Articles Posted in Uncategorized

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Newly released nursing home staffing data from the Centers for Medicare and Medicaid Services (CMS) proves that nursing homes have been “staffing up” for years in order to gain better ratings. In April, CMS began requiring nursing homes to submit daily payroll reports, versus the previous system in which nursing homes submitted staffing data for the two week period prior to an inspection. The problem with this method was that most nursing homes were aware that an inspection was coming and planned accordingly.

Using the new system of daily payroll submissions, the most recent quarterly report (April – June) shows that 1 in 11 nursing homes lost a star due to their poor staffing numbers. After data was added to Nursing Home Compare, the CMS website that rates nursing homes, Kaiser Health News reviewed the findings and found that 9% of all nursing homes received one star, the lowest possible rating for staffing.

To receive just one star, a nursing home must have had an abnormally “high number of days” without an RN on site during that quarter.

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The Office of the Inspector General (OIG), a division of the Department of Health and Human Services, has released a memo detailing the surge of Americans relying on hospice care in the 10 year period from 2006-2016. Some of the most notable findings include:

  • The number of hospice providers has grown 43% (from 3,062 in 2006 to 4,374 in 2016)
  • Medicare spending on hospice is up 81% (from $9.2 billion in 2006 to $16.7 billion in 2016)
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After a Legionnaires’ disease outbreak that took the lives of 13 Illinois veterans and sickened at least 60 more, Governor Bruce Rauner has signed HB 4278, a law requiring Illinois veterans’ homes to notify residents and their emergency contacts of 2 or more diagnoses of the same infectious disease within a month.

Effective immediately, the law gives veterans’ homes just 24 hours to notify residents and their emergency contacts in writing when at least 2 of their fellow residents have been diagnosed with the same infectious disease. Facilities are also now required to post signage near the main entrance that clearly states the presence of the disease within the home. They must also post a notice on their website. Finally, the new law requires facilities to inform the Department of Veterans’ Affairs and the Illinois Department of Public Health as soon as they have notified residents.

Public and Employees Left Unaware of Deadly Outbreak in Quincy

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A top elder rights legal group, Justice in Aging, has released a timeline of events in which the Centers for Medicare and Medicaid Services (CMS) have cut nursing homes a break by eliminating or easing restrictions that protect nursing home residents.

CMS is the federal agency tasked with the oversight and regulation of over 15,600 nursing homes in the United States. Their rules are intended to dictate how nursing homes operate and the group’s inspections and surveys often lead to fines and punishments that are intended to spur change and compliance. The number of incidents of neglect are still at an all-time high and in the second quarter of this year, the Illinois Department of Public Health (a state-run agency who works in cooperation with CMS) cited nursing homes for 28 more violations than in the quarter prior. If anything, rules, regulations, and laws need to be strengthened, with harsher punishments that send a message that improper treatment of the elderly is unacceptable.

CMS Easing Nursing Home Regulations

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The latest quarterly report on Illinois nursing home violations is in and the number of Type AA and Type A violations has increased since the first quarter of 2018.

The Illinois Department of Public Health’s (IDPH) Second Quarterly Report of Nursing Home Violators includes some repeat offenders from quarter 1, as well as one facility that received a $50,000 fine for a Type AA violation for the second time this year.

According to IDPH, Type AA violations are given when a nursing home has a “condition or occurrence at the facility that proximately caused a resident’s death.” Type A violations are situations “in which there is a substantial probability that death or serious mental or physical harm will result, or has resulted.” IDPH defines Type B Violations as those that would likely cause mental or physical harm to a resident.

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Symphony of Buffalo Grove, a 200-bed, for-profit rehabilitation facility in suburban Chicago, is being sued for alleged neglect that led to the death of a resident. The deceased, Librada Jacob, was admitted to the facility in June 2016 and over the course of the next 15 months became dehydrated and malnourished, suffered multiple falls, and developed several pressure ulcers. She died in September 2017, shortly after her 81st birthday.

