Inaccurate PBJ Files Directly Affecting Long-Term Care Star Ratings for Staffing
What are Star Ratings?
The Centers for Medicare and Medicaid Services (CMS) developed the Five-Star Quality Rating System to provide information for consumers and their families when faced with choosing a long-term care facility.
Each facility has an Overall Star Rating between 1 and 5. There are also star ratings for the categories of Health Inspections, Staffing, and Quality Measures.
How Does Payroll Based Journal Reporting Affect Star Ratings?
When considering the star rating for Staffing, CMS receives information from each long-term care facility in the form of an electronic file - a Payroll Based Journal (PBJ) report. The file is sent out quarterly and is due within 45 days at the end of the previous quarter.
These files are a relatively new way of submitting data to the CMS. Previously, long-term care facilities sent information manually, and star ratings were determined from there. Now, it’s an automated process. A facility’s labor management software system creates a file from all the data it has gathered and sends it off. This is tremendously easier than the long-form version, but it comes with its own set of potential issues.
Why are Star Ratings Potentially Low Right Now?
Providers that send PBJ files will receive a confirmation of submission, but it’s wise to follow-up to ensure that the files are complete and accurate. Alerts are not sent if the Certification and Survey Provider Enhanced Reporting (CASPER) and PBJ systems do not accept the data submission then alerts are not received. Additionally, if the file has inaccuracies within it, those will directly affect the star rating.
Workers must punch in and out correctly and accurately designate their time to the appropriate job category. This is because the star ratings in Staffing and Overall Star Rating are partially based on the ratio of skilled care worker hours to residents. Missed punches can take a toll on the staff to patient ratio, particularly if management steps in and assumes a missing punch is from a single shift when in fact it was a double.
Another important consideration is accurate Minimum Data Set (MDS) records. These MDS assessments are required in order to determine each resident’s functional capabilities. If assessments are missing - particularly discharge assessments - the PBJ-based “hours per resident per day” will have incorrect ratios. This affects star ratings.
How Can I Improve and Maintain My Star Rating?
The first thing a provider can do to earn and protect a five-star rating in staffing is to implement smart scheduling. Utilizing a labor management system that has enhanced scheduling elements, as well as collaborative shift-filling capabilities, helps to ensure that the appropriate number of skilled staff are working at all times.
Additionally, the CASPER reports can assist in determining the star rating for a provider at any given time. This is helpful in determining areas needing attention before documenting the final file and star rating.
Four reports, specifically, can give a great snapshot into the Staffing designation of a facility. They are:
- The 1700D Employee Report
- The 1701D Census Report
- The 1702D Individual Daily Staffing Report
- The 1702S Staffing Summary Report
Run these reports monthly, and compare the hours in the reports with payroll hours. This is a great way to stay on top of any inaccuracies due to missing or incomplete information.
PBJ reporting and the Five Star Quality Rating System gives providers the opportunity to prove that they are a facility worth choosing. While simply sending a file four times per year might seem like an easy task, ensuring accuracy is of the utmost importance.
Smart, collaborative scheduling of employees and running monthly status reports for auditing against payroll are key steps in ensuring appropriate staff-to-patient ratios, accurate records, and the highest star ratings possible.
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