This transcript was auto-generated using Adobe Premiere Pro.
00;00;05;01 - 00;00;33;21
Meg Pekarske
Hello and welcome to Hospice Insights: The Law and Beyond where we connect you to what matters in the ever changing world of hospice and palliative care. Hospice and Home Health Survey Perspectives: A Conversation with Kim Skehan, VP of Accreditation at CHAP. Kim, here we are. Thank you for joining me. I feel like we've known each other for a very long time and now here you are with CHAP.
00;00;33;21 - 00;00;39;15
Meg Pekarske
So that was an exciting move that happened. Was that the summer you you moved to CHAP?
00;00;40;05 - 00;00;52;16
Kim Skehan
Absolutely. I joined CHAP in May and yes, we've known each other for many years and in this industry and I'm really thrilled to be part of the podcast today. Yeah.
00;00;52;29 - 00;01;13;21
Meg Pekarske
You know, we've both been around the block and you've been around the block at hospice in lots of different capacity is because you're a nurse by training. Right. And then but then you were, weren't you, at the Connecticut Hospice Association Hospice and Home House. So tell me a little bit about your journey to hospice and then you know how you landed here at CHAP.
00;01;14;17 - 00;01;41;10
Kim Skehan
So ah well I am an arm that I have over 30 years and has this and home health and with prior experience in oncology. So it's been in my bloodline for virtually my entire nursing career. I now live in Maine, but previously I lived in Connecticut for most of my professional career, where a hospice agency must also be licensed as a home health agency.
00;01;41;18 - 00;01;41;25
Kim Skehan
So.
00;01;41;26 - 00;01;42;21
Meg Pekarske
Oh, really?
00;01;43;04 - 00;02;17;16
Kim Skehan
Yeah. So in many ways, I was able to work both roles with hospice being my passion. And you're right, I have worked as a clinician, a leader and educator. I was a clinical instructor for UConn many years ago, and and most of my experience has been in the areas of compliance, regulatory and quality in both clinical and administrative roles as a consultant and yes, as a an exact for the I was a VP of Clinical and Regulatory Services for the Connecticut Association for Health Care at Home.
00;02;17;16 - 00;02;59;01
Kim Skehan
My my work in consulting and where our paths have crossed over the years has been up until I move to CHAP has involved the compliance side extensively with government audits, appeals and investigations as well as operations. And then from a survey perspective, I worked for many years as a consultant and a stay and see him as appointed consultant, working with providers related to survey readiness and follow up related to plans of of correction and keeping abreast of the seemingly ongoing regulatory changes over these years.
00;02;59;01 - 00;03;16;02
Kim Skehan
And of course, you and I together are sort of an NHP CIO's regulatory committee, and also I also serve on Max Hospice Quality Work Group, so busy on the National as well as you know, certainly the state and industry forefront for many years.
00;03;16;24 - 00;03;45;25
Meg Pekarske
Yeah well and talk about changes we're going to be doing a podcast a year in review where it's probably going to be in early 2024. So depending on when this comes out, it's might not be in order. But I was saying to my team, I was like, we need to put together a chart of all of the changes because my head is spinning and I think there is like there might be like 12 or 14 different regulatory changes that have happened.
00;03;45;25 - 00;04;14;10
Meg Pekarske
And so much of it is like on the enrollment side, which obviously can have some interface with what you do at CHAP and so excited to learn what is it like being a CHAP like what are your days doing? Because you're not obviously a surveyor, you're heading up, you know, accreditation. So I'd imagine that's both working with your survey teams, but also seeing as you have a contract with CNS and all that stuff.
00;04;14;10 - 00;04;20;18
Meg Pekarske
So, so tell me a little bit about your days and what it is and is it like what you thought it was going to be like or.
00;04;20;25 - 00;04;45;13
Kim Skehan
Absolutely. I will say that it's actually even better than I imagined that it would be. I have worked very closely with CHAP as an AOE for accrediting organization for many years. As long as I have been alongside CHAP in my survey roles. But now in this role as VP of accreditation, I'm responsible for all accreditation or survey activities.
00;04;45;13 - 00;05;26;02
Kim Skehan
So all of the surveyors, we call them site visitors, all of our accreditation decisions and operations, do they do they do report and work directly with me. I work alongside. Yeah. Dr. Jennifer Kennedy, you may remember. Yeah, of course she does. Say hello. And she is she's my counterpart. She's the vice president of Quality and Standards. So between both of us and then Theresa Harbor, who's our chief operating officer, we really manage all of the day to day requirements, if you will, for for home health, hospice, home infusion and dummy post.
