1. CMS 5 Star Rating

2. What is a CMS 5 Star Rating?
A tool created by the Centers for Medicare & Medicaid Services (CMS) in 2008, the rating system uses information from Health Care Surveys, Quality Measures, and Staffing.
In July 2016, CMS made changes to improve the information consumers receive about skilled nursing care centers.
Expansion of the timeframe for determining the quality metric from a three to four quarter average.
Changing the scoring on the Activities of Daily Living measure from a state ranking to a national ranking. 
Plans are scored on data from two years prior.
Jeff Mazzamurro l Pharmacist Intern l WNE College of Pharmacy

3. How Does This Impact Pharmacy?
Medicare Advantage and Part D plans get star ratings based on quality measures such as medication adherence and patient safety.
Medicaid and commercial plans may also evaluate performance on medication related measures.
A plans performance is the sum of its providers, including pharmacies.
Jeff Mazzamurro l Pharmacist Intern l WNE College of Pharmacy

4. Why is this Important?
Though pharmacies don‘t get a star rating, plans may have their own rating system to determine a pharmacy’s performance.
Pharmacies that boost a star rating can receive benefits:
Preferred pharmacy network status- lower copays and access to more patients
Pay-for-performance programs
Jeff Mazzamurro l Pharmacist Intern l WNE College of Pharmacy

5. CMS Score Criteria Affected by Pharmacy
Medicare Part D Measures
Appropriate use of high-risk medication for elderly patients (65+)
Medication adherence for patients with diabetes
Medication ladherence for patients with hypertension
Medication adherence for patients using cholesterol medications
Medication Therapy Management program completion rate for Comprehensive Medication Reviews
Jeff Mazzamurro l Pharmacist Intern l WNE College of Pharmacy

6. CMS Score Criteria Affected by Pharmacy cont.
Medicare Advantage Measures
Annual influenza vaccine
Annual medication reconciliation in older adults
Osteoporosis management in women with previous fracture
Glucose control in diabetes patients
Blood pressure control
Fall risk reduction
Colorectal cancer screening
Rheumatoid arthritis management
Jeff Mazzamurro l Pharmacist Intern l WNE College of Pharmacy

7. CMS Display Measures
NOTE: not used in star ratings but used to monitor effectiveness
Part D
Avoiding drug-drug interactions
Avoiding excessive doses of oral diabetes medications
Rate of chronic use of atypical by elderly in nursing homes
Advantage
Administration of pneumococcal vaccine
Drug treatment of COPD
Stating therapy for patients with CVD (To be added in 2019)
Medication management for asthma patients
Medication reconciliation post discharge (To be added in 2018)
Jeff Mazzamurro l Pharmacist Intern l WNE College of Pharmacy

8. Ways to Boost Star Ratings
Counseling patients
Maintaining secure, reliable electronic health records
Completing MTM CMR cases
Completing outcome-based MTM alerts
Using motivational interviewing techniques with patients
Watching for drug-drug interactions
Offering medication synchronization services
Communicating with physicians
Jeff Mazzamurro l Pharmacist Intern l WNE College of Pharmacy

9. References
"Quality Measures for Pharmacies." Pharmacist's Letter/ Physician’s Letter (Jan. 2016): Web. <
"Star Ratings Explained: What Your Pharmacy Needs to Know." PBA Health. 29 Jan Web. 13 Mar <
"Five-Star Quality Rating System." Survey and Regulatory. Web. 13 Mar <
Jeff Mazzamurro l Pharmacist Intern l WNE College of Pharmacy