Archive for the ‘Senior Health Care Reform’ Category

CMS to Overhaul Nursing Home Compare

It seems the Centers for Medicare and Medicaid Services (CMS) has been paying attention. While the agency’s five-star rating system for nursing homes has always been the subject of a fair share of criticism, new concerns started gaining speed in the media within the past few months. At the beginning of September, we reported on criticisms surrounding the self-reporting measures and other practices leading some experts to say that they doubt the integrity of the rating system as a true barometer of quality of care.

IMPACT Act aims to improve quality ratings for skilled nursing facilities

On Oct. 6, President Obama signed the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, which aims to improve quality through increased transparency and standardized assessments in several areas surrounding critical care issues across skilled nursing facilities, home health agencies, long-term care hospitals, inpatient rehabilitation facilities, and other post-acute care (PAC) providers. Nursing Home Compare overhauls rating system

IMPACT will allow both payments and patient outcomes to be compared across these providers, fueling the development and public reporting of quality measures and facilitating the provision of new PAC payment models, to be presented to Congress by the Medicare Payment Advisory Commission (MedPAC), according to Long-Term Living Magazine.

New changes directly address recent criticisms

But in direct relation to the current five-star rating system used by CMS to grade skilled nursing facilities, there are some big changes coming, many targeted specifically at areas of concern recently addressed in the media. IMPACT, it’s worth noting, however, was first introduced back on June 26 and enrolled as a bill on Sept. 18.

Long-Term Living Magazine summarizes some of the changes that will occur as a result of the passing of the IMPACT Act of 2014:

  • More quality measures will be added to the rating system, beginning in January 2015, including re-hospitalization rates and anti-psychotic drug use.
  • Staffing data will be gathered directly from payroll records rather than through self-report.
  • Scoring methods will be re-evaluated to ensure they accurately represent the quality of providers earning these ratings.
  • A national auditing system will be rolled out to verify information reported through on-site visits.

New measures taken to verify formerly self-reported data, such as staffing ratios and staff turnover rates, are particularly welcomed by critics. Cheryl Phillips, MD, LeadingAge’s senior vice president of public policy and advocacy, tells Long-Term Living Magazine that staffing is one of the most accurate indicators of quality in long-term care settings.

Self-reported quality measures overshadow accuracy

In fact, it’s the self-reporting measures which the debate has primarily centered on in recent months. The controversy surrounding the hotly debated Medicare star-rating system heated up again after the U.S. Department of Health and Human Services Office of Inspector General released an August 2014 report finding that in a random sampling of 209 nursing homes, only 53 percent of allegations of elderly abuse, neglect, or exploitation are reported to federal agencies.

As self-reporting is currently the relied-upon method the CMS utilizes to gather data which determines a skilled nursing facility’s star rating, this naturally casts a shadow over the perceived accuracy of the ratings.

Sweeping changes to data collection and verification to begin in January 2015

While the improvements are expected to take at least one year to implement, consumers will begin to have access to more legitimate, verified data beginning in January. Nursing homes will begin reporting staffing ratios quarterly, and this information will be verified through payroll documents.

Also beginning in January, nursing homes will be rated on the percentage of residents:

  • Receiving anti-psychotic drugs
  • Re-admitted to a hospital
  • Discharged (released) from nursing home care

Most importantly, the system will eventually provide consumers access to this deeper data, such as staff turnover rates and other quality measures. While the additional measures will begin to be incorporated in 2015, this new data won’t actually be reflected in nursing home ratings until 2016.

These changes represent an increasing demand among today’s savvier consumers for high-quality, independent data that provides a true standard metric for navigating the challenges in decision-making when it comes to placing an aging loved one in senior housing. This is the need aims to address with the Best Senior Living Awards, an independent rating system for assisted living, independent living, and other senior housing options to provide families with a standard metric and valid, third-party ratings from experts to aid the decision-making process.

