2020 Occupational Mix Survey: Focus on job categories

By David J. Andrzejewski, CHFP, and Jay Sutton, FACHE, CNRA
| 6/16/2020
2020 Occupational Mix Survey: Focus on job categories

Every three years, the Centers for Medicare & Medicaid Services (CMS) requires all acute inpatient prospective payment system (IPPS) hospitals to complete the Occupational Mix Survey. The information gathered is used to determine the nursing salary portion of the hospital’s average hourly wage (AHW), which affects the organization’s wage index. This year, the survey is due Aug. 3. It previously was due July 1; however, CMS extended the deadline to aid hospitals nationwide that might not be able to complete the survey in time due to the COVID-19 crisis.1

The occupational mix factor has a direct impact on a hospital’s average hourly wage, and even a 1% difference in the calculation can make a difference of millions of dollars in additional reimbursement for providers. The occupational mix factor is calculated using hospital survey data and national AHW rates. This year’s survey uses 2019 calendar year labor data.

The survey comprises many data components. One area that hospitals often struggle with is correctly classifying the job descriptions within the survey’s nursing job categories. The following is an overview of the job descriptions within those categories and recommendations for correctly compiling this data for the survey.

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Defining nursing job descriptions

The CMS Occupational Mix Survey instructions provide a brief description and a standard occupational categories (SOC) number for all jobs.2 The survey comprises the following five nursing job code categories:

Registered nurses (RNs, SOC 29-1141)

Typical RN job functions include assessing patient health problems and needs, developing and implementing nursing care plans, and maintaining medical records. RNs may be assigned to various roles, such as:

  • Staff nurse
  • Advanced practice nurse (APN)
  • Case manager
  • Nursing educator
  • Infection control nurse
  • Performance improvement nurse
  • Community health nurse

It is worth nothing that APNs typically are paid by Medicare under a Part B fee schedule and not the IPPS. Therefore, they and all other positions reimbursed under Part B must be excluded from the survey.

Licensed practical nurses and licensed vocational nurses (LPNs and LVNs, SOC 29-2061) and surgical technologists (SOC 29-2055)

LPNs and LVNs typically care for ill, injured, convalescent, or disabled persons in various institutions, including hospitals, nursing homes, clinics, private homes, and group homes. They might sometimes work under an RN’s supervision.

The general role of a surgical technologist is to assist in operations under the supervision of surgeons, RNs, or other surgical staff.

Nursing assistants (SOC 31-1014) and orderlies (SOC 31-1015)

Nursing assistants, formerly known as nursing aides, perform, under the direction of nursing staff, a variety of duties, including changing linens and feeding, bathing, dressing, and moving patients. Orderlies transport patients throughout the hospital.

Medical assistants (SOC 31-9092)

Medical assistants perform various administrative and clinical duties under direction of a physician (not nursing staff), such as scheduling appointments, maintaining medical records, taking and recording vital signs, and preparing patients for examination. This category does not include the following positions:

  • Physician assistants
  • Phlebotomists
  • IT personnel
  • Health information management personnel
  • Medical secretaries
  • Ward clerks
  • General business office personnel

All other occupations

This category includes non-nursing employees who are included in IPPS reimbursable cost centers and outpatient departments that are included in the wage index. It also includes nurses, including APNs, who function solely in administrative or leadership roles and who do not directly care for patients themselves or supervise staff nurses who provide patient care. Other examples of personnel who fall into this category include:

  • Therapists and therapy assistants
  • Equipment technologists and technicians
  • Medical and clinical laboratory staff
  • Pharmacists and pharmacy technicians
  • Administrators (other than nursing)
  • Dietary and housekeeping staff
  • Personnel from the home office or related organizations if they perform solely administrative functions and work in IPPS cost centers and outpatient departments included in the wage index

Finding the right data

Some of the nursing job descriptions can be confusing or difficult to classify. If staff members need assistance determining the category under which a nursing position should be classified, they should consult with human resources. Nursing administration staff members can be another valuable internal resource.

It can be particularly difficult to determine a job code if an individual works in various roles. For example, some nurses might split their time between patient care and administrative duties. In these cases, job codes can be split as long as the individual’s duties are clearly defined in the job descriptions submitted to CMS on the survey.

The salary data submitted to CMS in the Occupational Mix Survey has a significant effect on a provider’s wage index. Making sure the survey data is submitted as accurately as possible is vital. For additional assistance with preparing for and completing the survey, healthcare organizations should seek help from third-party wage index specialists.

1 “2019 Occupational Mix Survey Hospital Reporting Form CMS-10079 for the Wage Index Beginning FY 2022,” Centers for Medicare & Medicaid Services, https://www.cms.gov/medicaremedicare-fee-service-paymentacuteinpatientppswage-index-files/2019-occupational-mix-survey-hospital-reporting-form-cms-10079-wage-index-beginning-fy-2022
2 Ibid.

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