Feature
Staffing Measures –
How the Not-For-Profit Difference and
PBJ Affect Your Five-Star Rating
By : Susan Chenail RN, CCM, RAC-CT, Senior Quality Improvement Analyst
S
taffing measures have never been more important to nursing facilities. The Centers for
Medicare and Medicaid Services (CMS) is using Payroll Based Journal (PBJ) data to
calculate Staffing Measures on the Five-Star Rating System.
Previously, the Staffing Domain on the Five-Star Rating System was calculated annually
using 671 and 672 forms completed by the nursing facility and presented to surveyors
at the time of their health inspection. Since this domain was only calculated annually, it
was not the most accurate reflection of staffing in a nursing facility. PBJ data however, is a
daily report of staffing that nursing facilities submit to CMS quarterly. This data consists
of staffing hours for many job titles in a nursing facility. For the calculation of the Staffing
Domain on the Five-Star Rating System, CMS focuses on Nursing Staff – Registered Nurses
(RN’s), Licensed Practical Nurses (LPN’s) and Certified Nursing Assistants (CNA’s).
Since PBJ data is submitted quarterly CMS is not only using this data to calculate the
measure but also updating the measure after each quarterly submission. The importance of
the Staffing Domain is that it can add or subtract a star from the facility’s overall star rating.
There is no doubt with all this attention, CMS believes that staffing is vital to the health and
well-being of residents in nursing facilities. Over the past several years, the measurement
and publicly reporting of staffing data by CMS has undergone a maturation process evolving
from numbers to ratios, competency and soon will progress further to longevity and
mastery. CMS is analyzing PBJ data to calculate rates of turnover and tenure. Ensure you
are providing the most accurate reflection of turnover and retention by using the CMS PBJ
linking software available for download here.
The not-for-profit difference has been well studied (e.g. Marshall University Digital Scholar,
2016 “Quality of Care and Profitability in Not-For-Profit vs For Profit Nursing Homes”).
The research discusses the advantages of Not-For-Profit (NFP) Facilities across several
dimensions but most notably the staffing differences. NFP nursing facilities have higher
staffing levels. These higher staffing levels lead to better quality of care and lower mortality
rates. NFP facilities well known for their strong staffing levels, staff education and staff
retention stand to benefit from changes to the measurement and reporting of staffing data in
the Five-Star Rating System with three additional opportunities to add a star to their overall
rating thus, improving their marketability, continuing the flow of admission referrals and
therefore promote business sustainability.
LeadingAge New York Technology Solutions provides a suite of tools as a member benefit.
One of these tools, the Staffing Scenario Worksheet, helps facilities measure the efficacy of
their staffing models. The Staffing Scenario Worksheet is located as a link in the Five-Star
Analysis Report. Members receive an email link to their Five-Star Analysis Report quarterly
in January, April, July and October. Facilities that use the Staffing Scenario Worksheet
have an advantage of predicting their Five-Star Staffing Rating and whether it meets their
Five-Star Staffing goal.
quality apex
Our newest tool launched in June 2018 is Quality Apex, a web-based analytics software
program that translates MDS 3.0 data into actionable information providing CMS quality
measures rates based on the most recent uploaded data. Available to members at a
subscription price of just $850 per year and to non-members for $1,250 per year, this
affordable tool can elevate performance. For more information, contact Marguerite Carroll
at [email protected].
leadingageny.org
46