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Sheehy AM, Locke CFS, Kaiksow FA, Powell WR, Bykovskyi AG, Kind AJH. Improving Healthcare Value: COVID-19 Emergency Regulatory Relief and Implications for Post-Acute Skilled Nursing Facility Care. J Hosp Med 2020; 15:495-497. [PMID: 32804613 PMCID: PMC7518138 DOI: 10.12788/jhm.3482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/02/2020] [Indexed: 11/20/2022]
Abstract
Rarely, if ever, does a national healthcare system experience such rapid and marked change as that seen with the COVID-19 pandemic. In March 2020, the president of the United States declared a national health emergency, enabling the Department of Health & Human Services authority to grant temporary regulatory waivers to facilitate efficient care delivery in a variety of healthcare settings. The statutory requirement that Medicare beneficiaries stay three consecutive inpatient midnights to qualify for post-acute skilled nursing facility coverage is one such waiver. This so-called Three Midnight Rule, dating back to the 1960s as part of the Social Security Act, is being scrutinized more than half a century later given the rise in observation hospital stays. Despite the tragic emergency circumstances prompting waivers, the Centers for Medicare & Medicaid Services and Congress now have a unique opportunity to evaluate potential improvements revealed by COVID-19 regulatory relief and should consider permanent reform of the Three Midnight Rule.
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Affiliation(s)
- Ann M Sheehy
- Division of Hospital Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
- Health Services and Care Research Program, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
- Corresponding Author: Ann M Sheehy, MD, MS; . Telephone: 608-262-2434; Twitter: @SheehyAnn
| | - Charles FS Locke
- Department of Care Coordination and Utilization Management, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Farah A Kaiksow
- Division of Hospital Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
- Health Services and Care Research Program, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - W Ryan Powell
- Health Services and Care Research Program, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Andrea Gilmore Bykovskyi
- Health Services and Care Research Program, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
- School of Nursing, University of Wisconsin, Madison, Wisconsin
| | - Amy JH Kind
- Health Services and Care Research Program, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
- Department of Veterans Affairs Geriatrics Research Education and Clinical Center, Madison, Wisconsin
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Ellingson KD, Noble BN, Tran D, Buser GL, Pfeiffer CD, Cassidy PM, Pierce R, Beldavs ZG, Furuno JP. Compliance with statewide regulations for communication of patients' multidrug-resistant organism and Clostridium difficile status during transitions of care. Am J Infect Control 2020; 48:451-453. [PMID: 31604624 DOI: 10.1016/j.ajic.2019.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/23/2019] [Accepted: 08/24/2019] [Indexed: 11/19/2022]
Abstract
In 2014, Oregon implemented an interfacility transfer communication law requiring notification of multidrug-resistant organism status on patient transfer. Based on 2015 and 2016 statewide facility surveys, compliance was 77% and 87% for hospitals, and 67% and 68% for skilled nursing facilities. Methods for complying with the rule were heterogeneous, and fewer than half of all facilities surveyed reported use of a standardized interfacility transfer communication form to assess a patient's multidrug-resistant organism status on transfer.
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Affiliation(s)
- Katherine D Ellingson
- Department of Epidemiology and Biostatistics, University of Arizona College of Public Health, Tucson, AZ; Acute and Communicable Disease Prevention, Public Health Division, Oregon Health Authority, Portland, OR
| | - Brie N Noble
- Department of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy, Portland, OR
| | - Dat Tran
- Acute and Communicable Disease Prevention, Public Health Division, Oregon Health Authority, Portland, OR
| | - Genevieve L Buser
- Acute and Communicable Disease Prevention, Public Health Division, Oregon Health Authority, Portland, OR
| | - Christopher D Pfeiffer
- Department of Hospital & Specialty Medicine, VA Portland Health Care System, Portland, OR; Department of Medicine, Oregon Health & Science University, Portland, OR
| | - P Maureen Cassidy
- Acute and Communicable Disease Prevention, Public Health Division, Oregon Health Authority, Portland, OR
| | - Rebecca Pierce
- Acute and Communicable Disease Prevention, Public Health Division, Oregon Health Authority, Portland, OR
| | - Zintars G Beldavs
- Acute and Communicable Disease Prevention, Public Health Division, Oregon Health Authority, Portland, OR
| | - Jon P Furuno
- Department of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy, Portland, OR.
