It’s that time of year when we all start looking to the future and a chance to start fresh.

The Centers for Medicare & Medicaid Services is no different, and officials there have delivered an early gift to help providers like you map out where they should focus their compliance efforts — not just for 2024, but for 2025 as well.

In an otherwise very dry memo to state survey agencies Nov. 20, CMS prodded inspectors to focus on three core areas over the next two years. Federal surveyors will follow-up in those same areas to check that on-site surveys hit all the required investigative steps.

Not surprisingly, nurse staffing led that list. This will be central to the agency’s nursing home regulatory push, especially if it can somehow get a first-ever staffing mandate into final form and enact it in the next year or so.

CMS over the last two years has increased how much staffing information it collects and incorporated more of that data into its Five-Star ratings. Under Payroll Based Journal reporting will become even more critical, with the latest quarter of data determining whether facilities are meeting proposed per patient day hourly minimums for registered nurses and certified nurse aides.

That means, more than ever, that providers must capture fully and accurately their staffing levels and understand what might be excluded, and what won’t be.

CMS itself also is under more pressure to ensure staffing data remains a viable measure of actual hours worked. The Health and Human Services Office of Inspector General last month announced that it was adding a broad audit of PBJ nursing home data to its 2024 work plan.

And before that, we should get a look at how well CMS has used early PBJ data in having surveyors review whether nursing homes met the existing requirement for “sufficient” staffing. OIG said last January its aim was to push CMS to improve the enforcement of federal nursing home staffing standards by state surveyors. 

So it makes sense that CMS would want to shore up its data collection and reporting processes, and to make sure its inspectors know how to use what they find for compliance purposes. That know-how will lay the groundwork for measuring staffing success and giving providers the information they need for a waiver if their efforts are unsuccessful.

And for providers who fail to submit PBJ correctly or incompletely, let’s not forget that you won’t even be eligible to seek a staffing mandate waiver.

The other two focus areas shouldn’t necessarily come as surprises either.

Nearly a year after launching off-site audits of schizophrenia diagnoses, the agency wants its surveyors to follow up by poring over psychotropic medication uses that might be unnecessary.

CMS views antipsychotics as drugs of last resort. Emphasizing that state surveyors must pay close enough attention to their use is just a new way to keep pounding that message home.

Antipsychotic drug use and concerns about rampant schizophrenia diagnoses among elderly nursing home residents were two major areas hit on by CMS Director of Nursing Homes Evan Shulman on the conference circuit this fall.

So, too, was the idea that providers are too often invoking involuntary, facility-initiated discharges, particularly for patients with behavioral health or substance use disorders.

And that will be the third area of focus for federal survey follow-ups in 2024 and 2025.

Shulman himself has acknowledged just how tricky meeting the spirit of discharge regulations can be.

“[Discharges] are very, very complex, in that a discharge could happen and the resident may not agree with it, and that could be non-compliance,” Shulman explained. “But — and this is very important — a discharge could happen and a resident may not agree with it and it still could be a compliant discharge. It really just matters: Did the facility follow the regulatory structure?”

This is why it’s helpful to know what’s coming. The roadmap gives time to reexamine policies and procedures, reach out for more resources and get survey-ready — even for the most complicated issues. 

Don’t let the rest of the year dwindle away while you make resolutions for 2024. That fresh start? It can happen as early as tomorrow.

Kimberly Marselas is senior editor of McKnight’s Long-Term Care News.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.