For the first time, the Centers for Medicare and Medicaid Services has revealed key facts about the shorter survey option for select, “higher quality” nursing homes, including how many government survey agencies may be involved and the evolving nature of the program.

Risk-based surveys officially launched this spring and are billed as a way for CMS to help state survey agencies catch up on routine recertifications after extensive COVID-era delays. But officials have kept details about the process and which facilities are eligible close to the vest.

In a letter responding to concerns from the Center for Medicare Advocacy and others, Dora L. Hughes, MD, CMS Chief Medical Officer and acting director of the Center for Clinical Standards and Quality, announced that providers in at least 20 states will be involved. testing time.

“Our primary goal is to test the RBS in as many states as needed to ensure the survey is tested at facilities and among surveyors who are generally representative of facilities and surveyors across the country,” Hughes wrote in a letter shared by the CMA on Oct. 17. on Thursday.

“States will be selected in collaboration with government agencies based on the availability of surveyors cross-referenced by nursing homes eligible to receive RBS,” he added.

This qualification threshold has raised concerns among the Center for Medicare Advocacy, but also leaves nursing home operators uncertain about whether they have done the necessary work to benefit from a potentially shorter audit.

In a short website announcement in AprilCMS says higher quality is associated with “less history of citations for noncompliance, increased staffing, fewer hospitalizations, and other characteristics (e.g., no citations for harm or abuse of residents, no pending investigations for residents in immediate danger from serious harm).” He said he could show it. , compliance with staffing and data submission requirements).

In May, the Center for Medicare Advocacy was one of 15 groups. protesting vague definition in a letter to CMS Administrator Chaquita Brooks-LaSure.

“The criteria are inappropriately limited: fewer citations for non-compliance is not a meaningful criterion when many facilities have not sought standard (re-certification) for two to three years or more,” the CMA wrote at the time. he wrote at the time.

The organization was unimpressed by Hughes’ letter, which wrote last week that the definition was “remarkably weak” and again cited “decades of reporting” from the General Accounting Office documenting that the deficiencies were less severe than they actually were; 2% of facilities cited immediate danger and with unclear “higher staffing” criteria.

While not sharing specific CMS criteria and acknowledging that the RBS process may vary from state to state, Hughes insisted that surveyors will have high expectations of all providers involved in the program.

“Regardless of the criteria or RBS process, if there are any concerns identified regarding the care of residents, surveyors will expand the survey and will not leave the facility until all concerns regarding resident safety have been addressed,” he wrote. “Regardless of the type of investigative process, the safety of residents will always be a priority.”

Hughes also said that even in states testing shorter surveys, states still have broader oversight of investigating complaints where alleged noncompliance could put residents in immediate danger of serious harm.

CMS said it will continue to improve the risk-based survey and its effectiveness by comparing the results with those of a full recertification survey; Involving additional researchers in testing to investigate whether there are any undetected concerns; and holding “comprehensive debriefing sessions” after each round of testing to obtain feedback for potential future changes.

Uncertainty continues

This latest survey process creates further uncertainty for providers, who anecdotally report that the length of traditional surveys has increased, even though many states still fail to resurvey every facility annually as required by the federal government.

“We know there are many inconsistencies with the survey and certification system,” said LeadingAge Vice President of Health Policy Janine Finck-Boyle, who described the current CMS study as a “beta test.”

“Instead of the normal survey process that you have with all the tasks and all the special requirements, it would be a shorter period of time and less actual requirements,” he told attendees at a federal policy discussion at the LeadingAge Annual Meeting on Sunday.

Considering the new, expanded civil penalties; poll delays in most states; and other concerns about how surveyors interact with nursing homes, LeadingAge is conducting a project to map differences in state interpretations of CMS rules.

“While CMS is doing the risk-based survey and they’re doing their job, we’re looking at the inconsistencies in the survey process itself: the good, the bad and the ugly, and we’re trying to bring those to CMS. “We’re advocating for some changes,” Finck-Boyle said.

In addition to the risk-based approach, CMS also announced last week that it was adopting a new approach. new performance metric For routine recertification investigators. The composite score includes target scores for the number of shortages per 1,000 beds; percentage of surveys free of omissions; Percentage of surveys identifying extent and severity of G, H, or I; and the percentage of surveys that identified J, K, or L extent and severity.

Some see this as pressure on government agencies to move toward a national standard for citations.