Tag: Healthcare

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PBJ Reports: What you need to know

Nurse looking at a pb&j sandwich on her screen

Summary

  • The CMS requires long-term care facilities to submit quarterly Payroll-Based Journal Reports detailing direct care labor hours and payroll information.

  • PBJ reports include information such as work hours, work dates, job titles, and more.

  • PBJ information can be compiled and submitted to the CMS manually, or, time and attendance software can automatically build PBJ reports for you.

Nearly everybody loves PB&J sandwiches, save for people with severe peanut allergies of course. These deliciously gooey creations are packed with not only taste but nostalgia for the blissful freedom of childhood.

But I am not here to sing praises to the whimsical marriage of peanut and fruit. No, instead a more important topic must be discussed concerning an extremely close relative to the PB&J sandwich: the infamous PBJ Report.

 

What is a PBJ Report?

Payroll-Based Journal (PBJ) Reports are not scrumptious lunchtime meals, unfortunately. They are quarterly reports from long-term care facilities to the Centers for Medicare and Medicaid Services (CMS) detailing direct care payroll and staffing data.

This reporting began in 2010 with Section 6106 of the Affordable Care Act. In 2018, the CMS introduced the PBJ system to facilitate the process of collecting and gaining insight into direct care staffing.

Payroll-Based Journal Reports typically include the following information:

  • Employee ID
  • Labor classification/job title
  • Job title code
  • Pay type code (exempt, non-exempt, contract staff)
  • Hire date (optional)
  • Termination date (optional)
  • Work days and dates
  • Hours worked per day
  • Job/labor descriptions
  • Census data (optional)

Review the CMS’ PBJ Policy Manual for more details.

 

Why are PBJ Reports Necessary?

The broader answer to this question is that they help the CMS monitor staffing level issues within the long-term care industry. They also help increase the amount of freely accessible data available to the public for analysis. Lack of adequate staff in healthcare can have serious repercussions, and it is more commonplace than one would think with labor shortages persisting across the country.

More specifically, Payroll-Based Journal Reporting is necessary for nursing homes to maintain their Five-Star Quality Rating on the CMS’ nursing home compare website. A good rating is crucial for attracting patients and gaining referrals – something that can’t happen if a facility reports a lack of staff, or worse still, reports inaccurate staff hours.

The impact of accurate PBJ reporting cannot be overstated. In 2018, the CMS handed out 1,400 one-star reviews to nursing homes across the country for being insufficiently staffed. This came on the back of new regulation from the CMS stating that all long-term care facilities reporting four days or longer in a quarter with zero registered nurse hours on their PBJ report would receive a one-star rating. The previous cut-off was seven days.

Non-compliant PBJ reports may happen for a variety of reasons. For one, they could be due to healthcare facilities simply being understaffed. They could also occur due to manual calculation errors. Regardless, it’s essential that facilities figure out a streamlined way to record and report direct care worker hours accurately and honestly.

 

PBJ Submission

There are two methods for submitting a PBJ report to the CMS.

The first way is to manually enter all information into the CMS’ system via their website. This data would include info about employees, their hours paid to work, dates worked, and census information (optional).

Alternatively, you can skip all the manual work by using an automated time and attendance system for nursing homes or payroll system to create a report which you can then upload to the CMS website in XML file format. Seeing as the CMS’ reporting requirements are quite strict, you’ll need to ensure your report includes all the necessary data and is properly formatted according to CMS guidelines.

Registering to submit PBJ data requires several steps:

Review the CMS’ PBJ FAQ document for more information.

 

PBJ Report Deadlines

Below you can find the quarterly deadlines for PBJ submission to the CMS:

FISCAL QUARTER REPORTING PERIOD DUE DATE

1

 October 1 – December 31 February 14
2 January 1 – March 31 May 15
3 April 1 – June 30 August 14
4 July 1 – September 30 November 14

 

Automate PBJ Reporting to the CMS

Creating and submitting PBJ reports does not need to be difficult or time-consuming. With the right systems in place, maintaining staff records and generating reports is actually quite simple. What’s difficult is finding and retaining the staff you need to maintain a five-star rating.

Webinar: How to Retain Hourly Employees

With Workforce.com, long-term care facilities can automate PBJ reporting to the CMS, freeing up hours of admin time to work on more pressing issues like employee turnover and short-staffing. The cloud-based timekeeping system maintains employee info like job codes, titles, and pay rates, while recording hours worked, breaks, and pay on a daily basis. And with a click of a button, you can create an accurate PBJ report and export it as an XML file.

