Harmony Healthcare Blog

AHCA Provider Lounge Series: Meeting New Staffing Standards

Posted by Kris Mastrangelo on Tue, Jan 09, 2018


Reviewed by Kris Mastrangelo

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


Interview with Jim Gomez, President of the California Association of Health Facilities

Kris Mastrangelo, President of Harmony Healthcare International (HHI) interviews Jim Gomez, President of the California Association of Health Facilities (CAHF), in the 2017 AHCA Provider Lounge.  Jim discusses the new staffing regulations facing California healthcare faciliites, as well as the challenges those changes are creating.  (Audio transcription below).

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Transcribed Audio:

Kris Mastrangelo: Good afternoon. Here we are at the Provider Lounge at the 68th American Health Care/NCAL Annual Convention in Las Vegas Nevada. Today we have James Gomez, Jim Gomez, President of the California Association of Health Facilities. Welcome Jim.

Jim Gomez: A pleasure to be here.

Kris: We're so happy to see you and lots going on in California, it's a big state. We've had a lot of discussion on 5-star, staffing and surveys, but specifically in California you’ve had a recent regulatory change that happened.

Jim: Yeah, we had a law change. Currently the law requires 3.2 nursing hours for every patient so on a hundred bed facility you got to have 320 nursing hours in a day and the law just passed makes that number 3.5 which means we're going to have to have more staffing in our nursing homes. It’s going to be one of the highest standards in the nation. It also has a secondary standard which is 2.4 CNAs or certified nurse assistants. We think the lower part of the standard is going to be difficult to meet because there's such a demand for certified nurse assistants. California’s average salary $14 an hour competing with McDonald's and others that are paying $12 an hour. So, our biggest issue will be over the next 18 months relative to that is can we train and maintain the certified nurse assistant workforce. We're already at 3.7 hours per client but we're not at the 2.4. We have more RNs and LVNs than most states.

Kris: So, this is interesting. So not all states have a staffing parameter and you're saying you've had it, but prior to this new ruling which will go into effect next July … so by July 1st they will have to have a 3.5 nursing hour PPD and 2.4 certified nursing assistant and tell us for the states that don't have the said requirement, how do they know when they are not meeting that?

Jim: They come out and audit and they take a look at 20 days and if you fail on any one of those 20 days, you fail. So, they do it at random so you don't know which days of the year they're going to pick and so they pick…December 2nd, November 13th, January 1st… whatever they pick and you have to demonstrate through your payroll that you have met those standards of 3.5 and 2.4.

Kris: So, tell me what do you do if you don't have the staff?

Jim: You do over time and you force overtime and if you don't have that you look at nurse registry in terms of hiring people on a registry, which is more expensive and you don't typically don't get reimbursed for it so it's a big challenge. So, the real issue is how can you maintain a workforce and not have turnover at the 60, 70%. You get yourself down to 20 or 30% and improve your ability to retain staff. So once again a good management, a good empowerment of staff, you get to keep more people; bad management pushing people, not being sympathetic to individual needs, you may lose staff and as that turnover takes place turnover in any industry is a problem from a training standpoint.

Kris: 100%. What are the ramifications the CMPs, civil monetary penalties, if you do not meet the standard for the nursing hours?

Jim: In California, the real the penalty could be as much as $15,000 but the real penalty is if you fail the test you can't compete for a pot of money called QASP, the Quality and Accountability Supplemental Payment. It's 90 million dollars that all facilities compete for and the average facility that wins gets two hundred and fifty thousand dollars. If you to fail this standard you can't even compete, so you could be passing up a quarter of a million dollars by not meeting the minimum standard.

Kris: How many how many nursing homes are in California?

Jim: 150. 85 did not meet the 3.2 standards last year. The others all met the standard and so now that it goes to 3.5 that number is probably going to go up a little because people have to go out and recruit and retain more staff.

Kris: And of the that the QASP, the funding, how many of the eligible skilled nursing facilities receive money from that? Like fifty percent, two percent? What percentage?

Jim: About forty percent receive anywhere between 200 and 250 thousand and another 10 percent improve significantly over the year prior and they receive about fifty thousand. So as an example, if you were at the 30th percentile, if you go from thirty to forty you'll get 50 thousand here at the 50th percentile and you go to the 60th percentile you get 200,000. So, it depends a little bit on where you're at.

Kris: That's amazing. Well we're out of time but this was a wonderful conversation. I'm sure the viewers are going to love to hear about what California is doing. We know that your innovative and ahead of the curve in a lot of areas so thank you so much and also, I heard that you are retiring from your current role but you'll continue on in a consulting fashion.

Jim: Absolutely. I've had 16 wonderful years with the California Association of Health Facilities, been a member of mark Parkinson's team in the national level. I've enjoyed every single day of it but everybody's time comes in life, my time is now and I will move to consulting but I'll still have a wonderful fondness for the American Health Care and this whole profession.

Kris: Thank you, we're blessed to have you as well. Thanks for coming.


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