On July 7, 2022, the Centers for Medicare and Medicaid Services published updates to the Payroll-Based Journal Five-Star Users’ Guide including how turnover rates and weekend staffing will affect the Payroll-Based Journal Five-Star ratings on the Nursing Home Care Compare website. This delivers on an announcement from the Centers for Medicare and Medicaid Services in January that staff turnover and weekend staffing measures would be added to the Care Compare website and used in the Nursing Home Five-Star Quality Rating System.
What is a Five-Star Rating?
Payroll-Based Journal ratings are calculated from a combined score across three domains:
• Staffing (including staffing on weekends and staffing turnover)
• Health Inspection (surveys performed on-site and remotely)
• Quality Measure (developed by the Centers for Medicare and Medicaid Services to measure facility health indicators)
What Does a Payroll-Based Journal Rating Mean to You?
The Payroll-Based Journal ratings are posted on the federal Nursing Home Care Compare website for public viewing and could have an impact on a nursing home’s reputation and business. These ratings affect Medicare reimbursements, are routinely relied upon when families select a nursing home for their loved ones and could even impact business outcomes.
What is New?
With the latest update, the Five-Star Users’ Guide now provides specific details about how weekend staffing levels and staffing turnover will be included in the Staffing Domain calculation. At a high level:
• Weekend Staffing: Nursing homes in the top 10% of “case-mix adjusted total” nurse and RN staffing receive the highest score, while those with the lowest levels receive the lowest scores.
• Nurse Turnover: Similar to weekend staffing, the top 10% lowest turnover rates receive the highest score.
• Administrator Turnover Nursing homes with no administrator departures during the measurement period receive full points; points are docked based on number of departures.
What’s Next?
The Smartlinx Product and Engineering teams are reviewing the enhancements needed to address the recent updates from the Centers for Medicare and Medicaid Services to the Payroll-Based Journal Five-Star calculations to include weekend staffing and turnover metrics.
The Five-Star Predictor module will be updated to include the four new measurement categories:
• Adjusted total nurse staffing on the weekends
• Registered Nurse Turnover
• Total Nurse Turnover
• Number of Administrator Departures
The Five-Star Predictor will also be updated to reflect the new scoring methodology.
Changes Impact Five-Star Ratings Calculations
There are no required changes to the actual Payroll-Based Journal output or calculations based on the updates from the Centers for Medicare and Medicaid Services. The changes only impact how Five-Star ratings are calculated.
