Five Must Haves to Promote Compliance: The Five-Star Way

April 18, 2022

In long-term care and post-acute care facilities, there exists a simple equation for success: The more compliant your facility is with Centers for Medicare and Medicaid Services (CMS) requirements, the more likely you will improve your Five-Star Rating.  And higher ratings translate to greater success.

This means more responsibilities fall to your administrators and compliance managers. Fortunately, with the right tools, they not only can do their jobs well but also help your business succeed.

To enable your team to meet evolving requirements, you must track CMS requirements while monitoring and controlling nearly every conceivable aspect of workforce management to ensure they align. The good news is you do not have to do this alone. You can use workforce management systems to set and achieve your desired staffing levels, as well as reduce and streamline operations, even during a pandemic.

Before we get to the five “must haves,” let’s review the Five-Star Rating system and why it’s imperative you do everything in your power to align your business practices to it. CMS calculates the overall Five-Star Rating based on several criteria, including the performance of other skilled nursing facilities, in addition to staffing, quality, and inspection ratings. Skilled nursing facilities awarded four and five stars are deemed above average quality. Those receiving one and two stars are considered below average.

Facilities with low Five-Star Ratings can sustain long-term damage to their reputation and their bottom line due to:

  • Higher risk assessment. The U.S. Department of Housing and Urban Development (HUD) use Five-Star Ratings to assess risk when making lending decisions.
  • Higher interest rates. Banks and institutional investors include Five-Star Ratings on underwriting checklists.
  • Higher insurance premiums. Insurance companies use Five-Star Ratings when designing policies.
  • Fewer residents. Select Medicare plans will not cover facilities that receive Five-Star Ratings with fewer than three stars, according to Leading Age.

Learn more,  watch Perspective on Payroll-Based Journal — Hear It from CMS and Other Experts.

Now, on to the five “must haves” that will help ensure compliance and lead to your desired Five-Star Rating.

1. Compliance Begins and Ends with Nurse Scheduling

Where we were:

Before workforce management took hold in post-acute and long-term care, nurses retrieved employee schedules by looking at paper spreadsheets posted on a bulletin board. In today’s fast-paced facility, static nurse schedules have become obsolete because they can’t adjust to all the changes facilities need.

Where we are:

Proactive employee scheduling—a system of employee scheduling that uses software to match employee and facility needs—not only eases the scheduling burden but can also anticipate and adjust to changes automatically. To maximize your benefits, you must look beyond standard workforce management technology to find employee scheduling tailored for long-term care environments.

Where you could be:

With the right software for proactive employee scheduling, your workforce management system can customize nurse schedules for your resident population and their changing medical needs. See how Trilogy optimized nurse schedules for 110 facilities.

With tailored workforce management capabilities, you can create nurse schedules for multiple facilities in moments, which is imperative for compliance. The software should proactively define the appropriate staffing level based on the resident population and healthcare needs (acuity). For example, SmartLinx workforce management deploys daily unit assignment capability to streamline nurse scheduling changes and automatically adjusts to changing patient-per-day (PPD) census values.

With proactive employee scheduling, your workforce management system can easily customize nurses’ schedules—adding flexibility—which can adapt to your residents and their needs all while meeting compliance standards. The best systems will also adapt nurse schedules to internal policies, such as union rules.

2.  Managers MUST Let Nurses Find and Fill Open Shifts …Before Problems Happen

An unfortunate reality is that even the most proactive employee schedules can’t prevent sudden openings when employees call out sick or arrive late.

Where we were:

To avoid same-day shortfalls, some long-term care facilities “overstaffed” while others rallied employees to work overtime or called in agency workers to fill the void. These common practices caused labor costs to soar and diminished the quality of resident care.

Where we are:

The good news is your long-term care and post-acute care facilities have an untapped resource at your fingertips…your employee base. The right workforce management system empowers nurses to close nurse scheduling gaps quickly while improving employee engagement.


Where you could be:

Now, nurses can make scheduling changes on the fly and the system can assure their schedule change complies to current regulations.  Instantly, your employees can check their schedules, determine what shifts work for them and which don’t. They can use the mobile app to request PTO and even swap shifts with co-workers. They can even check how much PTO they have left before requesting a day off.  A good workforce management app helps your employees explore their options. Some provide a list of available co-workers and let nurses initiate a swap shift request…all on the mobile app in seconds.

Managers can approve or reject shift swaps and PTO requests and the system automatically notifies employees in their preferred method, such as a mobile app notification, email, or text message. 

3. Compliance Managers MUST Merge Nurse Scheduling and Attendance Data

Your managers must constantly utilize the real data to be effective. When your workforce management system keeps you constantly connected to live nurse scheduling and attendance data, your managers can quickly identify and stop problems before they impact your residents or your bottom line.

