Here is something scary. The Government Accountability Office has issued a report that finds that general weaknesses in the nursing home survey process contribute to the understatement of deficiencies at nursing homes.
Shortcomings of current surveys includes too many tasks, problems with guidance on identifying deficiencies, workforce shortages, surveyor inexperience, inadequate training, and even pressure from stakeholders, such as nursing homes.
The GAO is making seven recommendations to the CMS administrator to address these issues. Among them:
- make sure that action is taken to address concerns identified with the new QIS methodology, clarify and revise existing CMS written guidance to make it more concise, simplify its application in the field, and reduce confusion.
- address surveyor workforce shortages and insufficient training, including establishing a pool of additional national surveyors that could augment state survey teams; evaluate the current training programs and division of responsibility between federal and state components in: (1) providing initial surveyor training to new surveyors, and (2) supporting the continuing education of experienced surveyors.
- address inconsistencies in state supervisory reviews by setting an expectation that states have a supervisory review program as a part of their quality-assurance processes.
- address state agency practices and external pressure that may compromise survey accuracy by reestablishing expectations that non-citation practices—official or unofficial—are inappropriate; establish expectations through guidance to state survey agencies to communicate and collaborate with their CMS regional offices when they experience significant pressure from legislators or the nursing home industry that may affect the survey process or surveyors’ perceptions.
I can not speak for outside pressure and lobbying efforts. You can see how that has watered down and diluted so called health care reform. The key I believe is for the federal government to consider a larger role in its authority over the industry. As it is now state regulations and enforcement varies widely, as In a Grand Canyon size gap, in how the industry is policed. More cooperation between the states and the feds is not the answer. In one case I do favor the government stepping in just as I favored them stepping in with a public option or Medicare at 55 in health care reform You see where that went!
Happy New Year. Hopefully it will be one with real change.