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Centers for Medicare & Medicaid Services (CMS), HHS. Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF) Final Rule for FY 2019, SNF Value-Based Purchasing Program, and SNF Quality Reporting Program. Final rule. Fed Regist 2018; 83:39162-290. [PMID: 30091551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2019. This final rule also replaces the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG–IV) model, with a revised case-mix methodology called the Patient- Driven Payment Model (PDPM) beginning on October 1, 2019. The rule finalizes revisions to the regulation text that describes a beneficiary's SNF "resident" status under the consolidated billing provision and the required content of the SNF level of care certification. The rule also finalizes updates to the SNF Quality Reporting Program (QRP) and the Skilled Nursing Facility Value-Based Purchasing (VBP) Program.
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Centers for Medicare & Medicaid Services (CMS), HHS. Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2018, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, Survey Team Composition, and Correction of the Performance Period for the NHSN HCP Influenza Vaccination Immunization Reporting Measure in the ESRD QIP for PY 2020. Final rule. Fed Regist 2017; 82:36530-634. [PMID: 28805359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2018. It also revises and rebases the market basket index by updating the base year from 2010 to 2014, and by adding a new cost category for Installation, Maintenance, and Repair Services. The rule also finalizes revisions to the SNF Quality Reporting Program (QRP), including measure and standardized resident assessment data policies and policies related to public display. In addition, it finalizes policies for the Skilled Nursing Facility Value-Based Purchasing Program that will affect Medicare payment to SNFs beginning in FY 2019. The final rule also clarifies the regulatory requirements for team composition for surveys conducted for investigating a complaint and aligns regulatory provisions for investigation of complaints with the statutory requirements. The final rule also finalizes the performance period for the National Healthcare Safety Network (NHSN) Healthcare Personnel (HCP) Influenza Vaccination Reporting Measure included in the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) for Payment Year 2020.
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Whitehurst K. Minimizing Litigation Risks In Skilled Nursing Care. Provider 2017; 43:35-38. [PMID: 29601713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Accountable clinical processes aligned with EHR workflow can boost risk management efforts.
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Abstract
Few systematically assess the determinants of Medicaid nursing facility reimbursement. Consequently, this article examines what factors influenceprogram administrators’decisions regarding nursing facility cost report data—the basic information states use to establish payment. Whereas elected officials focus primarily on how much is spent on nursing homes, state Medicaid officials assume primary responsibility for the esoteric and highly technical dimensions that help make spending goals a reality. Findings indicate that the federal government influenced state policy by enabling provider litigation under the Boren Amendment. They also indicate that program administrators responded rationally to fiscal and economic concerns, and that states with stronger administrative capacity were better able to overcome obstacles to sustaining desired policies. Although results reveal that states with more powerful nursing home lobbies tended to implement more generous systems, they fail to reveal significant associations between cost report year and lobbying activity on behalf of the elderly.
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Centers for Medicare & Medicaid Services (CMS), HHS. Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNFs) for FY 2016, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, and Staffing Data Collection. Final Rule. Fed Regist 2015; 80:46389-477. [PMID: 26242002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2016. In addition, it specifies a SNF all-cause all-condition hospital readmission measure, as well as adopts that measure for a new SNF Value-Based Purchasing (VBP) Program, and includes a discussion of SNF VBP Program policies we are considering for future rulemaking to promote higher quality and more efficient health care for Medicare beneficiaries. Additionally, this final rule will implement a new quality reporting program for SNFs as specified in the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). It also amends the requirements that a long-term care (LTC) facility must meet to qualify to participate as a skilled nursing facility (SNF) in the Medicare program, or a nursing facility (NF) in the Medicaid program, by establishing requirements that implement the provision in the Affordable Care Act regarding the submission of staffing information based on payroll data.