Where we were:

Many workforce management systems share employee scheduling and attendance data through periodic batch reports. This method forces you to dig through reports to find and analyze trends. Even worse, you can’t find problems until after they happened when it was too late to minimize the damage.

Where we are:

Since it’s designed especially for skilled nursing facilities, SmartLinx workforce management system provides real-time nurse scheduling and attendance information to help address problems when they happen. You’ll know the moment an employee clocks into work and receive alerts when a scheduled employee doesn’t clock in on time or calls out sick.

Where you could be:

Use workforce management to fill open shifts

To comply with CMS standards, you cannot have too many open shifts. Now, filling open shifts is easy because a good workforce management system not only notifies you of openings when they happen but also presents a list of qualified employees available to fill them. SmartLinx does this and more, enabling you to fill shifts while containing labor costs.

With the click of a mouse, administrators can offer an open shift to qualified workers who will not incur overtime hours. Employees receive the shift request instantly on their mobile device, via text message, voicemail, email, or in-app notification. See how Oriole Health Care reduced overtime costs by 25% in three months.

You can use an integrated workforce management to expose attendance problems (late punches, buddy punches, and missed punches) as they happen and uncover underlying causes. SmartLinx tracks key performance indicators (KPIs) important to long-term care operators and alerts you when a threshold is crossed.  You can use the color-coded dashboard to view KPIs of all your facilities in real-time and drill down for details.

By integrating workforce attendance and employee scheduling data, long-term care facilities can quickly:

  • Ensure Compliance
  • Ascertain gaps in coverage
  • Create strategies to reduce overtime
  • Improve payroll accuracy
  • Address chronic policy violations

4. Payroll-Based Journals MUST Track and Report, Instantly

For long-term care operators, compliance is always top of mind. And it should be.  A Five-Star Rating means everything from higher reimbursements and occupancy rates to lower insurance costs. A stellar rating requires effective Payroll-Based Journal reports. 

Where we were:

Some workforce management systems put the burden of collecting compliance data and creating Payroll-Based Journal reports on administrators, which can take days or weeks every quarter.

Where we are:

When you integrate Payroll-Based Journal reporting into your workforce management solution, you can slash this tedious process from hours to minutes.

Where you could be:

Innovative systems, like SmartLinx, optimize compliance reporting by integrating compliance tracking with employee scheduling and attendance functions. You can simply access the color-coded dashboard to track compliance across all your facilities simultaneously and push a button to generate a report.

State and federal regulators want auditable processes. Unfortunately, most workforce management systems follow traditional report collection and submission practices that lack auditability.

Systems that integrate real-time compliance tracking with nurse scheduling and attendance features can quickly create audit-ready Payroll-Based Journal reports. Real-time compliance reporting and a centralized dashboard also enables you to easily demonstrate compliance on demand. See how Greek American Rehabilitation & Care Centre refuted a compliance allegation in minutes.

5. You MUST Know How to Navigate the Five-Star Ratings Process

As a post-acute and long-term care operator, you understand the power of Five-Star Ratings and you know achieving and keeping your desired Five-Star Rating is a never-ending challenge.

Where we were:

Most skilled nursing facilities have failed to consistently meet the staffing requirements. And it’s not for lack of trying. Lack of qualified nurses contributed (and continue) to more than 1.1 million open positions every month, according to Argentum.

When this limited pool of qualified nurses, it’s even tougher to find qualified people to fill three shifts a day, every day.

Where we are:

Staffing to Five-Star Rating requirements adds another layer of complexity. You must modify schedules on the fly to keep up with changing resident needs and populations. Your Five-Star Rating for staffing really starts to slide when nurses take unexpected PTO and you can’t quickly fill their shifts.

Where you could be:

You need a workforce management system to stay on top of changing employee scheduling needs and  identify how staffing changes affect your Five-Star Rating. After the fact reporting may help spot staffing trends and fill out Payroll-Based Journal Reports but does little to prevent the gaps.

To improve your Five-Star Rating, your workforce management software must track staffing against CMS requirements. It must also alert you when scheduling gaps threaten your next Five Star-Rating.

SmartLinx uses current and historical data to calculate your actual star rating against your desired rating. The workforce management system then alerts you when staffing changes compromise your desired rating and tells what how to remediate the staffing problem before it impacts your rating.

Understand the Five-Star Rating calculation

CMS calculates RN and total nurse staffing ratings individually and assigns five stars for staffing to facilities who:

  • Earn five stars in both RN coverage and total staffing, or
  • Earn five stars for RN coverage and four stars in total staffing.

Workforce management systems with integrated Payroll-Based Journal, nurse scheduling and attendance functions can help providers improve their Five-Star Rating by proactively identifying days without RN coverage. SmartLinx workforce management system can even identify RN staffing violations as soon as they happen.

Learn how SmartLinx can help you advance your goals, book a personalized demo


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