The Technical Users’ Guide provided extensive details on the formulas and computations needed to predict a new PBJ-based staffing Five Star rating.
QSO Memo 18-17-NH
Technical Users’ Guide – April 2018
Skilled Nursing Facilities Can’t Just ‘Check the Box’ Under New Payroll Requirements
When the Centers for Medicare & Medicaid Services (CMS) began basing its rating of nursing home staffing levels on payroll records in April of this year, many skilled nursing facilities were found to be underreporting their nursing and caretaking personnel levels. Soon after the New York Times published an analysis of the records by Kaiser Health News — which showed serious fluctuations in skilled nursing facility staffing – CMS hit almost 1,400 facilities with one-star ratings for staffing coverage. The results came as a surprise to some facilities, according to Don Feige, the founder and former owner of SNF-focused software firm ezPBJ.
— Skilled Nursing News, August 14, 2018
Timely and Accurate PBJ Data is More Important Than Ever
The Centers for Medicare & Medicaid Services (CMS) reminds all nursing facilities that the deadline for submission of Payroll Based Journal (PBJ) data for the period April 1 –June 30, 2018, is Aug. 14. Timely and accurate submission of data is especially important, because CMS now uses PBJ data to calculate staffing measures in Nursing Home Compare and the Five-Star Quality Rating System.
CMS has made clear that it will only use data that is submitted and accepted by each quarterly deadline for these calculations. Data submitted or corrected after the deadline has passed is not used by CMS.
— Leading Age MN, August 7, 2018
The Centers for Medicare & Medicaid Services has evolved Payroll-Based Journal reporting rules and continues in their quest to create a standardized, consistent measure of staffing across the industry. Loopholes are closing and gray areas being clarified. Some changes ease the complexity of PBJ reporting, but make it harder for SNF’s to monitor and adjust their actions to improve staffing quality.
— McKnights Long-Term Care News, July 28, 2018
Nursing Home Staffing Measures Transitioning to PBJ Data
Leading Age NY informs its members how CMS is shifting the data source used to calculate the staffing measures of the nursing home quality rating system from self reported 671 data to auditable PBJ reports.
As has been the case prior to this transition, Nursing Home Compare will display the number of hours per resident per day for RNs, LPNs, Aides, and physical therapists (PTs), while the 5-Star staffing rating will continue to be based solely on nursing staff. CMS will continue to calculate the staffing rating by combining a total nursing staffing rating (RN, LPN, Aide) with an RN rating. However, CMS is changing the way in which they adjust the staffing measures to reflect resident acuity.
— Leading Age NY, April 8, 2018
CMS announces how PBJ will be used for Staffing Five-Star
CMS shared details with State Survey Agency Directors on how they will use Payroll-Based Journal data for Staffing Five Star measures. Download the full memo or read on for our summary.
There’s much to unpack in this detailed memo
— SimpleLTC, April 6, 2018
How will PBJ impact Five-Star staffing? Would you like one lump or two?
We don’t know when, and we don’t know how, but when Payroll-Based Journal staffing data replaces the data currently being captured from CMS Form 671 for calculating Five-Star staffing, we are likely going to take several lumps.
Skilled nursing providers have been submitting PBJ data since mandated as of July 2016 and today 92% are compliant with this requirement. Compliance in this case means PBJ staffing data was successfully transmitted to the Centers for Medicare & Medicaid Services and on Nursing Home Compare a staffing domain star rating is present.
— McKnights, March 30, 2018
PBJ Accuracy Becomes Increasingly Important as a Measure of Quality
The Centers for Medicare and Medicaid Services (CMS) knows staffing within long-term care (LTC) facilities significantly affects the care delivered to residents. Guidance to Surveyors, F851, requires the quarterly electronic submission of payroll data to CMS. Payroll-Based Journal (PBJ) data more accurately depicts a facility’s staffing levels by reporting actual hours worked during the reporting period. CMS plans to use the PBJ data to also measure staffing turnover and longevity.
CMS began collecting auditable PBJ data July 1, 2016. Beginning June 1, 2018, quarterly PBJ data replaces the CMS 671 form for calculation of the facility’s staffing star rating on Nursing Home Compare (NHC). The CMS 671 form was completed only once a year during surveys while PBJ data will be used to update the Five-Star Quality Rating, quarterly.
— Pathway Health, July 5, 2018
PBJ data will affect Five-Star ratings beginning in 2018
A new CMS warning alerts providers that PBJ data will be used in Five-Star rating calculations beginning next year. It also reminds providers that late submissions will result in star ratings being “suppressed” (i.e., removed) from ratings tables and the Nursing Home Compare website.
The CMS alert, which now appears on facility Five-Star reports, reads as follows:
— SimpleLTC, July 18, 2017
Ask the Payment Expert about … acuity-based staffing
It doesn’t make a difference which RUG system (state or federal) you use, but I recommend the easiest is the RUG 66 Medicare group.
— McKnights, January 6, 2017
Studies: Five-Star Ratings Linked To Consumer Demand, Nurse Training
Consumers increasingly are more likely to choose a skilled nursing care center if it has a Five-Star Rating of five stars, according to a recent study by Health Services Research. In its study , “Changes in Consumer Demand Following Public Reporting of Summary Quality Ratings: An Evaluation in Nursing Homes,” Rachel Werner, PhD; R. Tamara Konetzka, PhD; and Daniel Polsky, PhD, found that the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System ratings have had a significant effect on consumer choice of high- and low-rated skilled nursing care centers.
— Provider Magazine, May 16, 2016
