Long-Term Care Survey Process Bonnie Reed and Karen Tritz Division of Nursing Homes, QSOG

Disclaimer This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations. Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services. This publication is a general summary that explains certain aspects of the Medicare Program, but is not a legal document. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings. Medicare policy changes frequently, and links to the source documents have been provided within the document for your reference The Centers for Medicare & Medicaid Services (CMS) employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this guide.

What do we know so far? ????

Effectiveness? Number Invest/ Surveyor Total Investigation /Survey Average # Deficiencies FY2017, Trad   5.8 FY2017, QIS  5.3 23 April 11.60 55.90 6.26 May 11.42 55.52 6.5 June 11.47 55.26 July 11.41 54.72 6.6 August 11.38 54.16 SOURCE SOAR Abt

Other Effectiveness Measures Pct of Mandatory Tasks not Investigated Nationally 1-2% - Some states/tasks – 30% Scope/Severity (% of all deficiencies) QIS 2017 Trad 2017 LTSCP 2018 G+ 3.9% 2.6% Immed Jeopardy 1.5% 0.8% 0.7%

Number of Deficiencies Cited

Questions/Ideas Increase Effectiveness Cross referencing with other sources. % of 1-star staffed homes cited for sufficient staffing Review Investigative Pathways Resident Outcomes/Scope and Severity

Efficiency – Results to date Team Size Onsite Time Time/ Surveyor FY2017, Trad 4.4 101.55   23.08 QIS 126.02 28.6 April 5.15 140.28 27.80 May 5.13 139.05 27.48 June 5.08 136.28 27.21 July 5.06 133.34 26.97 August 5.01 130.12 26.67

Difference in Onsite Time/Team, 2017 v. 2018 Source – 670 Data QCOR

Percent of Investigations Cited

Now What?

Continued Improvement Post Implementation Plan How can we do better? Consistency Communication States/Regions/Central Office Post Implementation Plan? We developed an Implementation checklist for both regions and states We held kick off calls with every state and region Has anyone used this information and looked back to see how you can improve How can we do better? How to improve consistency? Analysis of F tags and SOD

Is there a Different Way to Do Business? Managing Computers and Software Updates Scheduling Surveys/Complaints Utilization of Survey Staff Training Is there a different way to do business? Dealing with computers and software updates What have we learned? auto update vs manual Scheduling surveys permanent set teams working 3-4 days/week instead of 5 starting surveys on Monday Utilization of staff specialty staff (e.g., pharmacist for med pass, LSC for kitchen environment) adding Perks (e.g., some states have said they are implementing more telework to help improve QOL for surveyors) Training routine staff training based on SOAR data? does cross training work?

Training & Resources What has taken place? LTCSP training Revised BLTCC Software release trainings Provider trainings New Regulations DNH website Surveyor Resource Folder

Training What is in process? Initial Pool Video Utilization of MDS on survey Surveyor Orientation Manual Phase 3 Regulations

Open Questions/Ideas Clear identification of further investigates Onsite Support Surveys Other? Routine Tracking Deep dives – rumor control – State decided not to implement? Surveyors not using computers at all? Audience: Anything surprise you? Anything you’re curious about?

How can we improve understanding of system, performance and results? Are the processes consistently effective/ efficient? What are the your results? What is the process for learning and improving? What is your help desk/IT support saying? Are you hearing from them? Qualitative feedback – hearing from teams?   SOAR Monthly Data Files - Training Feedback from States – What do you look at? Self-assessment. Help-desk inquiries – IT support – What are they saying? Are you hearing from them? Anecdotes – qualitative feedback – Is there a feedback loop from teams? Supervisors?

What would be helpful from CMS? Regional Office Ambassador Support SOAR Monthly – training on horizon Onsite Support Surveys Monthly Calls Help Desk E-mail box

Discussion of State Director Review What are the key 5-10 items you look at? What is most helpful? See Sample Handout– Anything you’d change?