Earlier this month, the Centers for Medicare and Medicaid Services (CMS) issued a memo with fresh instructions and guidance in the State Operations Manual (SOM) concerning surveys and enforcement.

The CMS updates affected Chapters 5 and 7 of the SOM to align instructions and guidance with current policies in Quality and Safety Oversight (QSO) memos and established practices, the agency said at the time.

Among the changes were revisions to Immediate Jeopardy (IJ) Priority Definition examples for Nursing Homes and clarification of off-site investigations. CMS also addressed survey team composition, survey procedures, and plans of correction, among other items.

CMS Pushes Control

Many of those reading the new requirements may have missed that the update is a “fairly comprehensive reset of how surveys are executed and how enforcement is carried out,” according to Jay Gormley, chief investment officer and COO, Advisory, Zimmet Healthcare Services Group, in a weekly update. The through line across all of the changes are consistency, documentation, and control.

“CMS is clearly trying to reduce state-to-state variability and move toward a more standardized national approach. Start with Immediate Jeopardy because that is where the biggest practical shift is happening,” he said. “The definition has not really changed, but the way CMS is pushing surveyors to apply it has. There is more focus on situations where serious harm is likely if action is not taken, not just where harm has already occurred.”

On the face it the new language may sound like a small shift, but it has real implications, Gormley said, as it “effectively lowers the threshold for when IJ can come into play. CMS is also being more explicit with examples, including discharge to unsafe settings, which brings more attention to care transitions and discharge planning as potential risk areas. The process around IJ is also getting more structured.”

There is more clarity on how it is identified, documented, and ultimately resolved. It is not just about fixing the immediate issue. Gormley said facilities are going to need to show that the underlying conditions have actually been addressed. And even after IJ is removed, the enforcement that follows does not just disappear.

Not Just IJ

Other areas for providers to note beyond IJ, he said, including:

• Complaint intake and triage, which are becoming more standardized, with more emphasis on documentation and timeliness.

• Offsite investigations being limited, which means more situations where surveyors are physically in the building.

• A continued push to include off-hours and weekend surveys to get a more realistic view of how facilities operate day-to-day.

• Plans of correction are more stringent, with general responses out and an expectation that facilities show how they are fixing the root cause and preventing issues from happening again.

• Civil money penalties being used in a more targeted way, and there is more visibility into how they are applied.

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