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Skilled nursing staffing levels under fire

Staffing levels seems to be the hot button topic in the back half of 2014. Skilled nursing facilities have been seeing a lot of pressure in recent months to provide more accurate staffing data, with everyone from CMS to the Center for Public Integrity calling out administration for “staffing up” ahead of survey.

In an October S&C letter, CMS noted that it plans to review staffing levels for the entire year as part of its new MDS-focused surveys. Earlier in the month, the IMPACT Act was signed into law, providing for changes to be made to Nursing Home Compare to provide more accurate data, including the use of independently verified data for payroll rather than using self-reported data. These changes were highlighted in August by the Congressional Seniors Task Force that called for the use of payroll data to verify staffing levels due to its correlation to the quality of care provided, for reimbursement and for consumer knowledge.

On the November 13, 2014 SNF Open Door Forum Call, this topic was no exception to the trend. CMS officials detailed a system that is being developed to capture all staffing data, which will probably be submitted via payroll vendors. The agency will also be asking SNFs to submit staffing data on a quarterly basis while the system in being built, but this will be voluntary.

Even the Center for Public Integrity has looked into this topic, and published an article last week that showed their analyses of staffing data on skilled nursing facilities are quite different from the data that is available on Nursing Home Compare. The article, “Analysis shows widespread discrepancies in staffing levels reported by nursing homes,” is pretty much summed up by its title. Using two data sets, one from the Medicaid cost reports and the other from quarterly staffing information that only including direct-care nursing staff, yielded similar results – over 80% of facilities self-reported higher RN staffing levels on Nursing Home Compare than were reported in the cost reports. The report also outlines some additional information on the staffing data system that is being developed by CMS and expected to be released in 2016. The Center continues to dig into the staffing data more deeply and has already released two additional articles that use the staffing data, “Running a five-star nursing home,” and “Nursing homes serving minorities offering less care than those housing whites.”

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