CMS Quality Measures for Nursing Homes Explained

The CMS quality measure rating comes from clinical assessment data. Learn what it measures, how it is adjusted, and where its limits are.

Category: staffing-and-quality · Updated 2026

The quality measure (QM) star on Care Compare summarizes clinical outcomes and processes drawn from data facilities submit about each resident. It is one of the three domains in the overall CMS rating, alongside health inspections and staffing. Quality measures can be a useful early-warning tool, but they are also the domain most dependent on how facilities assess and code their residents.

This guide explains where the data comes from, what the measures look at, and how to read the QM star without over-trusting it.

Where the data comes from

The quality measures come from the Minimum Data Set (MDS), a standardized clinical assessment that Medicare- and Medicaid-certified nursing homes complete for each resident at set intervals. Facilities submit MDS data to CMS, which calculates measures covering both short-stay residents, often after a hospital or rehabilitation stay, and long-stay residents. CMS then risk-adjusts the measures and combines them into the QM rating. The Five-Star Technical Users' Guide lists the current measures.

What the measures cover

Quality measures cover areas that matter to families, such as:

Falls with major injury
Pressure ulcers
Antipsychotic medication use
Activities of daily living and mobility
Incontinence and catheter use
Short-stay rehospitalization and successful return to the community

Because these are clinical outcomes and processes, they can reveal problems that inspection reports miss, such as a pattern of pressure ulcers across a building.

Short-stay versus long-stay measures

Population	What it reflects
Short-stay	Rehabilitation and post-acute care, including hospital readmissions
Long-stay	Ongoing care, including function, medications, and skin integrity

Match the measure to your situation. A family choosing long-term care cares more about long-stay measures; someone evaluating rehabilitation after surgery cares more about short-stay results.

How to use quality measures well

Compare the facility's measures with state and national averages shown on Care Compare
Look for the same concern repeating across measures, such as high antipsychotic use plus low function
Read the QM star alongside the inspection and staffing stars, not in isolation
Ask the director of nursing to explain an outlier measure and what the facility is doing about it
Check the data date, since measures refresh on a schedule

See How to Compare Facilities for a side-by-side method.

Limits of the quality measure rating

Because MDS data is submitted by the facility, coding practices can influence the numbers, even though CMS audits the data. Some measures are easier to influence through documentation than through actual care. A facility with excellent measures is not automatically better than one with average measures and stronger inspections and staffing. Use quality measures as one part of a broader picture that includes visits, family feedback, and the other CMS domains. Read the full context in How We Interpret CMS Data.

Sources: CMS Five-Star Technical Users' Guide; Medicare Care Compare; CMS Provider Data Catalog.

Related guides

Frequently asked questions

What is the MDS?

The Minimum Data Set is a standardized clinical assessment tool that certified nursing homes complete for each resident. CMS uses it for care planning, payment, and quality measurement.

Are quality measures self-reported?

The underlying MDS data is submitted by the facility, and CMS audits it. That is why the QM star is best read alongside inspections and staffing, which are less dependent on self-coding.

Which quality measures matter most for long-term care?

For long-stay residents, measures such as pressure ulcers, falls with major injury, antipsychotic use, and functional decline are especially relevant. Match the measures to the person's needs.

Why does a facility have a high QM star but a low inspection star?

The domains measure different things. Quality measures reflect reported clinical data, while inspections reflect on-site compliance findings. A gap is worth asking about directly.

Can quality measures be improved by documentation alone?

Coding practices can influence the data, which is a known limitation. CMS audits MDS submissions. Use the measures as a signal, then verify with a visit and other sources.

Data sources

CMS Provider Data Catalog · CMS Care Compare. This guide is informational and is not medical advice. Processing date: 2026-10-05.

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