CMS’ Risk-Based Nursing Home Surveys: Liability Considerations
Starting September 8, there is a new Centers for Medicare & Medicaid Services (CMS) risk-based survey process. The new risk-based model is designed for higher-performing facilities that meet specific criteria. Yet what are some of the litigation concerns around this change?
The article Inside the Litigation Impact of CMS’ New Risk-Based Survey Process on Nursing Homes explains the changes but also highlights that the issues can come from those recurring or systematic problems. Some potential areas for litigation include falls, pressure injuries, elopements, preventable infections, abuse or neglect, medication errors, and staffing-related failures.
This article falls under Clinical/Patient Safety and Legal/Regulatory in the Enterprise Risk Management (ERM) risk domains.
Clinical/Patient Safety
Risks associated with the delivery of care to residents, patients and other healthcare customers. Clinical risks include: failure to follow evidence based practice, medication errors, hospital acquired conditions (HAC), serious safety events (SSE), and others.
Legal/Regulatory
Risk within this domain incorporates the failure to identify, manage and monitor legal, regulatory, and statutory mandates on a local, state and federal level. Such risks are generally associated with fraud and abuse, licensure, accreditation, product liability, management liability, Centers for Medicare and Medicaid Services (CMS) Conditions of Participation (CoPs) and Conditions for Coverage (CfC), as well as issues related to intellectual property.