The Office of Inspector General (OIG) is recommending to the Centers for Medicare & Medicaid Services (CMS) that they assess the results of their infection control survey and revise the survey as appropriate. In addition, the OIG is recommending that CMS work with States to overcome challenges with personal protective equipment (PPE) and staffing, and clarify its expectation for State Agencies to complete survey backlogs. These recommendations come after the OIG analyzed CMS administrative data to determine the number of focused infection control and complaint surveys, and the types of deficiencies cited during the surveys which were conducted from March 23 through May 30, 2020.
CMS did not explicitly concur with the OIG’s recommendations to assess and revise the infection control survey or to clarify expectations for States to complete the backlogs, but has stated that it has taken steps to implement the recommendations. Also, CMS did not concur with the OIG’s recommendations to work with States to overcome challenges with PPE and staffing, CMS is citing their lack of authority to address issues of allocating PPE and staff. The OIG is continuing to recommend that CMS identify opportunities within its authority to support States facing challenges with PPE and staffing.
In response to the COVID-19 pandemic, CMS suspended annual “standard” surveys in March 2020, and introduced a new focused infection control survey. On June 1, 2020, CMS directed State Agencies to conduct these focused surveys for all nursing homes and to continue surveys for the most serious complaints. In consideration of these changes, and with nursing home residents’ high risk status in mind, the OIG conducted their review due to the importance of the State surveys that warrant close examination to assess the sufficiency of CMS oversight.
In the OIG review of CMS administrative data, they also interviewed officials at CMS and in 10 States to learn about their approaches to oversight, challenges to conducting onsite surveys, and experiences during the pandemic.
The OIG findings include that States conducted onsite surveys at 31% of nursing homes from March 23 through May 30, 2020; however, States’ compliance varied significantly. In comparison, during this same time period in 2019, 53% of nursing homes received an onsite survey. The OIG also found that the infection control surveys, which were conducted during this time frame in 2020, resulted in few deficiencies, likely due to their limited scope and less surveyor time onsite.
Also in the OIG review, State officials reported ongoing challenges to securing PPE and surveyors. The States did provide guidance and support, such as training to nursing homes, in addition to the survey process. The State officials reported concerns about the escalating backlog of standard and complaint surveys as the pandemic continues.
The OIG full report can be accessed at: Onsite Surveys of Nursing Homes During the COVID-19 Pandemic: March 23–May 30, 2020 (hhs.gov)
Issue
It is likely that there will be changes with the CMS infection control survey and how the surveys are conducted in response to the OIG report. It is critical that the administrative team at each facility be aware of any changes, and that their infection control policies and procedures are updated with those changes as they occur. Facilities’ infection control policies and procedures, when implemented correctly, slow the spread of COVID-19 and other communicable diseases. If infection control policies and procedures are not followed per requirements, this may be seen as placing residents in immediate jeopardy for harm and provision of substandard quality of care, which may result in citations and monetary penalties.
Discussion Points
- Review policies and procedures for infection prevention and control content. Ensure that policies are up-to-date with the most recent CDC and CMS infection control guidelines.
- Train all staff to follow the facility’s policies and procedures for infection prevention and control. Document that these trainings have occurred, and keep a signed copy in each employee’s education file.
- Periodically audit to ensure that all staff members are following infection control policies and procedures correctly. Provide additional education where determined necessary.
