CMS Guidelines Demystified: The Impact of Vital Sign Documentation on Your Facility’s Quality Scores

All nursing home administrators should strive for adherence to the Centers for Medicare & Medicaid Services (CMS) general guidelines and continually monitor their Nursing Home Care Compare ratings. Both have been put in place to protect residents and their families, staff at your facility, and more.

Low CMS quality scores can also sour your reputation, decreasing your overall appeal in the senior care market. They may also be a symptom of workflows and processes that need upgrading.

You're not alone if you’ve been having trouble meeting CMS guidelines or getting your Care Compare ratings up. With over 15,000 American nursing homes up for evaluation, senior care facilities nationwide are working on compliance and gunning for that 5-star rating. The good news is that there are things you can do to increase your CMS ratings and propel your facility to success.

In this blog, we’ll introduce you to advanced vital sign documentation and share how it can impact your facility’s quality scores. By the end of this blog, you’ll have some practical guidance you can put to use right away.

A rundown on CMS guidelines and quality scores for Skilled Nursing Facilities

CMS guidelines are wide-reaching and complex. Plus, they vary based on a variety of factors, including your facility type. Learn more below:

CMS guidelines

CMS guidelines are outlined in multiple online locations, but resources pertinent to nursing homes can be found on the CMS nursing home regulations and guidance page. The organization has made loads of information available on the following topics:

• Nursing Home Care Compare information
• National Partnership to Improve Dementia Care in Nursing Homes
• Nursing Home Enforcement
• Nursing Home Quality Initiative (NHQI)
• Policies and Memos to States and Regions
• Quality, Safety & Oversight-Guidance to Laws & Regulations for Nursing Homes

*This is not an exhaustive list of the helpful resources you’ll find. We encourage you to explore and see what you might learn.

Looking into CMS’s guidelines is essential if you want to make a difference in your facility and build your rankings. And the above link is a great place to start. If you don’t have the time to explore the regulations yourself, asking a legal professional for assistance is always a promising route to consider.

Compliance with general CMS guidelines will inevitably increase the quality of care your facility can provide.

CMS quality scores

CMS ranks each facility between 1 and 5 stars, with the bottom 20% of facilities getting 1 star and the top 10% of facilities getting 5 stars. Everyone else falls in between.

CMS calculates your quality scores using very defined criteria, which you can find in this CMS guide. Here’s a rundown of what the organization looks at when rating nursing homes:

• Health inspection – This category considers your nursing home and compliant surveys from the last three years. Surveys from before the last three years don’t carry as much weight as the more recent ones. Your facility is docked on deficiencies found in the surveys.
• Quality measure (QM) - This category includes both long-term and short-term QMs, such as ADL decline, UTIs, moderate to severe pain, and physical restraints among residents. Facilities must send QM data to CMS to be rated, and those who don’t will receive the lowest possible score for QMs.
• Staffing – The staffing metric comprises two metrics — the RN hours per resident day and the total staffing hours per resident day. The goal is to meet or exceed the CMS-determined staffing minimums.

For a more in-depth explanation of the quality scoring methodology, review the guide. Also, keep in mind that laws and regulations are always changing. So, it’s wise to be on the lookout for changes at any given time.

The impact of accurate vital sign documentation on SNF CMS ratings

Accurate vital sign documentation has a substantial effect on your SNF CMS ratings. This is because all of the factors considered in CMS ratings can be improved through vital sign documentation.

Before we explore that further, we’ll closely examine what vital sign monitoring means for progressive senior care facilities.

Collecting and loading vital sign data for later review are essential components of vital sign documentation, but there’s much more involved:

• Following documentation best practices, including leveraging vital sign documentation software and ensuring the security of vitals records.
• Publishing and distributing a preparedness plan for your staff and residents to follow in an emergency.
• Take steps to prevent infection while monitoring residents’ vital signs.
• Train staff to collect, sync/load, analyze, and manipulate vitals data properly.
• Workflows, chains of command, and communication channels should all be explored during training.

*This is not an exhaustive list of vital sign monitoring functions.

Getting on top of vital sign monitoring helps with your CMS ratings in some very specific ways:

• Cleaner nursing home and compliant surveys. Vital sign monitoring helps your staff make more targeted medical interventions quicker, develop more efficient workflows, cultivate a more competent staff, and more. This could result in fewer deficiencies.
• Better quality measure scores. Many CMS QMs can be improved by tight vital sign management. For instance, accurate collection, documentation, management, and analysis of the data enables you to take proactive action to reduce the percentage of residents who need help with ADLs or who develop UTIs.
• Improved staffing. Vital sign monitoring focuses heavily on utilizing technology where feasible. This includes leveraging solutions like EHR software and vitals management tools that save everyone time, reduce manual errors, and make it easier to deliver quality care. With more time to provide direct resident care, meeting those CMS staffing guidelines will be easier.

The key to quality score improvement at your facility

There is no one-size-fits-all approach to improving your facility’s quality score. To be successful, you’ll need to work hard on areas that need improvement while maintaining quality in other areas. As you might imagine, this will look different for every facility. For instance, if your facility struggles with certain QMs, you’ll need to work those out on a targeted basis.

That being the case, there’s one solution that every facility should explore to make things easier – invest in a proper vital sign monitoring initiative. Doing so results in some excellent benefits that not only improve resident care but aid in compliance, empower your nursing staff, and even help manage risk. Here’s a quick look at how to get started:

1. Collect vital sign data for all residents per current policies and schedules to ensure accuracy.
2. Review the data collected by nursing staff. Note anything that’s out of the ordinary and calls for a clinical intervention.
3. Do regular high-level data analyses to discover trends and outliers. The data may show that you need to make staffing changes, adjust room temperatures, change a staff policy, etc.
4. Do this over time. Like your residents, staff, and facility, vitals data is ever-changing. Quality score improvement is a long game, not a sprint.

Technology to ease the vital sign documentation process

Vital sign documentation, one of the most important functions under the vital sign monitoring umbrella, isn’t for the faint of heart. It’s time-intensive, potentially expensive, and difficult to manage. It’s for this reason that many senior care administrators struggle with it.

Thankfully, there are solutions out there that can ease the vital sign documentation process, saving you precious time, increasing productivity, and powering your vitals monitoring initiatives. They include:

• An EHR system. Such a system allows you to collect and store your resident’s health information in a centralized location for more coordinated care, adherence to privacy laws, and more. It aids in vitals review and management. If your facility hasn’t switched to electronic documentation, now is the time to do so.
• Vital sign monitoring software. This is dedicated, tech-forward software that automates the collection and syncing of your vital signs data. The best software solutions, like VitalLink, are secure and compliant and offer instantaneous syncing of vitals to your existing EHR using Bluetooth-enabled vitals devices. The result is saved time, enhanced efficiency, closer compliance, boosted data accuracy, and more. VitalLink also generates alerts for abnormal readings and seamlessly integrates with your existing EHR.

For even more information about harnessing vital sign monitoring and boosting your CMS five-star rankings, read this comprehensive guide on the topic.

So, there you have it — a quick guide to CMS guidelines, Nurse Care Compare rankings, and vital sign monitoring for senior care facilities. Vital sign monitoring very well could be the solution your facility needs to boost your rankings and overall quality. We are confident that the aforementioned information will empower you to push your facility to higher heights.