Quality Improvement in Skilled Nursing Facilities

Share this post

Quality healthcare services are important at all types of care facilities, but one of the top areas of concern for healthcare quality is in the skilled nursing facility (SNF). It is imperative to individuals that their loved ones receive attention and care at these facilities where healthcare practices are not always transparent or visible.

Fortunately, over the years, the Centers for Medicare and Medicaid Services (CMS) has rolled out value-based purchasing programs that structure provider reimbursements with a greater emphasis on quality of care and performance. The Skilled Nursing Facility Value-Based Purchasing (SNF VBP)  Program, which began on October 1, 2018, was tailored to help improve the quality of care given in both short- and long-term nursing facilities and has been a huge step in the right direction for improved quality at these facilities.

What is quality improvement in nursing?

Quality improvement in nursing is about maintaining patient safety. To drive change in the nursing industry, CMS developed quality measures that score providers based on patient outcomes, rewarding providers that take the time to appropriately treat individual patient needs and steer clear of process-driven nursing traditions. Nursing facilities that do not comply with these quality measures may be fined by CMS.

With specific, quantifiable goals in mind, nursing facilities can measure their success and consequent growth as quality healthcare providers.

How is nursing quality measured?

In November 2002, CMS began the nationwide Nursing Home Quality Initiative (NHQI). The purposes of this initiative and its quality measures are as follows:

  • Make information regarding the current level of quality care given at a nursing facility publicly available
  • Facilitate discussion with nursing staff about quality of care and how to improve it
  • Provide hard data to aid in quality improvements

Skilled nursing home quality measures are based on routine resident assessment data gathered by the nursing facilities themselves. These measures take into consideration a resident’s physical and clinical conditions, as well as personal preferences and life care desires.

Skilled nursing quality measures are defined through two categories: short stay and long stay. Short stay quality measures are based on patients who stay in a nursing facility for 100 days or less, while long stay quality measures are based on patients who stay in a nursing facility for 101 days or more.

Which quality measures CMS chooses to hold provider facilities accountable for can change over time based on feedback and further industry research.

Skilled Nursing Facilities ranked by Net Patient Revenue and Quality Rating


Definitive ID

Skilled Nursing Facility Name


Quality Rating

Net Patient Revenue



Twin Fountains Home






The Plaza Rehabilitation & Nursing Center






Hebrew Home at Riverdale






Isabella Center






Masonic Village at Elizabethtown Skilled Nursing






Boro Park Center






Cold Spring Hills Center for Nursing and Rehabilitation






Kings Harbor Multicare Center






Erickson Living - Greenspring Village Skilled Nursing






Upper East Side Rehabilitation and Nursing Center




Fig. 1 Data from the Definitive Healthcare Long Term Care database  (accessed June 2020). Annual Medicare Data is from the Centers for Medicare and Medicaid Services (CMS) Medicare Standard Analytical Files (SAF). The most recent annual Medicare data is from calendar year 2018; 2019 data is scheduled to be released in fall 2020.

How can nursing quality be improved?

There are many different ways SNFs can improve care quality. Nurses can start by being aware of the most common avoidable conditions that regularly plague patients and reduce facility quality scores:

Nurses should also be on the lookout for opportunities to improve patient safety. Medication errors, for example, lead to about 7,000 patient deaths per year. Nurses play a critical part in preventing medication errors, and should avoid distractions and disruptions when managing patient medications.

Another way nurses can improve patient safety is by taking extra precautions during patient handoffs. Clear communication when transferring essential information and patients between healthcare professional should always be prioritized.

Improved work conditions mean improved quality

A critical point to consider when discussing how to improve SNF care quality is nursing fatigue. Nurses tend to work long hours over consecutive shifts in an already demanding work environment. Facility administrators need to be mindful of the danger that comes with a fatigued nursing staff.

Not only has high turnover become standard for nursing jobs, patient safety also declines as staff become exhausted and burned out. Nursing workloads must be managed attentively and spread evenly among an appropriate number of staff members.

Learn more

If you’re looking for more information on how to break into the mindset of a long-term care facility, watch this Definitive Healthcare webinar replay: Selling to Long-Term Care Facilities

In the webinar, you will learn about:

  • The current state of the healthcare market
  • The biggest challenges in selling to this complex and challenging marketplace
  • The relationships between long term care (SNF, HHA and Hospice) with other provider types
  • Blog
  • Quality Improvement in Skilled Nursing Facilities
Explore our data