Columnist Norris Cunnigham discusses infection control penalties.

Q: I understand state surveys of skilled nursing providers are incredibly backlogged. A break from surveys might feel good, but isn’t this extremely dangerous? 

A: Despite the Centers for Medicare & Medicaid Services directing state agencies in November 2021 to resume standard survey activity, 34% of skilled nursing facilities nationwide have been waiting more than two years for a standard survey. This is potentially an extremely dangerous situation for nursing homes nationwide.

First, surveys are intended to not only ensure compliance with safety and quality of care regulations, but also to help facilities with important and timely self-correction. Going more than two years without a standard survey can lead to existing issues getting much worse. 

The last two years have presented new and compounding issues like worsening staffing shortages and COVID-19 infection control issues, for example, amid increased expenses and revenue shortages. Given delays, and surveyors’ need to catch up, facilities can expect surveyors to take deeper dives than usual when they do show up. The likely result will be more citations and higher financial penalties — two outcomes that would be enormously unhelpful to this struggling industry. 

Moreover, providers will continue to be impacted by the F-884 tag for COVID requirements. Facilities can expect that surveyors will continue to nitpick infection control and vaccination requirements, policies and procedures as well. 

It is interesting that CMS points to staffing shortages among survey agencies as a partial reason for the survey delays. We can only hope that survey agencies nationwide and CMS will be empathetic to facilities suffering nursing shortages since they now find themselves in a comparable situation.

We can hope, but we should not count on it.