Latest Changes to Quality Ratings: SNFs Face Possible Budget Buster with Staffing Concerns

The past two years have presented unceasing challenges for long-term care leadership, including staffing shortages, increased regulations, and reduced revenue. With fewer admission referrals and record-low censuses, it’s never been more important to seize every opportunity to optimize reimbursement. It’s time to refocus on quality and take control of your ratings. A skilled nursing facility’s (SNF) five-star rating influences the community’s perception of the quality of care and the facility’s ability to secure preferred provider status. Reputation in the community is a powerful factor that can also generate or deter admissions, affecting census and revenue.

The latest changes to the Nursing Home Five-Star Quality Rating System are also creating challenges for SNFs. During a staffing crisis, these new metrics will be an issue for SNFs with staffing concerns. To meet current and pending staffing mandates, many facilities are paying significantly higher rates for temporary staff, deepening revenue losses.

Revisions to the Nursing Home Five-Star Quality Rating System: Weekend Staffing and Staff Turnover Data

The Centers for Medicare and Medicaid Services (CMS) recently began posting weekend staffing and staff turnover data to the Care Compare website. While this information is initially being publicized for consumer awareness, beginning in July 2022 it will be used to calculate the staffing rating domain as part of the Nursing Home Five-Star Quality Rating System.

This initiative to publicize SNF staffing levels stems from concerns raised by the Office of Inspector General (OIG) about the impact of COVID-19 on CMS’s oversight of nursing homes. CMS also wants consumers to understand the varying staffing rates on weekends. Staff turnover rates will also be displayed to better illustrate the staffing environment of the SNF.

Weekend Staffing Measure

To determine weekend staffing metrics, nursing hours submitted through Payroll Based Journal (PBJ) reporting and the Minimum Data Set (MDS) census are totaled for all Saturdays and Sundays in the quarterly reporting period. They are then broken down to quarterly weekend nurse staffing hours per resident by dividing total reported weekend hours by the total weekend resident census.

Although weekend staffing hours and full-week staffing hours are published separately, exclusion criteria are not applied separately. Therefore, if any of the criteria are met for either full-week or weekend staffing, both will be excluded and the provider will receive a “not available” staffing rating on Care Compare.

Staff Turnover Measure

SNFs are not required to disclose employee termination dates for Payroll-Based Journal (PBJ) reporting — the termination date field is optional. Instead, nursing staff turnover is defined as eligible individuals who do not work for 60 consecutive days. That creates a universal measure that isn’t dependent on termination dates reported by SNFs.

It’s important for SNF leadership to understand the difference between changing and linking employee identifiers to avoid unintentionally lowering performance. Certain situations like changing payroll or time-keeping systems may require a facility to change its employee identifiers. Employee identifiers establish when each employee starts and stops working at a facility and are used to calculate staff turnover. If a facility changes an employee identifier, it looks like the employee is ending their work at the facility. Make sure you are linking employee identifiers when appropriate.