Step Into Excellence: Harness Vital Sign Monitoring to Meet CMS Guidelines and Boost Five-Star Quality Rankings

A nursing home's reputation on Nursing Home Care Compare is central to its success or failure. High rankings showcase that your facility is doing the most important things right. Conversely, bad rankings are evidence of substantial problems behind the scenes and may be associated with issues like reduced occupancy and compliance issues. So, you're right to be concerned about your facility's standing with the Centers for Medicare & Medicaid Services (CMS).

Bad reviews can be difficult to bounce back from, as people may instantly reject a nursing home based on a low Nursing Home Care Compare rating. Plus, information like resident vaccination rates, penalties, and inspections are clearly displayed for all to see. So, there's no way to hide your facility’s shortcomings. It’s essential to bolster your rankings to remain competitive in the senior care industry. To do that, you must comply with CMS's guidelines to the letter.

In this article, we'll share how you can harness vital sign monitoring to meet CMS guidelines and boost your Five-Star Quality rankings. This approach could be just what your facility needs to reach new heights.

Get to know the CMS guidelines for skilled nursing facilities

Before you get into cleaning up or boosting your facility's CMS ratings, you need to know what the guidelines are. Otherwise, you will be making unfounded guesses.

Federal Register

The CMS participation guidelines for long-term care (LTC) facilities in the U.S. are outlined in the Final Rule, which you can find on the U.S. Federal Register website. The Final Rule is updated periodically to ensure that residents' health and well-being are adequately supported. You'll find laws spanning topics like staffing requirements, resident assessments, admissions, transfers, medication administration, and more. This is your basis for compliance and general operation. The great thing about the Federal Register is that you can search for specific laws for clarification rather than skim all 185 pages.

Here are a few rules included in the Final Rule:

• Pharmacists must review a resident's medical chart during each monthly drug regimen review.
• There must be an RN on the facility grounds 24/7.
• There should be no more than two residents in any one bedroom.
• Your facility should have an Infection Prevention and Control Program (IPCP) with an Antibiotic Stewardship Program. You must also designate an Infection Preventionist (IP).

CMS website

You'll find a treasure trove of information on the CMS website, including helpful blogs, advice from CMS, and information about specific rules before and after they go into effect. Just like with the Federal Register, you can do specific searches to find targeted information through the main menu. Becoming acquainted with the website and consistently reading up on it can help you become familiar with CMS's expectations for your facility.

Manuals and documents from CMS

Another avenue you can leverage to learn about CMS guidelines is CMS-provided documentation — packets and guides that come directly from the source. It's easy to file CMS documentation away in the "handle it later" pile, but this could be detrimental to your facility. At best, you could be missing out on helpful information that could positively affect your residents and staff. At worst, a rule left ignored could lead to compliance issues and stiff penalties.

Even if you can't get your hands on the documentation you received from CMS, you may be able to find it online on the CMS website. As a last resort, try requesting it directly from CMS. They may be able to direct you to it online or send it to you. It never hurts to ask for informational resources from CMS. You may be surprised by the quality of help you receive.

As a senior care administrator, you need to know the rules and regulations like the back of your hand. And if you look in the areas listed above, you're on the right track. Be sure to get outside help from an attorney should you need assistance deciphering the rules. Legal language can stump even the most educated individuals.

All of these rules help LTC facilities operate in a safer, more efficient manner. They will directly and indirectly help you with your ratings and quality improvement.

Nursing Home Care Compare: CMS Five-Star Quality ranking criteria

We've got a good understanding of where to find the CMS guidelines and rules you need. Let's explore the Nursing Home Care Compare website, the Five-Star Quality Rating System, and CMS's methodologies to rank nursing homes. The information to follow will give you additional insight on how to make positive change at your SNF.

Nursing Home Care Compare overview

To make it easier for people to weed out underperforming nursing homes, CMS has developed an intricate quality rating system and displayed the ratings on an easy-to-access platform. People don't have to spend as much time calling and evaluating facilities because of the helpful information on Nursing Home Care Compare.

People can access detailed ratings and information for a facility by going to the Nursing Home Care Compare website and typing in a location (and a facility name if they'd like).

