CMS To Enforce Tougher Survey Guidelines

March 23, 2020, Alex Spanko, Skilled Nursing News - The federal government on Monday announced plans to release an updated survey tool for nursing home inspectors, with an even stricter focus on infection-control policies — derived directly from lessons learned at a facility in Washington state that served as the epicenter of the first COVID-19 outbreak in the United States.

The Centers for Medicare & Medicaid Services (CMS) doubled down on efforts to reorganize the nation’s nursing home survey apparatus around infection control amid the ongoing pandemic, stating its intention to more proactively target areas believed to be at the greatest risk for future outbreaks — as well as a self-assessment tool that administrator Seema Verma encouraged families to use as a quick pulse check on a given building’s safety.

“Nursing home residents and their families who want to be sure a nursing home is safe should not hesitate to ask staff directly: What are the results of your CMS self-assessment?”  Verma said on a Monday afternoon call with reporters.

In one of the earliest federal actions aimed at fighting the coronavirus, CMS on March 4 suspended all non-emergency survey work at nursing homes, reserving inspections solely for infection-control compliance and outright cases of abuse and neglect.

At the time, the general public was largely aware of COVID-19’s deadly potential because of an outbreak at a nursing home in Kirkland, Wash. operated by Life Care Centers of America.

The Centers for Disease Control and Prevention (CDC) last week determined that within less than three weeks after the first resident showed symptoms consistent with COVID-19 infection, more than a quarter of the building’s census was dead.

The CDC blamed the rapid spread in Kirkland on a variety of factors, including staff members continuing to work while sick — and employees working at multiple nursing homes, helping to hasten the spread of the disease.

Verma on Monday announced that CMS had concluded its own emergency survey of the Kirkland property, which resulted in an immediate jeopardy citation.  The property now faces the termination of its Medicare and Medicaid licenses unless an upcoming surprise inspection reveals that it has rectified the problems CMS surveyors identified.

“Specifically, the facility failed to identify and manage sick residents,” Verma said.  “They failed to notify the state health department, and the state about sickness amongst the residents.  And they failed to have a backup plan for when their staff doctor became sick.”

Those factors had a direct impact on Monday’s updated survey guidelines.

“We’ve also taken the lessons learned from Kirkland, about some of the issues that arose there, and put that into the survey tool,” Verma said.

While CMS had also previously announced that its infection-control efforts would be concentrated in areas with significant numbers of COVID-19 cases — including California, New York, and the Seattle metropolitan area — Verma on Monday said its new strategies will take things a step further.

Using the CDC’s database of reported COVID-19 cases and modeling tools, CMS will attempt to deploy its surveyors to potential COVID-19 hotspots before massive building-level outbreaks can occur.

“Beginning today, we will be working with the CDC to focus and identify areas the virus is projected to strike next, and target our inspections accordingly,” Verma said.  “This will allow us to focus inspections on the most urgent situations — so we’re getting the information that we need to ensure safety while not getting in the way of patient care.”

As of Monday, the CDC has identified 146 nursing homes across 27 states with confirmed COVID-19 cases.  Because the virus is particularly deadly for frail nursing home residents, many of whom have a host of underlying medical conditions, Verma reiterated the importance of obeying a federal ban on all non-essential visits to skilled nursing facilities.

“Unless you must absolutely go into a nursing home, don’t,” she said.