Inspector General Calls for More Disaster Preparations

CQ HealthBeat reports that a new report by the Office of Inspector General for the Department of Health and Human Services concludes that nursing homes were not adequately prepared for Hurricane Katrina.  An report also concludes that many still lack enough safeguards in case of flood, fire or storm. 

Find "Gaps Continue to Exist in Nursing Home Emergency Preparedness and Response During Disasters: 2007-2010 (April 2012)" at the Office of Inspector General (Report OEI-06-09-00270). 

The Centers for Medicare and Medicaid Services (CMS) requires that homes have detailed written emergency plans and also train staff on how to be prepared for disasters. The OIG’s office reviewed national survey data on those preparations.

In addition, OIG staffers visited 24 nursing homes that were struck by wildfires, floods and hurricanes in 2007 through 2010. Overall, disaster hit 210 nursing homes in seven states during that period, prompting evacuations and “shelter in place” decisions by administrators.

“Administrators and staff from 17 of the 24 selected nursing homes reported facing substantial challenges in responding to disasters, whether they evacuated or sheltered residents in place,” said the OIG report, which was requested by Senate Aging Committee Chairman Herb Kohl, D-Wisc. Kohl had held a hearing on this issue.

The report says, “Challenges included difficulty following emergency plans as written, logistical problems related to transportation and communication, and negative effects of evacuation on resident health. Further, most nursing homes that experienced challenges reported that they had not collaborated with local emergency management agencies to prepare for disasters.”

CQ HealthBeat reports that "Often the homes did not follow checklist tasks recommended by CMS" and that the report indicated that "state long-term care ombudsmen didn’t have any contact with nursing home residents until the disaster was over, and other state officials who deal with the licensing of nursing homes played a limited role."

OIG officials interviewed nursing home administrators, local emergency managers, state officials who oversee nursing homes and representatives from state long term care ombudsman programs.

Most nursing homes met the CMS requirements for both written plans and training, said the OIG report. But there were gaps, and many of them were the same ones identified by the OIG in an earlier study. The 2006 study was the result of the numerous hurricanes in 2004 and 2005, including Katrina, and the concerns they raised about how nursing homes could keep their residents safe.  Find "Nursing Home Emergency Preparedness and Response During Hurricanes (August 2006) at the OIG (Report OEI-06-06-00020)

On paper, the homes appeared to be ready for problems. Among more than 16,000 nursing homes surveyed in 2009 and 2010, the OIG found 92 percent met federal regulations for emergency planning, though that was a slight decrease from the 94 percent that were in compliance in 2004-05. A lower percentage, 72 percent, met standards for training, compared to 80 percent in the earlier report.

In real life, the experiences were different. “For example, one administrator of a nursing home that was flooded reported that its emergency plan did not include procedures for responding to floods, although the nursing home was in a flood plain,” said the OIG. “Administrators of two nursing homes reported that they did not consult their written emergency plans to prepare for evacuation. They reported piecing together transport by calling upon other nursing homes and local emergency entities to evacuate their residents.”

The OIG recommended that:
• CMS should be even more specific about items that should be included in emergency planning lists. The agency also should specify minimum federal standards for the frequency and extent of disaster response training, exercises and drills.
• CMS should develop better guidance for state officials on how they are to review the homes’ emergency plans.
• CMS should do more to promote the use of emergency preparedness checklists by homes.
• The Administration on Aging should develop models for state long term care ombudsmen to follow during disasters to help protect nursing home residents.

CQ HealthBeat reports that Marilyn Tavenner, CMS acting administrator, in a letter agreed with all of the recommendations and said they would be implemented. 

Finally, in a memorandum report (OEI-06-09-00271), the OIG outlines specific guidance that CMS can consider when revising the checklist for health care facilities.


SOURCE: CQ HEALTHBEAT NEWS (April 16, 2012)

"Nursing Homes Need to Step Up Disaster Preparations, OIG Says"
By Jane Norman, CQ HealthBeat Associate Editor

CMS Contracts With 27 ACOs Covering 375,000 Medicare Beneficiaries

In a press release dated April 10, CMS announced contracts with 27 Accountable Care Orgnizations, launching a new program authorized by the Affordable Care Act that is intended to help physicians, hospitals, and other health care providers work together to improve care for people with Medicare.

Under the new Medicare Shared Savings Program (Shared Savings Program), 27 Accountable Care Organizations (ACOs) have entered into agreements with CMS, taking responsibility for the quality of care furnished to people with Medicare in return for the opportunity to share in savings realized through improved care.

The Shared Savings Program and other initiatives related to Accountable Care Organizations were authorized by the Affordable Care Act, the health care law of 2010. Participation in an ACO is purely voluntary for providers and beneficiaries and people with Medicare retain their current ability to seek treatment from any provider they wish.

Accounding to CMS, the first 27 Shared Savings Program ACOs will serve an estimated 375,000 beneficiaries in 18 States. This brings the total number of organizations participating Medicare shared savings initiatives on April 1 to 65, including the 32 Pioneer Model ACOs that were announced last December, and six Physician Group Practice Transition Demonstration organizations that started in January 2011. In all, as of April 1, more than 1.1 million beneficiaries are receiving care from providers participating in Medicare shared savings initiatives.

