CMS updated the calculation methodology for the long-stay antipsychotic Quality Measure
CMS updated the calculation methodology for the long-stay antipsychotic Quality Measure earlier this year. Now that facilities are seeing the impact reflected in their Five-Star data, it is worth revisiting what this change means operationally.
Not all rating movement reflects a change in care. Sometimes it reflects a change in calculation.
With the incorporation of additional claims and encounter data into the measure, some facilities are experiencing unexpected shifts in their Quality Measure scores and overall Five-Star ratings.
While CMS announced updates effective January 2026, recent report activity suggests the impact has been more immediate than some providers anticipated. As a result, leadership teams are reviewing data that looks different even when prescribing practices have not changed.
What Changed?
The long-stay antipsychotic measure now incorporates Medicare claims and encounter data, including Medicare Advantage, in addition to Minimum Data Set (MDS) data.
Previously, this measure relied primarily on MDS coding. The expanded data sources are intended to reduce underreporting and capture prescriptions that may not have been fully reflected in MDS submissions.
Early Observations
Early analysis indicates:
• National benchmark percentages have increased under the revised calculation
• Many facilities are seeing higher reported antipsychotic rates
• Some providers have experienced a decrease in Quality Measure points
• In certain cases, QM star ratings and overall Five-Star ratings have declined
Importantly, these shifts may reflect a technical recalculation rather than a decline in prescribing practices or clinical performance.
Several facilities observed fluctuations in preview reports in late January, suggesting recalculations occurred as CMS refined the updated methodology. This created understandable confusion for leadership teams monitoring quality trends.
Why This Matters
For facilities in states with performance-based reimbursement or Quality Incentive Programs, changes to QM scores could have financial implications when recalculations are finalized.
Even in states without direct financial linkage, a drop in star rating can affect:
• Referral relationships
• Public perception
• Hospital partnerships
• Marketing positioning
• Survey scrutiny
Recommended Action Steps
1. Re-run Quality Measure Reports
Pull the most recent iQIES QM preview reports and compare them to prior versions. Document the generation date for tracking purposes.
2. Review Antipsychotic Prescribing Patterns
Ensure pharmacy and medical director teams review current prescribing practices and supporting documentation.
3. Align QAPI Monitoring
Because claims and encounter data are now included, MDS coding alone may no longer predict reported performance. QAPI monitoring should reflect the revised methodology.
4. Prepare Leadership Messaging
If star ratings shift, leadership should be prepared to explain:
• The methodology update
• The expanded data sources now included
• The steps being taken to monitor and improve performance
Bottom Line
This is a technical calculation update with the potential to significantly impact reported performance nationwide. Facilities should not assume ratings will remain stable simply because internal prescribing practices have not changed.
Five-Star management requires active oversight of how CMS calculates and reports performance, not just how care is delivered.
Polaris works with leadership teams to analyze Quality Measure trends, identify exposure tied to claims-based data, and align prescribing oversight with publicly reported outcomes. If your organization would like a focused review of its Quality Measure stability and Five-Star risk, reach out to Polaris Group for individualized guidance
