CMS announced in April that it will use PBJ data to determine each facility’s staffing measure on the Five-Star rating tool.

By Jane Kincaid

Performing well on the Centers for Medicare & Medicaid Services (CMS) nursing home quality measures is linked to obtaining and maintaining, higher star-ratings in the agency’s Five-Star Quality Rating System. And, of course, performing well on quality measures is also linked to the jobs of nearly every team member and nearly every aspect of care in a nursing home.

One of the most important aspects of quality care rests upon the shoulders of the nurse assistant (also known as CNAs), who spends more time with residents than any other staff member.

Payroll-Based Journal (PBJ) 

The amount of time staff members spend with residents is important and it must be documented and tracked to ensure proper care and proper staffing for shifts. In 2017, CMS began tracking hours spent and other data related to direct care for residents through an initiative known as the Payroll-Based Journal (PBJ) program. As a result, nursing homes must submit the following data to CMS on a quarterly basis:  

  • Direct Care Staffing Hours: All providers must submit the number of hours worked by each direct care staff member each day within each quarter.

  • Staff Tenure & Turnover: For each direct care staff member identified, providers must also submit start dates and end dates.

  • Census: Each facility must provide its census data on the last day of each of the three months in the quarter.

CMS announced in April that it will use PBJ data to determine each facility’s staffing measure on the Five-Star rating tool. According to a memo issued to the state surveyors, the agency will conduct staffing data audits to “provide lessons-learned from audits conducted and guidance to facilities for improving their accuracy.”

CMS said in the memo that nursing homes whose audits “identify significant inaccuracies between the hours reported and the hours verified, or facilities who fail to submit any data by the required deadline will be presumed to have low levels of staff,” which will result in a one-star rating in the staffing domain, and will also drop their overall (composite) star rating by one star for a quarter.

Also in the memo was an admonition to nursing homes that they not forget the “importance of RN staffing and the requirement to have an RN on site 8 hours a day, 7 days a week.” In addition, nursing homes reporting 7 or more days in a quarter with no RN hours will receive a one-star rating in the staffing domain, which will drop their overall (composite) star rating by one star for a quarter. This action was slated to be implemented in July 2018 (after the May 15, 2018, submission deadline for data for first quarter of 2018 data).

Keeping Up Your Star Ratings

So how will nursing homes contend with this challenge of keeping up their star ratings? One application that uses real-time location is iNFORM, a wireless or wired nurse call system from Cornell Communications, a Senior Housing Forum partner. iNFORM is a nurse call system that features two-way communication and real-time data on staff productivity and resident care levels. Many care centers have found that their residents stay longer and occupancy increases when staff utilizes iNFORM to reduce response times to resident needs. It also runs on an easy-to-use iOS mobile device that can accommodate multiple applications interfacing with the Electronic Health Record and other resident management systems.

To learn more about the products and services available from Cornell Communication, call (800) 558.8957 and visit their website at:



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