For better or for worse, the survey game is one all nursing homes are forced to play.

But if you’re a nursing home operator in certain states, it seems the playing field always tilts in the opponent’s favor. Or maybe it’s more fitting that I say the chips are stacked against you, given the financial implications of this off-balance system.

While we’ve seen a few states make a concentrated effort to get back into a regular routine with inspection and recertification activities, both consumers, operators and even the Centers for Medicare & Medicaid Services itself continue to demand a more responsive surveyor network.

Without coming right out and saying it, CMS released information last week that shows many state agencies continue to greatly underperform on survey frequency, follow-ups and other quality benchmarks that they’re supposed to be meeting to ensure quality oversight. (No word either on what penalties agencies faced when they fell below the 80% pass mark in specific categories.) 

Both the time between visits remains a major concern for providers. In a pattern that has been persistent since COVID started — and long before that in some poor-sport states like Maryland  — surveyors seem happy to tag whoever they can then leave the field for extended periods of time.

The ratings hits and penalties dependent on those tags already made that a no-win situation for providers. But delays count more than ever now, given that CMS just gave itself the power to dock facilities for per-day and per-instance civil monetary penalties for the same deficiency.

The longer a facility goes between site visits, the longer it might be operating outside the rules, possibly unknowingly or unintentionally. Under the expanded CMP framework, delays in spotting errors may mean more days in penalty given a lookback.

This new level of delay has built a new disadvantage into the survey game, bringing fresh resentment for a system that has clearly had more than its share of animosity over the years.

It’s a shame that survey agencies would be viewed as opponents at all, given that both the government and providers have an obligation to protect patient safety. But the gotcha mentality of some enforcement agencies — or the elected leaders able to use them for political gain — have made surveyor hostility a de facto part of long-term care operations.

Take the latest game of Storm the Castle in New Mexico. Gov. Michelle Lujan Grisham (D) gloated after she spent inspectors out to make unannounced visits to 91 senior care facilities over three days.

Nearly three-fourths of providers scored a 90% or better during their inspections, which last time I checked was an A. Better yet, 11 scored perfectly and 22 missed “perfect” by one mark.

But in an impressive display of spin, Grisham put out a flashy statement calling the findings unacceptable — while also noting most lapses were for administrative issues, smells and unposted menus.

Providers have begged for years for a more collaborative system, one more like the Joint Commission approach embraced by acute care providers and by the select few post-acute operators who have signed on to that program voluntarily for the opportunity to get more educational feedback.

And nursing home residents wouldn’t be the only ones to benefit from a system that was less hostile and more intentionally constructive; imagine the wonders it could do for surveyor recruitment to be seen as a teammate.

For now, however, it remains a game of underdog vs. the perennial winner. May the odds be ever in your favor.

Kimberly Marselas is senior editor of McKnight’s Long-Term Care News.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.