After clicking "search," individuals can see the following for every facility:

• Their overall rating (1-5 stars)
• Health inspection rating (1-5 stars)
• Staffing rating (1-5 stars)
• Quality measures rating (1-5 stars)
• Detailed inspection results, staffing information, and quality measures
• COVID-19 vaccination rates
• Fire safety inspections and emergency preparedness information
• Penalties
• General facility information (location, contact information, number of beds, ownership type, etc.)

CMS Nursing Home Five-Star Rating System

Getting high ratings with CMS is not easy. Only 10% of nursing homes in a state can achieve a perfect rating. But that doesn't mean your facility can't be part of that 10%. Knowing the inner workings ensures you're able to focus on the right things and make meaningful changes.

Every facility gets an overall rating between 1 and 5 stars and an individual star rating for each of three categories  health inspection, staffing, and quality measures. The criteria behind CMS's Five Star Rating System isn't hidden; it's there for anyone who wants to review it.

Here's a quick breakdown of each category.

• Health inspection - The health inspection rating considers your last three annual inspection surveys and the last 36 months of focused inspection control surveys and complaint investigations. Any deficiencies uncovered during those surveys and investigations could reduce your final rating.
• Staffing - Your nurse staffing levels and turnover rate affect your staffing rating. How closely are you following CMS's recommendations for nurse staffing hours per resident day? Are you going through nurses at a high rate? Both of these factors affect your staffing rating.
• Quality measures - For this category, CMS rates facilities according to 15 different quality measures (QMs), some of which include the number of long-stay residents with UTIs, long-stay residents with one or more falls, the number of hospitalizations, and more.

The link between vital sign monitoring and CMS quality rankings

At first thought, it may seem like linking vital sign monitoring to CMS quality rankings is a stretch. It isn't. When you take the reins of vital sign monitoring and make it a priority in your facility, you create a domino effect that results in higher quality care and better CMS ratings.

Things become clearer when considering all that vital sign monitoring entails for the average skilled nursing facility.

Vital sign monitoring involves the measurement and notation of residents' vitals. But this doesn’t even begin to describe the function’s true scope.

Vital sign monitoring encompasses all of this and more:

• Integrating vital sign data into resident care plans.
• Training nursing staff and other professionals on the latest vital sign monitoring procedures.
• Compiling and monitoring vital sign trends and outliers on an ongoing basis.
• Taking steps to prevent infection risks related to vital sign monitoring.

The above functions work together to enable facilities to better manage resident health issues, immediately pinpoint health deterioration, reduce hospital admissions, create effective workflows, and keep residents and their families happier. These benefits spill over into the facility's health inspections, staffing, and quality measures, which are all considered in CMS quality rankings.

If you can get a handle on vital sign monitoring, you're not only investing in the well-being of your residents but positioning your SNF favorably in the senior care landscape.

How to use vital sign monitoring to rank higher on nursing home care compare

Effective vital sign monitoring can be a challenge, especially if this function hasn't gotten much attention before. In cases like these, you should expect to do a complete overhaul of your current vital sign monitoring processes and procedures.

Still, even if you have devoted time and resources to vital sign monitoring in the past, there's always more to learn about it. Below, we'll outline how to use vital sign monitoring to rank higher on Nursing Home Care Compare.

Set goals in line with CMS guidelines and Nursing Home Care Compare

Which of the CMS evaluation areas do you believe your facility could improve on? If your facility is currently rated on Nursing Home Care Compare, note any areas of opportunity. If not, use your best judgment.

Maybe your facility is struggling with the staffing metric — perhaps nurse turnover is high. Reducing nurse turnover to a certain level would be an appropriate goal. In the steps to come, we'll help you remedy issues like these.

Collect vital sign data

Collecting vital sign data is the foundation of any solid vital sign monitoring initiative. Nurses and administrators should collect the data necessary to make a difference — blood pressure, heart rate, height, weight, etc. — as well as pain levels and symptoms. With complete vital sign data, you'll have the tools you need to impact your facility's rankings.