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Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program; prospective payment system and consolidated billing for skilled nursing facilities for FY 2015. Final rule. Fed Regist 2014; 79:45627-59. [PMID: 25122946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2015. In addition, it adopts the most recent Office of Management and Budget (OMB) statistical area delineations to identify a facility's urban or rural status for the purpose of determining which set of rate tables will apply to the facility, and to determine the SNF PPS wage index including a 1-year transition with a blended wage index for all providers for FY 2015. This final rule also contains a revision to policies related to the Change of Therapy (COT) Other Medicare Required Assessment (OMRA). This final rule includes a discussion of a provision related to the Affordable Care Act involving Civil Money Penalties. Finally, this final rule discusses the SNF therapy payment research currently underway within CMS, observed trends related to therapy utilization among SNF providers, and the agency's commitment to accelerating health information exchange in SNFs.
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Frandsen BM. Feds revise key survey & cert provisions. Provider 2014; 40:41-44. [PMID: 25058974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Zigmond J. A period of adjustment. Post-acute providers feel growing pains as they shift to Medicare and Medicaid managed-care contracting. Mod Healthc 2013; 43:28-29. [PMID: 24340708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Wagner L. Climbing the mountain of health care reform. Provider 2013; 39:22-4, 26-7, 30 passim. [PMID: 24273825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Abstract
OBJECTIVE To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. DATA SOURCES Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. STUDY DESIGN We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. DATA EXTRACTION METHODS We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010. We linked these measures with demographic information from the Census and American Community Survey, information on Certificate of Need laws, and Medicare share of facilities in each market drawn from Cost Report data. PRINCIPAL FINDINGS Payment reforms reducing average and marginal payments reduced entries and increased exits from the market. Entry effects were larger and more persistent than exit effects. Entry and exit rates fluctuated more for home health agencies than skilled nursing facilities. Effects on number of providers were consistent with entry and exit effects. CONCLUSIONS Payment reform affects market entry and exit, which in turn may affect market structure, access to care, quality and cost of care, and patient outcomes. Policy makers should consider potential impacts of payment reforms on post-acute care market structure when implementing these reforms.
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Affiliation(s)
- Peter J Huckfeldt
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138
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Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program; prospective payment system and consolidated billing for skilled nursing facilities for FY 2014. Final rule. Fed Regist 2013; 78:47935-78. [PMID: 23923146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This final rule updates the payment rates used under the prospective payment system for skilled nursing facilities (SNFs) for fiscal year (FY) 2014. In addition, it revises and rebases the SNF market basket, revises and updates the labor related share, and makes certain technical and conforming revisions in the regulations text. This final rule also includes a policy for reporting the SNF market basket forecast error in certain limited circumstances and adds a new item to the Minimum Data Set (MDS), Version 3.0 for reporting the number of distinct therapy days. Finally, this final rule adopts a change to the diagnosis code used to determine which residents will receive the AIDS add-on payment, effective for services provided on or after the October 1, 2014 implementation date for conversion to ICD-10-CM.
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D'Antonio A. Life's final journey.. Caring 2013; 32:40-43. [PMID: 23862376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Walecka BC. How Jimmo will affect skilled nursing facility coverage. Care Manag J 2013; 14:262-265. [PMID: 24579273 DOI: 10.1891/1521-0987.14.4.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Carlson J. Caught in the middle. Under tough scrutiny from the CMS over which patients should be admitted for care, hospitals are frustrated--and patients are fighting back. Mod Healthc 2012; 42:6-1. [PMID: 22666960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
As hospitals face growing pressure to reclassify inpatients to "observation" status, patients are the ones being hit with unexpected bills to pay what Medicare won't. One solution to the dilemma is a bill that would restructure the rules on when skilled-nursing care is paid for. "We have very broad-based support," says U.S. Rep. Joe Courtney (D-Conn.), left, one of the House sponsors.
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Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program; prospective payment system and consolidated billing for skilled nursing facilities for FY 2012. Final rule. Fed Regist 2011; 76:48486-562. [PMID: 21823267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This final rule updates the payment rates used under the prospective payment system for skilled nursing facilities (SNFs) for fiscal year 2012. In addition, it recalibrates the case-mix indexes so that they more accurately reflect parity in expenditures between RUG-IV and the previous case-mix classification system. It also includes a discussion of a Non-Therapy Ancillary component currently under development within CMS. In addition, this final rule discusses the impact of certain provisions of the Affordable Care Act, and reduces the SNF market basket percentage by the multi-factor productivity adjustment. This rule also implements certain changes relating to the payment of group therapy services and implements new resident assessment policies. Finally, this rule announces that the proposed provisions regarding the ownership disclosure requirements set forth in section 6101 of the Affordable Care Act will be finalized at a later date.
