Higher staffing level thresholds could cause star ratings to plummet despite quality care.
In March, the Centers for Medicare & Medicaid Services (CMS) announced that it was setting higher thresholds and evidence-based standards for nursing home staffing levels. Starting with April numbers, the agency will automatically give one-star staffing ratings to any facility that has four or more days each quarter with no registered nurse (RN) on site. This a significant drop from the previous standard of seven or more days. Now the real-world impact of this is starting to come to light, and it’s causing great concern. According to recent statistics, at least 550 providers could be affected, and it’s likely that the number ultimately will be higher.
The April updates to data posted on the Nursing Home Compare website, says the agency, “are part of a broad range of updates that have been under development for the last several years…. The updates further advance CMS’s goals to improve the accuracy and value of the information found on the site and promote quality improvement in nursing home care with the result of better health outcomes for residents.” The updates also include adding measures of long-stay hospitalizations and emergency room transfers, and removing “duplicative and less meaningful” measures. CMS is also establishing separate quality ratings for short-stay and long-stay residents and revising the rating thresholds to “better identify the differences in quality among nursing homes.”
However, there is widespread concern about the impact of these changes. In a statement late last month, David Gifford, MD, American Health Care Association (AHCA) vice president of quality and regulatory affairs, suggested that “abrupt change in star ratings” for nursing facilities could be confusing to consumers, residents, and families. He further noted, “By moving the scoring ‘goal posts’ for two components of the five-star system [staffing and quality components], CMS will cause more than 30 percent of nursing centers nationwide to lose one or more stars overnight, even though nothing changed in staffing levels and in quality of care, which is still being practiced and delivered every day.”
Others have expressed concerns about the fact that salaried workers who cover weekend shifts aren’t captured in payroll systems that track staffing on an hourly basis; although CMS says the agency has reviewed this issue and that it doesn’t appear to be the cause of days without RN staffing.
An additional consequence of the changes to the star ratings relate to referrals and census. As managed care organizations and hospital systems often limit referrals to facilities with special star ratings, many nursing centers that are impacted by these changes could lose admissions. Gifford observed, “While the five-star system can be a helpful tool, consumers should not rely on it exclusively when choosing a nursing center for themselves or a loved one.”
HR professionals can work with facility leaders to promote the overall quality of the care residents receive in their facilities and share the powerful positive stories about the good work and excellent outcomes happening every day.
