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 New CMS Actions on Staffing Raise Industry Concerns

The Centers for Medicare & Medicaid Services (CMS) on Nov. 30 unveiled new measures that it said would ensure skilled nursing facilities (SNFs) are staffed adequately by sharing more payroll-based staffing data with the states and giving providers more tools to address census concerns.

At the same time, advocates for long term and post-acute care providers said the moves by CMS would actually make it harder to meet regulations and hire staff.

The new agency actions include sharing data with states when potential issues arise regarding staffing levels and the availability of onsite registered nurses, clarifying how providers should report hours and deduct time for staff meal breaks, and providing facilities with new tools to help ensure their resident census is accurate.

CMS Administrator Seema Verma said the effort is aimed at concerns about potential low weekend staffing levels or times when registered nurses are not onsite, and the impact this can have on patient care. 

“Research shows the ratio of nurses to residents impacts quality of care and health outcomes,” CMS said. For example, the agency said skilled nursing facilities with higher nurse staffing levels tend to have fewer resident hospitalizations.  

“In general, the new payroll-based staffing data show most facilities have somewhat fewer staff on weekends, but some facilities have significantly lower weekend staffing,” CMS said. “Additionally, some facilities have reported days with no registered nurse onsite, although nursing homes are generally required by law to have a registered nurse onsite eight hours a day, seven days a week.”   

To address the matter, CMS said it will use payroll-based data to identify and provide state survey agencies with a list of nursing facilities that have a significant drop in staffing levels on weekends, or that have several days in a quarter without a registered nurse onsite. These state survey agencies will then be mandated to conduct surveys on some weekends based on this list. 

“If surveyors identify insufficient nurse staffing levels, the facility will be cited for noncompliance and required to implement a plan of correction,” CMS said.

In reaction to the CMS announcement, David Gifford, MD, senior vice president of quality and regulatory affairs at the American Health Care Association, said providers appreciate the work by the agency to find meaningful applications of the payroll-based staffing data, but not the specifics of their plan.

“Unfortunately, today’s action by CMS will enforce policies that makes it even more difficult to meet regulatory requirements and hire staff,” he said.

“Rather than taking proactive steps to address the national workforce shortage long term care facilities are facing, CMS seems to be focusing on a punitive approach that will penalize providers and make it harder to hire staff to meet the shared goal of increasing staffing.”

There are also concerns in the industry that the payroll-based staffing data being used by CMS are missing the mark. “The data, while an improvement, undercount RN hours by not counting hours when they work more than 40 hours in a week, such as covering shifts on the weekends,” Gifford said.

For more information on the CMS announcement, go to www.cms.gov.

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