The AHCA/NCAL Quality Initiative is paired with CMS’s Five-Star Quality Rating System. This collaboration hopes to prepare skilled nursing centers for future policy and regulatory changes. Recent changes to Five-Star include adding new quality measures, changing RN staffing thresholds, and lifting the survey freeze. Based on preliminary analysis, the changes have been well received by the nursing centers. There are currently 7,798 (50%) skilled nursing centers in the country that have achieved a goal in at least two of the four domains of the AHCA/NCAL Quality Initiative, which include hospitalizations, antipsychotics, customer satisfaction, and functional improvement. Nursing centers that achieved at least one goal in two or more disciplines were more likely to have an overall Five-Star rating of four or five stars compared to the rest of the country (47% vs. 37%). A similar relationship exists for the other components of Five-Star (Survey: 36% vs. 31%, Staffing: 32% vs. 29%, Quality: 59% vs. 41%).

These analyses do not prove causation, but they do support an association between success on the Quality Initiative and the performance on Five-Star. The association between the two is logical and the changes in both areas all emphasize reducing short- and long-stay hospitalizations and long-stay off-label use of antipsychotics. The customer service aspect of the Quality Initiative also reflects key components of Five-Star. It is expected that Five-Star will continue to grow and change in the coming years and the AHCL/NCAL Quality Initiative has proven to be an effective approach to adapting to said changes.