Thomas Jegou

As reporting standards go, Payroll-Based Journal (PBJ) reporting stands out as notoriously difficult. It involves a lot of labor and can be prone to ratings-endangering errors.

Meeting the PBJ reporting requirement is even harder for facilities that try to do it manually or piece it together with different systems. It’s particularly challenging for many facilities to meet the requirement of having a registered nurse on site at least eight hours a day, seven days a week.

While technology can aid in this reporting, not all PBJ software is made equal. Some PBJ reporting programs simply help skilled nursing operators collect historical data to more easily assemble reports. What really makes an impact is software that collects and stores staffing and attendance data continuously, which enables real-time compliance tracking.

The impact of integrated systems

Proactive PBJ systems can help operators advance business goals by improving facility reputation with better Five-Star Ratings and employee engagement.

To quickly generate compliance reports in minutes versus days, operators need PBJ software that integrates fully with workforce management systems. When unified with scheduling and time tracking functions, the system can immediately trace and prove compliance for any given day or time. 

These systems are most effective when connected with a mobile app to monitor employee staffing status, flagging operators within moments if they’re in danger of falling out of Centers for Medicare & Medicaid Services compliance.

Other benefits of an integrated workforce management and PBJ system include:

  • At-a-glance views of compliance across the business
  • Real-time alerts of scheduling gaps, such as days without a registered nurse on site
  • Detailed, automated data collection and reporting to ensure every CMS criterion is met

PBJ reporting software should track agency workers the way it does regular employees. It must also account for shift variations, such as overnight shifts and meal breaks.

Surprise audit assistance

It’s comparatively minor details, like failing to track and include meal breaks, that can lead to significant penalties. The right PBJ reporting technology partner can help cover all the bases.

On-demand, proactive reporting is beneficial when it comes to surprise inspections, which are on the rise. 

An integrated PBJ reporting system helped an Illinois operator meet the challenges presented by a surprise inspection from the state’s Department of Public Health at its suburban Chicago facility. 

The department arrived and demanded instantaneous proof that the rehabilitation and care center was in compliance with staffing requirements. Fortunately, the facility was using an integrated workforce management suite. The employee was able to immediately open a chart demonstrating proper staffing levels throughout the entire facility. 

Regulators then requested data regarding staffing and PPD census values for several random days. Facility employees used their integrated software to generate immediate reports showing compliance on all requested days. 

Workforce management applications also help maintain staffing levels by keeping staff more engaged, empowering employees to set their schedules and facilitating two-way communication between management and staff.

Maintaining sufficient staffing levels is crucial to enabling facilities to meet PBJ requirements.  Proving facilities did so is critical to passing a surprise inspection and achieving their desired CMS Five-Star Rating.

Why it matters with Five-Star Ratings

Five-Star Ratings can make or ruin a facility’s reputation and ability to succeed. A facility’s Five-Star Rating is used as a guide by residents and their families when choosing facilities. This has become even more true during the pandemic when in-person visits and interviews are limited at best. Potential investors, likewise, pay close attention to facility ratings.

Of all the factors that influence Five-Star Ratings, staffing is the most challenging, particularly in an age with chronic staffing and nursing shortages.

Five-Star Ratings affect per-patient Medicare reimbursements, as well as insurance and a facility’s
reputation and ability to get new residents. The U.S. Department of Housing and Urban Development
also uses ratings to assess risk when it makes decisions about lending.

It’s not hard to see the growing influence of Five-Star Ratings and how a reduction in a facility’s rating
can have a devastating impact on that facility’s finances.

But when integrated with workforce management software and analytics, the right PBJ technology can even help predict and improve Five-Star Ratings. Seizing this opportunity can help operators continually improve their quality care and bottom line. 

Predicting and improving Five-Star Ratings

For years, PBJ software helped skilled nursing operators demonstrate compliance. Now, combined with analytics and an integrated workforce management platform, the software can put five stars within an operator’s reach. 

However, operators have lacked the ability to manage their Five-Star Rating proactively. Many know what they must do to achieve their desired rating, but few had the technology to remediate it.

Now, there is Five-Star Predictor technology that helps skilled nursing operators predict their next
ratings at each of their facilities and improve it. This analytics system will tell you:

  • The staff you need based on your resident population and acuity
  • When your schedules fall out of compliance, often because employees submit PTO requests or resident needs change
  • What you can do to fix scheduling issues before they manifest, letting you know who’s qualified and available to fill open shifts
  • Which trends are emerging for your entire enterprise at a glance, then letting you dig further to lower-level data

Looking forward, it’s best to be prepared for enhanced oversight and anticipate the demands of regulators. This will take some work. But technology can smooth the way and enable facility operators to meet the challenges ahead.

Thomas Jegou is a Product Manager for SmartLinx, a provider of workforce and human capital management products and solutions. Jegou has worked with every aspect of human capital management systems since 1996, and is a Certified Payroll Professional through the American Payroll Association.