For more information on PBJ Reporting visit the CMS website or review their PBJ policy manual. If you want to learn more about how to automate PBJ reports, contact us today, or, visit our long-term care page to find out how to comply with the CMS’ five-star quality rating system.

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6 proven ways to prevent nurse burnout

Summary

  • Nurse burnout is a serious issue in the healthcare business and has several negative consequences for all parties involved.

  • Long work shifts, stressful work, high patient-to-nurse ratios, a shortage of nurses, and a lack of sleep are some of the causes of nurse burnout.

  • To prevent nurse burnout, leaders should address nurse concerns, support nurse wellbeing, encourage breaks, offer flexible hours, optimize nurse workflows, improve nurse-to-patient ratios, and work collaboratively with nurses.

As of February 2021, 47% of nurses wanted to leave their jobs in the US since their work was negatively affecting their health and wellbeing. The numbers are worse during the coronavirus pandemic, with 6 out of 10 health workers reporting that the pandemic has negatively impacted their mental health. Clearly, burnout is becoming a sad reality among nurses.

Nurse burnout has several negative consequences. It not only impacts their health, but it can also reduce the quality of treatment provided to patients, increasing the risk of medical errors. The emotional fatigue burnout creates also leads to high turnover rates for healthcare institutions, as was found in a study by the journal of applied nursing research.

What causes nurse burnout?

Nurse burnout happens due to several reasons, a few of which include:

  • Long work hours: Nurses are being given long work shifts with no time to rest. This takes a toll on nurses, as longer shifts are correlated with higher levels of burnout.
  • Stressful work: Nurses constantly have to deal with stressful medical situations, especially ICU and critical care nurses.
  • Staffing problems: In a recent survey, 83 percent of responding hospital and health system executives predicted nursing staff shortages. This shortage places higher demands on currently-employed nurses.
  • High patient-to-nurse ratio: The higher the number of patients being treated per nurse, the higher the chances of nurse burnout. A study noted a direct relationship between a high patient-to-nurse ratio (i.e., over 8:1) and medical errors.
  • Poor sleep quality: Research shows that 67% of nurses reported having experienced sleep problems, especially during the COVID-19 pandemic. A lack of sleep can negatively affect nurse health, leading to burnout.

Clearly, leadership must step up to prevent nurse burnout. Here are a few things they can do:

Address nurse concerns

Leadership can acknowledge, empathize, and address nurse concerns to make nurses feel valued. Nurses must be encouraged to openly share their concerns regarding burnout, so leaders can have a go at resolving them.

This can be done by allowing nurses to voice their concerns via an internal online forum or during one-on-one or team meetings. Shift feedback tools are also great for enabling nurses to leave feedback after each shift, so leaders can monitor nurse concerns and identify any early signs of burnout.

For instance, leaders can empower nurses to voice their concerns by giving them the opportunity to participate in decision-making, especially when it relates to their work. Nurses can be involved in discussions related to how patients should be treated, cleanliness and hygiene, break policies, standard of care, and more. Research has found that nurses are more likely to be fully engaged if they’re given autonomy and control over their work and if their opinions are valued by leadership, helping prevent burnout.

Support nurse physical and mental well-being

Leaders must ensure they’re paying heed to their nurses’ physical and mental well-being.

Employee well-being can be supported through sponsoring workout classes, partnering with gyms to encourage regular workouts, hosting meditation classes, starting a wellness program, or creating social events like potlucks or workplace birthday celebrations.

The Massachusetts Health and Hospital Association developed the Caring for the Caregiver initiative, which includes a focus on gratitude for nurses’ work, workplace safety, and wellbeing. As part of this initiative, they created a podcast called the Medical Professionals Empowerment Program, or MedPEP. Each episode contains tips to improve the health, wellbeing, and effectiveness of medical professionals.

Another great option to support nurses’ mental well-being is to provide on-demand psychological counseling services to help nurses cope with stress and emotional fatigue. Rush Health took a proactive stance by anticipating the risks of burnout and providing 24/7 psychological support to their employees for free. They’ve since reported a dramatic increase in the utilization of these services, especially participation in psychotherapy, coaching, and stress management training, which went from a few hundred employees in August 2020 to more than 1,500 in December 2021.

