to the facility's score.
Trend measures over time to identify early movement before a decline is reflected in the star rating.
Compare MDS coding with the supporting clinical record to ensure the resident's story is accurately represented.
Review claims-based measures alongside MDS-based measures and evaluate the clinical systems contributing to hospitalizations and ED utilization.
Use QAPI to develop targeted performance improvement plans for priority measures.
Bring QM trends into Clinical Risk, QAPI, and interdisciplinary meetings so the team understands how daily care processes connect to facility outcomes.
Establish accountability for follow-up, auditing, and sustained improvement.
Understanding your Quality Measure score provides a much clearer picture than looking at the star rating alone.
Quality Measures reflect resident outcomes not just MDS coding. Falls, pressure injuries, hospitalizations, antipsychotic use, functional decline, infections, and successful community discharge are all influenced by the daily work of the interdisciplinary team. While accurate MDS coding is essential, sustained Five-Star performance depends on consistent clinical practices and effective interdisciplinary collaboration.
The July 2026 update serves as an important reminder that quality improvement is not a destination. Five-Star performance is a moving target. Facilities that routinely review their Quality Measure scores, monitor trends, and address opportunities before they affect outcomes will be best positioned to maintain and improve their Five-Star ratings.
At Polaris Group, we help skilled nursing facilities look beyond the star rating by identifying the clinical, documentation, and operational processes driving Quality Measure performance. Through comprehensive clinical reviews, mock surveys, MDS and reimbursement consulting, Quality Measure analytics, and leadership education, our consultants partner with facility teams to identify risk, strengthen clinical systems, improve regulatory compliance, and achieve sustainable quality outcomes before they impact Five-Star ratings.
