Growing concerns about the quality of care and service outcomes for hospice patients has led to a new set of survey rules governing the ways provider oversight is handled industrywide.
A 2019 quality of care report by the federal Office of the Inspector General found broad disparities in the delivery of services, which fueled legislation that raises expectations and significantly tightens standards for hospice providers. Going forward, they’ll be assessed in a more consistent and comprehensive manner than ever before.
The Consolidated Appropriations Act last year included a range of hospice survey reforms that will apply to all providers, include stricter, more comprehensive enforcement measures. While the federal rule became effective January 1, 2022, the new survey requirements were not authorized to start for 60 days from that date. Because surveyors need additional time to be trained in accordance with the new requirements, most hospice providers should find their own survey process will get underway much later in the year.
But in anticipation of the changes, providers need to get up to speed about what the new rules entail so they won’t be off-guard when they’re contacted by surveyors ready to proceed. Providers need to understand the requirements well in advance to be sure they’re in compliance, and that their own staff receive training on the new rules.
Here’s a rundown of the key new elements in the hospice survey process that hospice providers need to be aware of:
For the first time, survey findings will be reported publicly. The Centers on Medicare and Medicaid Services (CMS) will have the responsibility to make sure that the information is prominently and easily accessible and searchable. Timely updates should also appear as warranted. The requirement applies to all surveys conducted on or after October 1, 2022, and offers a level of transparency the industry hasn’t seen before.
Because citations for any deficiencies in quality of care or broader conditions of participation will be included in the posted survey, this exposure will be a strong driver for providers to show a clean survey.
In the event of noncompliance with specific requirement, the survey may also show the targeted educational plan or other corrective action being taken by the hospice provider.
Under the new rules, the timetable for conducting standard surveys is lengthening from a minimum of every 24 months to 36 months. Because of the greater stringency and broader liability in the reworked survey requirements, providers are given more time to implement corrective actions, as needed, that are also included in the regularly updated published findings.
State and local agencies must establish hotlines to collect, maintain and update information regarding certified hospices in their jurisdiction. They need to be prepared to receive complaints and answer questions relevant to their location. The number of complaints will likely rise substantially given the new centralized reporting requirements and the follow-up through additional surveys.
The hospice hotline may be connected to or entirely separate from any existing home health agency hotlines.
The new law requires that CMS establish training programs for surveyors, which brings consistency to the overall training process. It also prohibits surveyors from conducting surveys for agencies with which they have a conflict of interest. These conflicts include having been an employee or a consultant to the hospice in the previous two years, or having a financial interest in the program to be surveyed.
If a hospice is being surveyed by a single person, the surveyor must be a registered nurse, which is new requirement. If a team is involved, they must comprise professionals from multiple relevant disciplines (e.g., physicians, nurses, medical social workers, pastors).
If findings result in the need for follow-up education and other corrective actions, these should take place ore promptly and thoroughly. Enforcement remedies are being expanded and strengthened, including civil penalties not to exceed $10,000 per day until compliance is met. Programs requiring corrective action may have more options for training and other plans, including a suspension of payments and temporary management being brought in. Providers also have the opportunity to appeal any determinations of noncompliance.
Because the aim of the new rules is to reduce inconsistency in hospice survey results and improve the level of care for patients, the credibility and reliable of the findings should benefit the pubic and the industry as a whole.
How Wipfli can help
The hospice survey reforms from the CMS may require changes to your practices and processes to meet the requirements of the stricter new rules. Wipfli consultants can help you understand the impact of the rules and how they may affect your operations. It’s important to prepare now to ensure you’ll be in compliance. Contact us to learn more.
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