Deficiency Determinations: Understatement of Deficiencies

 

CMS Federal Monitoring Surveys and other independent investigations of the nursing home health survey process have shown that some official Form 2567s fail to cite deficiencies or cite deficiencies at too low a scope and severity level. GAO refers to this as "understatement" of deficiency citations.

 

33. How useful do you feel that feedback from the CMS Federal Monitoring Surveys is in helping nursing home health surveyors make more accurate deficiency determinations on subsequent surveys?
(Check one answer in each row)
    Useful Somewhat useful Not useful Not sure/No opinion
  a. Feedback from Comparative Surveys
  b. Feedback from Observational Surveys
   

34. How frequently do the following issues contribute to understatement in this state survey agency?
(Check one answer in each row)
    Always Frequently Sometimes Infrequently Never Not sure/No opinion
  a. Weaknesses in the current survey methodology
  b. Inadequate number of staff to complete thorough surveys
  c. Inadequate time to complete thorough surveys
  d. Inadequate draft survey review process
  e. Reluctance to cite serious deficiencies because of workload burden (e.g., revisits, paperwork)
   

    Always Frequently Sometimes Infrequently Never Not sure/No opinion
  f. Inexperienced surveyors are not yet comfortable with their job responsibilities
  g. Inadequate initial surveyor training
  h. Insufficient (or lack of) ongoing surveyor training
  i. Fully trained staff members remain unsuited for surveyor role
  j. Confusion about CMS's definition of citations at the actual harm level and above
   

    Always Frequently Sometimes Infrequently Never Not sure/No opinion
  k. Survey predictability or other advance notice of inspection
  l. Frequent informal dispute resolution (IDR) hearings
  m. Pressure either during or after the survey from the nursing home
  n. Pressure either during or after the survey from the nursing home industry
  o. Pressure from state or federal legislators
  p. Other
   

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