00;05;26;02 - 00;05;39;05
Kim Skehan
We are on deemed a CMBS deemed accrediting organization. What that means is we can provide or conduct those surveys on behalf of CMS in lieu of a state survey agency.
00;05;39;15 - 00;06;06;23
Meg Pekarske
So I was going to sort of jump in. And so that's obviously a really big role, lots of different provider types in there. And I guess in terms of your interfacing with CMC, right, so they're giving and I'm thinking I feel like CHAP has been are they the longest standing hospice accrediting organization.
00;06;07;01 - 00;06;44;18
Kim Skehan
Yes we are. We are the the we were the first home health and hospice accrediting organization in the US over 55 years ago. And it's not just the CMC Deans, so site surveys that we perform, we also perform non Medicare certified home care agencies. So I do a lot of licensure for states, for several states, including Wisconsin, by the way, and and also we have accreditation for pharmacy palliative care and then certifications in disease management such as dementia and age friendly care.
00;06;44;18 - 00;07;36;18
Kim Skehan
So there's a lot more than our CMS responsibilities. However, our CMS responsibilities are certainly our top priority in terms of making sure that we have all of our processes in place to meet CMS requirements. And that includes updates that come from CMS to the ALS or to the industry. And and also we receive those notification sessions from CMS or the MAX, the Medicare administrative contractors or state agencies when there are substantiated complaint surveys, changes of ownership change, you know, all of those documentation that organizations have to fit in, fill, submit and also when they are approved, right, for their initial CC.
00;07;36;18 - 00;08;11;25
Kim Skehan
And so we in this role which I have almost daily and you know, communication in some form or fashion that involves CMS. And for that I'm actually very it's very exciting, believe it or not, part of my role, something I have I did more so in the years with the state association, but it really is see, I have to say that the groups that we work with at CMS are very supportive of the AOC and and and very responsive.
00;08;11;25 - 00;08;15;28
Kim Skehan
So yeah, it's it actually has been a very positive experience.
00;08;16;04 - 00;08;42;15
Meg Pekarske
I think everyone's mind is spinning and that I'm sure you as well CMS. I mean that number of changes they came out with and over the last year in response to a lot of the concerns which I'd imagine, you know, definitely impacts you since there's a lot of concerns about the types of providers getting certified and questions about how are all these people certified at this one location.
00;08;42;19 - 00;09;04;22
Meg Pekarske
So I'm sure there is a lot of, you know, training and education and stuff all around about that. But I was dying to do this podcast with you because I wanted to ask you all of these questions that I find confusing sometimes and that I think, you know, survey and you've been around the block a lot of years, too.
00;09;05;04 - 00;09;44;14
Meg Pekarske
You know, I came up doing a lot of nursing home survey work, which is so well developed for a very long time. You had the scope and severity grid, you know, the interpretive guidelines for like a thousand pages. I mean, there is lots of guidance and then, you know, you go to hospice and I mean, now it's a little bit more well developed, but there still lots of things that are on written, you know, and the place I want to jump to first was and this is maybe my soapbox a little bit is just this line between condition level citations and standard level citations.
00;09;44;14 - 00;10;17;12
Meg Pekarske
And, you know, I was really hopeful when we were doing some of the survey reform that would there would be greater clarity all around about when because I guess from my perspective, and I'm sure you maybe saw this as a consultant to is sometimes you're there's not a lot of right per reason like I sort of think like well you should get a condition label if you know there was actual harm and of a serious or the potential harm was very serious but sometimes I see not a lot of rhyme or reason to it.
00;10;17;12 - 00;10;47;01
Meg Pekarske
And we obviously don't have clear guidance that says like the scope and severity grid you have for nursing homes like this is when you're going to get an E level citation or whatever. But tell me like how asked to use that and how you view that and how you advocate around that because I think that that's a really important question as we think about all of the survey reform and penalties now that can be attached to certain things, that that's really important.
00;10;47;09 - 00;11;19;00
Kim Skehan
Well, certainly, as you pointed out, I have a lot of experience prior to that. But I can tell you that our processes with CHAP and CHAP are very thorough. We have to start with first that all of the site surveyors, we call them site visitors, our Trent QSEP train. So they receive CMS training and that is the same for the other accrediting organizations as well that I believe as well as the state survey agencies are also supposed to have that training done as well.
00;11;19;15 - 00;11;55;16
Kim Skehan
We also have in addition to so training, we have a really a two level review process. So I can only speak to our chat process when the site is when the findings are submitted by the surveyor, they are reviewed internally by our internal team and then we also have a board of review. So before that, sometimes we'll go after a plan of correction, but there's also there's a lot of discussion and decision before findings are, you know, are finalized.