According the CMS, anyone who has multiple doctors may have experienced the frustration of fragmented and disconnected care: lost or unavailable medical charts, trouble scheduling an appointment or talking to a doctor, duplicated medical procedures, or having to share the same information over and over with different doctors.

Accountable Care Organizations are designed to lift this burden from patients, while improving care and reducing costs. The Shared Savings Program was created by the Affordable Care Act after a number of efforts in the private sector showed that improving care can lead to lower costs. The selected ACOs include more than 10,000 physicians, 10 hospitals, and 13 smaller physician-driven organizations in both urban and rural areas. Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas they are serving. CMS is reviewing more than 150 applications from ACOs seeking to enter the program in July.

To ensure that savings are achieved through improving and providing care that is appropriate, safe, and timely, an ACO must meet strict quality standards. For 2012, CMS has established 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and the patient and caregiver experience of care.

CMS also announced today that five ACOs are participating in the Advance Payment ACO Model beginning April 1. This model will provide advance payment of expected shared savings to rural and physician-based ACOs participating in the Shared Savings Program that would benefit from additional start-up resources. These resources will help build the necessary care coordination infrastructure necessary to improve patient outcomes and reduce costs, such as new staff or information technology systems. CMS is reviewing more than 50 applications for Advance Payments that start in July.

To learn more about the ACOs announced today, visit: http://www.cms.gov/apps/media/fact_sheets.asp

For more information on the Advanced Payment ACO Model, including the participating ACOs, visit: http://innovations.cms.gov/initiatives/ACO/Advance-Payment/

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Debt Collectors Find Their Way Into Hospitals

The New York Times reports that “Hospital patients waiting in an emergency room or convalescing after surgery are being confronted by an unexpected visitor: a debt collector at bedside.”  Go to http://www.nytimes.com/ to find the article, "Debt Collector is Faulted for Tough Tactics in Hospitals," in the NYT Business Day (April 24, 2012).


The online article, by Jessica Silver-Greenberg , continues: “This and other aggressive tactics by one of the nation’s largest collectors of medical debts, Accretive Health, were revealed on Tuesday by the Minnesota attorney general, raising concerns that such practices have become common at hospitals across the country.”


The article also indicates tactics of embedding debt collectors as employees in emergency rooms who would be expected to demand that patients pay before receiving treatment.


To patients, the debt collectors may look indistinguishable from hospital employees.  They may demand that the patient pay outstanding bills and may discourage the patient from seeking emergency care at all.  According to reported allegations, Accretive Health employees were told to stall patients entering the emergency room until they had agreed to pay a previous balance. 


The report indicates that in some cases these workers would have access to health information while asking patients to pay overdue bills, what the Minnesota attorney general speculates may be a violation of federal privacy laws.  The Minnesota general asserts that “the hounding of patients violated the Emergency Medical Treatment and Active Labor Act, a federal law requiring hospitals to provide emergency health care regardless of citizenship, legal status or ability to pay,” and that “by giving its collectors access to health records, Accretive violated the Health Insurance Portability and Accountability Act.” In addition, the attorney general says that the company broke state collections laws by failing to identify themselves as debt collectors when dealing with patients.


It is noted that hospitals “have long hired outside collection agencies to pursue patients after they have left hospital facilities,” and “to achieve promised savings, hospitals turn over the management of their front-line staffing — like patient registration and scheduling — and their back-office collection activities.”


According to the New York Times report, “Accretive says that it trains its staff to focus on getting payment through revenue cycle operations. Accretive fostered a pressurized collection environment that included mandatory daily meetings at the hospitals in Minnesota, according to employees and the newly released documents. Employees with high collection tallies were rewarded with gift cards. Those who fell behind were threatened with termination.”


The Minnesota attorney general is currently in discussions with state and federal regulators about a coordinated response to Accretive Health’s practices across the country.

Health "Datapalooza" Announced

As part of the HHS Health Data Initiative, The Health Datapalooza will be held this year on June 5th and 6th in Washington, DC. This event is being put on by the Health Data Consortium, a group of organizations that joined together with the aims of promoting new data, making existing data more accessible by consumers and developers, and encouraging the development of products and services that improve health and health care. The Department of Health and Human Services (HHS) is a member of the Consortium.

More information on this event, including how to register to attend or submit an application to present, can be found at hdiforum.org.

The CMS Innovation Center is helping plan one session of this two-day event. An ACO “deep dive” will demonstrate how Accountable Care Organizations can make effective use of claims data through innovative software services and analytics. Surgeon and author Atul Gwande will be leading a discussion between the audience and a diverse set of stakeholders from data analysts to a number of the Pioneer ACOs.

From hdiforum.org:

HDI Forum III: The Health Datapalooza promises to bring together a diverse group of data experts, technology developers, entrepreneurs, policy makers, health care system leaders, CIOs, CTOs, and community advocates to support innovative applications of health and health care data.

