Home Health & Hospice Week

A radically new blueprint for surveyor action goes into effect May 1, but you can use it to protect yourself by beating surveyors to the punch. The Centers for Medicare & Medicaid Services has ordered state survey agencies to implement a new home health protocol that requires surveyors to focus their investigation by using five OASIS-based reports (see Eli's HCW, Vol. XI, No. 36, p. 290). Surveyors must follow specific directions for each report that may produce patients for record review and/or home visits. Some state survey agencies already have begun using the protocol after receiving training, noted CMS survey and certification staffer Lynn Riley in a presentation at the National Association for Home Care & Hospice's annual policy conference April 7. But most states are waiting until the May 1 deadline, in just a few short weeks, to undertake the new measure. Home health agencies can ward off bad survey results, prepare to defend themselves and prevent future problems by finding their own weaknesses using the new protocol - before surveyors do. "Surveyors look at the same reports you look at," stressed CMS' Heidi Gelzer in the presentation. And surveyors must follow the same instructions agencies can follow themselves, by looking at the enclosed pre-survey worksheet CMS has issued to its surveyors. (See the CMS worksheet articles) HHAs can anticipate where surveyors will strike by looking at these five reports: 1) Outcome-based quality monitoring adverse event outcome reports for the most recent quarter. If the adverse event report doesn't cover at least 60 patients, surveyors will look at the most recent six months, Gelzer noted. HHAs can follow surveyors' path by first looking at two "Tier 1" adverse event outcomes: emergent care for injury caused by fall or accident in the home and emergent care for wound infections, deteriorating wound status. If any patients at all show up under those events, they are automatically subjected to a record review and a home visit.

"Tier 2" adverse event outcomes are a bit less serious. Surveyors focus on patients with these six events only if the agency-specific incidence rate is at least twice the national reference rate in the report. Home visits are optional for patients with emergent care for improper medication administration, medication side effects or emergent care for hypo- or hyperglycemia. Only record review is indicated for patients with a substantial decline in three activities of daily living, discharged to the community needing wound care or medication assistance, discharged to the community needing toileting assistance or discharged to the community with behavioral problems. Patients that experienced more than one adverse event are ideal targets for surveyor review, Gelzer pointed out. 2) Outcome-based quality improvement outcome reports for the most [...]