00;11;55;16 - 00;12;32;24
Kim Skehan
And the criteria you are right. I mean, with the exception of immediate jeopardy, which of course has appendix Q with the triggers. Yeah. The the different the really the the differentiator. And I go back to the words scope and severity as well. Yeah. So, you know, is really whether there's an actual or potential severe or critical patient health or safety breach, you can have a situation where there are a number of standards under a condition or elements under a standard that, you know, combined may rise to a condition.
00;12;33;12 - 00;13;07;12
Kim Skehan
But more often than not, it's really about the impact of those findings and potential impact of those findings on qual safe and quality patient care. An example is a hospice aid. You may have several you know, you may have a few items, right? A tags out on a hospital, say, for not following the plan of care. But it may be related to not changing the bed or not, you know, brushing the patient's hair or or, you know, most of the age is competent.
00;13;07;12 - 00;13;37;29
Kim Skehan
But the survey supervisions may not always occur. That may be looked at differently. And I'm not saying every time, but I'm just using that as yeah, yeah. And then a hospice aide that was did not have the evidence of training and competency. So when there was no supervision and the items on the plan of care that the aged care plan that they were missing were things like, say, patient transfer, you know, bathing the patient.
00;13;38;06 - 00;14;05;18
Kim Skehan
The patient is on oxygen or the patient's bed bound and has a risk for skin breakdown or a wound. So you really have to look at that. The, you know, all of the aspects before you can make that decision. And like I said, I can speak for CHAP. We have an oversight process that we really do make sure that if we're citing that a condition and certainly at an age but at a condition that that those are also thoroughly reviewed.
00;14;05;18 - 00;14;09;24
Kim Skehan
So we take we take that our responsibility very seriously.
00;14;09;24 - 00;14;37;20
Meg Pekarske
I guess, on that front, because, you know, that that's sort of how I would see it, too. And if I were in your shoes, I mean, it shouldn't just be like, oh, had a number of standards out that automatically means a condition level, right? It's like, how serious is whatever deficiency we're talking about and potential or actual harm, which I think is important because we're wanted to turn our attention to was about advocacy, right?
00;14;37;20 - 00;15;05;16
Meg Pekarske
So you did this a lot as a consultant and it's what we do as lawyers is and I think is so critical when we talk about survey management. And I think it's something that, you know, as opposed to when we talk about government audits where it's like nameless, faceless person who's looking at records like you do have an opportunity with your site visitors to have a conversation.
00;15;05;16 - 00;15;39;16
Meg Pekarske
Or as you said, and we can talk about this a little bit more about the appeal process that CHAP has and things like that. But, but having a conversation about if you have some concerns as a provider, I think the first thing isn't just I disagree. Right. Like, well, but why? And that's why I guess getting this out on the table about things that are important when you're having a conversation like I'm not understanding where you're coming from, I think a scope and severity is a good place to start.
00;15;39;16 - 00;16;07;13
Meg Pekarske
But what are aspects of good survey management? Maybe that's go there for a second because obviously that's a lot what you did in your role as a consultant about how to stay prepared, but also how to navigate a survey that might not be going that well. Right. And you don't throw in the towel. How do you, you know, keep good lines of communication open and keep you know, it's critical that there is trust.
00;16;07;13 - 00;16;31;01
Meg Pekarske
You know, that both ways. Like if I bring something up, the survey or a site visitor is going to listen. And not that you always agree, but I think that mutuality of I'll listen to what you have to say and likewise so so tell me a little bit about, you know, good survey management. If a survey isn't going well, what do you do?
00;16;31;11 - 00;16;32;26
Meg Pekarske
You know, those kinds of things?
00;16;33;02 - 00;17;14;18
Kim Skehan
Well, first and foremost, I would say that what I hear most often from from from our customers are providers, is that the hallmark of CHAP is that we are that our approach is educational. So we we do our site visitors are, you know, very thorough. They're they're very communicative. We just I just had an example today of an organization that was very complimentary of the guidance, not just the guy, you know, not just, okay, this is what you need to do for the survey, but overall, you know, helping them to understand what the regulation is.
00;17;15;09 - 00;17;43;19
Kim Skehan
Ultimately, it is the organization's responsibility to be able to demonstrate how they meet the standard. So first and foremost, having a thorough understanding of the regulations before the survey occurs and then being able to demonstrate, at least in our case, our standards very closely mirror the copy so we don't have a lot of extra we don't put the interpretive guidelines, for example, in our standards.
00;17;43;25 - 00;18;20;13
Kim Skehan
So if you're clear with the standards and you can demonstrate how you meet the standard, then that's where the conversation starts. We also have, again, a process very similar to a state survey where if there is a question this same visitor does call in to assign director for that particular provider. So there's that ongoing relationship and communication. So that part of it is a survey management is really understanding the legs and how how the how the agency shows that they meet the standards.
