Home Health & Hospice Week

Stay on top of restrictions--or be shot down yourself.

Surveyors may be wielding a new tool the next time they come around: a camera.

A letter from the Centers for Medicare & Medicaid Services to surveyors, released Sept. 29, explicitly gives surveyors a green light to take photos "to support a finding of noncompliance."

Details: The survey and certification letter, S&C-06-33, tells agency directors that surveyors may use photography during the survey process to collect evidence to support their findings.

Surveyors can use photos to document examples of patient abuse such as bruises, improper or dangerous restraints, improper positioning, pressure ulcers, contractures, safety hazards, pest infestation, and faulty or dirty equipment, the agency suggests. Police the Surveyors The National Association for Home Care & Hospice has expressed "concerns regarding the use of photography in the survey process."

Top worry: Surveyors could use photos improperly, having a serious impact on home health patient rights, NAHC attorney Denise Bonn tells Eli.

To protect your interests, be sure that surveyors adhere to the guidelines set forth in the recent letter to survey agencies.
CMS spelled out the following basic rules of survey-linked photography:

•  Surveyors must obtain written permission of any individual to be photographed before pictures are taken.

•  A person's health and dignity "is always a paramount concern."

•  Nursing staff must be present if an individual's genital or rectal or, for females, breast area is to be photographed. As always, the surveyor must also have permission in writing in advance.

•  A surveyor may ask a legal surrogate to consent to photography if an individual is unable to do so. If unavailable, "the surveyor may use discretion in determining whether a photograph is necessary."

•  Only surveyors who are licensed nurses, physician assistants or physicians may survey genital, rectal or female breast areas.

•  Surveyors should avoid taking pictures that will reveal an individual's face or other uniquely identifying information.

•  CMS also advises surveyors to get a series of photographs, including an overview shot, a mid-range photograph, and a close-up. Measure scales and labels may be added, but only non-personal identifiers may be used to document photographs. Note: To view the transmittal, go to www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter06-33.pdf.