The Office of Inspector General has this month, released a report entitled CMS Improperly Paid Millions of Dollars for Skilled Nursing Facility Services When the Medicare 3-Day Inpatient Hospital Stay Requirement Was Not Met. Under the law, post-hospital extended care is reimbursable when there is a 3-day consecutive inpatient hospital stay. According to the OIG, there was a lack of coordinated notification between hospitals, beneficiaries and SNF's. The OIG recommended additional … [Read more...] about OIG Finds Improper Payment for Skilled Nursing Facilities
Texas State Senators and Representatives File Bill Regarding Freestanding ED’s
A bipartisan group of Texas Legislators has filed bills to empower the Texas Attorney General to stop "price-gouging" by freestanding emergency rooms. SB 866 and HB 1941 "would protect Texans from exorbitant charges in an emergency, make prices “unconscionable” if they are more than 200 percent over the average hospital charge for the same service, and allow the state to take action to stop freestanding ERs via restraining order against the facility if unconscionable prices. The penalty for … [Read more...] about Texas State Senators and Representatives File Bill Regarding Freestanding ED’s
State of the Union Address
During last night's State of the Union address, President Trump made health care "a consistent theme" in his speech. One area he stressed was drug prices and he vowed to take them on: “It is unacceptable that Americans pay vastly more than people in other countries for the exact same drugs, often made in the exact same place. This is wrong, this is unfair, and together we will stop it. We will stop it fast,” he said. “I am asking the Congress to pass legislation that finally takes on … [Read more...] about State of the Union Address
Sham Medical Director Agreements
The U.S. Attorney for the Middle District of Florida pursued a nursing home for an allegedly sham Medical Director arrangement with a local orthopedic physician. The nursing facility and physician are to pay 1.5 million back to the government as part of a settlement agreement. It was alleged that the purpose of the agreement was to induce the physician to refer patients to the facility for rehabilitation services: The settlements announced today resolve allegations that Conway … [Read more...] about Sham Medical Director Agreements
Disparagement versus Freedom of Speech?
McKnight's is reporting on a Georgia case involving three nursing facilities who sued a plaintiff's personal injury firm for ads that were false, fraudulent, deceptive and misleading and for violating a specific Georgia statute restricting the use of nursing home data in ads. The defendants have filed a motion to dismiss based on free speech grounds. The Georgia Supreme Courts heard arguments on Tuesday. In Texas, it is likely any such claim would be subject to the Texas "Anti-Slapp" statute … [Read more...] about Disparagement versus Freedom of Speech?
Lack of Hospice Care in the Texas Big Bend?
An interesting article with an accompanying Radiocast was posted in early January on the Marfa Public Radio website about the dearth of Hospice services in the West Texas Big Bend region. Apparently, the one Hospice in the area closed in 1997 and elderly residents are having to come to Central Texas for Hospice care. It's well worth a listen and read. … [Read more...] about Lack of Hospice Care in the Texas Big Bend?
Opioid Alternative Pilot Program Offering Access to Medical Marijuana Progressing in Illinois
In August 2018, Illinois passed the Alternative to Opioids Act of 2018, allowing a treating physician to refer a patient to the Opioid Alternative Pilot Program to avoid prescribing of opioids for conditions and to allow the use of medical cannabis instead. The pilot program starts at the end of January and medical cannabis dispensaries are gearing up for it by increasing infrastructure and workforce numbers. Training is a big part of the preparation: Staff at Green Thumb … [Read more...] about Opioid Alternative Pilot Program Offering Access to Medical Marijuana Progressing in Illinois
Hospital Re-Admissions and the Elderly
The New York Times is writing about the ACA's Hospital Readmissions Reduction Program and the question of whether or not this is causing increased mortality among older patients. This should be of increased interest to nursing facilities since the refusal of readmission after a nursing home sends a resident to the hospital and subsequent death of the resident when returned to the facility may increase scrutiny of the nursing home rather than the correctness of a hospital refusing … [Read more...] about Hospital Re-Admissions and the Elderly
Use of Marijuana in Nursing Homes? Obstacles to Medical Marijuana Weaken.
A nursing home in the Bronx began a cannabis program in 2016 and is having good results: The Hebrew Home at Riverdale, in the Bronx, first launched its “innovative” new cannabis program in 2016. With it, the facility provided educational sessions and a fact sheet on the often-misunderstood drug to both residents and their family members. About 10 residents have participated so far, and they have reported that cannabis has helped to lessen the severity of chronic pain and reduce opioid … [Read more...] about Use of Marijuana in Nursing Homes? Obstacles to Medical Marijuana Weaken.
Trump May Sidestep House to Rein in Spending for Skilled Nursing
Trump appears to continue his drive to implement the block grant approach to decrease costs for skilled nursing through Medicaid, though it is unclear whether he will do it through spending caps or stricter requirements for block grants: Trump sent providers reeling shortly after his inauguration when he made a first run at instituting the block grant approach. Healthcare providers and consumers banded together to beat back the contentious effort. It is believed that this time, … [Read more...] about Trump May Sidestep House to Rein in Spending for Skilled Nursing