Administrator Verma’s blog post details CMS’s efforts to improve the facility survey process (“Strengthening Oversight”) and specifically, the steps CMS has already taken, how CMS plans to continue its efforts going forward, and CMS’s proposed transition to a risk-based survey model that will “target low performing nursing homes.” Administrator Verma pointed to “variation across states in terms of the issues State Survey Agencies (SSA) identify” as the primary driver behind the agency’s efforts to strengthen oversight of the survey process. The steps already taken by CMS, along with those planned for the future, will have far-reaching impacts on the facility survey process, and how nursing homes and SSAs operate in general.
CMS’s first efforts to strengthen oversight were primarily meant to reduce burdens on the SSAs and bolster consistency in the survey process. These efforts included the new “Immediate Jeopardy” guidelines issued in March of this year, CMS’s move to a computer-based survey process, and CMS’s overall efforts to improve the survey process and evaluate SSA survey performance.
The new Immediate Jeopardy standards primarily address how SSAs respond to Immediate Jeopardy reports, and CMS claims that the new standards provide SSAs with “clear and consistent procedures when evaluating noncompliance that constitutes Immediate Jeopardy.” CMS also claims that the new standards are not only meant to protect patients, but to correct previously inconsistent enforcement efforts and ensure providers are held to uniform standards and survey processes.
CMS’s new computer-based survey process incorporates the October, 2016 revised nursing home requirements and is designed to ensure consistency in the survey process. The computer-based process provides SSAs with “streamlined, clear direction” on nursing home safety standards and standardizes the data CMS has available to assess SSA survey performance. Together with its revised IT infrastructure, CMS intends to use this new data to improve the existing Federal Oversight Support Survey process and make it easier for CMS to monitor survey quality and ensure transparency between CMS and the SSAs. As it moves forward, CMS plans to evaluate several other potential initiatives, including how it can use its own regional teams to improve the survey process and ensure SSAs are consistently applying quality and safety rules, along with potential ways to better address SSA performance issues.
Lastly, Administrator Verma revealed that CMS asked Congress, via their 2020 budget proposal, for authority to transition to a risk-based facility survey model. This proposed model would allow CMS to shift top performing facilities from the current annual survey model to a survey every thirty (30) months, with no more than thirty-six (36) months between surveys. CMS is proposing this change in order to “reinvest the [anticipated] savings to strengthen our oversight and quality improvement efforts” for lower performing facilities. This could be great news for consistently high performing facilities. It should also serve as a warning call for low performing facilities.