News flash: survey implementation "inconsistent". (NH News Notes).

Providers probably won't be surprised by the inconsistencies among state survey systems highlighted in a DHHS GIG report describing trends in nursing home deficiencies and assessing the consistency of the Medicare survey and certification process. But the numbers, nonetheless, are alarming. For example, the report found that while 11% of nursing homes surveyed in 2001 had no deficiencies, the proportion of deficiency-free nursing homes ranged from 33.5% in Virginia to none in Nevada. The national average deficiency rate was 6.2 per nursing home, ranging from 2.9 deficiencies per facility in Vermont to 11.2 in California; across the board, the proportion of nursing homes with deficiencies, the total number of deficiencies, and the number of deficiencies in categories directly related to quality of care have all increased since 1998.

The report says that different deficiency tags are being used to cite the same problem, surveyors do not consistently cite deficiencies, and states differ on how many deficiencies they will cite for a single problem of noncompliance. Variability in citing deficiencies is attributed to four factors: (1) inconsistent survey focus, (2) unclear guidelines, (3) lack of a common review process for draft survey reports among states, and (4) high surveyor staff turnover.

The report recommends that CMS provide clear, explicit guidelines to state survey agencies, including more specific guidance to states on quality-of-life deficiency tags and clearer directions on when to cite single or multiple deficiencies. In addition, the GIG says CMS needs to clearly communicate to states that the focus of the survey process is not consultative, and develop with states common review criteria for draft survey reports. CMS, commenting on the draft report, agreed with the recommendations and highlighted some of its own efforts in an appendix to the report.

To view the report, visit http://oig.hhs.gov/oei/reports/oei-02-01-00600.pdf.