Top 10 Health Technology Blogs

Technology is re-shaping the healthcare industry. With HIPAA and other regulations getting stricter by the day while technology becomes more prevalent for things like maintaining patient records, staying compliant becomes challenging. At the same time, new technology is streamlining the delivery of patient care, reducing medical errors and saving lives. Leading experts in health technology are taking to the blogosphere to keep both providers and consumers up-to-date on the latest technologies impacting the industry. Here’s a look at a few, listed in no particular order of importance.

1. HealthIT Buzz – Where else to turn for the latest regulatory information than the federal government? Run by the U.S. Department of Health and Human Services Office of the National Coordinator for Health Information Technology (ONC), HealthIT Buzz shares information on the ongoing transition of the healthcare industry to electronic health records. Regulations like the HIPAA Security Rule weigh heavily on Covered Entities, so this blog is an excellent resource for keeping tabs on changes to the rules and guidelines.

2. Personal Health Tech Blog – Ira Brodsky blogs about health technology from a personal perspective in an easy-to-understand format. While this blog is relatively new, we’ve included it in this list thanks to the easily digestible news on health technology that’s relevant to patients and caregivers. Definitely one to watch.

3. iHealthTran – The Institute for Health Technology Transformation “is the leading organization committed to bringing together private and public sector leaders fostering the growth and effective use of technology across the healthcare industry.” The Institute offers programming spanning a wide range of healthcare industry entities, including providers, medical device manufacturers, consumer and patient groups, and much more. The blog is engaging and highly informative — discussing the use of Twitter for customer service, new innovations that shape patient care, and more.

4. Kevin MD – Kevin Pho, MD, is “social media’s leading physician voice,” providing physician insights on the latest breaking medical news. Trust us, this blog is anything but dry. Pho sheds some light on the new voice of the physician world–the patient-empowering, thoughtful, and engaged practitioners that thrive on saving and improving lives, and aren’t afraid of trying the next great technology to make it happen.

5. Health Tech Hatch – This blog covers mobile technology — including a recent call-out to mobile app developers to come up with something to ease the process of self-care, along with news on progress with the move to electronic health records, cost savings and tons of other useful tidbits.

6. CNET One of the web’s leading news publications, CNET has an impressive section devoted solely to health technology. Recent posts include coverage of a children’s cancer wing transformed into a “superhero” wing and other heartwarming and informative news on the cutting edge of health tech.

7. My Health Tech Blog – The great thing about this list of health tech blogs is that there are so many different perspectives represented. Deborah Leyva, author of My Health Tech Blog, spent 17 years in the technology industry and is now a Registered Nurse and Health Informatics Specialist. She offers an abundance of insightful expertise on everything from HIPAA (including some valuable HIPAA checklists and tools), to healthcare analytics, awards, and EHR.

8. eHealth Focusing on all things electronic health technology, eHealth is managed by John Sharp, a medical center IT manager in Ohio. Sharp is active in a number of premier healthcare and technology associations and brings his expertise forward on e-health, personal health records, Web 2.0 and more.

9. Health Plan Innovation Health practitioners aren’t the only entities impacted by the technology wave. Health Plan Innovation focuses on ways to use innovation to “solve health care access, quality and funding issues.” We don’t think there’s anyone out there who would disagree that this is exactly the kind of thought leadership we need to solve the nation’s healthcare crisis.

10. Meaningful HIT News Neil Versel is a professional healthcare journalist, bringing yet another point of view to this blog roundup. Versel has written on healthcare technology for a wide range of publications and brings his investigative journalism experience to the blogosphere, sharing both light-hearted looks at the challenges in the industry as well as a serious approach to covering some of the biggest changes impacting practitioners, quality, mobile health and other pertinent facets of the industry.

What are your favorite reads on the intersection between health and technology? Any favorite bloggers who share insights from the changing world of health IT in an engaging way? Tell us what health IT blogs you love in the comments below.

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Post by Angela Stringfellow

The Fiscal Cliff Deal: Medicare Cuts for Physicians Averted

Almost 24 hours past the midnight, December 31, 2012 deadline, Congress cut a last-minute deal to avoid the impending “fiscal cliff” and the potentially devastating economic circumstances which would result from planned tax increases and spending cuts scheduled to take effect. The deal isn’t a fix-all, but more a band-aid to buy leaders more time to negotiate longer-term solutions to some of the nation’s most worrisome problems.

