Methodology
CMS publishes a 1-to-5 star quality summary for every Medicare-certified skilled nursing facility. Here's what goes into the rating, what each star means, and what the rating doesn't tell you.
The CMS Five-Star rating doesn't reflect: ownership history, recent CMP penalty totals, Special Focus Facility status, abuse-icon flags, or whether the operator has been linked to facility closures elsewhere. Placet surfaces all of these alongside the CMS star rating.
A 1-to-5 star summary CMS publishes for every Medicare-certified skilled nursing facility. It rolls up three sub-ratings: health inspections (most heavily weighted), staffing (from PBJ payroll data), and quality measures (resident outcomes like falls, infections, weight loss).
Health inspections. CMS uses inspection results to set a base star rating, then nudges it up or down based on staffing and quality measures. A facility with 5-star quality measures but 1-star inspections will land near the bottom of the overall scale.
From the Payroll-Based Journal (PBJ) system, which collects daily nursing hours straight from facility payroll. CMS adjusts for resident acuity, then compares each facility's hours-per-resident-day against national benchmarks. RN turnover and weekend staffing are now also factored in.
Some have tried. The biggest historical loophole — self-reported staffing — was closed when CMS moved to PBJ payroll data in 2018. Quality measure self-reporting still has audit risk, which is why Placet weights inspection results more heavily than CMS does in our Trust Index.
Because the CMS rating doesn't capture everything. We additionally surface RN turnover, weekend staffing, recent CMP penalties, and ownership signals — all from public CMS data — that can change the picture for a family making a placement decision.