Home Health & Hospice Week

Tip: Reach outside your organization for a fresh set of eyes.

Civil money penalties can be a killer, and they are on the rise. The best way to keep CMPs from forcing your closure is to prevent deficiencies in the first place.

“Surveys are one of … the never-ending stories in home care,” says Washington, D.C.-based healthcare attorney Elizabeth Hogue. “Now that CMPs are being used, now is not the time for agencies to slack off on this story.”

Read on for expert advice on avoiding citations and the very dangerous alternative sanctions that could come with them:

1. Know the rules. It seems simple, but many home health agencies fail to do it. “Read the regulations, know the regulations and follow the regulations,” consultant Lynda Laff with Laff Associates in Hilton Head Island, S.C., stresses to home health agencies. “There are a lot of well meaning and not so well meaning individuals owning and running home health agencies who have not paid credence to the Conditions of Participation with regard to the actual appropriate delivery of care.”

The basics: “The focus should always be on providing medically necessary patient care — according to the regulations — most of which have been in place for many years,” Laff advises. “It is the agency’s responsibility to make sure the patient is Medicare qualified and that the services delivered are reasonable and necessary.”

“Agencies need to re-double their efforts to be sure they achieve and maintain compliance with the COPs,” urges former state survey director Rebecca Friedman Zuber, now a Chicago-based regulatory consultant.

2. Establish a compliance plan. The HHS Office of Inspector General has offered HHA compliance guidance for 17 years, but lots of agencies are still lacking a plan. HHAs need to be focused on survey compliance or risk damaging CMPs, counsels attorney Robert Markette Jr. of Hall Render in Indianapolis. An effective compliance plan — not one that is incomplete, outdated, or collects dust on a shelf — can help you do that, Markette recommends.

3. Audit yourself. Don’t let the surveyor be the one to uncover your compliance problems, when it may be too late, Markette warns. Check yourself first to make sure you are complying with all applicable COPs.

Focus: As a starting point, you may want to use the Centers for Medicare & Medicaid Services’ list of most-cited deficiencies (see box, this page). Begin your review with these hot spot areas.

4. Learn from your mistakes. Another focus point is your previous citations, Markette suggests. Under the CMP regulations, it’s not only condition-level citations that can carry penalties. Surveyors can impose penalties for repeated standard-level deficiencies too.

Standard-level deficiencies “may be cited at the condition level if they are repeat deficiencies or are evaluated as being extremely serious,” CMS explained in the 2013 HH PPS final rule that finalized the sanctions. The surveyor will make the distinction clear, if so, the agency said.

Clarification: At the request of commenters on the 2013 proposed rule, CMS clarified its definition of “repeat deficiency” in the final rule. It “means a condition-level deficiency cited on the survey that is substantially the same as or similar to, a finding of standard-level or condition-level deficiency citation issued on the most recent previous standard survey or on any intervening survey since the most recent standard survey,” the agency said.

The bottom line: “Don’t make the same mistakes this year as last year,” Markette exhorts.

5. Get help. After you have reviewed your compliance internally, it’s worth seriously considering getting an outside party to conduct a mock survey, Markette says. A consultant “may find things that you miss,” he notes.

6. Establish a point person. If you do a great job shoring up your compliance, you may still get into trouble if you can’t communicate that information to your surveyor when survey day rolls around. “Things can go south real quick” if you haven’t prepared a person to deal with the surveyor and walk her through everything, Markette warns. And keep in mind a scenario where the point person is out sick, on vacation, or otherwise unavailable.

Under CMPs, you may not be able to afford to get a citation and correct it later, while fines in the thousands rack up per day.

“The survey process is very subjective,” Markette warns. “Do your homework.”

7. Consider deemed status. While it doesn’t totally eliminate the chance of CMPs and other alternative sanctions, getting accredited by The Joint Commission or Community Health Accreditation Program (CHAP) means you won’t face alter-native sanctions on your routine surveys. HHAs with deemed status are exempt from alternative sanctions, CMS has confirmed (see story, this page)