A report in the Journal of the American Geriatrics Survey detailing how the survey system for skilled nursing facilities has wide variation from state to state is not going to shock any provider familiar with the process, but the research does bring “useful color” to the issue, according to one analyst who has read the findings.

The report, titled, “Nursing Home Surveyor and Survey Team Characteristics Across States,” found large variation in the number of active surveyors working in each state.

“For example, we find that Alaska had 12.5 active surveyors per 1,000 nursing home [NH] residents in 2023, compared to Alabama, Mississippi, New York, and Pennsylvania who had fewer than 2.5 surveyors per 1,000 NH residents,” the report said.

The researchers also discovered wide variation in the intensity of RN usage and in surveyor experience. In Alaska and Minnesota, 85 percent of surveyor-survey combinations are associated with an RN compared to only 18 percent in Colorado and South Carolina, as an example.

‘Striking’ Discoveries

Jay Gormley, chief investment officer and COO, Advisory, Zimmet Healthcare Services Group, called the data cited in the report “striking,” and reflective of the fact that while the Centers for Medicare and Medicaid Services sets the basic rules for surveys, states are responsible for hiring surveyors and assembling teams, resulting in a patchwork system.

“Experience levels differ as well, with some states relying heavily on surveyors with four or more years on the job and others staffed primarily by newer surveyors. The authors are careful to say this does not automatically translate into stricter or looser surveys,” Gormley said. “Still, it clearly affects how much time surveyors can spend in facilities, how surveys feel on the ground, and how consistently clinical issues are evaluated.”

The bottom line is that the report reinforces the notion that rather than survey outcomes being driven solely by facility behavior or state-level policy. “The findings point to meaningful differences in who is doing the surveying, how teams are staffed, and how stretched those resources are in different parts of the country.”

Gormley said the key takeaway is that survey variation is not just about the rules on the books, but about capacity on the ground. Differences in surveyor staffing levels, RN participation, experience, and workload help explain why similar facilities can have very different survey experiences depending on geography.

“Lingering post-COVID disruptions, including staffing turnover and survey backlogs following the pause in routine inspections during the public health emergency, have amplified these dynamics. As survey outcomes continue to carry significant weight in ratings, enforcement, and public perception, this uneven survey infrastructure raises fundamental questions about consistency and comparability in nursing home oversight,” he said.

See the report at https://tinyurl.com/46wejew4.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.