Operate with an eye on quality, not the next survey cycle

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Steven Littlehale
Steven Littlehale
Every nursing home lives with the fact (and sometimes the fear) that surveys will occur on a regular basis. But the anxiety associated with an impending survey should be offset by the fact that the facility holds the secret to its own survey success – the knowledge of their customers.

The new challenge that may face providers as a result of an increase in surveyor workload and a decrease in fiscal 2012 Centers for Medicare & Medicaid Services budget requires a different approach to survey preparation.

In the interest of increasing survey and certification efficiency and effectiveness, CMS is exploring methods to increase the focus on certain high-priority areas: expansion of the Special Focus Facilities (SFF) initiative, inappropriate antipsychotic drug use, avoidable falls, and reduction in time spent for surveys of facilities that are consistently rated as 5-Star facilities.

How a facility manages these systems and uses data to track, analyze and detect changes becomes paramount in this new environment. Data analytics plays a major role in nursing home operations, from marketing to reimbursement to care outcomes. And today, providers have access to web-based analytics tools that help them make the most of their MDS data.

Armed with analytics, here are concrete ways in which providers can successfully manage survey outcomes:

• Use web-based tools to identify subtle resident decline in the areas of ADLs, Cognition, Mood, and Pain. Predictive analytics can target the probability of a resident developing a pressure ulcer or having a fall by the next assessment as well as the probability of death or a rehospitalization by the next assessment. This allows the provider to create not only a responsive care plan, but also a preventative one!

* Survey triggers related to staffing levels, allegations and complaints and recurrent deficiency trends

• First impressions are lasting impressions. How the facility looks, how staff interacts and how residents and families respond to the environment are often overriding factors that signal how the facility is doing. Just like an interview, the first 30 seconds leaves a lasting impression.

• Educate your staff, residents and families on the survey process. Everyone should have a basic understanding and be able to intelligently respond to surveyor requests. Provide support material and periodic informational sessions to expand the general knowledge levels.

• Don't just collect data; identify what to collect and why it should be collected. Use any available automated sources to organize and analyze data. Data trends are powerful visuals of facility performance and how systems improve over time.

• Know your ‘weak' areas and have written action plans that are actually implemented with documented follow-up. Your last survey findings will be a launching place for your current survey. Start there.

• Make sure the CMS 671 and CMS 672 information is accurate and reflects the facility current information for staffing and resident census and condition.

• Networking with your peers in your same survey district will help identify focus points of your survey team.

Finally, if and when deficiencies occur, develop and implement a plan of correction that is manageable and specific to the citation. Be sensitive to recurrent deficiencies regardless of severity and scope. Recurrent deficiencies, including Life Safety deficiencies, are good indicators that a facility is unable to sustain compliance over a period of time.

Survey success is not about operating within the survey window. It's about providing quality care 24/7, regardless of the time of year. A facility should operate with an eye on quality, not the next survey cycle.

Steven Littlehale is EVP and chief clinical officer at PointRight Inc. He is a gerontological clinical nurse specialist and former university instructor.

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