What the Total Quality Score is
Indiana Medicaid builds a quality add-on into each nursing facility's rate from a Total Quality Score. Myers and Stauffer, the state's rate-setting contractor, publishes every building's score and add-on each quarter in a public workbook.
Every input is public: CMS's quality measure and claims files and PBJ staffing data. So a building's score can be rebuilt, and forecast, from data anyone can download.
How the 625 points are built
| Part | Points | Measures |
|---|---|---|
| MDS | 200 | Falls with major injury and long-stay pressure ulcers, 100 each |
| Claims | 300 | Long-stay hospitalizations and outpatient ED visits per 1,000 resident days |
| Staffing | 125 | A PBJ staffing ratio |
Only about a third of the score comes from the MDS. But those two measures are where a lot of buildings are leaving points behind: in the July 2026 workbook, falls with major injury scored zero in 262 buildings and pressure ulcers in 144.
What it pays
The add-on is linear: about 5 cents per point per Medicaid day, so a building at the maximum 625 would get a little over $31 a day. There is no floor and no cap on the add-on itself.
At the median building, taking one MDS measure from zero to full marks is worth roughly $78,000 a year.
The second cliff
A low score also reduces the profit add-on. It is cut entirely at a score of 60 or less and reduced between 61 and 274. In the July 2026 workbook, 327 of about 497 buildings lost part of their profit add-on this way.
See your building’s falls and pressure ulcer rates against the nation.
What moves the score
- Falls with major injury. Code J1900C exactly, and work on prevention. It scores zero in more than half of Indiana buildings.
- Long-stay pressure ulcers. Stage and document accurately, and catch new ones early.
- Hospitalizations and ED visits. These are claims measures, moved by clinical care and transfer decisions rather than by coding.
- Staffing. The PBJ ratio is worth 125 points and belongs to the administrator and payroll.
How SuperQM helps Indiana buildings
SuperQM watches falls with major injury and pressure ulcers resident by resident, every day, and flags a code that doesn't match the notes while it can still be corrected. The Five-Star view shows the same claims measures Indiana scores. Ask us about Indiana.
