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Home Health & Hospice Week

Hospice:

Boost Compliance Under New Survey Protocols With 10 Expert Tips

Published on Fri Feb 10, 2023

End of COVID PHE heightens hospices’ risk under new framework.

Hospices have a lot to grapple with in the massive revamp of Medicare survey protocols.

Wise agencies will increase their chances of securing successful survey results by heeding the following advice from industry veterans:

1. Learn the new survey ropes. The Medicare Conditions of Participation hospices must comply with have not changed, points out attorney Matt Wolfe with law firm Baker, Donelson, Bearman, Caldwell & Berkowitz in Raleigh, N.C. The overhaul does not create “new or different substantive requirements for hospices,” Wolfe explains. “Notably, CMS has been explicit in stating that ‘all conditions of participation continue to have the same weight ... in terms of finding noncompliance and citing deficiencies.’”

That said, where surveyors will shine their spotlights is likely to change, as compared to past surveys. “We encourage hospices to read the new guidance,” says attorney Adam Royal with law firm Husch Blackwell in Austin, Texas.

“Hospices should become familiar with these procedural changes and the shifts in surveyor emphasis,” Wolfe urges.

Specifically, “providers should review the survey tasks, because the tasks have more detail in terms of what surveyors will be looking for during survey,” advises consultant Kim Skehan with SimiTree.

For example: CMS’ new sampling instructions tell surveyors to choose records related to live discharges, higher levels of care, and bereavement follow-through services (see story, p. 42).

And “hospices should closely review the surveyor tasks/ survey process changes, as the probe questions and audits, home visits, and document review are in some cases, more detailed than in the previous version of the SOM,” Skehan adds.

Bottom line: Get to know the new Appendix M inside and out. Hospices can also access the same training that surveyors must complete at . CMS released the training on Jan. 27.

2. Prioritize the four new core CoPs in P&P overhaul. While all the CoPs are important, you should put Phase 1 CoPs §418.52 Patient Rights, §418.54 Initial and comprehensive assessment of the patient, and §418.56 Interdisciplinary Group, and Phase 2 COP §418.58 Quality assessment and performance improvement at the top of your compliance to-do list.

“Hospices should ensure they have the policies and procedures in place to prioritize patient rights, especially as they relate to the development of the plan of care, and to monitor the quality of care delivered,” recommends Katie Wehri with the National Association for Home Care & Hospice.

“Hospices should carefully evaluate compliance with the four core CoPs … and be prepared to answer questions about how they meet quality of care requirements in each CoP,” says Judi Lund Person with the National Hospice and Palliative Care Organization

3. Check your facility contracts. In particular, new emphasis on patients not in their own homes, as well as clarifications of interpretive guidance for facilities, means you should double-check your facility contracts for compliance, experts urge.

“The revisions to the SOM Appendix M are helpful in identifying enforcement priorities for surveys based on the way that CMS has revised its interpretive guidance relating to certain regulations,” Royal tells AAPC. The fact that CMS has enhanced guidance related to facility contracts means you should train your attention there too.

“The professional management of hospice services for patients in a SNF/NF or ICF/IID should be done by the hospice,” Lund Person explains. “Hospices should pay special attention to the contracts and arrangements with facilities to ensure that the hospice maintains the professional management responsibility.”

4. Bolster your complaint processes. Under the new guidance, “surveyors will be reviewing the hospice’s complaint log,” Wehri notes.

The updated SOM Appendix M tells surveyors to request “documentation of grievances/complaints, including complaint logs and investigations with their outcomes during the past 12 months.” Surveyors should “verify that the hospice is tracking complaints and review the documentation of complaints made by patients or patients’ families for the previous 12 months, to determine how the hospice received, recorded, investigated, and resolved these complaints,” CMS elaborates.

“Patients should be aware of who to contact to make a complaint and the hospice should have detailed records regarding complaints and investigations,” Wehri emphasizes.

Why? “During home visits, ask the patient/family if they know how and whom to contact if they have a complaint,” CMS tells surveyors. “Ask the patient, the patient’s family, guardian, or other legal representative, if they have any comments or concerns, or have registered any grievances or complaints about the hospice or its services. If this has already occurred, ask how it was handled and what the results or outcomes were.”

CMS reiterates many of the instructions in a section about complaints of abuse, and adds directives such as “pay close attention to staff remarks and staff behavior that may represent deliberate actions to promote or to limit a patient’s autonomy or choice” and asks “who in the hospice is ultimately accountable for receiving, investigating, and resolving any patient concerns or problems that cannot be resolved at the staff level?”

“Hospices should ensure they have the policies and procedures in place … ensuring a process for the collection of data on any complaints received and a process for investigating and following up on these complaints,” Wehri says.

“Providers should take immediate action to improve reporting of allegations all types of abuse in both policy and procedure,” Lund Person tells AAPC.

5. Know your own profile. The much-enhanced directions for surveyors to check out media coverage, your Medicare Compare-Hospice scores, and more before setting foot in your agency means you should be on top of those items too.

“Hospices should be aware of public media information about their hospice, information available on the hospice’s website, Care Compare ratings, and other items that a surveyor is now required to do in pre-survey preparation,” Lund Person exhorts.

“Hospices need to ensure they are reviewing these documents regularly to ensure they contain accurate information regarding the hospice’s locations and services,” Skehan adds. And “CMS Care Compare should be regularly monitored as a component of the hospice’s QAPI program to ensure there are Performance Improvement Projects (PIPs) implemented to address scores below benchmarks,” she recommends.

6. Avoid survey panic with preparation. “We cannot stress enough that hospices should implement an ongoing survey readiness and mock survey process using the new SOM survey tasks, with a focus on the Phase I and Phase II CoPs in order to ensure the hospice meets regulatory requirements in anticipation of an unannounced survey,” Skehan tells AAPC. “A proactive approach to survey readiness and follow up, staff education and performance improvement is the best way to reduce the chance of negative survey findings, and limit the possibility of survey enforcement remedies,” she maintains.

7. Check yourself out. Don’t fall into common survey traps of thinking you are survey-ready because you have pristine P&Ps but neglected to train staff on them, or overlooked a new clarification.

“If a hospice has not reviewed the effectiveness of its compliance program recently, I would … encourage the hospice to consider an independent audit of its compliance program,” Wolfe says.

8. Keep the PHE end in mind. The Biden adminis­tration has announced a May 11 end to the COVID-19 public health emergency. Hospices will see a number of their regulatory flexibilities go away then or soon after, including exceptions for telehealth face-to-face encounters and volunteer requirements (see HHHW by AAPC, Vol. XXXI, No. 5).

There’s no grace period, and surveyors will expect hospices to be compliant with pre-COVID policies right away,

Assessments of compliance are especially important “as we prepare to emerge from the public health emergency,” Wolfe highlights.

9. Stay on top of disasters. Just because the PHE is ending, doesn’t mean you can let down your guard on emergency preparedness. “Emergency Preparedness is in a separate appendix [Appendix Z], but hospices must still meet the requirements in this separate appendix,” Lund Person advises.

10. Watch out for surprise surveys. If you haven’t been surveyed for nearly three years, you may expect a recertification survey any time and prepare accordingly.

But remember, those aren’t the only unannounced surveys, Skehan says. A complaint survey can hit at any time, she stresses. And soon, deficiencies will carry financial penalties (see related story, p. 46.).

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