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How Workforce Management Impacts CMS Five-Star Quality Ratings

The federal Centers for Medicare and Medicaid Services (CMS) created an in-depth rating system in 2008 to assist consumers and their families in choosing a nursing home. These star ratings have been used by countless patients, caregivers, and organizations, and the rating criteria continue to develop based on improved reporting techniques within the system. It’s an invaluable resource.

It’s not only potential patients and their families who depend on ratings when selecting a skilled nursing facility; the homes themselves often look to the ratings for feedback on how well managed they are. A great score promotes the facility, of course, and lower scores help identify needed changes.

Insurance companies also pay attention to ratings. As referrals for skilled nursing facilities come through, companies will often not approve homes with ratings of three stars or below.

Additionally, attorneys can use the star rating system when pursuing a case against a facility. Low ratings are seen as evidence of poor care at the site.

The Stars

Knowing the meanings of the stars is important. They are:

  • 1 Star - Much Below Average
  • 2 Stars - Below Average
  • 3 Stars - Average
  • 4 Stars - Above Average
  • 5 Stars - Much Above Average

There are three main categories rated within the system, each one earning an individual star rating. These include:

  • Health Inspections
  • Staffing
  • Quality Measures

In addition to these categories, each facility receives an “Overall” rating.

Staffing Star Rating Criteria

The staffing star rating measures both (1) the ratio of registered nurse (RN) hours to each resident per day and (2) the ratio of total licensed nurse hours (including RNs, licensed practical or vocational nurses [LPNs/LVNs], and nurse aides) per resident per day. Staff such as housekeeping or administration are not included in the ratios.

Staffing data is transmitted to CMS via Payroll-Based Journal (PBJ) reporting each quarter. Long-term care facilities manually upload an electronic file directly to the PBJ system, and the data is used to determine staffing levels.

The Workforce Management Connection

Workforce management providers play a pivotal part in improving a facility’s star rating. As nursing homes manage complex employee schedules and juggle them to align with patient care, utilizing workforce management tools that streamline this process — and predict future needs — can help ensure correct, consistent staff-to-patient ratios.

With so much at stake when it comes to star ratings, it’s vital that long-term care leadership understand the trickle-down effect of employee schedules. Implementing a system that hands employee the reins for their personal schedules — while at the same time making sure that the right qualified staff are working at all times — opens the door to greater employee satisfaction, more freedom for managers, better patient care, and, ultimately, higher star ratings.

WorkSync offers leading workforce management solutions for your organization. Learn more by scheduling a demo today.

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