Home Health & Hospice Week

Mock surveys are the most reliable way to avoid condition-level deficiencies.

If your surveyor imposes alternative sanctions following your next home health agency survey, it’s likely to kill your organization.

“You’re on notice,” warns attorney Robert Markette Jr. with Hall Render in Indianapolis. “You’ve got to take compliance — including survey compliance — much more seriously now that surveyors are imposing alternative sanctions.” If you fail to do so, your bottom line, your agency, and even your own assets could be at risk.

Follow this advice to prevent the imposition of punishing civil money penalties and payment suspensions:

1. Devote resources to compliance. “Compliance costs money,” Markette acknowledges. Many agencies have let compliance activities slide as they are deluged with new requirements such as face-to-face physician encounter documentation.

Formerly, agencies may have assumed that they could just fix any compliance problems after a surveyor found them, without much hassle. Now, HHAs could face CMPs up to $10,000 per day for noncompliance, Markette stresses.

“Rather than pay steep fines” after the fact that could close your doors, “pay for proactive survey readiness,” he urges.

2. Generate or update your compliance plan. The HHS Office of Inspector General has offered HHA compliance guidance for 17 years (see https://oig.hhs.gov/authorities/docs/cpghome.pdf). Make sure you have a plan that you actually use, and that it is up to date with current regulations.

Pointer: Include survey compliance in your compliance plan, advises former Illinois home health survey director Rebecca Friedman Zuber.

3. Integrate compliance. You should also include survey compliance in your quality improvement process, recommends Friedman Zuber, now a regulatory consultant in Chicago.

4. Lay the groundwork. The key to avoiding survey penalties is, of course, complying with all regulations and requirements. “Good supervision and monitoring of clinical service delivery and documentation should prevent the most common issues in poor quality care,” Friedman Zuber notes.

Do this: Spot check your staff’s visits, Markette counsels. “You want to find problems before the surveyors do,” he urges.

5. Follow through on problems. You may have solid policies and procedures in place, but “even the best agency can have a problem,” Fried-man Zuber cautions. “The question is, do they identify it and deal with it?”

“We need to be policing ourselves in ad-vance,” Markette says. “We can’t afford to have a bad survey now that alternative sanctions are in effect.”

6. Train staff on survey protocol. Your worst nightmare may arise from staff ineptly responding to the survey. “A mad surveyor or a confused surveyor is a bad surveyor,” Markette warns. Make sure staff have all the documents required for a survey ready to go. Also, make sure you have a backup plan in case your main survey point person is out when the survey takes place.

7. Address hot spots proactively. “Two areas of noncompliance that have been triggering sanctions are failure to follow the plan of care, e.g. no explanation and authorization for missed visits, and failure to contact the physician when patient exhibits changes in condition,” relates William Dombi with the National Association for Home Care & Hospice.

HHAs in Indiana are getting dinged on infection control procedures, Markette shares.

Peruse CMS’s top survey deficiencies for more ideas on where to focus your efforts, Markette suggests. (See Eli’s HCW, Vol. XXIV, No. 15 for CMS’s top 5 HHA deficiencies. For a free list of CMS’s top 25 HHA deficiencies in 2014, email the editor at rebeccaj@eliresearch.com with “Top HHA Deficiencies” in the subject line.)

8. Conduct mock surveys. You’ll never know how ready you really are until you test it. And you don’t want to find out you’re not passing muster when a surveyor slaps you with a $10K per day CMP.

“Conduct mock surveys to determine whether [you] have a risk of a finding of condition-level deficiencies,” Dombi advises.

9. Make your mock surveys count. A poorly done mock survey may be worse than none at all, by giving you a false sense of security and allowing you to let noncompliant behaviors slide.

Tip #1: When conducting the survey, don’t give yourself the benefit of the doubt. “The HHAs should apply a strict construction approach to the CoP,” Dombi urges. “Consider any doubts left by record reviews to be resolved disfavorably, as that is the way surveyors are addressing the reviews.”

Tip #2: Use all the tools surveyors actually use when conducting your survey, Friedman Zuber recommends. They are available on the CMS website.

Tip #3: Although it will cost you money, getting an outside consultant in to conduct your survey is likely to give you the clearest picture of your survey readiness, Markette offers. “The cost of noncompliance is much steeper under sanctions than the cost of preparation,” he says.

10. Follow up. When you find problems in a mock survey, fix them proactively, experts urge. Then monitor the issue to make sure the problem stays fixed, Friedman Zuber counsels.

One reason CMS uses alternative sanctions is to address the issue of cyclical compliance — providers that fall out of compliance between surveys. Expect surveyors to crack down on the problem.