Encourage nurses to take breaks

While the law may not make it mandatory for employers to provide breaks, leaders should ensure nurses aren’t overworking themselves. Breaks ensure nurses are well rested to perform their duties with care.

Encourage nurses to take short breaks every 2 hours. These can be breaks between 5 minutes to 20 minutes long, so they’re counted as paid breaks. Breaks longer than 30 minutes could be unpaid.

Katrina Emery, a MICU nurse working on her doctor of nursing practice (DNP), started a “restorative break initiative” to ensure nurses get the breaks they deserve and also to shift the culture to one where breaks are mandatory. She started the initiative as data shows that 35 percent of nurses rarely or never take a break, and almost half of the nurses didn’t know the number of breaks allotted in their shift. The nurse scheduling software used by leadership should automate and administer breaks so nurses are aware of the breaks they get and also commit to them.

Offer flexible hours

Offer flexible scheduling so nurses can pick the shifts they’d like to work. Working on shifts of their choice where they work with coworkers they get along with, or at times that suit them, can help prevent burnout.

Flexible scheduling becomes easy with an employee scheduling software that empowers nurses to pick and swap shifts at the click of a button with managerial approval. Try to limit scheduling staff for long shifts greater than 12 hours since long shifts increase the risk for fatigue-related incidents and increase the time workers are exposed to infectious diseases.

In a recent study, 55% of nurses reported that more control of their schedule would decrease exhaustion, and 60% mentioned that they would have a better work/life balance if they were involved in their shift scheduling. Clearly, if leaders want to prevent nurse burnout, they must allow flexible scheduling by giving nurses control over their schedules.

Optimize nurse workflows

Nurses don’t always focus on their core priorities. Burnout can happen when nurses do too much work outside of their core domain. Workflows need to be optimized in a way that allows nurses to focus on what they’re best at.

For example, a nurse may be doing too much administrative work, which might be unnecessary and counterproductive. Working to optimize workflows so nurses can focus on their core duties and delegate the rest of the work to the right people can help prevent burnout. Using an electronic health record system for administrative tasks might help in automating repetitive workflows, freeing up time for nurses to take care of patients.

Improve nurse-to-patient ratios

Not only are proper staffing levels important for CMS compliance regarding things like PBJ reports, but they are also important for nurse well-being. The more patients each nurse looks after, the higher the risk of burnout. Improving nurse-to-patient ratios could help prevent burnout and also benefit both patients and hospitals.

By improving nurse-to-patient ratios, it’s possible to improve mortality rates in hospitals. A study found that with every nurse hired, there was a 7% reduction in mortality rates. Clearly, there’s a strong case for improving nurse-to-patient ratios, and while improving nurse-to-patient ratios may require bringing on additional staff, the investment can offset other expenses, such as high nurse turnover, poor patient satisfaction, and even poor patient outcomes.

One way to go about improving nurse-to-patient ratios is to utilize demand-based scheduling. Automation like this uses historical foot traffic and demand data to optimally build schedules around appropriate nurse-to-patient ratios. Managers can easily match the right amount of nurses to projected demand every day and make edits in real-time when conflicts arise, ensuring hospitals are never over or understaffed.

Leaders should collaborate with nurses

Leaders should work collaboratively with nurses to support nurse well-being. They should constantly monitor burnout rates through regular check-ins with nurses and step up to control burnout rates. Controlling nurse burnout becomes possible through the use of technology, having open dialogue with nurses, making them a part of well-being initiatives, and recognizing and appreciating their contributions.

To find out more about how workforce management prevents nurse burnout, contact us today or sign up for a free trial to see how nurse scheduling software can help.

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How COVIDCheck Colorado Optimized Operations Across 55 Locations

 

During the peak of the pandemic in 2020, emergency testing and vaccination service COVIDCheck Colorado was established to help return half a million disconnected and isolated people back to their normal lives. For Carol Carrasquillo, COVIDCheck Colorado’s site optimization director, this proved to be a monumental yet extremely necessary challenge. In charge of continuous improvement measures and training protocols across all testing locations, Carrasquillo understands more than most what it takes to optimize a workforce to provide the best possible level of care. 

CHALLENGE

With communities throughout Colorado suffering amidst the pandemic, COVIDCheck Colorado acted quickly to expand its operations. While this rapid expansion provided more public access to testing and vaccines, it was very difficult for Carrasquillo to control frontline staffing issues like no-shows, emergencies, and most commonly, overtime. 

