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Savvy Forum: A Page for Testimonials, Comments, Questions, and Discussions

What People are Saying About Savvy on the SOM:

“Thanks so much for the information – I have added it to our survey preparation.”
-A. McCallis, Administrator

“SAVVY on the SOM is a great resource for skilled nursing facilities. The information provided is relevant and up to date with CMS changes. It provides excellent tools to keep the building survey ready at all times.”
–Fay Guerrero, Director of Nursing, St. Edna Sub-Acute and Rehabilitation Center

What People are Asking Savvy on the SOM:

Q:“During a recent state survey, it was reported one surveyor stated the survey team hoped the facility would choose a specific EHR because the surveyors found it easier to use then other computerized programs.

Are surveyors allowed to tell a facility which EHR they should choose?”
K.T., Texas

A: No, surveyors should not tell facilities which EHR to choose. However, before taking any actions be sure you have all of the facts. Find out as much information as you can. Which surveyor made the comment, during the survey of which facility and the date(s) of the survey.

It is important that the person who reported this incident be sure of what was said. Was the surveyor simply stating their preference – i.e. “I like working with xyz EHR, it is easier to find the information I need” or was the surveyor really suggesting the facility purchase a particular EHR.

If the surveyor was really suggesting the facility should purchase a specific HER, then the district office should be informed. It is note the role of any surveyor to tell a facility which electronic health record system to purchase.

Q: As an advocate for all LTPAC Health IT vendors I have learned that the Surveyors in Southwest US are telling the SNFs that they should buy Point Click Care for their EMR system as they think it is the best program for their surveying. Isn’t it against the law for a federal or state agency to advocate a specific vendor especially since the vendor is a Canadian Company and profits go to Canada. I thought government agencies are to advocate ‘Buy America’. If there is anything you guys can do to stop this, please let me know. I know when I was working with the QIOs in early 2000 we learned that one QIO was advocating a specific vendor and they were told to stop.
J.D., Nevada

A: As a former surveyor in California, I can unequivocally tell you this type of behavior is NOT allowed. You don’t say how you have learned of this behavior. If you yourself have experienced this behavior I would suggest calling the surveying agency and talking with a supervisor. If you have heard a rumor, I would suggest trying to nail down the source – when did this happen, at what facility, who was this said to and who said it and exactly what was said. Sometimes, a surveyor may say something along the lines of “we know xyz EMR and we find it easy to navigate the record.” That is completely different from telling a facility to buy a certain EMR program. Any kind of rumor can be damaging – to the agency, the facility and to vendors. At SAVVY on the SOM we advocate for open communications. I hope you feel comfortable in following up in the most appropriate way.

Q: Is there a published list of surveyors? I don’t think so but a friend has asked and I cannot find a list on the Internet. Do the Surveyors report to one central state department like the Department of Health?
T.S., Oklahoma

A: Surveyor names are not published. Each county has its own DPH for surveying in that county. In California, San Diego County has 2 offices- north and south. Orange County has one office. But states like Nevada have one office for the whole state. Each office reports to a single state office. This is not like the regular department off health. This is Dept. of Public Health, Licensing and Certification.

Hope this helps.

Q:“I do feel like I have a decent handle on it; DHS has been somewhat vague on some answers to questions we’ve had, and our ISSA/PAS agents are feeling pretty overwhelmed – we’ve been told to continue as usual (our plans are already very similar to what they are wanting), and they plan to request to schedule “early” staffings before the end of the year. I really feel like there won’t be too many changes for us.

My biggest questions revolved around an actual formal conflict resolution process if an agency is unable to meet an unattainable or unreasonable request or goal from the guardian, individual, or PAS/ISSA agent.”
B.R., New Jersey

A:Whenever there is discussion of the requirements of person-centered care, this question inevitably comes up. Let’s start with two strong pieces of advice:

1. Never say, think, or write the words ‘non-compliant’ again.
2. Document, document, document.

If we are to provide person-centered care, we must put the resident / family / surrogate in charge of all decisions. Providers have the same responsibility they have always had: to discuss choices, to try to uncover why the resident is making this choice, to offer alternatives and acknowledge the resident’s right to choose. What has changed for providers is what is documented.

In the past, documentation might look like this:

  • Physician order for low salt diet. Discussed with Resident. Resident is non-compliant.

The facility now has the obligation to explore why the resident is refusing, what alternatives have been presented to the resident, the resident’s response, and to clearly document all of this. All. Of. This. Without complete documentation the facility is at risk of deficiency. This is NOT going to change overnight, but a reasonable expectation of commitment to change that demonstrates staff training and increased effort will keep the surveyors at bay.

Q:“I have a question about the sources used to gather information about your service area.

  • According to the 2010 Orange county census, 19% of the population was 65 or older.
  • According to your CHNA 2016, 12.7% of your service area are 65 or older.

In reviewing your community resources used to gather information, there are senior centers but not one Skilled Nursing Facility, LTC or Assisted Living Facility. According to the Council on Aging Southern California, 28,000 people live in long term care facilities in Orange county.

Why were no long term care, AL, or SNFs included in your information resources?”
Leslie Mahoney, Savvy on the SOM, California

A:“Hi Leslie, I am the consultant who completed the hospital Community Health Needs Assessment. For the seniors, the percentage reported is specifically for the ZIP Codes in the hospital service area, which will be different than a county wide percentage. Also, the data source we used was more recent than the 2010 Census. Your question about the use of long-term care or SNFs, I am assuming you are referring to the use of these facilities as a primary data source? I will pass this suggestion to use a long-term care/SNF source in the upcoming 2019 assessment. This is a good idea and I am sure the hospital will be very open to this suggestion.”
CB, California

Q:“I have a question: we have just been acquired by a new company on Oct 1st. Do you know whether we get an extended deadline to comply since we are under new ownership? Please advise. Thanks.”
DD, Atlanta

A:“The best advice I can give you is to call the surveying agency in your county or your state agency. Sometimes the state listings are a bit overwhelming. You want the Department of Public Health, Licensing and Certification.

Remember, CMS has stated deficiencies in the new regulations will not carry CMPs and will not affect a facility’s star rating.”

*If you have a question we can help with please don’t hesitate to post it using the Contact Us link at the bottom of the page.