All residents of rehab and skilled nursing facilities are to be admitted with a care plan that, in part, provides detailed information on how to maintain their physical and mental well-being, including necessary therapies, a fall risk determination and necessary fall prevention methods, a detailed list of current medications, as well as a nutrition plan. The lawsuit alleges that Symphony of Buffalo Grove failed to follow and update Ms. Jacob’s care plan.

Symphony Facilities Make IDPH’s Violations List

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Starting next month, two new quality tracking measures will be included in Nursing Home Compare, the Centers for Medicare & Medicaid Services (CMS) nursing home information and rating system. Hospitalization rates for long-term nursing home residents will now be tracked and reported publicly on the site, as well as staffing data for non-nursing staff. Both categories are considered by CMS to be critical for determining the level of care being provided at nursing homes.

For each nursing home participating in Medicare and Medicaid, Nursing Home Compare currently includes 6 general categories of information, divided into tabs.

  1. General Information: Name, location, number of beds, affiliation (non-profit, hospital-affiliated, etc)
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“There’s this saying in nursing homes, and it’s really unfortunate: ‘When in doubt, ship them out.’ ”                         -David Grabowski, PhD, Professor of health policy at Harvard Medical School

Amid findings that 1 in 5 Medicare beneficiaries who go to a nursing home following a hospital visit return within 30 days, the government is finally addressing high hospital readmission rates after a nursing home transfer. Beginning this October, the Centers for Medicare and Medicaid Services (CMS) will start handing out bonuses or penalties to nursing homes based on their hospital readmission rates.

If this concept sounds familiar, that’s because it is. In 2012, CMS implemented a similar policy, the Hospital Readmissions Reduction Program (HRRP), for hospitals, rewarding or penalizing them based on their 30 day patient readmission rate. Due to the influence of this policy, hospital readmission rates for Medicare recipients has already begun dropping, albeit not by much. The readmission rate fell just over 1.5 percent in 5 years. The latest numbers from 2016 show a Medicare readmission rate of 10.8%.

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The state of Georgia has strengthened their law on background checks for nursing home employees and owners who have routine resident contact or access to any of their personal information. Effective October 1, 2019, all owners, applicants and employees of long term care facilities will be subjected to fingerprint and name background checks through the FBI’s database. Previously, state law required a name-only background check through a state database. The group behind the push for the new law, the Georgia Council on Criminal Justice Reform, said the stricter laws of surrounding states left Georgia open to employing those from neighboring states with a checkered past.

The new law, officially titled the Georgia Long-Term Care Background Check Program, applies to not just nursing homes, but assisted living facilities, home health agencies, and private in-home providers.

Illinois Nursing Home Employee Law

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There’s yet another acronym in the healthcare world that we’ve been hearing often. According to the Centers for Medicare & Medicaid Services (CMS), Accountable Care Organizations, or ACOs are “a group of doctors, hospitals and other health care providers who come together voluntarily to give coordinated high-quality care to their Medicare patients.  The goal is to ensure that patients get the right care at the right time while avoiding unnecessary duplications of services and preventing medical errors.”

Essentially, ACOs are a network of healthcare providers helmed by a Medicare fee-for-service patient’s primary care physician that all share information about the patient. Instead of seeing one doctor here and one doctor there and having to obtain records and experience gaps in care, healthcare providers within an ACO all have access to the same information. These groups are not insurance-based, so although a provider might refer a patient to another within the ACO, the patient isn’t required to see only providers within that ACO.

Hospitals have been under pressure to better care for patients and reduce costs since the 2012 passage of the CMS’  Hospital Readmissions Reduction Program (HRRP). The program seeks to cut down on the number of hospital readmissions within 30 days of discharge, namely by slashing their reimbursements paid to hospitals. It is the very real threat of reduced payments, as well as the lure of shared savings bonus from CMS that has led many hospitals and health networks to band together to form ACOs.