00;18;20;22 - 00;18;52;17
Kim Skehan
And then really being on top of the both all of those for hospice and exam changes all of I call it all all of the read in appendix, all the pre survey guidance that's there, all of the really detailed information regarding, you know, what clinical records to review examples of interviews and document review and approach to survey for all aspects of hospice is vitally important.
00;18;52;17 - 00;19;21;02
Kim Skehan
We can't I can't you can't underestimate the the the benefit of having a true proactive survey management process, because that helps all of the staff, especially the staff in the field who are, you know, draw the lucky card. And they are there for the survey. And I want to just add here that again, we also are as a team, the agency, we are surveyed by CNS.
00;19;21;20 - 00;19;54;19
Kim Skehan
And as an example, we recently had our home health deeming Application Survey. We had no findings. So what that says is see on that said to us, you know, that our documentation, you know, regarding the principles of documentation, the appropriateness of the level of findings and they looked at everything, site visits, plans of correction, our policies, they looked at a lot and they went on a home, on a on an on an actual site visit.
00;19;54;28 - 00;20;34;24
Kim Skehan
And they were you know, that just to me, it makes me very proud that that's that's that's that's validation then of the work, you know, that we're doing. Also, CMS has just started in November we zoomed validation surveys which are different than what we're used to. So they're they're called dog surveys, direct observation validation surveys see them as contractors are going out with that the surveyors and observing it's not a separate survey it's not going to be two sets of findings.
00;20;35;01 - 00;21;03;21
Kim Skehan
And it's they are not conducting the survey. They are observing our site, our surveyors. And so it just started in November. And and right now it is announced to the AOH to CHAP. So we know ahead of time agencies do not because of course that surveys are unannounced but very soon within the next six months even we will not know when they're coming.
00;21;04;14 - 00;21;28;08
Kim Skehan
So you know that and that is fairly frequent that it's happening now. So so again, we have all of that oversight in helping us to make sure that we have processes in place, you know, to to in to support our approach and our decision making and survey.
00;21;28;15 - 00;22;04;00
Meg Pekarske
So tell me this. Where do where do providers go wrong? Like when when surveys go real, Sal, which I'm sure you've seen your fair share even in the time you've been with CHAP like what's the don't do this list of things people do you know not that substantive so much but like you know we know what probably good survey management is and stuff but where do things just break down and what do people do?
00;22;04;00 - 00;22;25;11
Meg Pekarske
Because this is humans dealing with other humans and stress. And because I do think there is just things that that folks can do, I would imagine that just get things on the wrong foot and it's hard to ever get it on the right foot. So can you just give give our listeners some of those things of what not to do?
00;22;25;19 - 00;23;04;22
Kim Skehan
Sure. And I will call these couple of items low hanging fruit, and especially with the spotlight, as we know, that are on some states related to hospice, in particular, hospice operations. Number one, they need to make sure that if they are an operating hospice or any agency that they have an office, they have an office, they have people in the office, they have availability of an administrator and alternate the medical director, clinical leadership and staff.
00;23;05;03 - 00;23;44;19
Kim Skehan
It is interesting to see that there are times when an organization may have posted hours and yet there's the staff are not available. That's the first and foremost thing because we can't gain entry into a survey or can't complete the survey. We we we have to notify CMS. The second is really just making sure CMS is notified and and CHAP in our case of time of any changes, changes in location, ownership, you know, key leadership and make sure that all new staff and managers are involved in survey readiness and implementation.
00;23;45;00 - 00;24;36;12
Kim Skehan
We've had examples of these in larger organizations which we have wonderful relationships with what we call our corporates, and just they have a great most of the time there's a very strong corporate structure, but just making sure that the local the local office has also that training and they understand, you know, their role and responsibility and survey and, you know, just from a survey management standpoint, you've heard me say, I'm sure many times keep a survey readiness book online and in each location, and to facilitate timely provision of reports, whether it's a census report, you know, schedules the documents because that that's a personnel record list, you know, lists just things like that, that inevitably,
00;24;36;21 - 00;25;11;09
Kim Skehan
you know, any delays just causes, you know, more stress on the survey. As far as the survey itself, you know, they just really I can't stress enough how much practice, practice, practice. So that means those mock surveys with your field staff, because they're really, you know, they're the most vulnerable in terms of of really, you know, you know, first of all, being really nervous and then potentially saying or doing something just because they're they're they're scared.