Physicians temporarily saved from massive cuts

The deal will have major ramifications on the healthcare system, affecting many seniors in a number of ways. One of the biggest potential crises, a Medicare pay cut to physicians, has been avoided but at the cost of cutting payments to other providers — including hospitals. The scheduled cuts would have cut physician payments by 27 percent, causing many doctors to say they’d have to stop seeing Medicare recipients.

Image by Yuya Tamai on Flickr

A major change to the way Social Security cost-of-living increases has also been avoided, at least for now. Some leaders were pushing to adjust the calculation to a chained-CPI model, which would have reduced Social Security payments to seniors over the long term.

Medicare payment cuts hit hospitals

Of course, the major victory for physicians doesn’t come without a cost: Those $30 billion in funds will be covered by cuts to hospitals, a move providers aren’t thrilled about. Over 10 years, $10.5 billion will be saved by reducing Medicare base payment increases for inpatient care. An additional $4.2 billion over the same time period will be saved by reducing the Medicaid Disproportionate Share Hospital payments, according to Healthcare Finance News. Finally, payments for end-stage renal disease treatments will be re-priced for a potential savings of $4.9 billion over the next decade.

Rich Umbdenstock, president and CEO American Hospital Association, says these cuts will impact hospitals’ ability to provide care for senior citizens. Jeremy Lazarus, MD, president of the American Medical Association, points out that the Medicare program is unreliable due to the current practice of enacting temporary fixes each time current legislature is set to expire, and says the cuts will hinder Medicare’s progress in developing more effective delivery models for the benefit of seniors.

What’s to come?

Many Republican leaders are left frustrated after this final-hour agreement, regretful that the bill does not include any spending cuts. Republican leaders initially pushed hard for major spending cuts which would help control the federal deficit. In the end, they chose to vote on the bill as-is to avoid setting negotiations in motion again which could have significantly stalled progress and sent the nation into a severe financial crisis if middle-class tax cuts were allowed to expire, unemployment benefits halted for millions of Americans and physician payment cuts went into effect.

By March, Congress will be faced with making the decision to raise the debt ceiling to cover additional costs the current deal will add which aren’t offset by savings elsewhere, such as the $30 billion unemployment extension. It’s likely that a push for cost-cutting measures to Medicare, Medicaid and Social Security will be revisited at that time.


The Changing Landscape of Medicare for 2013 and Beyond

This is a guest post contributed by Shannon Martin, M.S.W., CMC is Director of Communications for Aging Wisely, LLC and EasyLiving, Inc

Medicare recipients will experience a variety of changes in 2013, as a result of healthcare reform measures, annual changes and various occurrences within the healthcare system.

The Affordable Care Act included a number of changes to the Medicare program.  Preventative care coverage has been expanded to cover many screenings.  Participants can take advantage of an annual wellness exam to plan which screenings are appropriate for them each year.  Healthcare reform included changing the “donut hole” provision to Medicare’s drug coverage (part D) and the donut hole will be phased out by 2020 (the donut hole is a period in which recipients pay all drug costs when they reach a certain cost level, up until reaching catastrophic coverage).  In 2013, people who hit the donut hole will have additional help/discounts during that period.

Medicare 2013

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Some of the changes that the Affordable Care Act implemented are more provider-oriented, such as quality care incentives and penalties for things such as “avoidable” hospital readmissions.  A number of cost savings measures were implemented in order to pay for new additions, but additional cuts may be necessary if the measures do not work as predicted.  Many experts predict there will be a lot of changes in the Medicare Advantage market, as significant changes to that payment system roll out.

Medicare recently published the 2013 copays, deductibles and other Medicare costs and most are increasing slightly.  Here are some of the primary

2013 Medicare cost updates:

The standard Medicare B monthly premium will increase from $99.90 to $104.90 (higher income individuals will pay more).

The Medicare B (yearly) deductible will increase to $147.

The Medicare A hospital deductible (for stays up to 60 days) will be $1184 and the skilled nursing facility co-pay will be $148 per day (for days 21-100, the first 20 days are covered at 100%).

