What’s needed for a vibrant compliance program in today’s increasingly scrutinized legal climate?

Depending on state licensure and the services provided, compliance programs may need to address the following: 

• Self-referral, fraud and abuse: Compliance programs should outline how to structure operations in compliance with the False Claims Act, the Stark Law, the Anti-Kickback Statute (AKS) and any comparable state laws.

• Facilities subject to state licensure should address regulatory issues such as resident rights and reporting of suspected abuse.

• Accredited facilities should address any applicable accreditation standards in compliance plans.

• Organizations that are exempt from federal income tax should ensure that compliance programs address issues that may threaten such exemption, including the need for negotiating agreements at arms’ length and for fair market value compensation.  

• Compliance programs should address federal and state privacy and security regulations applicable to the organizations.  

• Applicable organizations should detail compliance with the laws and regulations designed to prevent discrimination in housing.

• Compliance plans for facilities that bill commercial or governmental payors should address issues such as preventing upcoding or billing for items included in per diem payments.

In addition to the content, long-term care facilities should ensure that their compliance plans are written and that the organization designates a compliance officer or committee. 

Please send your legal questions to John Durso at ltcnews@mcknights.com.

Ending nursing home certificate-of-need laws could spur innovation within the sector, one expert argued in a published journal piece in June.

Duke economics professor Henry Grabowski, Ph.D., wrote in a blog that certificate-of-need laws that restrict bed growth would be “unfathomable” for other industries such as hotels. Currently 34 states have such laws in place.

“The notion that public nursing home spending would greatly increase in the absence of a bed constraint simply does not make sense,” Grabowski wrote. 

He pointed to previous research that found certificate-of-need laws negatively impact access and quality of care, while pushing up private-pay prices. He argued providers are driving the retention of CON laws due to  concerns about keeping occupancy levels high. 

McKnight’s Long-Term Care News won four national awards at the 2017 American Society of Business Publication Editors competition.

The editorial team won a Gold Award for the Daily Editors’ Notes column, which features blog posts by each of McKnight’s editorial staff members every week.

Also winning Gold was the McKnight’s 2017 Industry Directory, a valuable resource for long-term care providers, in the online Buyer’s Guide category.

McKnight’s also earned Silver for its print news section and Bronze for McKnights.com in the web news section category.
McKnight’s also garnered five regional awards.

Long-term care facilities were the largest single source of Legionnaires’ disease cases in healthcare facilities in 2015, according to the Centers for Disease Control and Prevention. 

Three-fourths (76%) of all Legionnaires’ cases were traced to healthcare facilities, and 80% of those were tied to long-term care facilities.

Just three days prior to the report release, the Centers for Medicare & Medicaid Services issued a notice stating that healthcare providers will soon be required to have policies in place to reduce the risk of Legionnaires’ disease. 

If current trends continue, occupancy rates in skilled nursing facilities could be headed to new lows this year, said analysts from the National Investment Center for Seniors Housing & Care.

Occupancy ticked up slightly to 82.6% at the end of the first quarter due to expected seasonal factors, including a relatively intense flu season, according to NIC’s latest data, which was released in early June. But the rate dropped slightly in March.

If year-over-year decreases continue, “a new low will be expected later in 2017,” NIC report authors wrote.

Average occupancy over the last year was 82.9%, compared to 84.3% for the prior 12 months and 85.7% for the year before that.

Meanwhile, managed Medicare patient day mix in February reached its highest point in NIC’s data series. 

It’s a statistic that backs up earlier analysis “suggesting a trend away from what had been a rapid decline in the managed Medicare [revenue per patient day],” said NIC Chief Economist Beth Burnham Mace.

The Centers for Medicare & Medicaid Services published guidance in June in advance of its final emergency preparedness rule for providers.

The rule, issued last September, applies to all healthcare facilities and will be implemented Nov. 15. Long-term care providers will have to meet additional standards under the rule, such as having emergency and standby power systems. They also must create plans regarding missing residents that could be activated regardless of whether the facility has activated its full emergency plan.

CMS shared an advanced copy June 2 of a new Appendix Z for the State Operations Manual pertaining to emergency preparedness. The final version will “vary slightly” from the advanced copy, CMS officials said.

The agency had previously urged providers not to put off planning their emergency training exercises until the guidance was released.

The Trump administration announced that it was abandoning an Obama-era rule that would outlaw pre-dispute arbitration agreements, initiating a celebration by long-term care providers.