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Tong PK. The effects of California minimum nurse staffing laws on nurse labor and patient mortality in skilled nursing facilities. Health Econ 2011; 20:802-816. [PMID: 20672247 DOI: 10.1002/hec.1638] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This article investigates how a change in minimum nurse staffing regulation for California skilled nursing facilities (SNFs) affects nurse employment and how induced changes in nurse staffing affect patient mortality. In 2000, legislation increased the minimum nurse staffing standard and altered the calculation of nurse staffing, which created incentives to shift employment to lower skilled nurse labor. SNFs constrained by the new regulation increase absolute and relative hours worked by the lowest skilled type of nurse. Using this regulation change to instrument for measured nurse staffing levels, it is determined that increases in nurse staffing reduce on-site SNF patient mortality.
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FL: Trial court ruled insurance had lapsed: reversed on appeal: no lapse in insurance. Brown & Brown v. Edenfield, 40710 FLCA1, 1D09-2379 (4/7/2010)-FL. Nurs Law Regan Rep 2010; 50:3. [PMID: 20499702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Sprigg PE. Continuing care retirement communities in North Carolina. N C Med J 2010; 71:170-172. [PMID: 20552773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Horton J, Goodman J. The challenges of regulation in long-term care. N C Med J 2010; 71:148-150. [PMID: 20552766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Jeff Horton
- North Carolina Division of Health Service Regulation, USA.
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Burgess K. "Rum raisin, monkey crunch, and mocha frappucino cherry with gummy bears on top:" striving for personal autonomy and choice in a regulated long-term care environment. N C Med J 2010; 71:164-167. [PMID: 20552771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Ken Burgess
- Poyner & Spruill, LLC, Raleigh, North Carolina, USA.
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Murer CG. 2010 OIG Work Plan. Implications for rehab, skilled nursing, and psychiatric providers. Rehab Manag 2010; 23:31-33. [PMID: 20143623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Walker L. Caregivers support regulation and education. Nurs N Z 2009; 15:9. [PMID: 20184194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program; prospective payment system and consolidated billing for skilled nursing facilities for FY 2010; minimum data set, version 3.0 for skilled nursing facilities and Medicaid nursing facilities. Final rule. Fed Regist 2009; 74:40287-395. [PMID: 19691170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs), for fiscal year (FY) 2010. In addition, it recalibrates the case-mix indexes so that they more accurately reflect parity in expenditures related to the implementation of case-mix refinements in January 2006. It also discusses the results of our ongoing analysis of nursing home staff time measurement data collected in the Staff Time and Resource Intensity Verification project, as well as a new Resource Utilization Groups, version 4 case-mix classification model for FY 2011 that will use the updated Minimum Data Set 3.0 resident assessment for case-mix classification. In addition, this final rule discusses the public comments that we have received on these and other issues, including a possible requirement for the quarterly reporting of nursing home staffing data, as well as on applying the quality monitoring mechanism in place for all other SNF PPS facilities to rural swing-bed hospitals. Finally, this final rule revises the regulations to incorporate certain technical corrections.
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Did amputation & death result from failure to monitor pt.? Nurs Law Regan Rep 2009; 50:2. [PMID: 20302149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program; prospective payment system and consolidated billing for skilled nursing facilities for FY 2009. Final rule. Fed Regist 2008; 73:46415-62. [PMID: 18949883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs), for fiscal year (FY) 2009. It also discusses our ongoing analysis of nursing home staff time measurement data collected in the Staff Time and Resource Intensity Verification (STRIVE) project. Finally, this final rule makes technical corrections in the regulations text with respect to Medicare bad debt payments to SNFs and the reference to the definition of urban and rural as applied to SNFs.