You can visit for more details or download Aging Wisely’s 2013 Medicare Fact Sheet.

Skilled Nursing and Rehabilitation Requirements: Lawsuit Settlement

The U.S. Department of Health and Human Services recently settled a class action lawsuit (Jimmo v. Sebelius) regarding Medicare’s coverage requirements for skilled nursing and rehab. services.  Medicare typically denies coverage for skilled nursing and rehabilitation (under Part A) if a patient does not demonstrate an ability to improve.  This class action lawsuit addressed patients who need skilled nursing and rehabilitation services to manage a condition (which may not be expected to improve) or maintain their current health.

Patients must still demonstrate a need for skilled care and meet all of the other criteria (visit or grab a summary at Paying for Home Care Tips).  Many patients rely on “custodial care” (help with activities of daily living, household assistance), which will remain outside the scope of Medicare coverage.  However, this change could have significant impacts on patients who have chronic conditions and rely on occasional skilled care and therapy to maintain functioning and health.

These changes will be rolling out over the next several months to providers and consumers.  In the meantime, a number of Medicare beneficiaries who were denied benefits for skilled services (before January 18, 2011 when the lawsuit was filed) will have their claims re-examined.  It is an important issue to be aware of and seek help if you (or a loved one) feel you are being denied services under these new standards.  You can file an appeal through Medicare’s appeals process or seek help from a patient advocate to understand requirements, care options and ways to appeal or find alternatives.

OIG’s Plan for Nursing Facilities

The Office of Inspector General, U.S. Department of Health and Human Services (OIG) has implemented a work plan affecting long-term care, specifically, nursing home and skilled nursing facilities. JD Supra highlights some of the focus areas of this initiative, which affect both payments and performance issues.

Focus on quality of care

In terms of quality of care, nursing homes are required to utilize the Residential Assessment Instruments (RAI) to create a plan of care for each resident and plan for eventual discharge. However, reports have indicated that about 25 percent of residents’ needs are not addressed in their care plans and residents are not receiving psychosocial services which are addressed in their care plans.

OIG scrutinizes nursing homes

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The OIG has also made state inspections a priority. Specifically, whether state agencies are following up on correction plans created in response to deficiencies identified during state nursing home inspections. There will also be a focus on the efforts of state agencies and the Centers for Medicare and Medicaid Services (CMS) to improve performance. Enforcement decisions, including follow-up actions and the implementation of corrective measures in response to complaints and survey results are a core focus in this area.

Focus on billing and payments

A number of focus areas have also been identified in relation to billing and payments. There will be increased scrutiny on both Medicare Part A and Medicare Part B claims submitted by providers with a history of billing errors. CMS will have the ability to deny a provider’s enrollment in the Medicare program if they’re found to have existing overpayments that they’ve failed to refund.

Medicaid overpayments will also be in focus: Medicaid is intended to be “the payor of last resort,” and providers are supposed to identify and refund overpayments. OIG will be reviewing patient accounts which have credit balances to identify and reclaim any overpayments found. State procedures for identifying and collecting third-party payments will also be reviewed, as these procedures can help avoid overpayments in the first place.

Hospice programs, and the relationship between hospice providers and nursing facilities, will also be scrutinized in light of findings that up to 82 percent of hospice claims for patients residing in nursing homes did not meet Medicare eligibility requirements. There have also been reports and findings that some hospice providers have aggressively marketed their services or have entered into inappropriate enrollment and compensation in conjunction with contracted nursing facilities.

Questionable billing patterns have also been identified in relation to Medicare Part B benefits for nursing home residents. Medicare Part B services must be billed directly by suppliers or other providers. The OIG will investigate these patterns to identify areas of inaccuracy.

These are just a few of the items addressed in the OIG’s Work Plan that will affect long-term care providers. These focus areas will place added responsibilities on both state agencies and CMS, as well as providers, although the implementation of these measures will serve to improve the quality of care received by residents and preserve funds that can help maintain the viability of Medicare and Medicaid programs.


