Survey Action Plan: The First 30 Minutes
It’s 9:15. All your staff has just arrived. Some people have already started working while others are making coffee and settling in. It’s a day like any other until the door opens and in walks your surveyor. Now it’s a bad day.
Although every home care agency tries to prepare for surveys, the preparation usually doesn’t involve an exact plan of action when the inevitable day occurs. This lack of preparation results in the agency loosing valuable time in getting all their ducks in a row. Normally, when a surveyor enters a home health agency, they need to sit with upper management and disclose their plan for the day(s), prior to starting the inspection process. This meeting can take anywhere from 30 minutes to an hour, and gives the remaining staff valuable time to conduct all necessary communication and ensure a smooth survey. Delegating the communication and document retrieval during this crucial time will significantly improve your survey experience. Here is everything that needs to be done while management is in their meeting with the surveyor:
Coordinate retrieval of late notes
Often times, agencies wait until credentials and charts are requested to ask their field staff for deficiencies. It’s important to give all your nurses, therapists and other employees/staff members enough time to put all their notes, licenses and so on together. In most standard surveys, field staff charts aren’t reviewed until the second or third day. Informing staff of their licensing deficiencies will give them the opportunity to contact and get the other vendors and third parties that may be holding them.
Coordinate the retrieval of late credentials
If your agency isn’t on a point of care system, tell your staff to fax or email the copies of the delinquent documentation prior to bringing in the originals. This way, if the surveyor asks for that chart earlier than the field staff can come to the office, you’re not left with an empty chart. Most field staff will happily comply to this.
Coordinate the retrieval of late MD orders
Of course the first course of action should be asking the doctor to sign them all quickly, however if the physician’s office isn’t compliant, sending someone to get the original signature will be very effective. Most doctor’s offices don’t like seeing someone lingering in the waiting area and may slip the doctor the paperwork to get you quickly out. From there, you can ask to use their fax to send the orders to the agency while you’re driving back to the office.
Make sure all the field staff competencies are up to date
This is an area of HR that goes unnoticed until it’s too late. All field staff, even those from staffing companies, need to have annual competency evaluations performed by a member of their own discipline.
Don’t worry about any patient care documentation that’s within 7 days of the current date
Many field staff don’t have un-submitted documents prepared. Chances are, once they are notified of your survey, they will sit down to write their notes and call their doctor to make an emergency appointment for that physical you’ve been trying to get for a month. Don’t make them do more work than necessary. If a patient note is less than 7 days old, you don’t need it.
Start pulling all your charts with wound care, IV, oxygen, therapy and any other high utilization cases
Surveyors don’t want to see your SN only 2wk2, 1wk7 hypertension charts. They want to see the patient with multiple wounds and oxygen. They want to see the patient chart with 3 or 4 disciplines. They want to see how you handle the coordination and care of your most difficult cases. Pull as many of those charts from your active patients as possible. Then remove the ones with the most certification periods, and work on the rest. Those will probably be the charts the surveyors will want to look at, and they will be the home visits surveyors will want to conduct. If those charts are spic and span, there’s a very high chance that there won’t be additional probes.
Understanding the above nuances and preparing for them can really improve your survey outcome. That's what we're here for...to give you all the tips we've learned over the years to make you faster, better and smarter at surveys.