Many facilities will lose a Staffing star due to CMS' increased emphasis on RNs in Staffing Five-Star ratings

In its March letter to State Survey Agency Directors and related updates to the Five-Star Users Guide, CMS announced a series of changes to Nursing Home Compare and Five-Star ratings, including:

• Changes to the Staffing Five-Star (read below)
• The end of the November 2017 freeze on Health Inspection ratings
• Changes to Quality Measures including new short-stay and long-stay measures

Monitor the impact of these two Staffing Five-Star changes when the new PBJ Five-Star ratings are published next week (late April):

(1) Daily RN Coverage Rule Tightened

Currently, SNFs can trigger an automatic one star for staffing if they report seven (7) or more days with zero (0) RN hours in a quarter. Beginning with the next PBJ submission, this threshold is now just four (4) or more days. SimplePBJ’s error checker has already been updated to this new rule.

(2) Five-Star Cut Points and Weighting Shifted

Less obvious is the shift in RN cut points and stars in the Staffing Five-Star table.  The focus on RN staffing comes from:

• A major shift in RN cut points – from 18% to 31% higher HPRD per star level
• Change in Star levels emphasizing RNs (see image)

These changes are RETROACTIVE

The Oct. 1 to Dec. 31 PBJ report (submitted by Feb. 14) will be the first to use these new cut points when the Staffing Five-Star ratings come out next week.

We recommend you assess your staffing levels and use ezPBJ to monitor your real-time Hours Per Resident Day metrics. Knowing what's coming enables you to plan your staffing to respond to the latest focus on RNs.