Thousands of Hospitals Penalized Under Medicare’s Readmissions Reduction Program

Medicare’s latest initiative, the Readmissions Reduction Program, has been assigned the task of reducing costly hospital readmissions. The program is part of the Patient Protection and Affordable Care Act, and will target providers with high readmission rates and test programs to help reduce these numbers. Currently, about one in five Medicare patients (approximately 2 million Medicare beneficiaries) return to the hospital within a month of discharge, creating about $17.5 billion in additional Medicare payments. According to Kaiser Health News, more than 2,000 hospitals are facing financial penalties from Medicare beginning in October for having excessive readmission rates.

Hospitals to lose $280 million in Medicare reimbursements

Penalties range up to one percent of the Medicare base payment, with about 278 hospitals facing the maximum penalty beginning in October. The total amount of the penalty across all 2,000+ hospitals is about $280 million. The Centers for Medicare and Medicaid Services (CMS) is targeting hospitals, which currently stand to benefit financially if a patient is readmitted. There was never really a financial incentive for providers to ensure patients receive the necessary care post-discharge to prevent unnecessary readmissions, which the Readmissions Reduction Program is hoping to change.

Hospitals penalized for high readmission rates.

Image via Home Instead Senior Care

Kaiser Health News also says that soon, hospitals will also stand to be penalized or rewarded based on “how well they adhere to basic standards of care and how patients rated their experiences.” In October 2013, penalties for excessive readmissions will rise to 2 percent of the base Medicare reimbursement, and in 2014, the penalty goes up again to 4 percent.

Are hospitals serving low-income populations being treated unfairly?

One concern that arose as a result of these penalties is the inclusion of hospitals who primarily treat a low-income population. Some say that external factors, such as lack of access to follow-up care, can artificially inflate readmission rates in cases where the hospitals could do little to prevent these outcomes.

A statistical analysis reveals that 76 percent of hospitals treating a low-income population are being penalized, while just 55 percent of hospitals which treat few poor patients will receive penalties. The concern is that these hospitals may not be able to afford the penalties assessed, and that providers treating poor populations are the ones who need funding the most to adequately care for a difficult population in which patients often fail to take prescribed medications, miss follow-up appointments and generally don’t receive appropriate follow-up care.

Medicare contends that there are many hospitals falling into the same low-income constituents group which do just as well or better on the measurement criteria compared to providers who serve very low numbers of disadvantaged patients. Medicare accounted for how sick patients were upon first admission when conducting its analysis, but didn’t account for income levels or socio-economic status. The analysis focused on Medicare recipients admitted for heart attack, heart failure and pneumonia between July 2008 and June 2011.

Goal to improve patient care

The goal of assessing penalties isn’t solely to save Medicare money, but to give providers a push to implement programs that improve follow-up care and reduce costly readmissions, which are often avoidable. The program is also implementing test programs that, if successful, will be rolled out nationally to enable providers to better reduce these numbers.

Boston Medical Center Brings Back House Calls for Seniors

Dr. Daniel Oates, a geriatrician at the Boston Medical Center, is bringing back an age-old practice by making house calls to elderly patients. Oates believes that house calls provide more consistent and personalized care, possibly even reducing the risk of a hospital visit and delaying the necessity to move to a senior living facility. That’s because by making house calls, physicians can monitor the care of patients who otherwise may not leave their homes to seek regular medical care, according to an article in

House calls: A money-saver or major expense?

The program has caught the attention of the Centers for Medicare and Medicaid Services, which is now looking at the Boston Medical Center as well as 15 other providers offering similar programs to determine if the practice is something that could be used to reduce healthcare costs under the Affordable Care Act.

On the contrary, programs like that run by the Boston Medical Center aren’t common because of the cost. It costs about $3,000 per year for each patient enrolled in the program, according to David Kornetsky, administrative director of geriatric services at Boston Medical Center, and Medicare only covers approximately half of those costs. In the case of the Boston Medical Center, the facility subsidizes the rest, although other cash-strapped providers may struggle to do the same. Currently, Boston’s program has about 575 patients enrolled in the service it has been offering since 1875. Overall, “Home care accounts for about 1 percent of all Medicare billing for ‘evaluation and management services,’ essentially time spent talking with doctors, versus tests or procedures, said Gary Swartz, associate executive director of the American Academy of Home Care Physicians.

