A tisket, a tasket ... No LPNs in the RN basket
Reporting direct care hours is nothing new, but the Affordable Care Act takes it to the next level with mandatory quarterly electronic submission of staffing and census data.
This focus on staffing ratios should not come as a surprise. The Centers for Medicare & Medicaid Services has been studying staffing and its impact on outcomes for years.
In fact, the CMS Staffing Study published by Abt Associates not only supported the relationship between nurse staffing ratios and nursing home quality of care, it identified staffing levels that put residents at significantly higher risk for quality problems. These findings became the foundation for the Five Star Staffing domain ratings.
As you are more than aware, high and varying SNF rehospitalization rates have garnered a great deal of attention. A recent PointRight study revealed a strong correlation between staffing and rehospitalization rates; the higher the staffing, the lower the rehospitalization. Although not all staff types seem to have the same impact; registered nurses had the strongest correlation. Those SNFs who staff in the top 20% of RN hours per resident day have an average observed rehospitalization rate almost 4% lower than those SNFs staffing in the lowest 20%.
Back to the ACA with its enhanced collection of data around staffing: One of the changes in reporting staff hours will more accurately capture RN hours. In the near future, licensed practical/vocational nurses (LPN/LVN) with Administrative Duties will be distinguished from RN with Administrative Duties. What that means is, for many SNFs, their total RN hours will be reduced. Although it's not certain if this change will inform Five Star, if it does … look out.
To illustrate: If 50% of your total Nurses with Administrative hours are reduced, the number of SNFs with 1 Star in RNs goes up 10%; if all those hours are removed, it jumps to 25%!
Think you can retain your Five Star Staffing rating with only 1 star in RNs? Think again. The best overall staffing star you can get with 1 star in RNs, is 3 stars. So, check your CMS 671 form and see whose hours are falling into the Nurses with Admin Duties category and develop an action plan to address your findings!
Steven Littlehale is a gerontological clinical nurse specialist, and executive vice president and chief clinical officer at PointRight Inc.