CMS releases civil money penalties proposed rule
The proposed rule, included in the Federal Register July 12, incorporates specific provisions of the Patient Protection and Affordable Care Act (PPACA). It “expands current Medicare and Medicaid regulations regarding the imposition and collection of civil money penalties by CMS when nursing homes” do not comply with Medicare regulations.
Comments will be accepted in regards to this rule until August 11. Currently, “a per day civil money penalty may be imposed from $50 up to $10,000 for each day of noncompliance. An upper civil money penalty range of $3,050 up to $10,000 per day may be imposed for noncompliance that constitutes immediate jeopardy, meaning the noncompliance has caused or is likely to cause serious injury, harm, impairment or death to a resident.”
New study reveals five-star ratings do not match customer satisfactions
Holleran, a national research firm specializing in the not-for-profit senior living sector, released a study July 12 which shows that a facility’s five-star rating does not line up with how a resident or family member will rate their satisfaction with the facility. The study, which used data from 182 nursing homes, found that a higher percentage of respondents from one-star nursing homes would select the facility again compared to higher-rated nursing homes. For example, over 88% of respondents from one-star nursing homes would select the facility again, while less than 86% of respondents from four-star nursing homes would select their facility again.
“Therefore, we can say with reasonable certainty that the Five-Star rating process is flawed in terms of resident and family satisfaction, and the systemic issue appears to be in the lower Five-Star Rating categories,” Shawn Kepner, vice president of research at Holleran, said in a press release. “Furthermore, just simply relying on submitted data to calculate a rating number appears to be some of the reason for the systemic flaw. Additionally, the ‘forced distribution’ method, where nursing homes are rated based on where they fall in comparative percentile cutoff ranges, seems to be affecting the results of this study. If the Five-Star Ratings were calculated as absolute constructs instead of comparative percentile rankings, perhaps we would see a more logical relationship with resident satisfaction.”
Mr. Kepner continued, “The good news is that simply tweaking the process to include a satisfaction component and specifically focusing on improving the Five-Star rating process in the lower rating categories could go a long way in solidifying the process.”
More on the accountable care front
Editor’s note: This article was written by guest blogger Anthony Cirillo, FACHE, ABC, a healthcare marketing and experience management expert and elder advocate. For more information about the author, please see our About page.
Atlantic Information Services’ Health Business Daily reported that at the Accountable Care Organization (ACO) Summit in Washington, D.C. on June 8, attorney Noah Rosenberg commented, “Everyone wants to form one, and they don’t know what it is, and neither do I.” Rosenberg is a former Health and Human Services general counsel.
The statute defines ACOs as provider-based organizations, comprised of multiple levels of providers and responsible for the full continuum of care, which are held accountable for the cost and quality of care and share in savings from it. The actual regulations should be out in late 2010 or early 2011.
Former CMS administrator Mark McClellan said implementation would be an “iterative process” as it was with Medicare Part D. So while regulations may be out as early as this year, providers may not be affected for many years.
At the American College of Healthcare Administrators conference in Philadelphia this May, a panel of experts urged their nursing home members to become more educated on the ACO concept. Here are a few problems in that regard. Right now, ACO’s are really being talked about in the Medicare sphere, and that is only one piece of long-term care reimbursement and not a large percentage, despite being a better payer (compared to Medicaid, that is). Also, most of the talk about ACO is really centered on physicians and hospitals.
So what is an organization to do? I would suggest that providers wait for the regulations to fall in place before taking some steps but act now toward certain initiatives. Care coordination is at the heart of ACOs. A physician office will be a microcosm and ground zero as it looks to implement the medical home concept. That coordination will be aided by electronic medical record but also through personnel that act as navigators. Geisinger is paying for extra nurses to act in this role even now. They are willing to spend more because they know where the market is generally moving.
Geisinger is a good example for nursing homes to follow. No matter where ACOs and reimbursement shake out, care coordination will be rewarded because, in the end, it will reduce healthcare costs through reduced re-admissions, medication errors, and duplicative testing. That coordination will reach into the long-term care space so, in the words of Rodney King, all players need to “get along.” That will call for better communication with your hospital neighbors but also with other care providers in the continuum. In some respects, heated competition must be replaced by mutual cooperation and sharing in the rewards. Progressive long-term care organizations will start approaching their colleagues in the continuum now to begin the conversation about ACOs, and these providers will be rewarded in the long-term.
Medicare physician payment cuts retroactively delayed
The House passed a six-month plan, known as the doc fix, on June 24 that repeals a 21% reduction of doctor’s fees paid by Medicare. The legislation comes with a price tag of $6.4 billion and will be retroactive to June 1 – when the cuts were first scheduled to take effect. The fix marks the 10th payment cut delay since 2002, but was deemed necessary so as to avoid the chance of doctors turning away Medicare patients, according to The New York Times.
A week earlier, the Senate approved the measure without a roll-call vote after it was separated from a piece of tax and safety-net spending legislation, which is currently stalled. House Speaker Nancy Pelosi voiced frustration with the Senate’s lack of action. She originally said the House would not approve any short-term resolutions that would only delay the Medicare physician payment cuts until a later date.
CMS releases quarterly update to HCPCS codes
On June 18, CMS issued the October quarterly update to the 2010 annual update of HCPCS codes. A number of codes were removed or added to categories of services excluded from SNF consolidated billing.,The complete list of HCPCS code changes, which become effective October 1, can be viewed at the CMS Web site.
The list is broken down by Major Categories and subsections. Most of the additions and deletions are within Major Category I. A single addition was made to the therapy section of Major Category V. The complete Change Request (7002) can be seen here.
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