Ask the payment expert ... about the observation stay loophole

What is acuity-based staffing and how do we know what our acuity is? 

We have multiple ways that acuity is evaluated in a facility. The best is to use available information with the Resource Utilization Groups (RUGs) levels. 

Each resident in your facility has a RUG level. It doesn’t make a difference which RUG system (state or federal) you use, but I recommend the easiest is the RUG 66 Medicare group.

Run a report that identifies each resident’s RUG level. Then apply the STRIVE study minutes to each RUG category. The STRIVE studies were completed in the early 2000s and applied the number of minutes it took to care for residents. The 66 groups were then developed using like number of minutes. When those minutes are applied to the RUG levels, it determines how many minutes of RN, LPN, CNA time is needed for your population on a per patient day basis. 

There are multiple ways that acuity staffing is used by the Centers for Medicare & Medicaid Services. One program that uses it is the Five-Star Quality Rating System. Its staffing component uses the data your facility submits on the CMS 671 during survey. That is considered your reported staffing. 

It then calculates your expected staffing based on the case mix of your residents. The per-patient days calculation relates to your needed acuity staffing. Then a staffing formula is calculated to determine your staffing component star rating. 

The MDS Focused survey also added staffing to its review. That survey and the new Payroll-Based Journal requirements will give CMS additional information about your facility. It will give the surveyors additional information to assess your staffing quality and numbers.