“We weren’t necessarily keeping up with the number of staff on-site as quickly as we could,” says Carrasquillo. “When you’re getting those types of 80-hour weeks, there’s cause for concern because that’s not sustainable.”

She also struggled with ensuring all staff had proper medical training and credentials. “Vaccination sites are very particular about the credentials that someone has to have in order to vaccinate,” says Carrasquillo. “It would put us at a big compliance risk if someone were performing duties that they weren’t actually medically certified to do.”

Perhaps the biggest challenge Carrasquillo faced with operations was adjusting staffing levels across 55 different locations in response to fluctuating demand. “It was hard knowing who was at each site and when they were working,” reflects Carrasquillo. “We were doing everything in Excel spreadsheets.”

Carrasquillo needed a solution that would provide her with increased operational visibility so that she could better control labor costs, ensure proper medical compliance, and adjust staffing levels across all sites. She also wanted to equip her staff with technology that would help them perform their jobs efficiently, effectively, and above all, safely.

SOLUTION

Carrasquillo used Workforce.com to optimize operations across all 55 of COVIDCheck Colorado’s sites. The workforce management platform automated tasks such as timekeeping and schedule distribution. It also provided Carrasquillo with more visibility into key operational areas like staffing levels, medical compliance, and labor costs. 

“Without Workforce.com, we wouldn’t be able to assess our staff as far as where they are, when they are working, and how many hours they’re working,” says Carrasquillo. “Workforce.com is able to quickly assess where we can reallocate extra resources.”

RESULTS

Powered by Workforce.com, Carrasquillo orchestrated 3,400 frontline workers in the successful administration of 300,000 vaccinations and 800,000 tests. With an overhauled workforce management system, operations across all 55 COVIDCheck Colorado sites were streamlined to ensure the best possible efficiency, safety, and patient outcomes. Here are some of the specific ways Workforce.com helped Carrasquillo achieve this success:

Reduced labor costs

With its live insights into scheduled vs actual wages, overtime, and demand data, Workforce.com provides Carrasquillo with the information she needs to pinpoint and limit overspending wherever present. “I can see how much overtime is being worked on a weekly basis,” says Carrasquillo. “[Workforce.com] gives us visibility and raises red flags where we might have opportunities to address unnecessary overtime.”

Most importantly, these savings have enabled Carrasquillo to carry out the equitable deliverance of care, an important part of COVIDCheck Colorado’s mission. “We can take any of those extra dollars that we have and really go out to the different communities that we wanted to reach.”

Improved patient outcomes

Optimizing labor costs has also led to better patient outcomes. “We’re able to provide more resources to our sites and newer sites, to be able to run them right from an operational perspective, and test and vaccinate as many people as we can in the community,” says Carrasquillo. 

The results speak for themselves, as COVIDCheck Colorado’s NPS scores have consistently fallen in the nineties since implementing Workforce.com. 

Labor compliance at all sites

Using Workforce.com’s Qualifications feature, Carrasquillo can easily check on employee medical certifications and training requirements. “What it has allowed us to do is be able to quickly assess who is actually qualified from a medical certification perspective to do different roles,” says Carrasquillo. 

She can also automatically limit scheduling according to qualifications, meaning shifts assigned to unqualified workers are flagged for managers to see and change.

Greater workforce visibility

With a live timeclock feed, Carrasquillo and her site managers can see where and when people are working, making it much easier to track down employees who need to be sent to understaffed sites. 

“We’ve been using Workforce.com to capture and really assess our capacity,” Carrasquillo states. “We’ve leveraged it to look at how many appointments we have compared to how many people are scheduled and determine whether we have enough staff.”

With the help of Workforce.com, Carrasquillo successfully optimized operations at all COVIDCheck Colorado sites, helping bring emergency aid to thousands of people in need. At the core of this achievement was her ability to empower and allocate her staff with the right tools. 

“Your staff is what is really going to make or break your operations,” reflects Carrasquillo. “Whether you have enough to help serve customers or you have too many and need to reallocate them somewhere else, Workforce.com helps make things more efficient and effective.”

Following COVIDCheck Colorado’s success with Workforce.com, Carrasquillo believes change is imminent for emergency health services regarding how administrative tasks and oversight are carried out. “I think the future of the healthcare space is that we need to leverage and utilize [workforce management] in a way that just makes things more operationally efficient.”