Boston Medical Center brings back house calls.

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Providers under pressure to provide better care for elderly and chronically ill points out that beginning in the fall, providers will be penalized for having high rates of re-admissions within 30 days for conditions such as heart failure or heart attacks. Because acute care is so expensive, a shift to a model that rewards providers for conducting better preventative care can reduce these unnecessary re-admissions and costly treatments by taking a proactive approach in the case of chronic illness.

National pilot program to test cost effectiveness

There’s a national pilot program underway, Independence at Home, designed to evaluate costs and quality of care with home care models like BMC’s. This large-scale test will evaluate up to 10,000 patients and is designed to put to rest conflicting study results from past years that didn’t consistently demonstrate a cost savings. (Most recent studies have, however, shown a clear savings benefit.) The Boston Medical Center is enrolling about 100 patients who meet the following criteria:

  • Have traditional Medicare coverage.
  • Have had a recent hospitalization.
  • Have a chronic illness.
  • Have functional limitations.

The trial is set to last three years, with a minimum average requirement of 200 enrolled patients throughout the study. And if the BMC program saves more than 11 percent, the Centers for Medicare and Medicaid services will pass some of those savings on to the hospital.The quality measures to be tracked include:

  • Patient satisfaction.
  • Frequency of emergency room visits.
  • Frequency of hospitalizations for preventable conditions.
  • How providers feel about their work.

The program will include measures such as social worker visits to monitor home safety (identifying problems such as loose throw rugs or poor lighting), determine whether patients are safe in the care of their family members or other caregivers, and even help sort through medications and help with accurate dosing. Overall, the care provided is more personalized and gives providers greater insight into patient compliance and other concerns that may not be obvious on an office visit. According to Swartz, if the program is successful, Congressional action would be required to expand beyond 10,000 patients, but he hopes that promising results will encourage other providers to revisit house calls.

U.S. Focuses on Alzheimer’s Research

The U.S. government is taking serious action against Alzheimer’s disease with a special task force and a boost of $50 million towards Alzheimer’s research. In 2013, another $80 million will be awarded. The initial sum includes $26 million allocated to caregiver support, public awareness and education and data infrastructure support, DailyRx reports.

It all started with The National Alzheimer’s Project Act, signed into law last year, which aims to develop strategies for improving diagnostics, treatment options and social support for those afflicted with the disease, their loved ones and caregivers. The initiative came to fruition in light of the staggering statistics demonstrating that more than 5 million Americans have Alzheimer’s disease, which has a significant financial and emotional toll on families affected and contributes an estimated $180 billion in healthcare costs each year.

Alzheimer's research

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The National Plan to Address Alzheimer’s Disease

The Department of Health and Human Services advisory panel rolled out its draft framework of The National Plan to Address Alzheimer’s Disease early in 2012. The plan includes ambitious goals, such as both preventing and treating Alzheimer’s disease by the year 2025.

While the plan evoked mixed responses from leading senior living groups, including ALFA, which drafted a response expressing concern that assisted living wasn’t considered as part of a plan to manage and care for individuals with the illness. Kaiser Health News asked a number of leading health executives to share their thoughts on the initial plan, including areas it may be falling short.

While most of those interviewed were pleased with the effort to tackle this growing problem, several interviewees pointed out some potential shortcomings. Robert Egge, Vice President of Public Policy for the Alzheimer’s Association, says he hopes the first draft will contain specific, measurable and attainable outcomes, noting that “the stakes are high.”

Dr. Rachelle S. Doody, the Effie Marie Cain Chair in Alzheimer’s disease research at the Baylor College of Medicine, who directs the Alzheimer’s Disease and Memory Disorders Center, also weighed in with her reactions.  Doody tells Kaiser Health News that the overall objective to prevent and effectively treat the disease by 2025 is promising and illustrates the government’s dedication to advancing research, but the draft framework fails to identify how new research will be translated to practice, nor a target date for doing so.