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Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program; prospective payment system and consolidated billing for skilled nursing facilities for FY 2008. Final rule. Fed Regist 2007; 72:43411-63. [PMID: 17682291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2008. In addition, this final rule revises and rebases the SNF market basket, and modifies the threshold for the adjustment to account for market basket forecast error. This final rule also responds to public comments submitted on the proposed rule and makes a technical correction in the regulations text.
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NJ: Did patient need skilled nursing care? Did Medicaid eligibility influence decision? Nurs Law Regan Rep 2007; 48:3. [PMID: 17899644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Martin CM, Saxton-McSpadden C. Implementing changes to the state operations manual. Consult Pharm 2007; 22:105-8, 110-2, 115-7. [PMID: 17367245 DOI: 10.4140/tcp.n.2007.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
For most consultant pharmacists, long-term care pharmacies, and nursing facilities, preparation for and implementation of the new Pharmacy Services and Unnecessary Medications guidelines in the State Operations Manual will be a multistep process. In the final guidelines released in December 2006, the Centers for Medicare & Medicaid Services made modifications to the "Advance Copy" version of the guidelines released in September 2006. Consultant pharmacists will play a key role in helping facilities interpret the newest version of the guidelines and determine whether they need to alter their processes to maintain regulatory compliance.
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Segal SP, Burgess PM. The utility of extended outpatient civil commitment. Int J Law Psychiatry 2006; 29:525-34. [PMID: 17070577 PMCID: PMC7735736 DOI: 10.1016/j.ijlp.2006.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Revised: 08/27/2006] [Accepted: 09/01/2006] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This study considers three hypotheses regarding the impact of extended involuntary outpatient commitment orders on services utilization. METHOD Service utilization of Victorian Psychiatric Case Register (VPCR) patients with extended (> or =180 day) outpatient commitment orders was compared to that of a diagnostically-matched treatment compliant group with similarly extended (> or =180 day) periods of outpatient care (N=1182)--the former receiving care during their extended episode on an involuntary basis while the latter participated in care voluntarily. Pre/post first extended episode mental health service utilization was compared via paired t tests with individuals as their own controls. Logistic and OLS regression as well as repeated measures ANOVA via the GLM SPSS program and post hoc t tests were used to evaluate between group and across time differences. RESULTS Extended episodes of care for both groups were associated with subsequent reduced use of hospitalization and increases in community treatment days. Extended orders did not promote voluntary participation in the period following their termination. Community treatment days during the extended episode for those on orders were raised to the level experienced by the treatment compliant comparison group during their extended episode and maintained at that level via subsequent renewal of orders throughout the patients' careers. Approximately six community treatment days were required for those on orders to achieve a one-day reduction in hospital utilization following the extended episode. CONCLUSION Outpatient commitment for those on extended orders in the Victorian context enabled a level of community-based treatment provision unexpected in the absence of this delivery system and provided an alternative to hospitalization.
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Affiliation(s)
- Steven P Segal
- School of Social Welfare, University of California, Berkeley, United States.
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Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program; prospective payment system and consolidated billing for skilled nursing facilities for FY 2006. Final rule. Fed Regist 2005; 70:45025-127. [PMID: 16082772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
In this final rule we update the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs), for fiscal year (FY) 2006. Annual updates to the PPS rates are required by section 1888(e) of the Social Security Act (the Act), as amended by the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA), the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), relating to Medicare payments and consolidated billing for SNFs. This final rule also responds to public comments submitted on the proposed rule published on May 19, 2005 (70 FR 29070), and promulgates provisions set forth in that proposed rule, along with several additional technical revisions to the regulations.
