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WHITE PAPERPayroll-Based Journal(PBJ)Vijay AgadiPointClickCare CustomerKarey ThigpenPointClickCare Customerwww.PointClickCare.comCopyright 2016 PointClickCare . PointClickCare is a registered trademark.Richard WhitePointClickCare EmployeeLora ArpPointClickCare CustomerAmy CassataPointClickCare Customer

Payroll-Based Journal (PBJ)The goals of the Payroll-Based Journal (PBJ)Staffing Data Submission Program are to:1Standardize reporting requirements, and2Collect information related to direct care staffing (including agencyand contract staff) and facility census on a more frequent basis, in anelectronic format.These mandatory compliance measures are being undertaken in connection withSection 6106 of The Affordable Care Act, Ensuring Staff Accountability.iiThe data, when combined with census information, can be used to not only report on thelevel of staff in each nursing home, but also to report on employee turnover and staffingstability, which can impact the quality of care delivered. This further supports qualitydirectives such as AHCA’s Quality Initiative on Staff Stability, whose goal is to “decreaseturnover rates among nursing staff (RN, LPN/LVN, CNA/LNA) by 15% or achieve/maintainturnover rates at or below 40% by March 2018.” iiiTerraces of San Joaquin Gardens (employees)Helping you prepare forCMS NEW Payroll-Based Journal.Staffing ratios andstability have clearlybeen recognized asa key componentof positive residentoutcomes.There is a well-established link between facility staffing levels and quality of care.Staffing ratios and stability have clearly been recognized as a key component ofpositive resident outcomes. In studying staffing levels, Centers for Medicare andMedicaid Services(CMS) identified staff to nursing ratios, below which qualityissues will affect resident quality of life.i CMS also included staffing levels withinthe Five-Star system, making that data publically reportable and a marker ofquality care provision. Starting July 1st, 2016, electronic submission of staffinglevel data aims to improve the accuracy and transparency of the care providerratios reported.The collection of staffing data in a standardized format evens out the playing field forproviders, as it relates to consistency in the reporting of direct care workers.The new requirements ensure a comprehensive picture of all care providers – not justthose on the payroll – that have an overall impact on the quality of care provided to clients.Staffing represents the single largest operating cost in the long-term care industry.iv Themandate will focus providers’ attention on staffing, scheduling and the related costs of labor.Since staffing is used in the Five-Star Quality Rating and also reportable through NursingHome Compare, accurate reporting is important for your brand and reputation.The staffing measure is a complex calculation, but at its heart is the resident care contacthours the facility provides. Expanding the picture to include all direct care providers,regardless of employment status within the facility, paints a much better picture of the typeand frequency of care provision within each home. On full implementation of PBJ, homeswill be measured on both staffing ratios and staff stability understanding consistency in careis as important as staffing ratios to support person-centered care.vwww.pointclickcare.com 2

Payroll-Based Journal (PBJ)What’s new?Currently, all full time and part time staffing data used on Nursing HomeCompare and in the Five-Star calculations are derived from the CMS-671submission form.viThe current calculation relies on homes annually recording total nursing and RNhours worked (not scheduled), per resident per day over a 14-day time period.Total hours include RN, Directors of Nursing, Assistant Directors of Nursing,LPN/LVN, and Aides (Nursing Aides, Aides in training, Medication Aides andTechnicians). Contracted staff hours and non-payroll staff were not included anddepending on the stability of your staffing mix, could represent a significantamount of care provider time with clients.As of July 1, 2016, all of that changes.As of July 1, 2016 newregulations will be in effect.For most providers, this will meana process change, which requiresimmediate attention in order toimplement systems in time.With the new PBJ submissions, homes will no longer be simply submitting dataon employees, but on all facility based and external staff affecting care provision.The new guidelines require that homes track time for all direct care staff or “thoseindividuals who, through interpersonal contact with residents or resident caremanagement, provide care and services to allow residents to attain or maintainthe highest practicable physical, mental, and psychosocial well-being.” viiThis now includes direct care providers, employees, contracted staff andagency employees as well as medical professionals – all of whom will need tohave hours tracked and reported.Submission of reports will be required quarterly instead of annually and homeswill need to submit hours paid for services performed onsite or “direct care staff”hours which are auditable or trackable through some mechanism (for examplepayroll, invoices, or contracts). For the first time, facilities must be able to provethe direct care hours reported. For most providers, this will mean a processchange, which requires immediate attention in order to implement systems intime for the July 1, 2016 mandate.There is also a change to how the census is reported. Homes will now berequired to submit their full census as of the last day of the month with eachquarterly staffing submission, sorted by payer mix.CMS requires all payers to be funneled into one of three buckets; Medicare,Medicaid and other. This may differ from how you are currently tracking yourpayers, so understanding which residents fall into which category will help inproviding the right information back to CMS.www.pointclickcare.com 4

