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Date ArticleType
3/14/2018 Regulatory
Staffing to Affect Five Star Rating soon – Will Your Score Go Up or Down?

The new Payroll-Based Journal (PBJ) staffing measures will be posted to Nursing Home Compare as early as April.   CMS plans to post new Payroll-Based Journal (PBJ) staffing measures on Nursing Home Compare and use them in Five-Star rating calculations.

  • CMS will post two staffing measures: RN hours per resident day (HPRD) and Total Nursing Staff (RN, LPN & Aide) HPRD which will replace the measures currently used from the form “CMS-671” completed during the annual survey.
  • They will also post a Physical Therapy HPRD but do not plan to use this metric in Five-Star right away.

After analyzing the PBJ data, the AHCA research team has identified several staffing patterns that may hurt a center’s Five-Star staffing ratings, such as:

  • Failing to submit timely MDS discharge assessments.
    • CMS uses the discharge assessment to determine your daily census which is used to determine the hours per resident day. Failure to complete an MDS discharge assessment will make your average daily census look higher than actual and will cause your HPRD to be lower than actual. 
  • Reporting daily RN hours of 0. 
    • It is a regulatory requirement to have at least 8 hours of RN each calendar day. CMS plans to force the Staffing Component of Five-Star to ONE star when you have >7 days in the quarter with 0 RN hours in a calendar day.
  • Reporting outlier Aide and Total HPRD values.
    • When data on a given day looks out of range, which most often happens at the low range, suggesting incomplete data submission, this causes your center’s HPRD to be lower than actual.

Click here to view the report that has flagged centers in Indiana with these issues. For the missing discharge rate, the denominator captures all resident stays that resided in the SNF at least one day in the 12 month window July 1st 2016 to June 30th 2017. The calculation reflects the percentage of those resident stays that had a non-discharge assessment and then 150 days without another assessment.

According to AHCA, sometimes, the issue isn’t really a “missing” discharge  assessment but rather something off with the schedule of the data submission, an assessment with the wrong admission date, a duplicate record,  or a long list of other data issues that throw off the grouper logic. The measure is really a proxy for MDS data quality. It’s very common for a center to have at least few of these inconsistencies.  You can see more details about the report data and calculations on the “Report Details” tab of the attached report.

We recommend members with these issues review their PBJ data submissions before the next deadline for Q1 2018 on May 15, 2018.

We hope you find this information helpful. If you have any question about the report,  please email Elizabeth Eichhorn at eeichhorn@ihca.org  or Lori Davenport at ldavenport@ihca.org.