Proactive Compliance Strategies for Nursing Homes: OIG Guidance and Best Practices

OIG’s Perspective

Many nursing facilities operate reactively, focusing on survey preparation or addressing deficiencies from recent evaluations. The Department of Health and Human Service, Office of Inspector General (OIG) urges facilities to establish proactive systems and processes that detect and prevent legal violations while promoting quality care and resident well-being. A proactive approach will likely result in better survey outcomes.

Nursing Facility ICPG

In November 2024, the U.S. Department of Health and Human Services' Office of Inspector General (OIG) issued updated Nursing Facility Industry Segment-Specific Compliance Program Guidance (Nursing Facility ICPG). This voluntary guidance builds on the 2008 directives and supplements the mandatory Requirements of Participation (ROPs) for Medicare and Medicaid programs. The guidance emphasizes improving resident care quality and safety and covers four key compliance areas:

• Quality of Care and Quality of Life
• Medicare and Medicaid Billing Requirements
• Federal Anti-Kickback Statutes
• Other Risk Areas

This article focuses on OIG’s recommendations for enhancing quality of care and quality of life and considerations in implementing a proactive compliance program addressing some of these issues.

OIG’s Key Recommendations for Nursing Facility Compliance

• Staffing Enhancements: Nursing homes must hire adequate and skilled personnel, prioritizing leadership with expertise in geriatric care, offering competitive compensation, and investing in continuous training.
• Individualized Care Plans: Facilities should create personalized care plans that address residents’ medical, mental, and psychosocial needs, with regular evaluations and updates.
• Resident Activities: Establishing well-supported activity programs ensures residents remain engaged and improves their quality of life.
• Medication Management: Facilities must train staff on proper medication use, implement review processes to prevent errors, and eliminate unnecessary prescriptions.
• Resident Safety: Nursing homes should develop a culture of safety with effective communication, continuous monitoring, and specialized training to prevent neglect and abuse.
• Staff Screening: Facilities must verify staff credentials through the OIG’s List of Excluded Individuals and Entities to prevent hiring excluded personnel and avoid overpayment liabilities. Best practices include standardized hiring processes, comprehensive background checks, and monthly license verification.
• Emergency Preparedness and Life Safety: Many nursing homes fail to follow their own emergency plans. Facilities must dedicate resources, routinely evaluate emergency protocols, and include post-evacuation procedures to address residents' safety concerns.
• Infection Control: Nursing homes must prioritize infection prevention and control programs (IPCPs). OIG recommends hiring an infection preventionist, conducting frequent staff training, and ensuring a reliable supply of essential resources.
• Facility-Initiated Discharges: Improper resident discharges are increasing. Facilities must train staff to comply with legal discharge requirements, notify residents and families about new placements, arrange pre-discharge site visits, and ensure a smooth transition.

Compliance Implications

OIG emphasizes that non-compliance with these guidelines could lead to allegations of substandard care and enforcement actions. Nursing facilities must integrate these recommendations into their compliance programs to maintain high-quality resident care and safety.

A Proactive Approach to Compliance

Given nursing homes' resource constraints, finding and keeping high quality staff are essential for transitioning from a reactive to a proactive compliance culture. Staff training and knowledge play a critical role in meeting quality care requirements. With respect to compliance, training goes beyond future instruction—it includes verifying past qualifications, knowledge, and licensing backgrounds of employees providing resident care. Placing experienced and qualified staff in the right positions ensures compliance with many OIG recommendations.  However, nursing homes are poorly equipped to foster and maintain a proactive compliance environment with respect to quality and training of their staff.

As staffing shortages persist, HR and training managers remain critical to a compliance culture. According to May 2023 U.S. Department of Labor data, HR and training managers only comprised 0.05% and 0.01% of nursing home total employees, respectively. Despite a slight increase in HR and training personnel since 2021, the numbers remain inadequate given the increasing compliance demands on nursing homes.

HR and training executives play a pivotal role in hiring quality staff and establishing a compliance culture. Instead of jumping into mass hiring HR and training personnel to keep up with increasing compliance requirements, nursing homes should consider restructuring HR functions to align with business strategy and workforce changes. Integrating HR analytics could help facilities recruit, develop, and retain top talent.

Even with additional HR executives and staff, antiquated and redundant administrative processes hinder efficiency. According to McKinsey’s 2021 report on administrative simplification, healthcare administration has lagged in adopting cost-saving automation, keeping administrative costs up to 40% higher than necessary. This inefficiency prevents nursing homes from creating and maintaining a proactive compliance program.

The Role of Automation in Compliance

Many operational processes remain manual and labor-intensive, leading to inefficiencies, errors, and a lack of transparency. Addressing these inefficiencies will free up resources, reduce errors, and improve compliance with OIG recommendations. One effective way to achieve proactive compliance is through strategic personnel deployment and workflow optimization by which nursing homes could assess and streamline processes related to:

• Employee onboarding
• Credentialing and staff credentials management
• OIG and licensing verifications
• Training and policy maintenance
• Vendor contract management
• Compliance reporting and documentation

Identifying operational bottlenecks and leveraging automation will significantly reduce administrative workload, costs, and risks while improving compliance. Solutions like Perla offer automation tools that simplify compliance-related processes, making them more efficient and error-free.

Conclusion

Optimizing and automating time-consuming administrative processes will reduce staffing burdens while making HR compliance efficient, effective, and error-free. The ROI on automation far outweighs the current costs and risks of manual operations. By embracing strategic HR management and workflow automation, nursing homes can cost effectively maintain high standards of resident care while ensuring long-term compliance with OIG guidelines.

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