The Forum will feature keynote addresses, an Apps Expo, demonstrations of new, cutting-edge apps, and thought-provoking panel discussions. There will also be plenty of time for networking and one-on-one interaction.

Source: CMS News Release

Health Insurance Rate Hikes in 9 States Deemed Excessive by HHS

Health and Human Services (HHS) Secretary Kathleen Sebelius announced that health insurance premium increases in nine states have been deemed “unreasonable” under the rate review authority granted by the Affordable Care Act.

"Thanks to the Affordable Care Act consumers are no longer in the dark about their health insurance premiums," said Secretary Sebelius. "Now, insurance companies are required to justify rate increases of 10 percent or higher. It’s time for these companies to immediately rescind these unreasonable rate hikes, issue refunds to consumers or publicly explain their refusal to do so."

Secretary Sebelius also released a new report showing that, six months after HHS began reviewing proposed health insurance rate increases, consumers are already seeing results. Since the rate review program took effect in 2011, health insurers have proposed fewer double-digit rate increases. Furthermore, more states have taken an active role in reducing rate increases, and consumers in all states are getting straight answers from their insurance companies when their rates are raised by 10 percent or more. As of March 10, 2012, the justifications and analysis of 186 double-digit rate increases for plans covering 1.3 million people have been posted at HealthCare.gov, resulting in a decline in rate increases. According to the report, in the last quarter of 2011 alone, states reported that premium increases dropped by 4.5 percent, and in states like Nevada, premiums actually declined.

HHS determined, after independent expert review, that two insurance companies have proposed unreasonable health insurance premium increases in nine states—Arizona, Idaho, Louisiana, Missouri, Montana, Nebraska, Virginia, Wisconsin, and Wyoming. The excessive rate hikes would affect over 42,000 residents across these nine states.

In these nine states, the insurers have requested rate increases as high as 24 percent. These increases were reviewed by independent experts to determine whether they are reasonable. In this case, HHS determined that the rate increases were unreasonable, because the insurer would be spending a low percentage of premium dollars on actual medical care and quality improvements, and because the justifications were based on unreasonable assumptions.
Most rates are reviewed by states and many states have the authority to reject unreasonable premium increases. Since the passage of the health care law, the number of states with this authority increased from 30 to 37, with several states extending existing “prior authority” to new markets.

The report released today shows that:
* States like Texas, Kentucky, Nevada and Indiana are reporting fewer requests for rate increases over 10 percent.
* States like California, New York, Oregon, and many others, have proactively lowered rate increases for their residents.
* The rate review program has made insurance companies explain their increases, and more than 180 have been posted publicly and are open for consumer comment on companyprofiles.healthcare.gov.

This initiative is one of many in the health care law to ensure that insurance companies play by the rules, prohibiting them from dropping coverage when a person gets sick, billing consumers into bankruptcy through annual or lifetime limits, and, soon, discriminating against anyone with a pre-existing condition.

Information on the specific determinations made today is available at: http://companyprofiles.healthcare.gov/

The rate review report released today is available at: http://www.healthcare.gov/law/resources/reports/rate-review03222012a.html
General information about rate review is available at: http://www.healthcare.gov/law/features/costs/rate-review/

Source: HHS News Release

Graduate Nurse Education Demonstration Announced

The Centers for Medicare & Medicaid Services (CMS) announced a call for applications for a new Affordable Care Act initiative designed to strengthen primary care in the United States.

Under the Graduate Nurse Education Demonstration, CMS will provide hospitals working with nursing schools to train advanced practice registered nurses (APRNs) with payments of up to $50 million annually over four years to cover the costs of APRNs’ clinical training.

Growing the ranks of APRNs is an important way to increase the base of primary care providers in this country. In the past, the cost of clinical training has limited the ability of hospitals and other healthcare providers to accept more APRN students into their settings for clinical training.

Under the Graduate Nurse Education Demonstration, CMS will provide reimbursement to up to five eligible hospitals for the reasonable cost of providing clinical training to APRN students added as a result of the demonstration. Hospitals participating in the demonstration must partner with accredited schools of nursing and non-hospital community-based care settings.

Payments to the participating hospitals will be linked directly to the number of additional APRNs that the hospitals and their partnering entities are able to train as a result of their participation in the demonstration. The payment will be calculated on a per-student basis, comparing previous enrollment levels in APRN training programs with enrollment under the demonstration.

For more information, or to view the solicitation, visit: innovation.cms.gov/initiatives/gne.

Source: CMS News Release

TJC Issues List of Most Challenging Requirements from 2011

The Joint Commission collects data on organizations’ compliance with standards, National Patient Safety Goals, the Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery™, and Accreditation and Certification Participation Requirements to identify trends and focus education on challenging requirements. The table identifies the top five Joint Commission requirements that were most frequently identified as “not compliant” for 2011 for accredited organizations and certified programs.

For more information, see the Frequently Asked Questions.

Source: TJC News Release