The Centers for Medicare & Medicaid Services instead has proposed a new rule that would allow the agreements — as long as they are written in plain language and explained to residents and their representatives thoroughly, and the resident  acknowledges understanding.

“The ban was an overreach, flying in the face of the Federal Arbitration Act and Congressional intent,” AHCA President and CEO Mark Parkinson said.

The long-term care sector is reeling a bit, thanks to two recent developments.

One is President Trump’s budget proposal for the next fiscal year. The other is a Congressional Budget Office assessment of the House health bill.

Each promises to severely gut Medicaid outlays in the name of deficit reduction. But the reality many providers are prepping for is this: If it was tough to deliver champagne services on a beer budget, how will that be even remotely possible on what amounts to bread-and-water rations?

So why do the powers-that-be find Medicaid such a tempting piñata? It’s a fair question. 

Truth be told, there are two main drivers. But only one is usually mentioned in polite company.

The happy-to-discuss reason is this: Medicaid expenditures have been on the rise, and the trending is for much more of the same. In many states, Medicaid expenses now exceed outlays for kindergarten-through-grade 12 education. Moreover, the Affordable Care Act (better known as Obamacare) essentially incentivizes states to expand the tent. So if you want to start restoring some fiscal sanity at the state and federal levels, Medicaid is an obvious place to begin.

But there is a more insidious reason for the targeting: Medicaid is seen by many in Washington and elsewhere as a program primarily for layabouts with dark skin. Bear in mind I’m not suggesting the sentiment has merit. Far from it. But it would be naïve to believe that such a prejudice is not in play here. 

Medicaid just might become the poison pill that sinks Trumpcare. 

That’s because planned program cuts won’t be limited to poor people with darker complexions. As it turns out, most Medicaid recipients happen to be white. Moreover, quite a few are card-carrying members of AARP. A more accurate name for that organization might be 40 Million Older Voters You Really Don’t Want To Tick Off.

Many Republican lawmakers may soon have to make a tough decision: keep their day jobs or support a man who sees loyalty as a one-way street. My guess is that in tight races, that may not really be much of a choice. 

How can I simplify the policies and procedures at my facility to make them more user-friendly?

Policies and procedures (P&Ps) can be user-friendly and also support compliance on a daily basis. When performing your policy review, consider these:

1. A policy identifies issues and scope. You and your staff will be held accountable for adhering to your P&Ps, as written, in day-to-day operations, during both survey and litigation processes.

2. It’s not necessary to include workflows. You don’t need a P&P for every action in the facility, and certainly not for all workflows. In fact, many workflows can be taken out of policies and included in protocol documents. Examples include ordering labs and completing a requisition form for medical equipment.

3. A policy should not be too exclusive. Sometimes policies stipulate that only an RN can perform certain tasks, when, in fact, under the state’s nurse practice act, a trained LPN also would be appropriate. 

4. Procedural manuals are helpful resources. Instead of writing out each P&P to exhaustion, it is sometimes appropriate to refer to a current, evidence-based resource, such as Lippincott procedures for LTC.

5. Short-and-simple is better than all-encompassing. Policies should be one to two pages long. If a policy has more than two pages, it likely needs to be divided into separate policies, or a workflow needs to be removed.

Effective policies and procedures are crucial for compliance, as you and your staff will be held to them. Policies that lead to better outcomes are those that are accurate, clear, concise and flexible enough that your team can adjust workflows to best meet the care needs of residents.

Please send your nursing-related questions to Kathy Owens at ltcnews@mcknights.com.

The best way to combat universal fatigue among nurses might be to grant them more control over their schedules.

Almost all nurses, 98%, believe their job is physically and mentally demanding, according to a Kronos Incorporated survey of 257 registered nurses.

Although 93% said they love their work, the demands clearly take a toll. About 63% said their job has caused burnout. Many (83%) said that hospitals were losing nurses because other employers offered better work-life balance, and 90% had thought about leaving their job to find better work-life balance.

Fatigue is also linked to negative coping mechanisms. These include nurses driving home from work drowsy (56%), worrying their patients will suffer as a result of their fatigue (44%) and calling in sick to get rest (28%).

The solution may be as simple as allowing nurses control over their schedule. More than half surveyed said this is a top factor that would alleviate a significant amount of fatigue.

“This survey shows that it’s time to care for the caregivers,” said Susan Reese, DNP, MBA, RN, CPHIMS, director, healthcare practice group, Kronos.