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Long-term care providers must pay special attention to the CMS’ Payroll Based Journal (PBJ) system, which plays a significant role in ensuring staffing transparency and accountability. It also collects comprehensive data on staffing levels, employee details, and resident census information

But what exactly is the PBJ? The Payroll Based Journal is a reporting system established by the  CMS to collect staffing and payroll data from nursing homes and long-term care facilities in the U.S. The Affordable Care Act (ACA)—whose Section 6106 mandated electronic submission of staffing and census data to the CMS for nursing homes participating in Medicare or Medicaid programs—is what ultimately led to the development of the PBJ system. The Payroll Based Journal’s primary goals include:  

1. Ensuring adequate staffing levels

Researchers have consistently shown a strong link between staffing levels and resident outcomes, with higher staffing levels often resulting in better care quality and improved resident well-being. It is, thus, fortunate that, by way of the PBJ system, the CMS can:

  • Monitor staffing levels: By collecting data on the number of staff members, their roles, and hours worked, the CMS can analyze staffing patterns and ensure that facilities maintain appropriate staffing levels to meet resident needs.
  • Identify discrepancies in staffing levels: PBJ data allows the CMS to identify facilities with inadequate staffing and take action necessary to ensure compliance with federal regulations, thereby protecting residents from potential harm.
  • Encourage accountability amongst providers: The PBJ system incentivizes facilities to prioritize adequate staffing, as the CMS publicly reports the staffing data on the Nursing Home Compare website, which helps consumers make informed choices about nursing home care.

2. Promoting transparency

Transparency is needed in the long-term care space to better inform future residents and their families. Regulators also require transparency from long-term care providers, who must be held accountable for the quality of care provided. The Payroll Based Journal system fosters transparency through:

Nursing home staff analyzing staffing working hours for the CMS payroll based journal.
The CMS publishes the staffing data submitted through the PBJ system on the Care Compare website.
  • Public reporting: The CMS publishes the staffing data submitted through the PBJ system on the Care Compare website. This information enables seniors and their families to assess and compare facility staffing levels, promoting informed decision-making.
  • Enhancing oversight: PBJ data assists regulators in identifying potential staffing issues, monitoring compliance with federal requirements, and enforcing necessary corrective actions, thereby ensuring greater transparency and accountability in the industry.

3. Simplifying data collection

Data collection can be a cumbersome task, especially considering the staffing shortage and that there are approximately 26,514 nursing homes in the US caring for over 1.4 million residents. The PBJ system streamlines the data collection process, offering several advantages such as: 

  • Standardization: By requiring all long-term care facilities to submit staffing data in a consistent format, the PBJ system ensures that the collected information is easily comparable and reliable.
  • Efficiency: The electronic submission of data reduces the administrative burden on the  CMS as well as long-term care facilities, allowing nursing home staff to allocate more time and resources to providing direct care to residents.
  • Timeliness: The PBJ system enables the CMS to collect staffing data more frequently, ensuring that the information available to consumers and regulators is up-to-date and relevant.

One should note that long-term care facilities are required to submit Payroll Based Journal data to the  CMS on a quarterly basis. The reporting periods and deadlines are as follows:

  • Q1 (January-March): The data submission deadline is May 15th
  • Q2 (April-June): The data submission deadline is August 14th
  • Q3 (July-September): The data submission deadline is November 14th
  • Q4 (October-December): The submission deadline is February 14th

Direct-care staff—such as LPNs and RNs—must be reported in PBJ submissions, but staff not involved in direct care, like janitors and maintenance, are exempt from the reporting. 

Payroll Based Journal: CMS Five Star Quality Rating and How It Relates to PBJ

As part of complying with the Payroll Based Journal, CMS requires long-term care facilities to submit detailed staffing and census information, which the  CMS uses to ensure adequate staffing levels, promote transparency, and streamline data collection. 

Some of the details that the  CMS requires facilities to submit in their Payroll Based Journal include:

A group of nurses discussing the payroll based journal. The CMS requires long-term care facilities to submit detailed staffing and census information.
CMS requires long-term care facilities to submit detailed staffing and census information, which the CMS uses to ensure adequate staffing levels, promote transparency, and streamline data collection.
  • Employee unique ID
  • Hire date and termination date
  • Pay type code
  • Workday and date
  • Job category code and job title code
  • Hours worked per day/date

In addition to the above, the  CMS mandates accurate reporting of hours worked, particularly for night shifts that span two days. Therefore, facilities should observe the following before making a PBJ submission: 

  • Separate entries for night shifts: When a night shift extends across two calendar days, facilities must report the hours worked on each day separately. This ensures that the CMS accurately calculates daily staffing levels and avoids potential distortions in the data.
  • Overtime and breaks: Facilities should report actual hours worked, accounting for overtime, breaks, and any other factors that may affect the total hours an employee spends on duty.
  • Consistency in reporting: To maintain data reliability and comparability, it is essential that all facilities consistently adhere to these reporting guidelines.

