Nursing homes take Medicare ratings hit for understaffing, lax recordkeeping

Nearly 1,400 of the nation's nursing homes — or 1 in 11 — have received lower Medicare star ratings for inadequate staffing levels, reports Kaiser Health News.

Nursing homes with lowered ratings did not have enough registered nurses or did not provide payroll data showing they met requirements for nursing coverage, the report states, citing federal records released last week.

Medicare recently implemented a new approach to calculating average staffing ratings at nursing homes, as required by the ACA. Medicare payroll records now provide data on staffing levels at nursing homes. Previously, such evaluations had been based on unverified, self-reported data from facilities.

A recent KHN analysis showed 25 percent of nursing homes submitting payroll records did not report registered nurses at work during October, November and December 2017. Federal officials do not require a minimum resident-to-staff ratio at nursing homes, but they do require facilities to have a registered nurse for eight hours daily and a licensed nurse around the clock, according to the report.

Overall, 1,387 of 15,616 U.S. skilled nursing facilities received one star out of a possible five from CMS for staffing on July 25, KHN's analysis of the latest Medicare data showed. Medicare said the facilities did not have a registered nurse for "a high number of days" over three months, provided unverifiable data or failed to provide their payroll data, according to KHN.

David Grabowski, a professor of healthcare policy at Boston-based Harvard Medical School, told the publication the Medicare action on nursing home star ratings for staffing represents "a real positive that they actually are taking the payroll-based system seriously, that they're using it to punish those nursing homes that either aren't reporting staffing or those that are below the federal limit."

Katie Smith Sloan, president of LeadingAge, a Washington, D.C.-based association of aging services providers, expressed disappointment in Medicare's action and cited a workforce shortage as the primary contributing factor.

"Our members are battling on multiple fronts to recruit and retain all types of qualified staff, and nurses in particular," she told KHN.

According to the report, CMS acknowledged challenges with reporting data for salaried staff in the payroll system, which focuses on reporting hourly work, but said nursing homes were notified in April of potential downgrades if they showed no registered nurses on the clock.

Read the full KHN report here.


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