Healthcare, Senior Living, Economics
Late last week, I ran across a number of news posts regarding a proposed class action lawsuit against the hospital/health system giant Advocate Aurora, alleging that the organization used its market mass to limit competition and in return, impose excessively high prices on commercial health plans and their insureds. The suit was filed in Wisconsin (where … Read more
TGIF! I live and have an office in Illinois, though my part of the state differs dramatically from the Illinois most people recognize. I live and work in a small town (Galena) in an area known as the driftless region. The driftless region is “original” terra-firma, where the glaciers did not touch. This area is in the far northwest … Read more
In 2023, regulators re-instituted audits of facilities for inappropriate diagnoses of schizophrenia (justification for anti-psychotic use), plus a five-claim audit of every nursing home. The purpose of the audit was to address a long-standing concern that inappropriate coding was driving higher Medicare reimbursement under PDPM, despite documentation in patient records, not substantiating the level of care … Read more
An issue that I have been interested in for most of my career is coordinated care, especially in terms of older adults who utilize the most care resources and typically, have multiple providers (physicians in particular). Fragmented, uncoordinated care is the primary driver of over-treatment or inefficient treatment. The outcomes of over-treatment include polypharmacy, test … Read more
In January of 2022, a resident with dementia wandered out of her Assisted Living Memory Care facility in Iowa and ultimately, froze to death. The State of Iowa investigation uncovered that the resident wandered outside of the building at 9:30 p.m. the previous night. Her absence went unnoticed for eight hours plus even though the alarm … Read more
Happy Hump Day! Yesterday I wrote about the OIG’s (Department of Health and Human Services) report and focus on CMS’ oversight of state survey agencies. The impetus behind this focus no doubt comes from the U.S. Senate Special Committee on Aging’s investigation into nursing home survey activities at the state level. The report is available … Read more
Last week, the U.S. Department of Health and Human Services Office of the Inspector General (OIG), issued a report regarding the performance of contracted state agencies with respect to nursing home (SNF) compliance surveys. CMS contracts with state agencies, typically state departments of health or divisions thereto, to perform compliance/regulatory activities (surveys) in nursing homes. The report … Read more
TGIF! Greetings from the great white northland! ‘Tis January and Iowa Caucus time and of course, winter settles in. In the rapidly evolving landscape of Assisted Living, it is crucial for states to adapt and refine their regulations to ensure the safety and well-being of residents. Between July 2022 and July 2023, a total of … Read more
This morning, the Department of Labor issued a final rule interpreting who is and who is not, an independent contractor v. an employee. Contract work in health care has boomed since the pandemic, though even pre-pandemic, the use of contractors (physicians, nurses, therapists, etc.) was on the increase. The final rule is available here: 2024-00067 The … Read more
Two articles in my email caught my attention to start the week. Both have to do with SNF closure risks, one regarding rural facilities and the other regarding staffing challenges. Interesting enough, both cross the same issues for closure, approached however, somewhat differently. I’ve written about this subject for years now yet, attention has only become acute … Read more