HPPD and The Impact Of CMS’s July 2022 5-Star Quality Rating Changes

With the July 27, 2022 refresh, the Centers for Medicare and Medicaid Services (CMS) revised its methodology for calculating the staffing rating for long-term care facilities. In addition to existing staffing measures for registered nurses (RN) and total nurse hours per resident per day, the new staffing domain rating methodology includes four new measures:

  • Total nurse (RN, licensed practical nurses, and nurse aids) staffing hours per resident per day on weekends.
  • Total nurse staff turnover within a given year.
  • RN turnover within a given year.
  • Number of administrators who have left the nursing home within a given year

Similar to the Quality Measure (QM) rating, CMS converts performance on each measure into points. The points are then summed and the total staffing score is compared to staffing rating point thresholds to assign a rating of one to five stars.  Detailed specifications for constructing the star ratings are provided in the CMS Technical User’s Guide

Additionally, the methodology for assigning the overall quality star is also changed. Previously, facilities that obtained a four- or five-star staffing rating, received an additional star in their overall star rating. Now, only facilities with a five-star staffing rating will get an increase in their overall star rating. 

Staffing is front and center!

Thousands of nursing homes will likely face lower CMS star ratings with the changes in the methodology for the overall quality rating. Long-term care facilities that used to earn a “bonus” star for their 4-star staffing rating will see a rating drop unless they can raise their staffing rating to 5-star. Because of today’s market conditions, they may find it difficult to reach 5-star staffing.

The changes specify that a maximum of 100 points can be assigned for case-mix adjusted total nurse staffing and RN staff. Weekend nursing levels will earn you a maximum of 50 points. The level of administrator turnover will carry a maximum of 30 points, whereas total nurse turnover and RN turnover will each earn a maximum of 50 points. CMS gave a lot of significance to the new turnover and weekend staffing data in long-term care Five Star rating. With a competitive job market, retaining staff will be difficult.

What does this mean for long-term care facility administrators?

If you’ve previously relied on a four-star staffing rating to get an additional star in your overall star rating, there are steps that you can take to improve your staffing rating and reduce employee turnover.

  • Know your hours per patient per day (HPPD): You know that boosting hour-per-patient-day (HPPD) ratios is critical for improving CMS Star Ratings and avoiding regulatory enforcement fines. As patient census can change daily, you need to know the HPPD for each job code when scheduling your employees to ensure adequate staffing to meet your HPPD goals. Tracking all of this data can be difficult and time-consuming without the help of long-term care scheduling software like Snap Schedule.  
  • Offer flexible scheduling: With today’s competitive job market, your healthcare peers are more inclined to give employees flexible hours and self-scheduling. Offer shorter, flexible shift options and use software like Snap Schedule to offer shifts to employees and let them easily look up their schedules, pick up, and trade shifts from the mobile phones.
  • Revaluate your employee experience: Make recruitment and retention a priority if you want to stay competitive. It’s now time to reconsider your employee experience and introduce perks and programs to create a culture in which employees feel supported, valued, and heard. Those perks may include things such as transportation reimbursements, daycare expenses, and career advancement possibilities. 

Are you struggling to meet the new challenges of CMS 5-Star ratings? Relax – Snap Schedule is here to help. With its interactive dashboard, you can see exactly the HPPD for each staff position, what the patient census is, and more. Its time and attendance feature tracks work hours so you can use the data to submit Payroll-Based Journal (PBJ) reports to CMS. So don’t struggle – let Snap Schedule take the hassle out of it for you!