Jeff Marcus

The Centers for Medicare & Medicaid Services have made information technology and staff competency a priority for the past five years. In response, skilled nursing facility educators expanded training programs to keep up with increased needs. For example, a Certified Nursing Assistant early detection training program was focused on decreasing re-hospitalizations.

Then in July 2016, the Payroll Based Journal system became mandated. It requires a SNF to deduct the hours CNAs participate in in-service training so that staffing levels will be accurately reflected for the Nursing Compare Five Star Rating reporting. Consequently, SNFs are be penalized for training their staff. That’s despite saving the CMS money by avoiding unnecessary hospital readmissions and improving quality of care.

What was CMS thinking?

Continuous high quality education is vital in today’s very dynamic healthcare environment.

Our nursing home operations put restraints on staff training to ensure maximum staffing is reflected on the Five Star Rating report while simultaneously expecting first line staff to improve patient outcomes by avoiding unnecessary transfers to the hospital.

I have a proposal for how this can work better for all parties. My recommendations are:

1. Remove the caveat that all CNA training time be deducted from PBJ reporting OR 

2. Add a quality measure to the Five Star Rating rating system reflecting the amount of training SNF staff receive. That would demonstrate commitment to staff education that leads to favorable patient outcomes.

More training should be valued, not something in which nursing homes are punished. Let me know if you agree.

Jeff Marcus, RN, is a corporate trainer and staff educator at Momentum At South Bay for Rehabilitation and Nursing in East Islip, NY.