It's not enough to simply compile the data in a spreadsheet or another run-of-the-mill program. This sensitive data should be stored securely in an application authorized parties can easily access. Doing so will make for seamless vital sign tracking.

Lean into vital sign monitoring technology geared toward SNFs

The amount of work mentioned up until this point may seem bewildering, and it has the potential to be. But if you have access to advanced vital sign monitoring gear and software, you could save time and effort and still achieve enhanced ratings.

Vital sign technologies of today include the following and more:

• Bluetooth-enabled vital sign equipment. This equipment reduces human error in vital sign documentation. When used in combination with vital sign monitoring software, you can sync and store the data in a secure digital location in seconds. No more writing down vital sign measurements on a slip of paper and entering them later.
• Wearable devices. Wearable devices allow your clinical staff to track a patient's vitals continually, regardless of their location. These devices can send out alerts in the event of an abnormal reading, quickly informing next steps and potentially boosting care quality.
• EHR systems tailored to nursing homes. Many nursing homes already utilize an EHR system to store resident documentation, but not every EHR is suitable for the LTC setting. Specialized systems enable you to leverage vital sign data (and other forms of data) and technological capabilities to help you and your staff reduce readmissions and better manage occupancy through enhanced decision-making.
• Vital sign monitoring software. Vital sign monitoring software is a dedicated application geared toward solving documentation issues and informing resident care largely through documentation automation. The best vital sign monitoring software options enhance operations by facilitating seamless staff workflows, ensuring data quality and compliance, and empowering your nurses and other staff to do their best work.

VitalLink, one of the leading vitals management applications, works by transmitting data from Bluetooth vitals equipment and securely syncing it to your existing EHR system. Staff can then add to the synced data (pain measurements, height, weight, etc.), set thresholds for readings, and get real-time alerts for staff to make timely, effective resident interventions. The result is a better-run facility equipped to provide stellar care.

With technology like this in your facility, you can reduce your nurses' and paraprofessionals' administrative workload. This will give them more time to provide direct patient care per CMS's minimum staffing standards.

Retrain Your Staff on Vital Sign Monitoring

Though your nursing staff has been trained in vital sign monitoring in the past, implementing periodic training sessions can help them resharpen their techniques. This applies especially to LTC facilities that will be adding new technology or equipment to their workflows. Doing so will build confidence in your staff, increase morale, and ensure that your residents are in the most capable hands.

Here are a few tips to ensure your retraining goes off without a hitch:

• Focus intently on how to use the required tech (software, equipment, etc.)
• Keep classes very upbeat to maintain staff engagement.
• Ensure that your staff knows when to expect training sessions.
• Push the importance of accuracy in vital sign monitoring.
• Inform staff of the vital sign issues you, as the administrator, seek to improve. Get them on board with your initiative.
• Build a sense of communication and collaboration among team members so everyone feels supported.
• Walk through current and/or changing workflows so all team members know what's expected of them in routine scenarios and emergencies. Designate specific team members for pertinent functions.

Set up and implement refresher courses regularly to keep everyone up to date.

Implementing ongoing training will help you build a team equipped to provide high-quality care. It can also reduce nurse turnover levels, which is fantastic for your CMS ratings.

Monitor vital sign data to uncover trends

Behind the scenes, a data analyst should be monitoring vital sign data over time to scope out trends or anything else of importance. They should monitor all of the pertinent vital sign data you can securely and reasonably compile, including resident respiratory rates, blood pressure readings, body temperatures, and more. Sometimes, sustained trends could indicate:

• Issues with staffing
• Opportunities for impromptu training
• Workflow issues

Continually monitor your progress against your goals

We recommend pairing your initiatives with ongoing facility monitoring. How else will you know whether your facility is improving? On the simplest level, vital sign data should be reviewed before and after significant changes like onboarding new technology or changing workflows. Note any differences and try to pinpoint the cause. Retain changes that bring you closer to CMS goals.

So, there you have it — how to use vital sign monitoring to get compliant with CMS and boost your Nursing Home Care Compare Ratings. Though there's no overnight fix for CMS rating issues, the information in this article gives you a solid roadmap to start with. We wish you the best as you work towards providing high-quality, recognition-worthy care for your residents and their families.