What Your CMS Staffing Rating Is Worth in Dollars

Staffing hours do two jobs at once. They feed the staffing domain of your Five-Star rating. And total nurse staffing hours per resident day are one of the measures in the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program, which decides how much of your Medicare Part A money comes back to you.

Most administrators know their star rating. Far fewer can say what a gap in staffing hours costs them per year. The tool below closes that gap.

Look up your facility

Enter your facility and the tool pulls your numbers from CMS's own public data for all skilled nursing facilities in the US. The data is updated monthly.

You get a high-level overview first, then your own numbers: your nurse hours, the gap CMS uses to set your staffing star, your exposure under the VBP program, and an estimate of what closing the gap could be worth with voize.

How the VBP withhold works

CMS withholds 2% of every skilled nursing facility's Medicare fee-for-service Part A payments. It then pays back between 50% and 70% of that pool as incentive payments, based on performance. In practice CMS redistributes 60% and keeps 40% in the Medicare Trust Fund (CMS SNF VBP overview).

Two things follow from that:

• A facility that scores well can get back more than was withheld.
• A facility that scores poorly loses money on every Part A claim for the whole fiscal year.

An example with round numbers

This is an illustration, not a prediction. Take a facility that receives $5 million a year in Medicare fee-for-service Part A payments.

• CMS withholds 2%: $100,000.
• A facility that lands exactly at the average payback of 60% gets $60,000 back and is out $40,000.
• A facility that scores below average gets back less than $60,000. A facility that scores above average gets back more.

Your own figure depends on your payment volume and your performance score, which is why the lookup above uses your real data instead of an average.

Where staffing hours come from

Staffing hours come from the Payroll-Based Journal (PBJ), which facilities submit to CMS every quarter. The data is built from payroll and timekeeping records, not from clinical documentation. The resident census comes from MDS assessments.

CMS divides the hours by the number of residents to get hours per resident day. It then adjusts them for resident acuity using PDPM nursing groups, so your case mix index matters for the staffing rating too.

That makes staffing the one domain where your own records decide the result directly. If hours are missing or reported wrong, CMS counts them as missing. A gap in hours is also a number you can see, track and act on during the quarter, before it shows up in a payment.

For the six staffing measures and how points map to stars, see how the Five-Star staffing rating is calculated.

What to do with your result

Treat every number in the tool as a starting point for a conversation with your finance and staffing leads. To talk through your numbers with the voize team, book a demo.