‘Which defeats the purpose’: Looming five-star staffing moves don’t address ongoing workforce issues


Nursing home operators and industry leaders are eagerly awaiting the implementation of new staffing measures in its five-star rating system from July, a move seen by some as insensitive in light of the current situation. ‘a historic shortage of staff and the growing use of agencies.

While facilities have been reporting staff turnover and weekend staffing data since January, it’s unclear what weight the Centers for Medicare & Medicaid Services (CMS) will place on the new metrics relative to other areas such as as quality and regulatory requirements.

CMS adds three measures of staff turnover as part of its scoring system – the percentage of RNs who left more than a year; the total number of nurses who left during the year, including RNs, licensed practical nurses (LPNs) and practical nurses; and percentage of director turnover.

“I celebrate nursing home comparison metrics in general…I’m not sure I celebrate sometimes how it’s calculated or what goes into it,” said Michael Manuel, vice president of strategic development at AbleHearts. “We are not fixing the problem, all we are doing is reporting the problem. In the industry, we know very well what the problem is.

Understanding how to report good and bad players is a start, Manuel said, but there should be something to help the industry figure out how to fix the staffing problem as well.

“When the government demands more and more information, data collection, we pull that clinical leadership off the ground and away from the patient. It’s counter-intuitive to the goal,” Manuel added.

AbleHearts operates 16 skilled nursing facilities in Texas, Missouri, Illinois, New York and Florida.

Rotation measures would also include agency staffing, according to Steven Littlehale, chief innovation officer for Zimmet Healthcare Services Group.

“The staffing crisis we find ourselves in is going to be reflected in the way the metrics came in at five stars – it won’t be that fabricated ideal that CMS judged the facilities against,” he told SNN.

Weekend staffing data will also be posted on the Care Compare website but will not be part of the five-star system, Littlehale said, at least for now.

If they were to incorporate weekend data into five stars, the metric would be “quite powerful,” impacting rehospitalization data and survey performance, according to Littlehale.

He also wonders whether the additional measures will have unintended consequences on a system that already acts as a means for CMS to influence market behavior.

Rather, the additional measurements would confirm the gap between high-performing and low-performing facilities, rather than widen it, he said.

“I am sure that [CMS is] well aware of the influence of five stars on the day-to-day creditworthiness of a qualified nursing facility,” said Littlehale. “They are already paying the consequences, they are already paying the price. It just goes, I think, to underline it a few times and bold it.

Manuel said the metrics could widen that gap, but at the same time force operators to get creative with ways to improve those staffing metrics.

AbleHearts, for its part, considers weekend staffers to be full-time employees — many work three 12-hour shifts Friday, Saturday and Sunday, Manuel said.

Implementation remains unclear

Just a month away from implementation, institutions still do not know how the new measures will influence their overall score or if any concessions will be made in light of the current staff crisis.

Littlehale assumes that the metrics will be incorporated into the staffing realm, but it’s unclear how the metrics will be weighted.

“Is this going to influence your five-star staffing rating a bit? A lot? We just don’t know at this point. They didn’t elaborate, even on the most recent open house call…he’s a little late in the game at this point,” Littlehale said.

The five-star “stool” is made up of three legs, Littlehale said, including staffing, quality and regulatory measures. Historically, regulatory metrics have been weighted the most, followed by staffing and then quality, he added.

When CMS implemented a star rating overhaul to separate short and long stays, approximately 36% of SNFs saw their overall rating drop, while 17% saw their rating improve.

“It might be in the final moments that we really understand how they’re using this data,” Littlehale explained.

CMS can use state averages or national averages as a benchmark for positive staffing data because they have both, Littlehale said, but he hopes the agency will choose state data.

Staff availability is so regionally influenced by what’s going on in a given community, he said.

Looking at RN revenue alone, the national average is about 51.2%, according to Care Compare. Florida’s RN revenue is just over 56%, a “pretty decent deviation” from the national average, Littlehale said.

“It’s proof that a Florida facility shouldn’t be compared to the nation or other states with very low turnover,” he added.

CMS has not indicated whether it would recognize such disparities in its methodology.

The federal agency’s timing of collecting this personnel data and integrating turnover into five stars “isn’t going well” for industry executives, Littlehale said, with continued staff shortages crippling the industry. ‘industry.

Manuel pointed to the sunsetting of the temporary nurse aide (TNA) program, coupled with “onerous” regulation lacking any federal financial support.

Many facilities across the country still make heavy use of agency staff, which further skews turnover rates.

At the same time, Littlehale does not believe CMS would impose additional penalties on staffing actions. The repercussions are already built into the investigative process for proper staffing, he said, but there’s really nothing that specifically looks at turnover or agency usage.

Data opportunities and alternative measures

While Vincent Mor, a professor of health services, policy and practice at Brown University, believes revenue additions to the five-star rating system are a step forward, he also thinks retention would be a better move. quality measure.

But retention, Mor said, can generally be harder to predict than turnover.

“Some of these people won’t make it through the first couple of weeks…in a way, that’s kind of the cost of doing business in a labor shortage market or environment,” Mor said. “You can have a very high turnover rate, but still have a very high retention rate.”

Littlehale said he would like to see customer satisfaction better represented in five-star metrics.

CMS has the ability to measure both, Mor added, but it’s increasingly difficult for the agency to aggregate all of those variables into a single measure of staffing level.

Still, the data that exists on the Medicare.gov website can still provide operators with a way to take a close look at how that staffing data compares to their peers and take steps to improve it if needed, explained. Littlehale.

“A facility has the opportunity today — and since January — to look at its performance against the state and compare it against the nation,” Littlehale said. “It’s very easy to say, ‘CMS is doing something to me,’ and dismiss it as regulatory sanction or bureaucracy.”

Manuel said these were always challenges that the nursing home sector and the broader healthcare industry had to deal with. It will just be easier to measure who is doing better, he said.

Operators could gain “considerable insights” from recently reported staffing data, Littlehale added. Facility managers can see how they stack up against competitors, identify what they’re doing right for weekend revenue or headcount, and perpetuate positive data, or shine a light on problematic data before that they do not get worse.

“Now is the time to make sure the data you submit is actually accurate, because it is made public,” Littlehale said. “What more can we learn from this data…what else can it indicate? If not, how can this help me.


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