Home Health & Hospice Week

Tip: Have nurses start documenting time on verbal orders right now.

Instead of relaxing and enjoying the holidays over the next month, many home health agencies will be scrambling to get into compliance with the imminent Conditions of Participation.

"Merry Christmas to us all," jokes CoPs ex-pert Sharon Litwin with 5 Star Consultants in Cam-denton, Missouri. HHAs will be pressed to the limit over the always-hectic holiday period to make sure they are following the new CoPs to the letter, or else face survey citations and resulting consequences as serious as payment suspensions or program terminations.

"We're coming down the home stretch now," says Washington, D.C.-based healthcare attorney Elizabeth Hogue.

To boost your CoP compliance and head off survey woes, consider this advice from industry veterans:

1. Assess your compliance status. Before you know how much work you have ahead of you in the next month or so, you'll need to see where you're already fulfilling the CoP requirements - and where you're falling short.

Pay special attention to the hot button CoPs that surveyors are most likely to focus on, experts agree (see story, p. 347, for those priorities).

2. Generate your deadline strategy. Once you know where you stand, it's time to map out your plan for achieving full compliance by the Jan. 13 deadline for the new and revised CoPs. "Your first priority must be to get everything implemented by the deadline," urges attorney Robert Markette Jr. with Hall Render in Indianapolis.

Do this: "Prioritize the conditions and standards [you] are not yet compliant in and assign task forces to work on and get them done," Litwin says.

Keep in mind, "agencies should continue to look for efficient ways to meet the requirements with as little burden as possible for both staff and patients," Hogue recommends.

3. Undertake training ASAP. Many of your compliance strategies will likely focus on educating staff throughout your organization. "The most important thing for agencies to do right now is to educate their staff," urges Julianne Haydel with Haydel Consulting Services and The Coders in Baton Rouge, Louisiana.

Critical new CoP changes in Patient Rights, Emergency Preparedness, Care Planning, and more depend not just having the correct policies and procedures formulated and written, but in your staff understanding them thoroughly and executing duties accordingly.

4. Stay alert for the IGs. Your P&Ps and staff training are likely to need some updating when the Centers for Medicare & Medicaid Services issues the final version of the survey Interpretive Guidelines.

Reminder: CMS issued a draft version of the CoP IGs in late October via the National Association for Home Care & Hospice, and gathered feedback on them via the trade group (see Eli's HCW, Vol. XXVI, No. 39). While the IGs contained a few welcome clarifications, many gray areas HHAs hoped to see cleared up remained.

When the final IGs finally come out, "we have to read those closely and see what differences they contain compared to the draft IGs," Litwin counsels. HHAs should be sure they understand the IGs fully, since it will provide the map to surveyors. Hopefully the final IGs will "clarify a lot," Litwin says. "And will give us G tags."

Watch for: "The industry is not clear on whether verbal orders require a revised and newly signed PoC, or whether we can continue to handle them as we always have," Markette says. "The draft IGs could have stated very specifically what CMS required or how CMS interpreted this, but did not." Hopefully the final IGs will do so.

But don't be surprised if CMS doesn't come through with the specifics HHAs desire, experts say. It's more likely the industry will have to learn these details through survey trial and error.

5. Start early compliance, when allowed.

Some troublesome new requirements exceed the current standard, so HHAs can start implementing them early to help ensure compliance when the deadline rolls around. Agencies and their staff "can use these last few weeks to start building that habit," Markette recommends.

For example: Under the new CoPs, nurses must not only sign and date, but document the time, when signing a verbal order, Markette points out. "Agencies already have difficulty getting the nurse to sign and date," he says. "Adding the time will require developing a new habit and I expect, at least initially, this will not happen as frequently as we might have hoped. Just like you will keep writing 2017 on the date in January, I expect nurses will forget to include the time with their signatures ... because they have been doing it differently for years."

Act now: "There is no reason a nurse cannot include the time on her signature now and, for that reason, they should be requiring it now," Markette suggests. "Require it now, audit for it now, and correct/train on it when nurses make a mistake. This gives agencies four weeks to reinforce this habit."

6. Maintain current status. While preparation for the new CoPs is crucial, "agencies need to be careful that, through Jan. 13, 2018, they maintain compliance with the current CoPs," Markette urges. "I fear a 'gotcha' scenario in January" for those agencies that don't carefully stay in compliance with the current conditions.

Distinction: You can implement the revised standards early for "those areas where the new CoPs provide a greater right, so complying with the new CoPs would be simply going above and beyond the requirements of the current CoPs," Markette says.

7. Audit for compliance. Some agencies are ahead of the game and have implemented steps 1-5. Others are scrambling to finalize compliance before the deadline, Markette notes.

For the former, they can "use the next four weeks to audit their compliance efforts and educate/reinforce any weak areas," Markette counsels. For the latter, they can start auditing as soon as they get their new practices in place and follow up with the education.

8. Check state compliance. Don't forget that you still have to comply with your state regulations, which may not be updated in concert with the CoPs. Compare the two to know what you need to do.

For example: "In my state, there is still a requirement for a PAC meeting, and that has been eliminated in the CoPs," Haydel offers.

9. Keep updating your practices. As CoP implementation and enforcement develop, "continue to make changes as new ideas unfold throughout the year," advises consultant Karen Vance with BKD in Springfield, Missouri. "It's important to continue to tweak the processes until you reach a solution that meets the true intent of the condition, with a minimum impact on staff."

Note: For a free PDF copy of the draft IGs, email editor Rebecca Johnson at rebeccaj@eliresearch.com with "Draft IGs" in the subject line.