00;25;11;09 - 00;25;39;29
Kim Skehan
They're they're nervous, you know, hand hygiene or, you know, answering a question, you know, you know, completely wrong or providing a lot of information that really the survey doesn't necessarily need to have. And also remember that surveys can happen at any time. And substantiated complaints. Surveys along with condition level findings and I saw are components of potential inclusion for the SFP.
00;25;39;29 - 00;26;02;13
Kim Skehan
So they really have to make sure that they have a tight complaint process, you know, and a follow up with their quality programs and monitoring their hospital quality reporting. So all of those components, they really that the agency really needs to have a process in place to be able to know how they are addressing them.
00;26;02;13 - 00;26;29;16
Meg Pekarske
On going Another new acronym, SFP, does not roll off my tongue, but special focus program. When you're talking about ages and condition level and substantiated complaints, which again one of the many, many changes that we're seeing and how that will actually play out is going to be interesting over time. I mean, I just think the stakes on surveys is just so much greater.
00;26;29;16 - 00;27;02;12
Meg Pekarske
Obviously, we can get civil monetary penalties and we can, you know, have the manager, outside manager assigned an hour payment for new admissions. I mean, all of the staff I mean, if you weren't taking it seriously before, I mean, it's the ramifications of this are just really significant and can really have money problems too, because the drought denial payment for new admissions for hospice is a huge deal because our like the stay is really short.
00;27;02;12 - 00;27;47;27
Meg Pekarske
So if that's in place, I mean, so much of our census turns over every single bond. So if you have a denial payment for new admissions, like for a nursing home, the number of Medicare patients that, you know, new patients are getting might not be, you know, the same volume we're dealing with. So these are really significant. Another significant thing that happens as we sort of wind down here that is not new, but I think it has some logistical things that just I think would be helpful for you to explain about when someone who has gained status get like they lose their dream status and they go to the state survey authority.
00;27;47;27 - 00;28;06;02
Meg Pekarske
And what does that actually mean? How does that happen? How do you get back to the AOE and can you explain a little bit that's typically I've run into when you have a condition level citation and then but why don't you tell me more the story about how that works.
00;28;06;07 - 00;28;50;06
Kim Skehan
Sure. Well, when an organization has typically substantiated complaints with the with condition level deficiencies, it may not be just a condition level deficiency. It may be that they've had condition level deficiencies that were then are re rectified, if you will, you know, within the 45 days. It really depends on the circumstance. I j for sure. Immediate jeopardy in those cases or if a state conducts a complaint survey and identifies a substantiated complaint, what happens is the agency is notified that they're deemed status is is not is is no longer is temporarily removed.
00;28;50;26 - 00;29;26;25
Kim Skehan
What that means is that the hospice still has the still has their can they some of the provider number they can still admit patients. And unless, you know without any proper remedies they can still build they don't lose their billing privileges because a lot of times there's some confusion there and it is redeemed or they they are able to be reinstated as an a as a deemed accredited organization when the condition levels that they have clearing out their condition levels or their immediate jeopardy.
00;29;26;25 - 00;29;53;00
Kim Skehan
So there's a process where a CMS actually notifies the agency of the removal of their deemed status and then the reinstatement it says deem status is maintained. So, you know, again, we monitor those, you know, with organization and we have an obligation to report to CMS all of our survey findings. And then CMS will notify the agencies.
00;29;53;12 - 00;30;00;21
Meg Pekarske
So then that revisit that has to happen to get back into Dame status then. Does the state do that then.
00;30;01;08 - 00;30;32;02
Kim Skehan
Or it depends. Again, if it's a if it's a regular condition clearing, you know, under normal circumstances, if we have just condition level deficiencies, it doesn't automatically revert to the state. I always thought that it did, but it does not. We do condition clearing visits and then we notify CMS. The way we see deemed status removed is typically if there's an IG or a state substantiated complaint survey with condition level deficiencies.
00;30;32;22 - 00;30;58;04
Kim Skehan
And in which case we see the trail, we see the communication to the provider, we see when that survey was done. But nine times out of ten, we do that sometimes. If we have a situation where we were not able to gain entry into an agency, then we notify the the CMS and then their accreditation is temporarily terminated.
00;30;58;04 - 00;31;27;09
Kim Skehan
But they are terminated, but they they stay still, maintain their provider number. So they they then also refer to the state agency. So it's it's a little bit complicated, but I think the biggest you know, there's a lot of nuances, if you will. Yeah, but the biggest lesson is that just because, Deane, status statuses, you know, is temporarily removed, it doesn't mean that the state, the provider number is removed.
00;31;27;25 - 00;31;46;10
Meg Pekarske
And then that revisit surveys. So that say they say your team status is temporarily removed. Obviously, you're going to need a revisit to get back into substantial compliance. I'd imagine typically be like, so who does that do you does not do that.
