This article is sponsored by PointClickCare. This article is based on a Q&A discussion that took place during the Skilled Nursing News Clinical Conference featuring input from Genice Hornberger, Director of Regulatory Affairs of Skilled Nursing at PointClickCare. The Q&A took place on May 5, 2022. The discussion has been edited for length and clarity.
Skilled Nursing News: Genice, can you share with us a little about your background?
Genice Hornberger: I actually started my career on the provider side, in a skilled nursing facility, in my hometown. I’m a registered nurse by background, worked various positions within the organization, including Director of Nursing, I did MDSs for a while, moved into a regional position where I did clinical reimbursem*nt for quite a few years, and then eventually moved into an informatics position where I helped implement PointClickCare for about four years in 120 of our skilled nursing facilities.
Advertisem*nt
At that time, I started to understand how technology can really help create efficiencies in the caregiver’s workflow and really enjoyed that piece of it and moved on over to PointClickCare. I’ve been at PointClickCare for almost 10 years. Most of my time has been on the clinical product side, supporting a lot of our core clinical products. Now I am on our Regulatory Affairs team, monitoring regulations, ensuring that we stay compliant, and helping our clients stay compliant with regulations within our application. I get to dig into all the fun regulatory stuff, and I’ve been doing that probably for about a year now.
It’s interesting, the jump from the clinical side to the regulatory side.
Yes. I think it was a nice fit just because of my background and being a clinician. Sometimes you have to understand the world we live in and understand the provider side to be able to really understand what those regulations mean for our clients and then certainly for the technology that is supporting our clients.
Advertisem*nt
CMS has been focusing a lot on staffing and skilled nursing facilities, and earlier this year, they started publicly reporting several new staffing measures on medicare.gov and Care Compare. Can you give a quick overview of the new measures for us?
As you probably know, CMS started publicly reporting five new measures. Currently, they’re not incorporated into the five-star rating yet, although they have said that some of them will be incorporated in July. Two of them are around weekend staffing, so looking at total staff hours as well as registered nurse hours per resident on the weekend and then the other three are around turnover.
I think the former discussion ties nicely into this topic because certainly staffing is a high priority, but they talked a lot about the impact of staff turnover and its impact on staffing. The new turnover measures are looking at registered nurse turnover, total nurse turnover, and administrator turnover. It looks at how many staff members left in a 12-month period and stayed gone for 60 days or more.
I know CMS has really looked at how to calculate the turnover rate. I’m not sure it’s the perfect rate, but it’s a way for them to do it at a federal level across the board. The new measures started being publicly reported at the end of January which you can see on Care Compare, but like I said, they’re not factored into the Five Star ratings yet. We’re hoping CMS will share the specifications for that prior to July, but we may not see that until early July.
What are some of the insights you’re seeing with the staffing measures?
We did a little bit of analysis on what is the correlation between some of these new measures and the existing five-star ratings. One of the things that came to light was the RN staffing and specifically the RN turnover. I think what David was mentioning earlier, looking at his local leaders and where they have more consistency, it definitely has a positive impact.
One of the things that we saw from an overall standpoint with the RN turnover is for each star rating that goes up, there’s about a 5% decrease in RN turnover. If you look at a one-star facility, they have about 62% RN turnover on average, and then if we look at a five-star facility, they have about 41% RN turnover, so having that consistency in leadership, the RN staff that’s doing assessments and participating in the care coordination, I think that it really reflects in that overall rating.
When we compare it to total staff, there’s a little bit of a difference. For total staff overall, a one-star facility has around 60% total nursing staff turnover, and then if you get to the five-star facility, then it’s around 45% total nursing staff turnover, so there’s not as much of a change. There is still a change, for sure, and it does still impact that overall rating, but definitely seeing some differences between total nursing staff versus the RN staff in the two different measures.
I think the other thing, too, is the health inspections. When we compare the correlation there, we saw very similar numbers as well, and definitely a higher impact when there’s more RN staffing turnover as it relates to health inspections and really looking at those outcomes.
How do you see this evolving and how do you feel CMS will use this data in the future?
I think there are a lot of ways we’re starting to see this data being used. We certainly saw in President Biden’s Nursing Home Reform speech, talking about staffing minimums. Now we see it in the PPS proposed final rule. I know they mentioned staffing in the value-based purchasing measures. Specifically, they are proposing for 2026 a total staffing measure that would be similar to what we see in the five-star rating today, so they’re looking to incorporate that into value-based purchasing.
In addition, they’re looking at whether they should incorporate turnover into a value-based purchasing measure, so that is a request for information in the proposed rule. If you don’t normally comment, this is the time to comment on the staffing measures. We are seeing a lot of staffing measures being incorporated into state financial reimbursem*nt as well on the Medicaid side.
Then, how much time do operators have before CMS makes their decision?
CMS in the proposed rule did say that they were planning to still publish or put a rule out within a year of President Biden’s speech. I would say by the end of the year we’ll start to see some more discussion or more regulations around that, so certainly acting now is important.
How has PointClickCare helped facilities gather data around COVID vaccines, boosters, positive cases related to reporting guidelines?
Looking at that information we have in our infection control program where we can aggregate some of that data. We’ve done some updates in our system over the last couple of years to ensure we’re giving facilities an opportunity to collect the data that they need. We also have some discussions where we’re working to see how we can share that data more at a state level or even at a federal level for customers. There are still some discussions we’re having, but anything that we can do to try and help streamline that process and aggregate that data would be a win for our customers.
Were there any other points that you wanted to bring up given what you see in your role at PointClickCare that you feel operators would need to know?
I think certainly we continue to see and track a lot of the regulations that are changing at a federal level. Staffing is certainly a hot topic, and as we mentioned, even at a federal level, if we don’t see changes there, we anticipate seeing some changes at a state level. If they didn’t have staffing minimums or reimbursem*nt incorporated into their regulation, they are starting to really talk about that at the state level.
Being aware of that, always talking to your members of congress whether at a state or federal level is important to share your views and what is working in your facilities. We’ve heard some great success stories this morning, and being able to share those stories, it really does matter with your members of congress. They do listen and they want to hear directly from you.
PointClickCare provides fully integrated solutions powered by a mobile-friendly and regulatory compliant EHR and revenue cycle management platform. To learn more visit https://pointclickcare.com/.
