The BH-FHI™ and the CMS star rating answer different questions, so they will not always agree. Stars measure inspections, staffing and clinical quality. The BH-FHI™ adds what stars leave out — whether the building makes money, what it pays for labor and agency, and how therapy is performing. A strong-star facility that lost money last month will score lower here, and that gap is the point: it is the part of the picture CMS never shows you.