00;31;46;28 - 00;32;14;27
Kim Skehan
It depends. If hasn't if if the deemed status has not been removed under most cases where we have condition level deficiencies. Right. Yeah. Even I j will go and do the restart, will do the return visit and then and, and then we report that to CMS and that is cleared. There are just times when the state has then determined that they are going to go out and do a visit.
00;32;15;02 - 00;32;39;13
Kim Skehan
Sometimes if we if we report to CMS, our findings, especially if it's a complaint and the state has also received a complaint, there may be a second survey by the state agency that. So it's not an automated check that a condition level deficiency or even an ECG automatically means that it reverts to the state. That really is a CMS determination.
00;32;39;13 - 00;33;04;18
Kim Skehan
We most often will conduct those surveys and get the and get the work to to get the agency back into compliance. Right. So they can demonstrate it. But, you know, and we've had that experience where we've got, you know, gone out close to the deadline, right, close to 23 days or close to the 90 days, even after the 45 days.
00;33;04;25 - 00;33;30;23
Kim Skehan
And it's at that point, you know, first of all, at that point, certainly as a consultant, we used to say, make sure you have a hospice experience lawyer. Yeah, yeah. To help you and and also, you know, and even in this, you know, also making sure that they have certified consultants in some cases. But, you know, it's it's it's it's a little bit complex.
00;33;30;23 - 00;34;00;08
Kim Skehan
And like I said, it's not cut and dry. But generally speaking, if if if the status is removed, it typically can revert back under, you know, once the state has cleared them, you know, if it's been a complaint, a state driven complaint, or there are some cases where the organization has to reapply for accreditation. So but it's you know, it's it's it's not something that has to be permanent.
00;34;00;20 - 00;34;27;28
Meg Pekarske
So the last thing I want to cover, which started dovetails on some of the stuff which I think is an area that we as an industry need to get way better at, which is writing plans of correction, as I am sure you saw this all the time, when you're a consultant, you still see this all the time where people either write too much or too little.
00;34;27;28 - 00;34;50;20
Meg Pekarske
You over promise to under-deliver like, you know, people just don't hit the right tone. Like, it's really like who what, where, why? One how in short form, right? Like who's going to make sure this is going to happen? You know, when is this going to be done? How are you going to, you know, measure this or, you know, whatever it may be?
00;34;50;29 - 00;35;11;19
Meg Pekarske
I still think people really struggle with writing effective plans of correction because, you know, one thing I see again in the do not do list is don't over promise you can do more than you say you're going to do in your plan of correction. You don't need to write it in there, right, if you want to do something.
00;35;11;29 - 00;35;32;22
Meg Pekarske
But the worst you can do is say you're shooting for the moon and you know, and then you get a fail revisit because you didn't do what you said you were going to do. And it's like you don't get extra credit for saying you're going to do more. So I think stick to to sort of what is actually needed.
00;35;32;22 - 00;35;48;24
Meg Pekarske
Not like the gold the gold star or triple gold star or whatever. I see that a lot. But I guess what's on your sort of top, top five list of like what people do wrong and plans of correction?
00;35;49;08 - 00;36;11;27
Kim Skehan
Well, again, I'm I'm leaning on all of my experience when I respond to this. First and foremost, they need to make the plan of correction measurable and achievable. Exactly what you said. You want to make sure that it makes sense for the organization to address, you know, the the finding, you know, identify what they're doing for monitoring and follow up, but make sure it's achievable.
00;36;11;27 - 00;36;45;16
Kim Skehan
Also making sure that the monitoring is has an end point, you know, because sometimes we'll see periods of correction that look as though they're going to continue on with 100% audit in perpetuity. And, you know, so you want to have a threshold. You want to have, you know, a self defined tapering down, if you will. You know, once thresholds are met and then incorporated into the your organized organizations quality program, whatever, the routine quality management program.
00;36;45;16 - 00;37;21;18
Kim Skehan
So, you know, you don't have really an untenable plan of correction. However you do have them, they do have to make sure that there's oversight of that plan of correction to make sure it is implemented, as noted, because previous deficiencies may be taken into account if there are still issues. And remember, with the survey changes, if there are findings concerning findings across multiple providers, if you have a larger organization, oh, weekends we look for for trends, you know, we are able to do that.
00;37;21;18 - 00;37;58;21
Kim Skehan
We we definitely do it. And any survey agency will look at prior survey information as well. And, and if, you know, if, for example, individualized care planning was out because that seems to be the top off the top line. If that if you had this great, robust plan of correction and you completed it and you had a condition, we'll just say for, you know, for for, you know, for the for that citation and then or for that condition and, you know, the surveyor comes out 45 day clearing, right?
