Home Health & Hospice Week

Will your survey history put you on the fast track for more scrutiny? If you operate in one of six states singled out by a recent report, you're more likely to get dinged on your surveys. That's what the HHS Office of Inspector General found when looking at "cyclical noncompliance" for home health agencies, according to its report issued Aug. 7 (OEI-09-06-00040). About 15 percent of HHAs repeated the same deficiency citation on three consecutive surveys, the OIG also found. These repeat offender agencies were most commonly cited for "written plan of care established and periodically reviewed by a doctor" or G Tag 158. (For all 10 most frequently cited deficiencies, see box, p. 228.) Cyclically deficient HHAs also received twice as many citations on average (11.3) as agencies that did not repeat citations (5.7), the OIG notes. Notorious 6: A whopping 64 percent of repeat offender agencies were in six states -- Cali-fornia, Florida, Illinois, Iowa, Michigan and Texas, the OIG adds. Only 30 percent of HHAs in the study population were in those states. That figure probably points out uneven application of the Medicare Conditions of Participa-tion by surveyors across states as much as a difference in the provider population, suspects Bob Wardwell with the Visiting Nurse Associations of America. "There certainly has always been significant variation in both State Survey Agency performance and in the composition of the home health agency community between states," Wardwell says. "There is a distinct difference in the survey process across the states," maintains consultant Sharon Litwin with 5 Star Consultants in Ballwin, MO. "Some states are much more lenient than others, which is certainly not fair to the agencies in very strict states," Litwin says. "I have had clients who should have gotten many deficiencies on survey, that have received none," Litwin tells Eli. "And in another state, very good agencies may have received four or five deficiencies -- it is that different between states." "There are always rumors and reports of particularly aggressive surveyors in some states," points out attorney Marie Berliner with Lambeth & Berliner in Austin, TX. "This may account for the disproportionate distribution." Provider populations just aren't that different. The OIG's finding "does in my opinion reflect surveyors' subjectivity in most cases," maintains attorney Elizabeth Zink-Pearson with Pearson & Bernard in Covington, KY. Agencies can also look to the demographics of the states in question, suggests Chicago-based regulatory consultant Rebecca Friedman Zuber. Many of the states have very large Medicare populations and many new entrants into the Medicare program, which could lead to more deficiencies. Often "there are problems with the providers who are new to health care altogether and do not understand the strictness of COP compliance," Pearson [...]