One thing is clear: No time for delays

Experts and commentators consistently agree on one point: There’s no time to hesitate implementing a plan of action to address this disease. As the population continues to age, the number of people with Alzheimer’s disease could double by the year 2050. The devastating emotional and financial impacts on both family members and the healthcare system as a whole mean that doubling the current impact could be the country’s tipping point. But will it be enough, and will the plan work? Many are anxiously awaiting the first draft of the National Plan with hope that it outlines a solid and attainable strategic course of action.

Ohio Legislation makes Medicaid payments contigent on Quality of Care

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In recent years, there has been a surge of news exposing the neglect and often abuse of the elderly in nursing homes.  This has made states’ take a greater interest in the quality of care in nursing homes and how they regulate it.  Ohio has come up with a bill that will aim to improve the overall quality of care their residents pay for.  Their house bill 153 seeks to use medicaid payments to motivate nursing homes to improve their practices.

Measuring Quality of Care

A subcommittee made up of elderly advocates, nursing home representatives, state officials and legislators.  They created a list of measures that were defined, and developed into a calculated point system that could determine the quality level of a nursing home. For example to receive one point the nursing home must enroll in “Advancing Excellence in Nursing Home Campaign” and select at least three goals.  Another point was given to homes that assured that at least 50% of Medicaid certified beds were in private rooms. There are 20 measures that will earn the nursing home one point, they are divided into categories: framework, choice, clinical, environment, and staffing.

Calculating Payments

A facility is required to get 5 points to receive the full quality payment, which is $16.44 per Medicaid bed day in 2013. Facilities with less than 5 points receive one-fifth of the full quality payment per point. The budget assumes that every nursing facility will receive the full quality incentive payment. If some facilities do not achieve 5 points and there is a residual amount left at the end of the fiscal year, then that amount will be distributed to facilities that earned more than 5 points based on each facility’s Medicaid bed days and total points received.

To see a full list of these measures and how they are calculated in this 5 point system go here.


These measures aim to:

  • Encourage person centered care
  • Limit staff turnover
  • Improve family Satisfaction
  • Reduce Bed sores and Urinary track infections

If Bill 153 is successful in passing it may act as an example to other state governments on how to attain quality care in their nursing homes.

What has your state been doing to try to improve the quality of care available to seniors?

Remember to always watch out for these warning signs of elder abuse and notify your local authorities if you suspect your aging loved one or community member is being abused.

Nursing Homes Face Uncertain Economic Future

Nursing homes in nearly all 50 states are looking into their future with uncertainty, as Medicare and Medicaid cuts seem certain. Further, skilled nursing facilities are required to comply with the Affordable Care Act, which mandates that employers with 50 or more employees provide health insurance or pay a shared responsibility fee. According to a White House brief, 96 percent of all employers with more than 50 employees already provide ample coverage. Many nursing homes, however, do not offer health insurance to hourly employees. Many nursing home and home care workers are uninsured

The New York Times recently reported on the growing concern of many nursing homes and home care agencies who are petitioning for exclusion from the new law. Twenty-five percent of nursing facility staff and 33 percent of home care workers are uninsured. Low wage-earners who work for organizations that do offer coverage often can’t afford premiums.

Mark Parkinson, president of the American Health Care Association, is active in lobbying efforts to exclude nursing homes and home care providers from the requirement. According to Parkinson, Medicare and Medicaid reimbursement rates are too low to allow health providers to cover the cost of insurance for workers. Potential cuts to these reimbursement rates only further complicate the issue. Skilled nursing facilities who opt out of providing coverage will face a penalty, which The Times estimates could exceed $200,000 per year for a mid-size facility.

Charlene A. Harrington, professor at the School of Nursing at the University of California in San Francisco, has a different take on the situation. She feels that nursing homes and other healthcare providers should not be exempt from the requirements, pointing out that direct care workers with adequate health care coverage are more likely to be treated for illness and, therefore, less likely to pass dangerous infections to residents.

Parkinson has suggested a number of alternative solutions, such as exempting only those organizations who enter financial distress as a result of compliance or allowing penalties to be used as a tax write-off.

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