Companies going through an accreditation process usually experience at least some degree of anxiety. The importance of achieving and maintaining accreditation is often “life and death” to an organization—lose it and you may not be able to continue billing or receive referrals from a payer or a referral source. If it’s the first time you’re going through the process, you can also add the fear of the unknown to that equation. Add these factors together and you have a combination that can cause a lot of stress!
HQAA’s process strives to alleviate that stress and impart knowledge and understanding to you and your staff. Beginning with the workroom, where coaches guide you through the application process, and culminating with the on-site survey, the process is meant to set you up for success. Knowing what to expect during the survey—the on-site inspection—is helpful in getting your staff through the process. Just as important, it also alleviates the stress in the weeks and months leading up to the survey.
The first consideration in the on-site survey is scheduling. Yes, its unannounced and you won’t know when the surveyor will be there. This is a requirement of Centers for Medicare & Medicaid Services (CMS) and other payer sources. While it can be challenging to work around the fact that the visit is unannounced, understand the rationale behind this rule: Your company should in theory always be ready. The inspection measures quality of care and the very internal processes that your company live every single day. The surveyor wants to see what happens on a normal day, what your typical day is like, how your processes work. You will not be scheduled for a survey until you say you are ready and then you are typically given a three month window during which you can expect to see the surveyor.
The surveyor typically comes in at the start of the workday. If you are a multi-branch organization, the survey will start at the location you designate as your corporate headquarters or main branch. They will immediately identify themselves as an HQAA surveyor (look for the photo identification badge with the HQAA logo) and ask for the owner, manager, or person designated to oversee the accreditation process. And voila—the survey starts!
The surveyor will invite you and your staff to have a quick meeting to talk about what to expect—again trying to impart knowledge and take away the fear factor. It’s completely up to you how many of your staff members you want to include. Most surveyors recommend “the more the merrier”. The surveyor will lay out an agenda and describe what he or she needs to accomplish over the day/days of survey. A typical agenda (if there is such a thing!) might look something like this:
8:30-9am: Opening Conference. Surveyor and staff meet each other. Staff explain their role in the company. Surveyor lays out agenda.
9-9:30am: Facility Tour. Staff and surveyor walk around the office, the retail showroom, and the warehouse and equipment processing areas.
9:30-10:30am: Personnel File Review. Usually done with the owner or manager (or the human resource manager at larger companies). Surveyors are interested in documentation of training and competency, performance evaluations, job descriptions, contracts, licenses, healthcare records, and I 9 forms.
10:30am-Noon: Home Visit. Surveyor rides along with staff member to do a delivery, a service call, or a clinical visit. The surveyor wants to observe patient care and this is the best way to do that.
Noon-12:45pm: Lunch Break. Sometimes surveyors will do “working lunches” and ask for paperwork to review during the break.
12:45-2pm: Patient Record Review/Billing Staff Interviews. Surveyor will look at both the clinical file—with records of education, training, and assessments; as well as billing files. Often done in conjunction with interview of staff members who perform billing functions.
2-4pm: Staff Interviews. Surveyor will interview several staff members, typically representative of all departments. For instance, he or she might ask to interview one customer service rep, one driver, and one warehouse/equipment staff member.
4-5pm: QI Conference/Staff Interviews. Depending on how big your QI committee is, the surveyor will most likely either interview the entire committee or interview some representative to gain insight into how the program works and what useful information you’ve gained from it.
Evening: Test of the On-Call System. For companies that have 24 hour on call, the surveyor will want to test the system by actually calling your on-call staff.
8:30-10am: Policy Review. Now that the surveyor has worked with your staff, they may want to spend a bit of time reviewing the policies and procedures associated with the work they observed. They are making sure that staff followed appropriate guidelines and internal procedures. This time might include reviews of complaint logs, review of after hour call logs, review of staff training records, etc.
10-11am: Financial Overview/Leadership Interviews. The surveyor will want to see how the company manages its finances. To do this, they usually look at budgets, financial reports, and profit/loss statements. They are not assessing your actual finances as much as they ensuring that you track your finances for proper planning.
11am-12noon: Patient Care Observation. If you provide patient care in the office or retail showroom, the surveyor might want to observe that care. If not, they may ask to go on another home visit/delivery. Typically, they would not want to go out with the same staff member they accompanied earlier in the survey.
12-1pm: Lunch Break.
1-3pm: Work on the Report. Toward the end of the survey, the surveyor will need some down time to work on the report. The paperwork is such that the surveyor needs to review it prior to wrapping up with your staff. This is also the time to follow up on any issues that came up during the survey so far. Finally, it is a good time for the surveyor to make up anything they missed or want to revisit or review.
3-4pm: Exit Conference. Surveyor reports on findings and explains how the reporting works and what your company should expect in the weeks to come in terms of follow up.
Keep in mind that the surveyor doesn’t approach the survey with a specific “agenda” or timeframe. They have a list of items they need to accomplish and can do it in any order. For the most part, they will let you drive the schedule as long as the survey process is progressing and activities are being done. They will remain flexible and work around your operations. Open communication is the key to success—let the surveyor know if there’s any scheduling issues you’d like to try to work around and they will try their best to accommodate.
The more involved and engaged your company and staff are in the accreditation process, the more comfortable you all should feel regarding the survey. “Knowledge is power” and knowing what to expect during a survey should help alleviate the fear associated with the visit.