Post-Acute Care & Nursing Facilities

A study published in the February 2014 issue of Health Affairs concludes that the use of telemedicine by nursing homes can reduce hospitalizations and generate savings for Medicare. However, there are several barriers to successful implementation, including the cost of the technology, the willingness of staff to utilize the service and traditional Medicare and Medicaid payment methodologies.

The researchers noted previous studies suggesting that the lack of on-site physicians in many nursing homes during off-hours (evenings, weekends and holidays) may be one cause of inappropriate hospitalizations. Typically, if a medical issue arises off-hours, an on-call physician is phoned by nursing home staff. The physician can then either travel to the nursing home or, more likely, recommend that the resident be transferred to a hospital emergency room. Could the availability of telemedicine prevent some of these transfers?

Eleven for-profit Massachusetts nursing homes, owned by a single company, and all dually certified to accept both Medicare and Medicaid, were studied. All were very similar in terms of resident characteristics, staffing and quality scores. The nursing home residents received their primary care through physician group practices; prior to the study, most after-hours medical services involved the nursing home staff phoning the residents’ on-call physicians. Telemedicine services were introduced in six of the eleven nursing homes, with five serving as a control group. The six nursing homes utilizing telemedicine services each received a cart with equipment for two-way videoconferencing and a high-resolution camera for wound care. A remote medical call center staffed by an RN, a nurse practitioner and a physician provided the telemedicine services (most of the nursing home residents’ treating physicians had signed over their off-hours coverage to this remote center). Before the telemedicine service was introduced in the six nursing homes, separate training sessions were held for the direct care staff and the residents’ physicians. The annual cost of the telemedicine service was $30,000.00 per facility.

When was the last time you thought about your compliance program? As we know, an effective compliance program is important for healthcare companies. It’s also important to review your compliance program periodically and update it according to the latest guidance. OIG guidance and recent Corporate Integrity Agreements (CIAs) are informative about what the OIG is…

CMS continues to emphasize readmissions as a marker of quality.  CMS research shows that approximately 45% of hospital admissions among those receiving either Medicare skilled nursing services or Medicaid skilled nursing services could have been avoided.  Husch Blackwell attorneys Mark Chouteau and Michael Crowe recently authored an article in the October issue of AHLA Connections…

In late February of this year, an employee at an independent living facility in Bakersfield, California was asked by a 911 dispatcher to begin CPR on an 87-year-old resident.  Despite the 911 dispatcher’s pleas, the employee refused.  The employee was allegedly following a facility policy that, in the event of a health emergency, the staff is to immediately call EMS for assistance and wait with the resident. The residents are informed of and agree to this policy on admission. The resident ultimately passed away.  Although the resident’s family expressed satisfaction with the manner in which the facility handled the situation, the situation generated a great deal of negative publicity. This situation also caused many assisted living facilities (“ALFs”) to question whether they are required to provide CPR. Unlike skilled nursing facilities, ALFs provide a lower level of care to their residents and often do not have nursing personnel on staff 24-hours per day.

The answer to the question of whether an ALF can have a policy like the one at issue in the California situation depends largely on state law.  At least 18 states have explicit laws requiring CPR-trained staff members in ALFs.  Oregon recommends CPR training, but does not require it.  Montana law provides that CPR-trained staff need only be on duty if the facility offers CPR, impliedly authorizing a “no-CPR” policy.  Kentucky is similar but more explicit:  ALFs must train staff on CPR “unless the policies of the [ALF] state that this procedure is not initiated by its staff….” 

As the government shutdown drags on, some CMS activities are grinding to a halt. CMS recently released a memo to State Survey Agency Directors regarding which CMS survey and certification activities will continue and which ones have been put on hold for providers of all types. According to the memo, complaints that are triaged as…

The time for SNFs to become more vigilant about self-auditing is now, according to the Report on Medicare Compliance.  Skilled Nursing Facilities (SNFs) should have began receiving the first round of PEPPER at the end of August.  “PEPPER” stands for Program for Evaluating Payment Patterns Electronic Reports.  These reports, which are a free compliance…

Adoption of EHR technologies has greatly increased as the result of the EHR Incentive Program. Touted as one of the necessary building blocks for creating integrated delivery systems, EHR is considered vital to improve health quality, efficiency and patient safety.  The EHR Incentive Program has been very successful and CMS has awarded over $10…

Alzheimer patients wandering off.  Jewelry stolen from a resident’s room.  Arthritic hands unable to maneuver a key in a lock.  All of these can be issues at senior living communities.  However, these issues may become less common as more and more senior communities are moving toward digital key systems.

According to an article in Seniors…

Are you still trying to understand the changes made in the HIPAA Omnibus Rule?

Do you want an opportunity to ask questions and hear how other providers are handing HIPAA issues?

Do you need a chance to brush up on your HIPAA knowledge and evaluate current strategies? 

If so, then you should consider attending one…

Are healthcare providers at your facility texting patient information to each other?  This type of communication is becoming more and more common, but such text messages are often in violation of HIPAA.  To address this issue, Sprint announced last week that it is now offering two texting products that provide the proper security for PHI…