00;37;58;21 - 00;38;34;17
Kim Skehan
You do everything you're supposed to do. And the minute the surveyor leaves, you put it on a shelf and never look at it again. So then a complaint re survey, right, three years later or a complaint survey six months later. And we still have the issue. That's the kind of thing that organizations really need to make sure that it is reasonable, but that they can maintain that monitoring and hold accountable all staff for not just regulatory compliance, but for their responsibility in, you know, implementation of the plan of correction.
00;38;34;17 - 00;39;06;21
Kim Skehan
And I we also recommend I always have recommended utilizing hospice experienced consultants and in some cases legal counsel to address any ongoing or serious findings, you know, especially if enforcement remedies are being considered because there's not there's there are many hospices that are there are many wonderful hospices. Most hospices, I will say are wonderful. And they really do strive to, you know, to to to meet the highest standard.
00;39;06;27 - 00;39;28;11
Kim Skehan
There are many hospices that are newer, that may not have experienced staff or leadership or have had changes. And they really need to have that expertize to help guide them, you know, to be able to make sure that they are successful long after the survey, you know, the survey complete.
00;39;28;16 - 00;39;57;28
Meg Pekarske
Yeah, well, right. The plan of correction is not a piece of paper. Compliance is not a person. Right. Compliance is a organizational responsibility. The plan of corrections, a living, breathing thing that, you know, you don't need to get an A-plus, you need to get through, and you can do A-plus, but don't write it down right, and do something that you can actually accomplish.
00;39;57;28 - 00;40;24;28
Meg Pekarske
Because I just see people, I guess, get sidetracked by doing more than is required. And therefore they don't end up being what they actually needed to do to get out of it. And so they may fail that revisit and people won't know that that we actually do this so we can see each other. And Kim shaking her head and like, yeah, because it's like how have we seen that?
00;40;24;28 - 00;40;45;11
Meg Pekarske
Where it's like, gosh, you don't need to promise the moon. And so it sounds like you're in agreement with me as well. People get just sort of they almost overreact to stuff like, Oh, I got to try. Oh, I'm taking this seriously. It comes from a good place. But actually you only have so much energy and so much time.
00;40;45;11 - 00;40;56;09
Meg Pekarske
And that's why it's like you need someone who's skilled at looking at what is the essential part of what we need to do and then start there and do it.
00;40;56;10 - 00;41;32;24
Kim Skehan
And and not yeah, start by not missing the mark, but then making sure that again it's a reasonable, sustainable plan of correction. Now I will say that, you know, they have a plan, a correction does at least the first part always needs to be implemented within a, you know, relatively short period of time. But but again, it says sustainability, you know, that that becomes that that really is what the organization needs because ultimately that's really the goal is, you know, the the survey, it's the responsibility of everybody in the organization.
00;41;32;24 - 00;41;46;04
Kim Skehan
And with this, you know, increased scrutiny, organizations need to make sure that they have have processes in place, that they, you know, have reasonable monitoring ongoing.
00;41;46;14 - 00;42;17;07
Meg Pekarske
Yeah well I was part of me was sad when you last consulting because you have been so helpful to me and clients over the years because I think, you know, lawyers can be great. But I also think lawyers are not the best in terms of implementing. Like I'm not a clinician. I mean, I've been around this long enough that I can do that stuff.
00;42;17;07 - 00;42;44;02
Meg Pekarske
But I just think if you are struggling, really having a consultant that can help be your guide. And I also think it signals to the accrediting body like, Hey, I'm taking this seriously and your self identifying like I need somehow because I do think, you know, there's not a lot of grace in this new system that we're facing and it's pretty.
00;42;44;02 - 00;43;17;27
Meg Pekarske
So you don't have like three strikes. I mean, yeah, it's not like you're going to be or a termination track now immediately, but like there is very serious ramifications even though it's not termination that can happen. And so I just was, you know, sad to lose you as a colleague, as a consultant to someone when a client's calling me in crisis and thinking like, I need someone that can go and sort of speak the language and get things done and all that.
00;43;17;27 - 00;43;45;20
Meg Pekarske
But at the same time, you know, it's very cool, your current job and someone that I know brings the wealth of experience that you do and different perspectives because I think you operationally understand what it is to be in a hospice. So hopefully in terms of, you know, providers having conversations, you understand it doesn't mean you always agree.
00;43;46;01 - 00;44;09;27
Meg Pekarske
But I think probably the thing that could be most frustrating for providers is they just don't get it. Like I'm talking to someone who just never has done this. They don't know. And that feels bad, right? I mean, and so it again, it doesn't mean like, oh, Kim's going to make different decisions because, you know, there's no favorites here.
