If you work in skilled nursing, you already know the Five Star Rating shapes census, referrals, financial stability, and how families, hospitals, and regulators see your building. And with CMS making significant changes to the system in recent months, many teams are finding that what they knew a year ago just doesn’t hold up anymore.

The good news? Five Star is not a mystery, and it doesn’t have to be a source of stress. The facilities that do best use their data, with clear roles and repeatable processes, to see what’s coming before the rating is published. Let’s call that becoming a “Data Smartie.” Here’s how to get there.

Start with the basics: three domains, one rating

Your overall Five Star Rating is a “snapshot” of your nursing home based on three domains: Health Inspections, Staffing, and Quality Measures. Each domain earns its own 1 to 5 stars, and they combine into your overall rating.

The key takeaway: these domains are connected. Daily documentation and MDS coding decisions touch all three, so managing them in silos leads to frustration and surprises.

Smartie Tip #1

Define it, prioritize it, own it

Before you can improve outcomes, you need to decide which ones matter most to your facility and who they matter to. Then ask three simple questions: Where are we? How do we compare? What is our trend?

Just as important is ownership. Who is taking the lead? Who is responsible for managing, auditing, and correcting the data? Even if it takes baby steps, the goal is to move from reactive to proactive.

Smartie Tip: Put your data to work and hold your vendors to a higher standard. Expect more from the tools you already have.

Smartie Tip #2

Build a proactive workflow

Quality excellence comes from systematic processes. A proactive workflow looks like this:

• Scrub the MDS for coding accuracy before it is submitted.
• Investigate quality measures in real time so you can see why a measure is triggering.
• Audit Five Star projections and forecasts regularly and make course corrections early.
• Collaborate as a care team so the plan leads to the outcomes you expect.

Smartie Tip #3

Know the new survey rules and look ahead

As of July 2025, CMS changed how Health Inspections are scored. The system now looks at the two most recent annual survey cycles instead of three, and Cycle 1 carries 75% of the weight while Cycle 2 carries 25%. Revisits can also add points.

What does this mean for you? Your most recent survey matters more than ever. Find or build a view that shows everything in one place and helps you think ahead, so you can see both your opportunities and your threats.

Smartie Tip #4

Watch staffing trends and snapshots

Staffing stars are calculated from Payroll Based Journal (PBJ) data, which is submitted quarterly. Miss the reporting deadline and the facility drops to 1 star in staffing, so timeliness matters. Staffing hours are also adjusted for resident acuity using PDPM case-mix, and nursing turnover is part of the picture.

The best question to ask of your data is, “Where am I, and how far am I from improvement or decline?” Quarter-over-quarter trends and forward-looking views help you answer it.

Smartie Tip #5

Know your quality measures, and see them coming

Quality measures are split into long stay (100 days or more) and short stay (fewer than 100 days). Some are driven by live MDS data, some are hybrid, and some are claims-based, which means their data collection periods are different and delayed. They also feed into other programs, including QRP, VBP, and state incentive programs.

To work them effectively, you need to see the CMS data, your projections, and your live MDS data together. A simple “cheat sheet” for your team that lists each measure, why it triggers, its exclusions, and tips to help can make the whole process easier to understand.

Five Star Quality Measures in a nutshell: documentation, clinical care, and pro-active data working together to drive the outcome.

Smartie Tip #6

Make roles clear and make data everyone’s business

Effective, planned communication between your MDS, nursing, and interdisciplinary team members is vital. Accurate MDS coding depends on good chart documentation, which is the result of good team collaboration. Simple habits help, like morning meetings, care communication huddles, resident risk reviews using data, and care plan reviews using data.

Then grow your internal talent. Every building has a “data nerd” or data-driven person. Find them, support them, and make them your Quality Data Champion.

Smartie Tip: Systematic means well-ordered and repeatable, so your team can use the data and keep learning from it.

The bottom line

Five Star will continue to change, but your ability to adapt doesn’t have to be left to chance. When you define your outcomes, clarify who owns what, and use live data to look ahead, you move from reacting to ratings to creating them. Your goal is simple: make sure your outcomes are an accurate representation of the care you provide.

At SHP, we love helping skilled nursing teams build that confidence. If you’d like to talk about how data analytics can support your Five Star and quality improvement journey, we’d love to hear from you.

About the Author

Dahlia Kroth

VP of Strategic Relations

As VP of Strategic Relations for Strategic Healthcare Programs' skilled nursing solution, IntelliLogix™, Dahlia Kroth brings over 15 years of expertise in performance improvement to the long-term care sector. Recognized as a trusted industry data expert, she proudly represents SHP at national and state conventions, as well as corporate on-site educational sessions, where she collaborates with skilled nursing organizations across the country to achieve performance and quality excellence through data analytics.