Immediate Jeopardy Series: What It Means and Why It Matters (Part 1 of 3)

Thanks for reading Hospice Excellence, where we discuss critical insights affecting the hospice community. This issue focuses on understanding what an Immediate Jeopardies (IJ) is and the potential consequences when these serious deficiencies occur. Then we’ll be exploring the significant and almost completely preventable reasons providers encounter Immediate Jeopardies (IJs).?

With the increasing oversight and regulatory compliance focus on hospices, we may start seeing an increase in immediate jeopardy deficiencies as well.

Immediate Jeopardy (IJ) Tag Defined:?

“Immediate jeopardy means a situation in which the provider's noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a patient(s).” https://www.ecfr.gov/current/title-42/section-488.1205?

Non-Compliance + Serious Adverse Outcome or Likely Serious Adverse Outcome + Need for Immediate Action = IJ

Because of the urgent nature and related harm, a surveyor cannot wait until the exit or findings to notify a provider of immediate jeopardy status. The surveyor must notify the administrator and call an immediate jeopardy immediately after they notify their survey lead of the findings that indicate direct harm has occurred.

The Cost of an IJ:

IJ’s are VERY costly to your agency, in more aspects than just financially. With the IJ tag your agency will be imposed any combination of the below remedies from CMS with a 2-day notice;

• Temporary management: A management company will take over operations until compliance is determined and there is proof of correction of broken processes that led to the harm occurring.?
• Payment remedies & Suspensions: CMS may freeze all payments or may suspend payment on all new admissions during the period of non-compliance.
• Civil money penalties: (fines) on a per day basis until the IJ is cleared and surveyors return to determine compliance is achieved. These penalties are significant and can go up to $10,000 PER DAY, PER INCIDENT.
• Directed plan of correction: A third party will execute the plan of correction and there will be specific areas that need to be addressed and met with extensive education, training, and audits.
• Termination of licensure: CMS will terminate the hospice program provider license no more than 23 calendar days from the last day of the survey if the immediate jeopardy has not been removed. All patients will be transferred to other providers.

https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-488/subpart-N?

Implications for Reputation and Operational Continuity

An IJ can strain the financial and operational capabilities of an agency and even impact an entire organization's stability. Limited admissions, penalties, or non-payment status will strain margins, and revenue and labor costs may increase. Turnover in the field and at the management level can occur due to increased stress and longer hours to attain compliance.?

Operational Workload:

Managing the increased administrative and clinical workload of correction can mean:

• Bringing on extra field clinicians to ensure care standards are met
• Hiring independent consultants to conduct audits and education, monitor compliance, and provide advisement on corrective actions
• Managers can often become bogged down and need more support laterally and from above and below them in the organizational structure to ensure complete compliance is achieved and maintained

Community Reputation: The public disclosure of an IJ can damage the facility’s reputation in the community, leading to a decrease in admissions and challenges with staffing due to diminished morale and trust. Existing staff may share frustrations in the community and culture needs to be a major focus of the corrective action plan. It can take months to years to repair referral relationships and rebuild the census.?

You can read more in-depth about immediate jeopardies in Appendix Q of the State Operations Manual (SOM) https://www.cms.gov/Regulations-and-guidance/Guidance/Manuals/downloads/som107ap_q_immedjeopardy.pdf

Make sure you're subscribed so you don’t miss part two, where we will go in-depth into the reasons why immediate jeopardies are issued to agencies and give specific examples of the situations that have resulted in immediate jeopardy.

Part Two: Causes of and Findings for Immediate Jeopardy in Hospice

Part Three: Proactive Measures - How to Prevent Immediate Jeopardies