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CMS Needs to Come Clean on Immediate Jeopardy

Cheryl Clark, for HealthLeaders Media, March 17, 2011

"The federal government doesn't count them, the state government doesn't count them, and they were not intended to be used in the reimbursement arena at all," Dalton says.

Of concern is what he called the "wide latitude" the federal immediate jeopardy definition gives state surveyors to call an IJ, if they feel like it.

For example, Dalton says, survey teams in some parts of the country or in some states may level IJs only when serious physical harm or death to a patient has occurred. But for survey teams in other states, an IJ might be levied when the harm is only psychological.

Neglect can provoke an IJ in some states, but not others. The possibility of harm might be applied in one region, but not another. The rules for what is and what isn't an IJ go on for 36 pages.

"It's unreasonable to start punishing hospitals economically for things that are somebody's perception of a situation," Dalton says.

He adds that it might appear North Carolina hospitals are worse than those in other southeastern states, when North Carolina enforces some of the most stringent quality outcome and process measure criteria in the country.

Danielle Lloyd, senior director for reimbursement policy with Premier Healthcare Alliance, a purchasing group that includes more than 2,400 hospitals, says she's hearing similar concerns. In particular, objections are coming from California, where hospital officials "think they're getting a lot more IJs than other states," Lloyd says.

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1 comments on "CMS Needs to Come Clean on Immediate Jeopardy"


wilcox (8/30/2011 at 6:26 PM)
I am a former surveyor, and after many years of contact with both federal and surveyors, I can confirm that the discrepancies among surveyors are real and astounding. Some surveyors base their findings of deficiencies on their own preferences and interpretations, despite a lack of supporting evidence of how a practice fails to comply with professional standards of practice. In some instances, surveyors themselves, are not knowledgeable about certain practice. This is not meant as a criticism, rather it should give each side an opportunity to share information. Of even greater concern regarding state surveys (which are contracted by CMS), is that there are well-known facilities with political connections that are often able to have their citations reduced in scope and severity, or eliminated altogether. Or some surveyors simply develop a fondness for certain facilities, and then find it difficult to cite those facilities.