February 18, 2005

A Little CMS Bird Chirps In My Ear About Inservices

I have received some insights from a source from CMS in Dallas about how your inservices could be improved that may help you when you are dealing with survey issues.

The holding of an inservice in and of itself is not compelling evidence that you are fixing problems before (as part of Quality Assurance) or after (as part of a Plan of Correction). The folks at CMS want to know that an inservice has effectively taught staff how to carry out particular functions.

The folks at CMS are concerned that staff is merely going to an inservice to pick up paychecks and is not focused on learning. This is a reasonable concern. How many times have you written grocery lists during a particularly boring seminar you have attended for Continuing Education credit? Haven't we all occasionally gone off to La La Land when we should have been listening?

It is important that you not only inservice, but that you perform "return demonstrations" or competency tests to ensure that your staff is "getting it" and not just sitting there like a bump on a log. It is equally important that you monitor staff for competency in the area for a reasonable time after the inservice to ensure that staff members remember, understand and accept the importance of the information or change in systems.

How is this important in the context of surveys and regulatory litigation?

If you are confronted with an issue of past noncompliance already fixed by your Quality Assurance Committee, the surveyors need proof that the "fix" really took and that the facility did come back into compliance.

Also, if you failed to clear on the second survey--and then you do clear on a third--CMS will fix the compliance date as the date of third revisit rather than as the date you alleged compliance. Thus, DPNA and CMP's may be treated as if they run past your POC date. For instance, if you allege that you were in compliance pursuant to your POC on October 18 and the surveyors actually clear you during a third revisit on November 18, CMS will consider November 18 to be the date you came back into compliance. This, of course, is unfair. However, you may be able to negotiate with CMS if you have good evidence that you actually were in compliance on October 18.

Good evidence of compliance must include proof that the staff is actually doing things in accordance with what you taught them during the inservice. Thus, documentation of the results of "return demonstration" or other measures of competency will be crucial to convince CMS that CMP's and DPNA should have ended on October 18 rather than November 18. Also, provide documentation showing that you monitored the "fix" for a reasonable period after, and that it was actually working.

Such evidence is important to convince CMS for purposes of negotiating a case. It is also important should you go to Hearing.

The bottom line is that just showing that you inserviced staff to correct and issue is not enough. Essentially, you must show that you led the horse to water--and he did, indeed, drink.

This is what the little bird said to me.