The Centers for Medicare and Medicaid Services' announcement last week that it plans to start using payroll data to ensure nursing homes comply with staffing requirements is a move toward stricter regulation, experts said.
Beginning Oct. 24, surveyors will use the Payroll Based Journal staffing data for inspections to ensure staffing requirements are met, such as having a registered nurse on site for eight hours per day or having licensed nurses on staff 24 hours a day.
David Grabowski, a professor of healthcare policy at Harvard Medical School, said the decision is the first step toward the Biden administration's plan to establish minimum staffing requirements in the industry within the year.
"This is sort of a glide path to that," Grabowski said.
Nursing home associations question the timing of such changes, noting the staffing challenges facilities continue to face in light of the COVID-19 pandemic. They say they want to comply with staffing requirements but continue to struggle to afford to hire workers.
"At this time, when the sector is finding its footing after years of COVID-induced financial stress and workforce challenges, continuing the additional pile-on of regulations will strain already-stretched providers," Katie Smith Sloan, president and CEO of LeadingAge, an association that represents 5,000 aging service providers, including nursing homes, said in an emailed statement. "We all know that staffing goes hand-in-hand with quality care, and our mission-driven members are working valiantly to stay compliant. But we continue to urge the administration to back its words of commitment to ensuring older adults' access to care with meaningful action and funding."
The Biden administration identified the nursing home industry as one in need of comprehensive quality and safety changes after seeing the disproportionate toll the pandemic took on residents in long-term care facilities. About 155,000 residents have died from the virus, CMS data show.
Terry Fulmer, president of The John A. Hartford Foundation, a nonprofit focused on improving care for older adults, said the pandemic brought longstanding issues with care and quality to the forefront and provided an opportunity to address those problems at the core.
"This is a golden moment to capitalize on the good will of this administration to improve care through staffing and improve financing for the care we need for older adults," Fulmer said.
But she cautions against penalizing facilities, because it could force some to close and further exacerbate care access in the industry. Instead, she recommends providing adequate funding for nursing homes to meet standards and hire workers.
"I think fundamentally, we want to get ourselves in a position to not catch people doing the wrong thing but to encourage them to do the right thing," Fulmer said.
Ashvin Gandhi, assistant professor at UCLA's Anderson School of Management, said he thinks facilities will be more diligent in filing payroll data precisely, knowing there will be more oversight.
"It gives us a much clearer picture on noncompliance," Gandhi said. "A health inspector can't be there all of the time. The state can't always be watching."
CMS was mandated by the Affordable Care Act to start collecting payroll data in July 2016 but hasn't used it for compliance issues, Grabowski said.
"To me, this was overdue to leverage the data," Grabowski said. "You want to get a picture of what staffing is like, not just when your surveyors are in the building, but really around the clock."
In the past, nursing homes were expected to self-report staffing levels over two-week periods, which didn't provide as much accuracy as the daily counts now being reported through payroll data, Grabowski said.
