Medicare Compliance & Reimbursement

Starting in May, home health agencies won’t have to wonder if a friendly surveyor will show up on their doorstep armed with incriminating evidence from their OASIS-based reports — they know she will.

The Centers for Medicare & Medicaid Services provided training to surveyors last fall on how to include in the survey process information from OASIS-based reports — adverse event, outcome- based quality improvement, case mix, submission statistics and error summary reports. In the interim, many surveyors have used the reports to target their surveys — but many haven’t. Now CMS says in a Feb. 13 letter that “effective May 1, 2003, the home health survey process shall include the specific review and incorporation of information generated from the OASIS data … into the survey process.” That means all surveyors must use the pre-survey worksheets to determine which patients and areas to focus on.

The protocols and tools included in the 31- page letter from the Center for Medicaid and State Operations “will help surveyors identify specific closed records for review when on site for survey, as well as identify types of patients for focus who are ‘at risk’ for specific outcomes,” the letter says. Surveyors seem thrilled to possess “another baseball bat to go after home health agencies,” notes consultant Glenna Mills with Walnut Creek, CA-based Mills, Pollin & Associates. Her clients have reported already seeing surveyors arrive on the scene with lists of patient charts to look at based on adverse event reports.

In a perfect world, mandating surveyor use of this protocol would be helpful, Mills notes. HHAs  would be able to analyze their own OASIS reports, pinpoint their problem areas and either resolve problems or prepare a defense in preparation for a surveyor visit. “That should be a plus,” she says. But in this imperfect world of rate cuts and stretched resources, many agencies — especially smaller ones — simply haven’t had the time to look at their OBQI and other reports, Mills contends.

That means surveyors have a map that leads straight to agencies’ worst problems, and those agencies are woefully unprepared to defend themselves against citations.

Coupled with the General Accounting Office’s urging to toughen up on home health surveys, this new protocol could be enough to put well-meaning HHAs out of business.

At least CMS does stress in the letter that “onsite compliance decisions will not be based solely on OASIS data,” notes Chapel Hill, NC-based consultant Judy Adams with the Larson Allen Health Group. While surveyors are free to cite agencies from afar for OASIS encoding, accuracy and transmission problems based on their submission stats, other deficiencies must be investigated onsite before any action can be taken.

“The whole intent of using the OASIS tools in the enhanced survey process is to help to identify areas of potential quality problems” for further investigation, stresses Adams.

CMS agrees, reminding surveyors that the reports “are to be used to identify quality of care indicators, not quality of care determinations.”

If surveyors do try to make citations based on the reports rather than substantiated findings, HHAs can use these instructions to defend themselves against the action, Adams suggests.

The letter is at www.cms.gov/medicaid/ltcsp/sc0313.pdf.