So how does all this relate to the CMS’ Five-Star Quality Rating System? The CMS now incorporates weekend staffing rates for nurses and data on annual turnover rates for nurses and administrators (information obtained through the PBJ) when calculating the five-star rating.

The updated methodology for the staffing measure on Care Compare now includes four new components:

  1. Total nurse staffing hours per resident per day on weekends: This measure accounts for registered nurses (RNs), licensed practical nurses (LPNs), and nurse aides.
  2. Total nurse staff turnover within a given year: This component tracks the rate at which nursing staff leave and are replaced in a nursing home.
  3. RN turnover within a given year: This measure focuses explicitly on the turnover rate for registered nurses.
  4. The number of administrators who have left the nursing home within a given year: This component monitors the turnover rate for nursing home administrators.

These updates to the staffing measure have led to several consequences for skilled nursing facilities, such as:

  • A shift in staffing ratings: Due to the new methodology, one-third of nursing facilities nationwide experienced a decline in their staffing rating, with 939 facilities losing two or more stars.
  • Increased focus on weekend staffing and turnover rates: The inclusion of weekend staffing rates and turnover rates highlights the importance of maintaining adequate staffing levels and minimizing staff turnover to ensure quality care for residents.
  • Changes to overall rating calculation: The CMS no longer adds a star to a facility’s overall rating on Care Compare if the facility has four stars in the staffing domain. Now, only nursing facilities with five stars in staffing will receive an additional star in their overall rating.

All these changes emphasize the critical role of staffing levels and staff turnover in nursing homes. Therefore, it is up to long-term care leadership to adapt to these changes by maintaining adequate staffing levels and addressing staff turnover to ensure continued high-quality care for their residents.

Contact us here for a demo of payroll software that could improve your PBJ submission.

Payroll Software That Streamlines PBJ Submission 

The payroll process for long-term care facilities can be time-consuming and complicated, especially when it comes to meeting regulatory requirements for employee hours reporting. That’s where Experience Care’s new payroll system comes in. This long-term care financial software will soon be able to simplify and streamline PBJ submission by integrating Payroll Based Journal information into the system, ultimately saving time and money for long-term care facilities.

The challenge with most traditional payroll systems is that they don’t handle time and attendance tracking. This can be a problem as the CMS’ Payroll Based Journal reporting requires this information. 

To fill this gap, facilities typically use third-party punch clock apps, which results in additional costs and increased workload, as staff must spend time manually inputting this data into payroll systems. Not to mention, such manual processes increase the chances of errors. 

Experience Care’s new payroll system, headed for release in early 2024, is designed specifically for long-term care and post-acute facilities, eliminating the need for third-party punch clock apps. The system will allow facilities to import detailed employee hours directly into the payroll process, streamlining the electronic submission of quarterly Payroll Based Journal CMS reporting and saving at least one week of work per quarter. In the second release, it will fully automate the PBJ submission process as well.

The second release of Experience Care’s long-term care payroll system promises to further revolutionize the payroll process by introducing automated electronic submission of Payroll Based Journal data. This upgrade will eliminate the need for third-party vendors, making payroll management even more efficient and cost-effective.

With Experience Care’s upcoming payroll software, your facility will:

Nursing home staff analyzing data for PBJ submission.
The payroll process for long-term care facilities can be time-consuming and complicated, especially when it comes to meeting regulatory requirements for employee hours reporting.
  1. Save time and eliminate the need for third-party punch clock apps, reducing workload and expenses.
  2. Streamline electronic PBJ submission by allowing detailed time clock hours to be imported directly into the system.
  3. Enjoy a tailored solution specifically designed for long-term care/post-acute facilities, ensuring that regulatory requirements are easily met.
  4. Benefit from time and labor savings, especially for smaller facilities using manual entry methods.

The future looks bright for long-term care payroll management with Experience Care’s long-term care payroll.

The CMS Payroll Based Journal: What to Expect in the Future

The CMS continuously reviews and updates its regulations to better serve the needs of residents and improve the quality of care in long-term care facilities. And that includes the Payroll Based Journal system. So providers must stay updated on changes to PBJ reporting requirements, submission methods, and data elements. Regularly reviewing the CMS guidelines and participating in industry conventions are great ways to stay up to date. 

One easy way to better manage these changes is through the adoption of an effective nursing home EHR. As EHR systems and PBJ reporting software become more sophisticated, long-term care providers can expect greater integration, automation, and data analysis capabilities, which can benefit them for years to come. 

For more on recent trends in long-term care, read our blog and subscribe to the LTC Heroes podcast

Elijah Oling Wanga