OIG Study: HHS Watchdog Probes Enforcement Of Nursing Home Staffing Standards

Aug 30, 2020 | Research Studies of PBJ Data, Nursing HPRD & Turnover

News Digest: OIG Calls for Improved Staffing Levels & Consumer Transparency

Nursing homes’ reported staffing levels often vary on a day-to-day basis. CMS’s Five Star Rating system ranks nursing homes on their average staffing levels each quarter. As a result, daily staffing variations are not transparent to consumers.


Some Nursing Homes' Reported Staffing Levels in 2018 Raise Concerns; Consumer Transparency Could Be Increased

Nurse staffing is a key contributor to the quality of care provided in nursing homes. This review, initiated before the COVID-19 pandemic emerged, focuses on staffing data from 2018. However, the 2020 pandemic reinforces the importance of adequate staffing for nursing homes, as inadequate staffing can make it more difficult for nursing homes to respond to infectious disease outbreaks like COVID-19.

Consumers need meaningful information about nurse staffing at nursing homes to make informed care decisions. CMS created the Payroll-Based Journal (PBJ)-a system containing self-reported provider data-to collect nursing homes’ daily staffing hours. CMS uses the PBJ data to calculate Staffing Star Ratings reported on the public Nursing Home Compare website. CMS requires a minimum number of daily hours for different types of nurses (nursing homes must have a registered nurse (RN) on staff at least 8 hours each day and licensed nurses on staff around the clock). However, CMS does not use PBJ data to enforce these daily Federal staffing requirements, nor does it regularly publish day-to-day nurse staffing on Nursing Home Compare.


Office of the Inspector General. “Some Nursing Homes’ Reported Staffing Levels in 2018 Raise Concerns; Consumer Transparency Could Be IncreasedDepartment of Health and Human Services, OEI-04-18-00450. 3 August 2020.


OIG Calls on CMS to Crack Down on Nursing Home Staffing, Increase Consumer Transparency

The Centers for Medicare & Medicaid Services (CMS) should be doing more to enforce proper staffing levels at nursing homes, while providing more detailed information about nurse coverage hours to the public, the federal government’s top health care watchdog found in a new report.

About 7% of the nation’s nursing facilities failed to meet one of two key staffing requirements for at least 30 total days in 2018, the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) determined; another 7% logged between 16 and 29 days with non-compliant staffing levels.


Spanko, Alex. “OIG Calls on CMS to Crack Down on Nursing Home Staffing, Increase Consumer Transparency.” Skilled Nursing News, 7 Aug. 2020, skillednursingnews.com/2020/08/oig-calls-on-cms-to-crack-down-on-nursing-home-staffing-increase-consumer-transparency.


Nursing home staffing headed for more scrutiny

When a government watchdog decides it wants to investigate you, it’s usually not going to be content with a “No fire here, folks!” conclusion. Nobody knows that better than nursing home operators.

And so we unfold the latest Office of Inspector General investigationinto skilled nursing staff levels, which came out Monday.

In brief, nearly 1,000 operators (7%) were found to have had more than 30 days without the required amounts of nurse staffing in 2018. Also, 900 had 16 to 29 days that weren’t up to snuff. Those are pre-pandemic days, of course. But still not too early to set the stage for a little “You always were slack” blame-gaming over coronavirus carnage, if we know how this game works. And we all do.


Berklan, James. “Nursing Home Staffing Headed for More Scrutiny.” McKnight’s Long-Term Care News, 7 Aug. 2020, www.mcknights.com/daily-editors-notes/nursing-home-staffing-headed-for-more-scrutiny-again


CMS nursing home oversight under federal probe

HHS’ Office of Inspector General is investigating the enforcement of staffing standards at skilled nursing facilities, according to a Kaiser Health News report.

1. The OIG’s investigation began earlier this month. It comes after a KHN and New York Times probe indicated some nursing homes are not meeting Medicare staffing requirements, according to the report.

2. The KHN and New York Times probe showed nearly 1,400 of the nation’s nursing homes — or 1 in 11 — have received lower Medicare star ratings for inadequate staffing levels. Nursing homes with lowered ratings did not have enough registered nurses or did not provide payroll data showing they met requirements for nursing coverage, according to a separate KHN report, which cites federal records.


Gooch, Kelly. “CMS Nursing Home Oversight under Federal Probe.” Beckers Hospital Review, 30 Aug. 2018, www.beckershospitalreview.com/legal-regulatory-issues/cms-nursing-home-oversight-under-federal-probe.html.


HHS Watchdog To Probe Enforcement Of Nursing Home Staffing Standards

The inspector general at the Department of Health and Human Services this month launched an examination into federal oversight of skilled nursing facilities amid signs some homes aren’t meeting Medicare’s minimum staffing requirements.

The review comes on the heels of a Kaiser Health News and New York Times investigation that found nearly 1,400 nursing homes report having fewer registered nurses on duty than the Centers for Medicare & Medicaid Services (CMS) requires or failed to provide reliable staffing information to the government.

The Office of Inspector General said it would examine the staffing data nursing homes submit to the government through CMS’ new system that uses payroll records.


Rau, Jordan. “HHS Watchdog To Probe Enforcement Of Nursing Home Staffing Standards.” Kaiser Health News, 30 Aug. 2018, khn.org/news/hhs-watchdog-to-probe-enforcement-of-nursing-home-staffing-standards.


OIG to Investigate CMS Oversight of Skilled Nursing Staffing Measures

In the wake of controversy over nationwide skilled nursing staffing levels, the health care industry’s top government watchdog has stepped in to investigate.

The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) announced that it will launch a probe into the way skilled nursing facilities maintain their staffing records — with a focus on the Centers for Medicare and Medicaid Services’ (CMS) oversight of those requirements.


Spanko, Alex. “OIG to Investigate CMS Oversight of Skilled Nursing Staffing Measures.” Skilled Nursing News, 30 Aug. 2018, skillednursingnews.com/2018/08/oig-investigate-cms-oversight-skilled-nursing-staffing-measures.


Inspector General investigating nursing home staffing: Report

A federal government watchdog is launching an investigation into enforcement of nursing home staffing standards in the wake of a high-profile New York Times report on the issue.

The Office of the Inspector General at the Department of Health and Human Services this month kicked off its examination of federal oversight related to skilled nursing facilities. This comes after a joint report from the Times and Kaiser Health News, noting that many nursing homes had lower staff levels than reported to the government.


Stempniak, Marty. “Inspector General Investigating Nursing Home Staffing: Report.” McKnight’s Long-Term Care News, 10 Sept. 2018, www.mcknights.com/news/inspector-general-investigating-nursing-home-staffing-report.

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