Eli's Hospice Insider

Published on Tue Nov 16, 2021 PDF

A provision of the hospice survey regulation is now more clear, and hospices are generally happy about it.

Background: The bevy of survey-related changes in the home health 2022 proposed rule last July included “the use of multidisciplinary survey teams when the survey team comprises more than one surveyor, with at least one person being a RN.”

Commenters on the rule generally were supportive of this change.

“This is a positive step that will increase the likelihood that survey results will include a comprehensive evaluation of the integrated nature of the [interdisciplinary group] and take into account the unique role that various professions play in the provision of the Medicare hospice benefit,” praised the National Partnership for Healthcare and Hospice Innovation in its comment letter.

“Diverse professional backgrounds among surveyors reflect the professional disciplines responsible for providing hospice care as represented in the hospice core services requirement,” said accrediting organization Accreditation Commission for Health Care in its comment letter.

“We appreciate CMS’ call ... for diverse professional backgrounds among surveyors to reflect the professional disciplines responsible for providing hospice care, and its recognition of the disciplines included in the hospice core services requirement,” National Association for Home Care & Hospice executives said in NAHC’s comment letter.

While the proposal enjoyed wide support, commenters wanted to know if two-person teams would be allowed to have two RNs serve as surveyors. (One RN is required.) “CMS’ language indicating that survey entities ‘should’ leaves some lack of clarity and promotes confusion about CMS intent,” indicated the National Coalition for Hospice and Palliative Care in its comment letter.

Many providers and their reps were pro-multidisciplinary teams. “We strongly support use of multidisciplinary teams when more than one surveyor is utilized for a hospice survey,” the Coalition stressed.

In contrast, the Accrediting Organizations were against the requirement to use multidisciplinary teams. “The Joint Commission strongly supports the use of two RNs when more than one surveyor is needed,” according to its comment letter. “An RN is best suited to perform hospice surveys, as most hospice CoPs relate to the care provided by nursing staff and staff qualifications. Non-RN survey members would be focused on only a narrow set of CoPs, limiting their contributions to multi-member teams,” said The Joint Commission’s Margaret VanAmringe in the letter.

“It is the professional with hospice experience that is key to a valid survey,” said CHAP CEO Nathan DeGodt in the AO’s comment letter. “If more team members are needed for a survey, CHAP adds hospice RNs.” That’s because “as a matter of efficiency and effectiveness, hospice RNs have the practice knowledge and experience to assess physical palliative patient care, as well as understand the role and benefit of psychosocial intervention,” DeGodt explains.

“Hospice nurses have participated in hundreds of interdisciplinary team reviews of patient/family need, recommending physical and psychosocial intervention, and assessing patient/family outcomes. These meetings include utilizing appropriate intervention by chaplains, counselors, and social workers,” DeGodt continued. “CHAP does not support the proposed required addition of chaplains or social workers or other disciplines to survey teams.” That’s because “not all social workers, chaplains or physicians are trained or have experience in palliative care or patient/family intervention prior to death or bereavement.”

In any case, most Joint Commission surveys are conducted by single RN surveyors, VanAmringe pointed out.

“There are numerous times that it is not necessary to send multiple surveyors on a survey; but rather the number of days on site for one surveyor may instead increase,” ACHC agreed. “We believe that the intent of the rule allows for two surveyors to both be RNs,” the AO added.

Now hospices and AOs have their answer on that issue.

“Because an RN will be on every survey team, to ensure that the survey team is multidisciplinary, if there is more than one surveyor, then the additional team members must be selected from other disciplines included in the interdisciplinary group,” CMS spells out in the final rule.