Healthcare is experiencing significant change, driven by demographic trends, outdated financial structures, and technological progress, not to mention the glaring problem of COVID-19 and its ramifications throughout the care continuum. Many non-hospital organizations are struggling with how they have long operated. Not only is it becoming harder and harder to retain employees, but everyone in healthcare needs more staff to care for our aging population. At the same time, government oversight and the wide range of measures aimed at improving the quality of care may be inadvertently creating additional problems for already-burdened care providers. Here is a specific challenge affecting this area of care.
The Centers for Medicare & Medicaid Services (CMS) may impose Civil Money Penalties (CMPs) against nursing homes and other residential care facilities for either the number of days or for each instance a nursing home is not in substantial compliance with one or more Medicare and Medicaid participation requirements for long-term care facilities. A portion of the CMP fines collected are given back to the states in which the CMPs are imposed. State CMP funds may be reinvested to support activities that benefit nursing home residents and that protect or improve their quality of care or quality of life. An 18-month moratorium was established for these fines by CMS, prior to the planned imposition of stricter guidelines in 2019, so that care providers had time to educate themselves and prepare for the heightened oversight. According to McKnight’s Long-Term Care News, the “Phase 2 requirements were ‘a little bit of a bigger lift’ for facilities, and some providers, particularly in rural areas, were having a hard time getting up to speed” (Stempniak, 2019).
Subsequently in 2019, in response to requests from the nursing home industry, “The Trump administration’s decision to alter the way it punishes nursing homes has resulted in lower fines against many facilities found to have endangered or injured residents. Federal records show that the average fine dropped to $28,405 under the current administration, down from $41,260 in 2016, President Obama’s final year in office” (Rau, 2019). Current practice does not require inspectors to “to fine facilities unless immediate-jeopardy violations resulted in ‘serious injury, harm, impairment or death.’ Regulators still must take some action, but that could be ordering the nursing home to arrange training from an outside group or mandating specific changes to the way the home operates” (Rau, 2019). According to NPR, “consumer advocates say penalties have reverted to levels too low to be effective” (Rau, 2019).
In a recent development, CMS announced on June 1, 2020 the imposition of “increased civil monetary penalties (CMPs) for nursing homes with patterns of infection control deficiencies, while also implementing new enforcement of lower-level infection control issues to bolster compliance” (Spanko, 2020). At the time of the announcement, nearly 26,000 nursing home residents had died in the unfolding COVID-19 Pandemic, and about 60,000 infections had been reported. These numbers are expected to increase as the pandemic continues.
This blog post continues a series based on our article, Top Issues Across the Care Continuum, which looks more closely at some of the serious concerns of healthcare organizations across the care continuum. Subsequent challenges to be examined include:
There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about HealthStream solutions for non-acute care organizations.
HealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.View All Learning & Performance
When you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.View All Quality & Compliance
Fulfill compliance requirements with a variety of programs and courseware designed to address critical regulatory requirements as well as educate staff to recognize and mitigate risks.View All Products
HealthStream offers professional training and education on how to best optimize your reimbursement process within your healthcare organization.View All Reimbursement
Improve the preparedness of your staff, increase survival rates, and cut costs with the advanced resuscitation training services from HealthStream.View All Resuscitation
Expand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.View All Clinical Development
Delivers everything you need to request, gather, and validate information about a provider to create a single source of truth for downstream processes.View All Credentialing
Make sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.View All Scheduling & Capacity Management