Quality-measure stars were more closely related to next-year long-stay emergency-department use than overall stars. In the same 9,598 homes, the 2025 correlations were −0.388 for QM stars and −0.220 for overall stars.
I compared the four rating domains on the same homes, rather than allowing each correlation to use a different sample. December 20, 2024 ratings were paired with outcomes for care delivered in 2025. A separate comparison paired December 21, 2023 ratings with 2024 care.
The earlier comparison showed the same ordering: QM stars had a correlation of −0.361 with long-stay ED use, versus −0.224 for overall stars, across 9,712 homes. Negative values mean higher ratings accompanied lower ED-use rates. Spearman correlations measure a rank relationship, not a change in visits caused by one additional star.
The common samples required complete data for four rating domains and four claims outcomes within each year. This makes the rating comparison consistent, but excludes homes with missing measures. CMS certification numbers were used to link files, and repeated publications of the same care period were deduplicated.
There is an important reason to be cautious: earlier care outcomes contribute to quality-measure ratings. The association may partly reflect persistence in those outcomes. It is not evidence that the QM formula independently predicts quality, and many homes appear in both years.
Overall stars still contain information. In a separate 2025 hospitalization comparison, homes with one prior overall star averaged 2.06 hospitalizations per 1,000 resident-days, versus 1.68 for five-star homes (11,114 homes; rank correlation −0.164). There was substantial overlap between rating groups.
These are exploratory facility-level associations selected from a screen of 72 correlations and 36 adjusted models. ED visits can be medically necessary; a lower rate alone is not a complete definition of better care.
Analysis completed November 5, 2026, with AI-assisted coding and writing.