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Staffing On the Firing Line

November 7, 2014 | Mark Woodka


Five-Star Quality RatedA new era of accountability and transparency into staffing practices has been ushered into long-term care.  The convergence of initiatives by CMS, a recent Executive Order signed by President Obama and stepped up actions by the Department of Justice and the Office of Inspector General are placing a huge target on the staffing practices in skilled nursing facilities.

CMS recently announced the expansion of surveys to focus on MDS coding and staffing levels.  CMS piloted the focused surveys in five states and found deficiencies in 24 out of 25 surveys.  During the focused MDS surveys, surveyors also reviewed records and conducted interviews to corroborate self-reported staffing levels and to get a clearer picture of turnover throughout the year.

A recent New York Times article asserted that nursing homes are gaming the system with self-reported staffing levels. This article influenced President Obama taking action with the recent Executive Order which could affect Five Star Quality Ratings. The order requires staffing information to be submitted electronically to CMS using payroll data. And compliance is just around the corner. The use of payroll data to verify staffing in determining Five Star Quality Ratings will be phased in beginning on January 1, 2015. The goal is to have all facilities electronically reporting by the end of 2016. 

To get ready for these changes, providers must know what is going on with staffing long before payroll is run and submitted to CMS.  Getting predictive and proactive with staffing, and managing labor on a day-to-day basis, will deliver better results and safer staffing. If you wait for payroll reports to assess staffing efforts, it’s too late to make adjustments.

The emphasis on staffing does not stop there. On top of new focused surveys and electronic submission of payroll data, the DOJ and OIG are pursuing providers for quality of care violations under the False Claims Act. At the heart of their efforts is staffing. They are analyzing staffing data to determine if it was possible for providers to deliver the level of care for which they billed the government.  One of the key trends in asserted liability is inadequate staffing and the failure to have measurable acuity-based processes.

The risks with these developments are very real. Hospital partners are narrowing down their number of post-acute provider partners and using Five Star Quality Ratings as a leading indicator for selection. It has never been more incumbent on providers to shore up staffing practices and gain much needed visibility into and control over staffing practices -- day in and day out.  It is also imperative to move away from a reactive stance to a proactive one. If payroll reports indicate improper staffing, there is nothing that can be done about it but report…and hope.  I am a big fan of hope but not when referrals, reimbursements, fines and ultimately quality of care are on the line.

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About Mark Woodka

Mark Woodka is CEO of OnShift and has over 25 years of experience in enterprise software sales and marketing, having worked for startup organizations as well as Fortune 500 companies. He often leverages his extensive background in technology-enabled process improvements speaking at industry conferences as well as authoring articles on long-term care trends and issues.

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