00;44;09;27 - 00;44;30;19
Meg Pekarske
But I think that I was I felt warm hearted, though, when you had this position, because I felt like you're a great person, too. I never really thought we'd have someone like you in that position, because I just think if I had to pick up the phone and call you about something, I feel like you'd understand where I'm coming from.
00;44;30;19 - 00;45;05;18
Meg Pekarske
And we might not agree, but like you're hearing me out. And I also think you bring a level of I real world experience. It's not like I read a book and this is what it's said, you know. And I think that that's what in terms of trust and the process that I think is really helpful. And I think it's something that if you do have team status and you're accredited, I mean, I think there can be a real value to that and I think, you know, Cap has been around for a really long time.
00;45;05;18 - 00;45;32;03
Meg Pekarske
And, you know, I just think the fact that you are there and it says something about the kind of approach that they have. And I know that, you know, you really, you know, can bring all of your different perspectives to your job. And I think you're a great listener and, you know, a very, very fair person and, you know, want to find ways to get through things, you know.
00;45;32;03 - 00;45;53;28
Meg Pekarske
And so I think that's really important because there are, as you said, there is board review and you have appeal rights and, you know, and so you do listen to what people have to say. And I think that's really important. So so thank you for for being in the role that you're in, because I can't imagine that it's it's an easy job.
00;45;53;28 - 00;46;02;02
Meg Pekarske
Sometimes it it seems like, oh, it must be great to be the regulator, right? Like, oh, you hold all the cards, but I'm sure it's also very difficult.
00;46;02;14 - 00;46;43;12
Kim Skehan
Well, you know, I will say that it's I actually, you know, I feel truly honored to be in this role. And I am surrounded not just by all the experts that we talked about before, within charts, our site visitors, all have real world operational experience. So these are not, you know, folks that came up through a system and they surveyed in, you know, another setting and they're now in hospice, you know, so really, they they bring profound understanding and when they are working with that, with the organizations.
00;46;43;12 - 00;47;23;23
Kim Skehan
But I do agree with you that in this era of increased CMA scrutiny on the survey side, it's highly recommended that agencies consider accreditation and certainly CHAP accreditation because we do have valued value added oversight consistency which is really important and educational focus for the surveys as well as ongoing education and programs outside of the survey that can wrap around the hospice and help meet not only regulatory compliance but also move the hospice forward in improving their services and outcomes and their staff knowledge.
00;47;23;23 - 00;47;53;27
Kim Skehan
And ultimately, the goal is to for to able to support partner with agent organizations, to provide safe quality care and, you know, and really help them to sustain and that's it's it's I enjoy the role of being, you know, again, yes, we are adding authority but. We really have to work to be a supportive, supportive to our or our customers.
00;47;53;27 - 00;47;57;12
Kim Skehan
So yeah. And to add to our partners such as you.
00;47;57;24 - 00;48;32;11
Meg Pekarske
Yeah. Well it is important work and you know I think everyone's committed to what this work is, which is compassionate, quality, end of life care. I mean, that's why we're all here, right? So we all want the same goal. And well, I thank you for for all of the work you do. And I'd imagine, you know, lots of learning, too, because obviously you've been around the block, but then, you know, all things that your new role, I'm sure, required you to learn many new things too.
00;48;32;11 - 00;48;39;07
Meg Pekarske
So I got to keep learning or else you learn every day. You learn every day so well.
00;48;39;07 - 00;48;42;04
Kim Skehan
This is mess. We'll make sure that we do this well.
00;48;42;05 - 00;48;50;26
Meg Pekarske
Exactly. You know, just when you thought you understood every hour, most things that you know, but keeps us young and vital.
00;48;51;16 - 00;48;52;01
Kim Skehan
They go.
00;48;52;11 - 00;48;58;00
Meg Pekarske
Yes, so but well, this was delightful. And I really, really appreciate your time. Kevin, this is wonderful.
00;48;58;04 - 00;49;18;21
Kim Skehan
Thank you. Thank you very much for having me. It's been a pleasure. I enjoy working with you and I love being able to, you know, help in in providing additional guy education and insight for, you know, for your listeners. So thank you.
00;49;18;21 - 00;49;19;14
Meg Pekarske
Well, that's it for
00;49;19;14 - 00;49;40;20
Meg Pekarske
today's episode of Hospice Insights: The Law and Beyond. Thank you for joining the conversation. To subscribe to our podcast, visit our website, huschblackwell.com or sign up wherever you get your podcasts. Until next time, may the wind be at your back.