Harmony Healthcare Blog

The Long-Term Care Survey Process: Refinements in the Making

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Tue, Aug 15, 2017

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Edited by Kris Mastrangelo


Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

medical-survey.jpgThe Centers for Medicare and Medicaid Services (CMS) is refining survey process and they are raising the bar!  This seems to be a pattern with everything they are doing in the context of Regulatory Refinement. New standards and expectations will be effective November 28, 2017.  The days of decade old rules are far behind the Post-Acute Industry.  The government is in a CQI state of mind and appears to be practicing what they preach.  

Regulation Refinement

The massive changes in regulatory reform are infused within the legislation from the Affordable Care Act (ACA) and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act.  The intent encompasses the notion that residents require better continuity within the walls of the facility and this initiative permeates beyond the walls into the community. 

Themes that encompass the mission include Systems, Education and Transparency. 


The expectation of a functional Quality Assurance and Performance Improvement (QAPI) program within each facility is a directive by the government to address areas of improvement with an approach inclusive of data, goals and processes. In other words, fix the system not just the problem.  The advent of technology is a critical factor affording the Dr. Deming approach to work in a service industry. QAPI principals were originated in the manufacturing industry which readily supplied data. Until Skilled Nursing Facilities could produce, collect and compare data, this approach seemed unattainable.  Today, data is flowing with mounds of information ready for inclusion in a QAPI forum. 


The fundamental requirement for providing better care is through staff education and training. Employees need information in a user-friendly manner while competencies are critical for demonstrating an understanding of the information. While the flow of materials on standards is accessible, Providers need to define their services (facility assessment) and assure the client expectations are congruent to the patient population and community. 


The advent of technology influenced every one of us in the context of our day to day lives.  Immediacy, big data and accessibility are at the forefront.   One can immediately search the internet for an answer to a question.  As we search, pop up screens from a store display an item or related item we “Googled” last week in hopes of a purchase.   Our friends and families text us and become frustrated if more than 20 minutes elapse before a reply.  With this, is the overarching theme of transparency.  

Consumers are aware of products, services and satisfaction with one click of the button. While this may be perceived as “only relevant” to the service and manufacturing industry, it has arrived into the world of healthcare. 

Now, this is impacting the Regulatory Survey Process in every Skilled Nursing Facility in the U.S. 

The New Survey Process 

The Center for Medicare and Medicaid Services (CMS) offered the following information via webinar last month.  Highlights include: 

Why is CMS Changing the LTC Survey Process? 

  • Two different survey processes existed to review for the Requirements of Participation (Traditional and QIS).
  • Surveyors identified opportunities to improve the efficiency and effectiveness of both survey processes.
  • The two processes appeared to identify slightly different quality of care/quality of life issues.
  • CMS set out to build on the best of both the Traditional and QIS processes to establish a single nationwide survey process. 

Goals of the New Process: 

  • Same survey for entire country.
  • Strengths from Traditional & QIS.
  • New innovative approaches.
  • Effective and efficient.
  • Resident-centered.
  • Balance between structure and surveyor autonomy. 

Stay tuned for Harmony Healthcare International’s (HHI) next blog post comparing the New Long-term Care Survey Process for: 

  • Automation
  • Sample Selection
  • Off-Site Survey Review
  • Information Need Upon Entrance
  • Initial Entry to Facility
  • Survey Structure
  • Group Interviews

Harmony Healthcare International (HHI) is available to provide assistance You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 

Additional Information:

Additional information about the survey process and implementation can be found at: 


So much information, so little time to learn it!
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