Enhancing Collaboration in Skilled Nursing: Key to Survey Success

Collaborating with industry leaders and state survey agencies is crucial for operators to thrive in a challenging survey environment.

"As providers, it's easy to focus solely on our company," said Kimberly Green, COO of Diakonos Group, during a recent Skilled Nursing News panel on the skilled nursing survey environment. "We must recognize that there are enough patients for everyone and that the industry is evolving. Collaboration is essential. We want state agencies to work with us, and we need to see each other as peers and work together."

Green and Tim Fields, CEO of Ignite Medical Resorts, and Sonya Pusser, AVP of Clinical Operations at American Health Communities, discussed improving the survey process by making it more collaborative and productive. They shared examples of undeserved and avoidable citations and advocated for a return to pre-pandemic practices, including educational opportunities.

Green recounted an incident where her team challenged a survey finding at the federal level, only to face surveyors' reluctance to review documentation. "We are still waiting for a response," she said. "When we tried to discuss the documentation with the surveyor, they refused to review it, saying, 'This is what it is, we're moving on.' Immediate Jeopardy has a particular process."

Pusser echoed Green's sentiments, citing regulatory misinterpretations leading to undeserved citations despite her teams' prompt compliance efforts. "For example, medication labeling and storage regulations often get misinterpreted, leading to citations that don't align with the actual guidelines."

She highlighted the importance of improved communication and collaboration between healthcare associations and regulatory bodies. Before the pandemic, Tennessee operators had an annual educational forum where operators and surveyors could exchange questions and insights.

"I think we need to return to those practices," Pusser said. "Surveyors with long-term care experience can provide valuable insights into the realities of long-term care facilities."

Addressing Regional Variability

Fields emphasized the need to track regional variability in survey approaches, as Ignite operates in multiple states. "We're seeing variability in every state," he said. "Some surveyors are collaborative and fair, while others are more rigid."

Building relationships with other multi-state operators and surveyors can help identify potential areas of concern. "Elopement might have been in immediate jeopardy in one state years ago, but not now," Pusser noted. "Surveyors with experience can offer assistance and guidance if they see you are proactive in addressing issues."

The panelists agreed on the importance of proactive communication with survey agencies, fostering mutual understanding, and working towards shared goals of enhancing resident care. During the pandemic, regular communication and collaboration proved beneficial.

"The state had weekly calls with providers to discuss new regulations and changes," Green said. "Initially, it was a joke because officials often didn't have answers, but it evolved into a valuable Q&A session where we learned together."

Education and Internal Policies

Fields recommended using the entire management team to address patient and family concerns before they escalate. Adopting a concierge or hospitality model can engage families directly and resolve issues internally.

"We have to assume we're guilty until proven innocent," Fields said. "By taking a proactive approach, we can prevent issues from escalating."

Ignite implemented 'Guardian rounds,' where the management team checks on patients and families to address concerns early. "State representatives usually visit annually unless called," Fields noted. "Preventing those calls is a good strategy."

Pusser advocated for continuous education, policy development, and staff training. She advised, "Develop your internal plan for adjusting education, policies, procedures, and electronic health records (EHR) to address updated Minimum Data Set (MDS) questions."

By fostering collaboration, enhancing communication, and prioritizing education, operators can navigate the challenging survey environment and improve care for residents.