CMS Instructs State Surveyors on more "Focused" Surveys to Start May 1

Be ready for tougher state surveys in the coming months. CMS recently issued a memo to state survey office on the new home health survey protocol. State surveyors are expected to begin following the instructions on May 1, 2003. You can review the document at http://cms.hhs.gov/medicaid/ltcsp/sc0313.pdf.

New surveys will be based on five reports: Adverse Events, Case Mix Reports, OBQI outcome reports, and two reports on OASIS submission based on timeliness and errors. CMS notes that compliance with Conditions of Participation (CoPs) will include surveys in other areas as in the past. The reports are designed as part of a presurvey preparation process that will help to indicate potential quality problems. Providers will not be required to comply with the new CoPs prior to their publication in the Federal Register (scheduled for July 2003).

This directive from CMS coupled with recent GAO criticism of the state survey process should peak the interest of home care providers in the survey preparation process. While working diligently to control costs, prepare for HIPAA, assure readiness for the OBQI report cards, and build a stronger referral base, remember to be vigilant about state surveyors. Be aware that CMS has received criticism about state surveys being lax. As such, we are likely to see state surveys followed by CMS surveys shortly thereafter so CMS can check on state surveys.

HHS Announces Quality Reporting Plan

I've written previously about home health report cards. The Department of Health and Human Services, which oversees CMS, has formally announced that Outcome Based Quality Improvement (OBQI) efforts will be tested in the coming months by making quality report cards available on home health later this year.

The first phase will be a pilot release of scores in eight states: Florida, Massachusetts, Missouri, New Mexico, Oregon, South Carolina, Wisconsin, and West Virginia. CMS will release scores for agencies in these states online on the CMS Web site and will purchase full-page ads in newspapers to report provider quality of care data. These states will herald the full program, which is due to commence in October 2003 for the rest of the country.

The key part of the initiative is CMS' release of 11 quality measures that are a subset of 41 OASIS outcome measures. Those 11 measures include:

* four measures related to improvement in getting around (e.g., getting better at walking and moving around using less equipment, getting in and out of bed without help, getting to and from the toilet without help, and having less pain when moving around);

* four measures related to improvement in meeting basic daily needs (getting better at bathing, taking medicines, and dressing the upper part of the body without help; staying the same at bathing without help);

* two measures related to medical emergencies (had to be admitted to hospital and needed emergency medical care);

* one measure related to improvement in mental health (being confused less often.)

Look for further articles about the quality measures and their impact on your practice in future issues of HHN.