CMS PBJ Update

Lisa Volk in Clinical & Quality

In April, CMS plans to post new Payroll-Based Journal (PBJ) staffing measures on Nursing Home Compare and use them in Five-Star rating calculations. CMS recently published PBJ data for the third quarter of calendar year 2017 through files posted here and plans to continue to do so quarterly moving forward.

CMS will post two staffing measures: RN hours per resident day (HPRD) and Total Nursing Staff (RN, LPN & Aide) HPRD which will replace the measures currently used from the form “CMS-671” completed during the annual survey. They will also post a Physical Therapy HPRD but do not plan to use this metric in Five-Star right away. See AHCA's summary below.

After analyzing the PBJ data, the AHCA research team has identified several staffing patterns that may hurt a center’s Five-Star staffing ratings, such as:

  1. Failing to submit timely MDS discharge assessments.
    • CMS uses the discharge assessment to determine your daily census which is used to determine the hours per resident day. Failure to complete an MDS discharge assessment will make your average daily census look higher than actual and will cause your HPRD to be lower than actual.
  1. Reporting daily RN hours of 0.
    • It is a regulatory requirement to have at least 8 hours of RN each calendar day. CMS plans to force the Staffing Component of Five-Star to ONE star when you have >7 days in the quarter with 0 RN hours in a calendar day
  1. Reporting outlier Aide and Total HPRD values.
    • When data on a given day looks out of range, which most often happens at the low range, suggesting incomplete data submission, this causes your center’s HPRD to be lower than actual.

The attached report has flagged centers in your state with these issues. We recommend members with these issues review their PBJ data submissions before the next deadline for Q1 2018 on May 15, 2018.

We hope you find this information helpful. If you have any question about the report, please reach out to the AHCA research team at<


Lisa Volk, RN, MS
Director, Clinical & Quality Services
518-462-4800 x15