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Murer CG. The LTACH in rehab clothing. Rehab Manag 2005; 18:44, 46. [PMID: 15957496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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35
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Lenhoff DR. LTC regulation and enforcement. An overview from the perspective of residents and their families. J Leg Med 2005; 26:9-40. [PMID: 15849096 DOI: 10.1080/01947640590917918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Rosenbaum S. Law and the Public's Health. Public Health Rep 2005; 120:96-8. [PMID: 15736338 PMCID: PMC1497676 DOI: 10.1177/003335490512000116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sara Rosenbaum
- Department of Health Policy at the George Washington University School of Public Health and Health Services, Washington, DC, USA
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Mantone J. Two-timing. Disputed deal doesn't stop Select's new merger plan. Mod Healthc 2004; 34:10. [PMID: 15605781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Burgess KL. When 'strict liability' is abused. Provider 2004; 30:49-51. [PMID: 15354551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Sollins HL. Joint ventures scrutinized anew. Provider 2004; 30:43-4. [PMID: 15040056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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40
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Rich BA. Thinking the unthinkable:the clinician as perpetrator of elder abuse in patients in pain. J Pain Palliat Care Pharmacother 2004; 18:63-74. [PMID: 15364633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Some advocates for improved pain management have devised and had initial success utilizing a controversial new weapon-the elder abuse claim. In California, two recent cases have been brought under the state's elder abuse statutes against physicians and health care institutions. The first lead to a much publicized jury verdict against a physician, and the second was recently settled as to all defendants, with related disciplinary actions against a treating physician and a skilled nursing facility by their respective regulatory agencies. This commentary reviews the phenomenon of litigating cases of undertreated pain, analyzes the most recent cases, and considers the implications of invoking elder abuse statutes in such cases.
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Affiliation(s)
- Ben A Rich
- Bioethics Program, University of California at Davis Medical Center, 4150 V St., Suite 2400, Sacramento, CA 95817, USA.
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Burgess KL. SNF survey revisited: preparation. Provider 2003; 29:39-42. [PMID: 14606273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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42
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Centers for Medicare and Medicaid Services (CMS), HHS. Medicare program; prospective payment system and consolidated billing for skilled nursing facilities--update. Final rule. Fed Regist 2003; 68:46035-72. [PMID: 12901392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs), for fiscal year (FY) 2004. Annual updates to the PPS rates are required by section 1888(e) of the Social Security Act (the Act), as amended by the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA), and the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), relating to Medicare payments and consolidated billing for SNFs.
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Rubas WL, Masker SE. OSHA guidelines: what's expected. Provider 2003; 29:43-4. [PMID: 12920737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Olsen GG, Reisinger RA. No time to rest. Rehab Manag 2003; 16:66-7. [PMID: 12962004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Markenson AJ. Crafting risk-free vendor contracts. Provider 2003; 29:75-7. [PMID: 12820500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Abstract
The nursing home problem in Florida was characterized as a debate over quality of care and the rapid increase of lawsuits against nursing homes that led to a decline in the availability of affordable liability insurance. The staff for Florida's Task Force on Availability and Affordability of Long-Term Care analyzed lawsuit and quality-of-care data from one county in Florida and quality-of-care data statewide to understand the relationship between the two sides of the argument. Analyses showed support for both positions and a middle-ground policy position was achieved. The subsequent nursing home reform legislation and implications for the future of long-term care in Florida are discussed.
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Affiliation(s)
- Larry Polivka
- Florida Policy Exchange Center on Aging, University of South Florida, #30437, 4202 East Fowler Avenue, Tampa, FL 33620-3043, USA.
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Keough CL, Greene A. Judicial review of CMS policies: an evolving doctrine. Healthc Financ Manage 2003; 57:76-80. [PMID: 12602316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
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Herschman GW. OIG 2003 work plan ready for SNFs. Provider 2003; 29:45-7. [PMID: 12640922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Grabowski CJ. Falls.... A prelude to litigation. Director 2003; 11:50-4. [PMID: 12741052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
For years long-term care has found itself vulnerable to law suits. This is still true today. On any given day, nursing homes and the staff employed by them are only one unhappy client away from receiving a notice of intent. In today's litigious world, nursing homes must have in place, effective policies and procedures to minimize their risk for a lawsuit. Part of managing the risk, is having a multi-disciplinary team in place that takes a proactive approach to patient safety. The particularly high risk patients for incident are ambulatory patients with cognitive impairment. The multi disciplinary team must aggressively address each of these residents in relation to their fall risk. Implementation of a comprehensive plan of care, maintaining good communication between facility and the patients' physicians and families, and quality charting by the nursing staff, are some of the key elements in preventing litigation.
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Burgess KL. Building on program parallels. A facility's corporate compliance structure may well provide the nucleus for a strong risk management program. Provider 2002; 28:43-4, 47. [PMID: 12491864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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