Payroll-Based Journal (PBJ)Act NOW!Providers need to be acting now. Before July 1, 2016, providers need to analyze their facility’scurrent reporting and data collection processes related to staffing and begin to plan, redesignand formulate a new process that will ensure the complete and accurate reporting of staffinginformation for both employees of the organization as well as contract staff who serve in theroles defined by CMS.Don’t be fooled – it isn’t as simple as just recording the comings and goings of your workforce. AllContract and Agency Staff must each have a unique Employee ID when entered into the systemviii– something that may not be happening now. Employee roles need to be mapped to one of 40specific labor codes for reporting. In the absence of the ability to capture and submit the dataelectronically in the home, the data needs to be entered manually into the QIES CMS-PBJ inputscreen; a process which has been conservatively been estimated at 2 FTE’s for every 100 staff.ixHomes should be reviewing staff mix now to properly identify labor categories and pay types forsubmission and ensure they are registered with the QIES system for submission.x Challenges will lie ina system’s ability to accurately capture time of contract and agency staff with the proper information.Sign-in and out sheets are hard to monitor. Homes should be reaching out to vendors and externalservice providers on how they will manage this data capture and submission. Providers shouldconsider partnering with time and attendance/scheduling software vendors to plan the methodsof collecting, assembling, storing, and reporting staffing data to CMS in a timely and efficientmanner.EHR vendors will be instrumental in extracting, aggregating and submitting the census dataappropriately as well.Terraces of San Joaquin Gardens, Patty Olino (employee)In a nutshell.The deadline is drawing near and homes need to beready now. The first submission deadline is November 14,2016 and having the right data collected is the key to asmooth transition. Communicating changes to all involvedparties will ensure consistent and accurate auditabledocumentation. EHR and Time and Attendance vendorsBefore July 1, 2016, providers need to prepare for:Staffing informationfor employees of theorganization as well ascontract staff who serve inthe roles defined by CMS.All contract and agencystaff must each havea unique Employee IDwhen entered intothe system.Employee roles need tobe mapped to one of 40specific labor codesfor reporting.The data needs to beentered manually into theQIES CMS-PBJ input screen ifelectronic data submissionis not in place.have thought through the hiccups and have developedprocesses, making them invaluable partners in meetingthat deadline. Managing the business of care is vital toyour brand, your reputation and most importantly, yourresidents. Keeping your stars and reputation aligned meanspreparing now for future changes.iKramer AM, Fish R. “The Relationship Between Nurse Staffing Levels and the Quality of Nursing Home Care.”Chapter 2 in Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes: Phase II Final Report. Abt Associates, Inc., Winter /read-the-law, iiihttps://www.ahcancal.org/quality ll-based-journal, vhttps://www.ahcancal.org/quality -Forms/downloads/CMS671.pdf, ointclickcare.com 6

PointClickCare has helped over 12,000 skilled nursing and senior living facilities meet the challenges of senior care by enablingthem to achieve the business results that matter – enriching the lives of their residents, improving financial and operational health,and mitigating risk. PointClickCare’s cloud-based software platform takes a person-centered approach to managing senior care,connecting healthcare providers across the senior care continuum with easy to use, regulatory compliant solutions for improvedresident outcomes, enhanced financial performance, and staff optimization. For more information on PointClickCare’s ONC certifiedsoftware solutions, please visit areCopyright 2016 PointClickCare . PointClickCare is a registered trademark.pointclickcareEHRwww.PointClickCare.com