Quality and Healthcare Compliance in Skilled Nursing: A Unified Approach

Healthcare Compliance Is More Than Avoiding Citations

In the skilled nursing world, compliance is often synonymous with survey readiness. We train staff to be alert for documentation issues, we monitor policies for regulatory changes, and we track corrective actions with precision. But as the regulatory landscape evolves, particularly under CMS’s quality-driven payment models, skilled nursing facilities must broaden their definition of compliance.

The Intersection Is Not Optional

Skilled Nursing Facilities sit squarely in the middle of a growing number of overlapping expectations:

• State and federal regulations require accurate, timely, and complete documentation of care.

  
  

• CMS’s Five-Star Quality Rating System scores facilities on staffing, inspections, and quality measures—many of which are documentation-dependent.

  
  

• Value-based purchasing (VBP) now ties reimbursement to metrics like hospital readmissions and infection control.

  
  

Each of these domains touches compliance. Each is also a quality initiative. Facilities that don’t actively integrate their compliance and quality programs risk duplication, inefficiency, and worse—missed opportunities for improvement.

A Common Challenge: Documentation That Serves Two Masters

Consider this scenario: a compliance audit finds inconsistent pain assessments in the electronic health record (EHR). Meanwhile, the quality team is analyzing resident satisfaction scores, which show complaints around pain management.

Without collaboration, each team addresses the problem separately. Compliance recommends a new documentation protocol; quality rolls out additional staff training. The result? Confusion, mixed messaging, and minimal impact.

But when teams work together, the strategy shifts. Compliance helps ensure that new protocols meet regulatory standards. Quality leads process improvement to enhance assessment accuracy. Together, they develop a training plan that supports both objectives—and gets results.

Why Alignment Matters More Than Ever

Today’s SNFs face heightened scrutiny from multiple directions:

• State surveyors are increasing focus on infection prevention and emergency preparedness.

  
  

• CMS QRP and VBP programs require accurate data collection and reporting.

  
  

• Litigation risk remains high for documentation gaps, particularly in falls, wounds, and medication management.

  
  

In this environment, quality and compliance are no longer parallel efforts. They are interdependent. Facilities that don’t align these functions will feel the impact—not just in deficiencies or civil money penalties, but in quality ratings, revenue loss, and resident trust.

Practical Steps for SNFs

Integrating compliance and quality doesn’t require a total overhaul. Here are three practical ways to start:

1. Create Shared Oversight

   Establish a joint quality and compliance committee—or at minimum, ensure that representatives from both teams attend each other’s meetings. When audit findings and QAPI data are reviewed in the same forum, it’s easier to spot trends, assign ownership, and drive real improvement.

   
   

2. Align Audit Tools

   Update audit tools so they capture both regulatory compliance and quality performance. For example, when reviewing pressure ulcer documentation, assess whether staging is not only accurate (compliance) but timely and effective in triggering appropriate care (quality).

   
   

3. Train with Both Lenses

   Build training modules that tie regulatory requirements to quality outcomes. When staff understand that MDS accuracy impacts both reimbursement and survey results—or that hand hygiene logs support both infection control and compliance—they become more engaged in the process.

Compliance Supports Quality—and Vice Versa

In skilled nursing, compliance and quality must speak the same language. Survey readiness depends on accurate documentation, yes—but also on safe, coordinated care. Similarly, quality improvement depends on process integrity, policy adherence, and accurate reporting—all core compliance functions.

When compliance supports quality initiatives, and when quality informs compliance priorities, SNFs become more resilient, more responsive, and ultimately, more successful.

Looking to align your compliance and quality efforts in skilled nursing?

Simply Compliance partners with SNFs to streamline oversight, reduce risk, and support care that’s both defensible and impactful.

Get in touch with Jessica Zeff @ Simply Compliance.