The Centers for Medicare & Medicaid Services will be testing truncated survey processes starting in 2024, part of an effort to make on-site inspections more efficient as the agency deals with multiple compliance-monitoring challenges. 

“Over the last few years, we have looked for ways to improve the consistency, accuracy and efficiency of the nursing home survey process within the context of increasingly constrained survey resources,” Debra Lyons of the CMS Division of Nursing Homes said during a Skilled Nursing Facilities /Long Term Care Open Door Forum Thursday afternoon.

“The need to ensure surveys are conducted timely at high risk facilities has become urgent due to a backlog of surveys caused by the COVID public health emergency, increases in complaints and a flatline survey budget for eight years,” she added.

Earlier this month, CMS officials warned Congress that they would need to extend layoffs and limit activities if the government were to shut down and the agency did not receive a budget increase. The agency has not seen its survey funding increase to keep up with higher demand and recruitment and retention needs, officials have said.

Lyons said testing of the new survey processes will help surveyors complete tasks more “efficiently” and be tested “in limited instances where the risk of resident harm is demonstrated to be lower.”

“This would help surveyors where risk of harm is higher and help address the survey backlog,” Lyons added. “We expect to be conducting these survey tests over the next several months into 2024 as part of our regular testing of procedures that enable more effective oversight.”

While providers might see additional staff on survey teams to help conduct tests or notice new approaches to “investigations,” Lyons said the agency does not expect any new burdens on providers.

She noted the last major update to the survey process was in 2017, when all states migrated to a uniform survey process.

Later, pressed by a caller to give more details on what processes could be targeted or whether more activity might shift offsite, Lyons demurred.

“We are early in the testing phase right now so we really don’t want to share that, but as I said, we are looking for ways to more efficiently conduct the survey process and I think that’s where we will have to leave it,” she said.

Early in the pandemic, Sen. Bob Casey (D-PA) secured an additional $100 million in federal support for survey and certification activities, but routine compliance checks still lagged throughout 2023. A report this spring issued by the Senate Special Committee on Aging, which Casey chairs, found one of every nine US nursing homes had not had an annual survey in two years and that 32 state survey agencies had vacancy rates of 20% or higher.

He, like CMS, placed much of the blame on Congress and its willingness to “flatline” funding for oversight. Overall, the federal government spends 80 cents per resident per day on nursing home oversight, Casey said.

In April, Casey and Sen. Ron Wyden (D-OR) urged the Senate Appropriations Committee to add $566 million in funding to CMS’s Survey and Certification program. Congress, however, still hasn’t finalized a 2024 budget, instead passing a series of continuing resolutions that continue funding health agencies based on 2023 rates.

Also during Thursday’s call, another CMS leader noted that the agency would update the MDS manual again in 2024, but with just three significant changes.

Those incorporate two edits needed to align with changes to the SNF Value Based Purchasing program: The removal of self care and mobility discharge goals for patients admitted after Oct. 1, 2023, and the addition of COVID-19 vaccine reporting for residents to the MDS (separate from reporting currently done in a Centers for Disease Control and Prevention system).

In addition, the “small” 2024 update will add a place to report the use of a new high-risk medication: anticonvulsants. In late 2022, CMS agreed with an Office of Inspector General report that found it needed to do a better job of tracking anticonvulsants, whose use climbed in nursing homes amid a largely successful bid to reduce the use of antipsychotics.