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

2. 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.

3. What do we know so far?
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4. 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

5. 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%

6. Number of Deficiencies Cited

7. 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

8. 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

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

10. Percent of Investigations Cited

11. Now What?

12. 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

13. 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?

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

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

16. 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?

17. 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?

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

19. 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?