The Kansas state department in charge of inspecting nursing homes failed in 2014 to verify that problems found in facilities were corrected, a federal government agency reported.

The fact that Kansas and six other states didn't follow proper procedures in previous years led the U.S. Department of Health and Human Services Office of the Inspector General to issue recommendations this week that would change the way all states handle inspection reports. 

In a close look at Kansas' data from 2014, OIG estimated the Kansas Department for Aging and Disability Services, which is responsible for inspecting nursing homes, failed to verify that 65 percent of the problems found during inspections — called deficiencies — were corrected.

Kansas was one of nine states OIG audited to determine how well deficiencies were being corrected, and if the states were meeting requirements set by the Centers for Medicare and Medicaid. Seven of those states did not always verify that nursing homes' took corrective actions after deficiencies were found.

But more importantly, Kansas was one of just four states that failed to verify serious deficiencies, OIG said. Deficiencies were broken down into levels of seriousness, giving examples to illustrate the difference. A less serious deficiency was listed as one in which the nursing home failed to follow proper restraint procedures, whereas a serious deficiency was one in which a medication error was made.

Patty Brown, interim commissioner at KDADS' Survey, Certification and Credentialing Commission, said bluntly, "We were not doing things correctly."

But problems in how the deficiencies were followed by KDADS staff were corrected in early 2017, she said. There had been misunderstanding on staff who were doing the desk review of the facility surveys, and they were not correctly following up.

"The change that occurred was that we now require providers to submit the evidence that shows that that plan has indeed been implemented and the deficiencies are corrected," Brown said. "We will always go back and do an onsite revisit for serious deficiencies."

The changed internal processes brought KDADS into compliance with CMS requirements, she said.

The OIG recommended in its report that CMS take steps to change processes, including improving guidance to state agencies, improving forms related to the certification process and clarifying what is acceptable documentation depending on the seriousness of the problem.

The Kansas OIG report indicated the agency found 2,127 deficiencies from 302 nursing homes that had ratings requiring KDADS "verify correction by either obtaining evidence of correction (1,949 deficiencies) or conducting a followup survey (178 deficiencies)." 

In looking at a random sample of 100 deficiencies, the OIG found KDADS failed to follow procedure on 52 deficiencies found at nursing homes, either not obtaining evidence of correction for the deficiencies or failing to provide sufficient evidence of correction.

In other findings, the OIG determined that KDADS, failed to do inspections every 15 months, as it is required to do, of 35 of the 79 nursing homes that were in the 100 sampled deficiencies. The longest interval between inspections was 18 month, the report said.

Data on the CMS website shows that as of Feb. 4, 2019, 24 nursing homes in Kansas had late surveys, exceeding the 15-month limit. 

In a letter dated in August 2017, Codi Thurness, then the KDADS commissioner of the Survey, Certification and Credentialing Commission, said steps were taken in 2016 before the OIG audit to correct "deficiencies in our process."

The OIG report noted that KDADS had five regional offices with 61 surveyor positions, 13 of which were vacant. Brown said the agency still struggles to fill surveyor positions.

"As of Feb. 1, we now have four regional offices instead of five," she said. "We combined two north central and northeastern region into one district because it made more sense. We have 58 surveyor positions, and we do have 12 vacant."

One or two surveyors have been hired and will be starting work soon, Brown said. But filling those positions is a challenge, in part because the registered nurses who typically are surveyors can be hired away by healthcare facilities that offer higher rates of pay.

The Legislature did in 2018 provide a budget enhancement, Brown added, so they were able to increase the wage for the survey positions. An RN working for the state in that job would start at $52,000, she said.

"We are still not competitive with nursing facilities," Brown said. "We have a lot of nursing facilities who do recruit from our surveyor population. So we have a fair number of turnover that way. They’re offering significantly more money."

The position is demanding, she said, with travel and overnight stays away from home two or thee nights a week. It also takes six months to a year for training before the surveyor can be CMS certified.

"We’re in a much better position than we were even six months ago," Brown said.

She pointed to figures from January that showed just two facilities were past 15.9 months in having their surveys, which are supposed to be done every 15 months, according to CMS regulations. Just 18 were over 12 months, Brown said.

"Compare to July 2018, we had 110 over 16 months and another 66 over 12 months," she said. "We have made a very significant change in that, and very significant improvement in the last six months."

UPDATE: This article was edited at 9:50 a.m. Feb. 12, 2019, to clarify that Thurness was the former head of the Survey, Certification and Credentialing Commission.