Nursing home performance is gaining increasing influence on your reimbursement and compliance. This means increased pressure on administrators to get as close as possible to a CMS 5 Star Rating.
Regardless of where you’re starting, you have multiple options to inch that score even higher, but there is one area of focus that can enhance the experience of your residents while improving your standing with CMS. That area of focus is staffing.
By turning your staffing strategy into one that supports achieving a CMS 5 Star Rating, you can keep your promise of quality care to your patients and families while reducing turnover and improving the experience for your nursing professionals. Here are a few tips to get started.
Create a Best Practice of Using Updates to Inform Your Staffing Strategy
First, make sure you’re on top of the most recent changes to star rating requirements. For example, in mid 2022, CMS enhanced its Nursing Home Five-Star Quality Rating System, integrating data from nursing homes on weekend staffing rates and annual turnover for administrators and nurses. This move was born out of an understanding of the connection between staffing levels and the quality of care for residents—so expect adjustments and additional announcements around staffing and the Star Rating system in the future.
If there isn’t someone on your team who currently owns CMS updates and making suggested adjustments to your staffing strategy, now is an excellent time to delegate that responsibility and establish a schedule.
Remember That Insurance Is Also Affected
Providers aren’t the only ones looking to CMS for better star ratings. Insurance plans work under a somewhat similar system, where five-star status is rare. But a recent winner of the top rating is sharing advice that can be easily translated to post-acute staffing practices.
Five-star rated Cigna HealthSpring of Florida boasts the highest award from CMS, and it’s likely in part to their having titles responsible for their star ratings. For example, their “Vice President of Stars” cited excitement at earning stars across the board. If your Star Rating improvement goal doesn’t have an owner, you might benefit from identifying one.
Listen and communicate
Cigna stepped out to communicate and listen to their beneficiaries, using their advice to inform decision-making year over year. While the process is different for providers, listening to your nurses and patients can go a long way in addressing opportunities and problem spots in your staffing strategy.
Cigna gradually improved its medication delivery system with a focus on long-term success. The lesson? Improving your CMS star rating is a journey that will involve slow and continuous integration of the lessons you learn—iterating instead of taking one-off actions.
Focus on Staff Reporting Accuracy
Reporting is the foundation of CMS’ perspective on your staffing practices. In the past, some facilities have incorrectly provided staffing information on CMS form 671, reaching beyond the certified facility to include staff that shouldn’t be counted. Today, audits that reveal significant inaccuracies can cause setbacks in attaining your star goals. For example, if a nursing home’s audit identifies a conflict between hours worked and hours verified, or if you fail to submit data by the required deadline, it will be assumed that you have low levels of staffing. The result will be one star in the staffing domain and drop your composite score by an entire star for the quarter.
Take this as an opportunity to review your history with reporting, clarifying issues like reporting hours for feeding assistants or hospice staff, and how administrator hours should be reported.
Schedule Well to Improve Retention
Losing nursing professionals is more than just a few unfilled shifts. It can mean a loss of knowledge and understanding that cannot easily be replaced. This is exactly why examining your scheduling practices should be front and center of your CMS Star Rating tactics.
Suboptimal scheduling practices can be a significant contributing factor to fatigue and burnout, leading to poor work-life balance and your staff feeling that they lack control in their work experiences. But by taking a few steps, you can turn the tide on your nursing professional retention and recruitment, stabilizing and improving your CMS star ratings. These can include:
- Investing in your nurse experience
- Providing flexible training and support
- Bridging the nurse staff generation gap with mentoring
- Looking for opportunities to build flexibility into their schedules with new approaches to staffing technologies.
Dive Into Competency-Based Nursing Home Staffing
A focus on nurse competency will go a long way toward creating a star-winning staffing strategy.
The American Nurses Association (ANA) defines competence as a level of performance that successfully integrates the skills, knowledge, judgment, and ability your nursing staff brings to your organization—and competency informed staffing has clear benefits for post-acute organizations. By being innovative in your staffing choices and considering patient acuity along with caregiver competency, you can better foster a high-quality work experience and improved patient care.
What does this mean for organizations like yours? It means that staffing for the average daily census is only the beginning. You will need to layer on a competency-informed staffing strategy to keep up with and get ahead of modern post-acute challenges. This will mean not only accessing a cost-efficient float pool workforce but also investing in training them across adjacent specialities so you can best fill vacancies.
When your staff and float pool competencies align with organizational goals, you can:
- Identify gaps in skill and competency more efficiently
- Make change management more efficient
- Improve documentation, tracking, and reporting
- Recruit staff more effectively
CMS offers competency assessment resources for frontline staff roles (both for CNAs and RNs) and one for management (covering administrators, directors of nursing, and assistant director of nursing).
As you look for ways to incorporate your use of per diem options in your plans to improve Star Ratings, know that you don’t have to worry that your staffing inconsistencies will affect your outcomes. New workforce management options allow you to post blocks of shifts that can be filled by reliable nursing professionals—enabling you to improve care consistency and move your Star Rating closer to your goals. You can learn more about leveraging per diem staffing here.
Megan is a business writer with over 15 years’ experience in healthcare enterprise technology. She holds an MBA and B.S. in Healthcare Administration. She now keeps an ongoing eye on the latest developments and successes in healthcare admin technology and the people who use it to build a better world for providers, patients, and their care communities.