Home Health & Hospice Week

Immediate jeopardy determination will make the biggest difference.

How will a surveyor decide you just need some training versus imposing punishing civil monetary penalties? And if you are subject to CMPs, how will the Centers for Medicare & Medicaid Services set them? All of these elements would play into the decision, CMS says in its 2013 HH PPS proposed rule:

1. Whether the deficiencies pose immediate jeopardy to patient health and safety;

2. The nature, incidence, degree, manner, and duration of the deficiencies or noncompliance

3. The presence of repeat deficiencies, the HHA's compliance history in general, and specifically with reference to the cited deficiencies, and any history of repeat deficiencies at either the parent or branch location;

4. Whether the deficiencies are directly related to a failure to provide quality patient care;

5. Whether the HHA is part of a larger organization with documented performance problems;

6. Whether the deficiencies indicate a system wide failure of providing quality care.

Using these factors, CMS generated a CMP rate chart based on the seriousness of the deficiencies cited (see chart, p. 208). Here's the rationale for where a deficiency would fall in that system:

• Upper range -- A deficiency that poses immediate jeopardy to patient health and safety
• Middle range -- A repeat and/or a condition-level deficiency that does not pose immediate jeopardy, but is directly related to poor quality patient care outcomes
• Lower range -- Repeated and/or condition-level deficiencies that do not constitute immediate jeopardy and are deficiencies in structures or processes that do not directly relate to poor quality patient care.