The Nursing Staff Turnover Quality Measure is a structural measure. This measure began impacting the Value Based Purchasing program this Fiscal Year, 2026. It further impacts Five-Star and Care Compare. Data for this measure is sourced from CMS’ Payroll Based Journal (PBJ) system.
The numerator for this measure is nursing staff who no longer work in the nursing home. This is determined by those individuals who have not worked in at least 90 consecutive days. The nursing staff considered for this measure are:
- Registered Nurses (RNs): RN Director of Nursing + RN with administrative duties + RN
- Licensed Practical/Licensed Vocational Nurse (LPN): LPN with administrative duties + LPN
- Nurse Aide: Certified Nurse Aides + Aides in training + Medication Aides/Technician
Regular employees and agency staff are included in this measure. For the numerator, data is used from four quarters based on the Fiscal Year (10/01through 9/30).
The denominator for this measure is individuals who work at least 120 hours within the 90-day period beginning with the 1st workday observed in the baseline quarter and the first 2 quarters used in the turnover calculation. The baseline quarter is the quarter prior to the first quarter used in the calculation.
Employees can have multiple ‘employment spells’. Those who return to work after more than a 90-day period may be used in the turnover calculation if they meet the requirements for subsequent employment. Basically, they are considered a new employee.
This measure requires 6 consecutive quarters of PBJ data as indicated in the chart below.
There are a number of nursing-home level exclusions for this measure.
- Nursing home did not submit PBJ data or submitted invalid data for 1 or more quarters used in the turnover calculation. It will not be calculated again until there are enough quarters with valid data to determine the measure.
- Nursing home did not submit MDS assessments and therefore there is no resident census information.
- Nursing home has less than 5 nursing staff – RN, LPLN, and nurse aides.
- Nursing homes with 100% daily total nurse staffing turnover for any day in the 6-quarterperiod when there were at least 5 eligible nursing staff. This is often due to a change in employee IDs, which is why it is an exclusion.
The calculation for this measure is:
For Five-Star, a facility receives more points for lower turnover. For those facilities who fail to submit data or submit erred data for 1 or more quarters used in the calculation, they will receive the lowest score possible for the Nursing Staff Turnover measure, which is 5 points. This scoring rule applies to all of the turnover exclusions noted above except for those nursing homes with less than 5eligible nurses.
Providers need to ensure they are submitting accurate and timely PBJ data as well as MDS data to ensure they receive optimal credit for this structural measure for the Value BasedPurchasing Program, Five-Star, and Care Compare.
To learn more go to CMS' Value Based Purchasing (SNF VBP) Program Scoring Methodology & Payment Adjustment.