While regulators are working furiously to push through a comprehensive nursing home reform agenda backed by the Biden administration, providers remain concerned about an earlier change whose impact is soon to be revealed: the inclusion of additional staffing measures in 5-Star rating calculations.
Government officials on a Skilled Nursing Facility Open Door Forum call Thursday were not ready with answers regarding the methods they’ll use to make changes to 5-Star starting in July. Instead, Centers for Medicare & Medicaid Services representatives asked a prominent provider to email his question so they could directly address it later.
The implications of the changes could be ominous, warned questioner Joel Van Eaton, executive vice president of compliance and regulatory affairs at Broad River Rehab, in an interview with McKnight’s Long-Term Care News. Van Eaton had asked agency officials to provide information on exactly how staffing turnover and weekend nurse coverage data will be calculated into ratings, but essentially came up empty.
The agency announced in January that it would incorporate turnover data for nurses and administrators and weekend staffing levels into the consumer-facing rating system this summer. But it has yet to provide any details on how that information will be calculated. That has left providers concerned about how their efforts to retain staff during the pandemic will be perceived.
“When might we be able to expect some updated materials to help us prepare for that?” Van Eaton asked on the call. “July’s coming our way and we’d certainly like to know, as an industry, how that’s going to work.”
He pushed the agency to make its strategy public soon to help providers across the sector.
Will turnover rates hurt?
Currently, the staffing star-rating is still based only on registered nurse hours per resident per day and total staffing hours per resident per day. Staff turnover rates captured through Payroll-Based Journal reporting have been listed since late January but not incorporated into the star rating.
What’s unclear is how much weight the turnover or weekend staffing elements will have in the staffing equation — and whether that new data will also be weighted more heavily in computing a facility’s overall star rating. An April manual update did not address the scoring approach.
After the forum, Van Eaton told McKnight’s that it may be important for providers to get in front of the July data drop, especially if they anticipate the new data elements could drive their staffing or overall rating below a certain threshold.
“It could have a disastrous effect, especially if I’m going from a 3 [-star] to a 2 or a 2 to a 1,” he said. “I’d want to be proactive about that and be able to explain to certain people…. If you lose a star, you may lose a contract, especially in some of the belts where managed care is so prevalent.”
Standing up for therapists
Also during the call, CMS officials covered pending payment changes for fiscal year 2023; proposed ICD-10 coding changes; upcoming quality reporting requirements and proposed additions to the SNF Value-Based Purchasing program.
Officials also mentioned a request for information on how best to code infection isolation, noting that providers had told the agency its pre-COVID specifications were not working during the pandemic. Providers have asked for modifications to the language that would allow isolation coding for patients who were cohorted. The agency said in a previous fact sheet that it wants to “ensure that the payment rate impact of infection isolation is consistent with the increase in relative costliness associated with these patients.”
Kris Mastrangelo, president and CEO of compliance consultancy firm Harmony Healthcare, suggested CMS adopt an additional code for “quarantine” versus isolation. She also asked the agency to consider calculating the work of respiratory therapists toward hourly coverage captured through PBJ “given the desperate need for staffing and the value respiratory therapy can provide in caring for these residents.”
New MDS confirmed for 2023
A CMS official also confirmed that the agency intends to issue a draft of an updated Minimum Data Set in early 2023 for use starting Oct. 1, 2023. The MDS and some reporting requirement updates were delayed in May 2020 due to the public health emergency.
“We wanted to provide maximum flexibility for SNFs to respond to the public health threat posed by the COVID-19 PHE and to reduce the burden and administrative efforts associated with attending training, training their staff and working with their vendors to incorporate the updated assessment instrument into their processes,” the official said. “We believe this revised date of Oct. 1, 2023, which is a three-year delay .. is sufficiently far enough in advance.”
