Monthly Archives: June 2019

Government to start posting list of troubled nursing homes

Posted on by • Posted in Center for Medicare and Medicaid Services (CMS), Nursing Home, Nursing Home Compare, Patient Safety, Quality of Care • Leave a comment

https://www.apnews.com/c8e1e70253fb405e8fe13cd7b2eda70f

In this Oct. 26, 2018, file photo, Sen.Bob Casey, D-Pa., speaks to reporters in the studio of KDKA-TV in Pittsburgh. For years the federal government for years has kept under wraps the names of hundreds of nursing homes around the country found to have serious health, safety or sanitary problems. Lawmakers say the silence calls into question the government’s commitment to families going through the difficult process of finding a nursing home for a loved one. The secrecy began to crack Monday when two U.S. senators from Pennsylvania released the government’s list.

In a turnabout, the government said Wednesday it will start posting a list of some 400 troubled nursing homes , days after senators released the “secret” document along with a report questioning oversight of poor-quality facilities.

Dr. Kate Goodrich, chief medical officer with the Centers for Medicare and Medicaid Services, said the agency soon will post the list and update it regularly. She didn’t set a date.

“We are working actively to get the list posted,” Goodrich told reporters, saying that attention focused on the issue “has amplified a very important national dialogue on nursing home quality.”

The Associated Press reported Monday that Sens. Bob Casey, D-Pa., and Pat Toomey, R-Pa., had found that conditions at the 400 facilities were “indistinguishable” from those at about 80 poor-performing nursing homes that are publicly identified by the government and undergo an additional level of inspections.

In a statement, Casey welcomed the commitment to post the list, but said more work is needed to make sure the government’s program to improve poor-performing nursing homes is running properly and has enough financing.

About 1.3 million Americans live in nursing homes, with more than 15,700 such facilities nationwide. The troubled nursing homes that Casey and Toomey identified are part of the government’s Special Focus Facility program, representing about 3 percent of all homes.

Budget cuts appear to be contributing to the problem by reducing money available for focused inspections, according to documents and interviews.

Agency officials say they currently only have enough money for 88 slots in the special focus program. Those facilities are publicly identified. Consumers can spot them on the government’s Nursing Home Compare website by looking for an icon that resembles a traffic “caution” sign.

But a larger group of some 400 nursing homes are designated as “candidates” for the program, and their names have not been publicly disclosed. The agency says that’s now about to change.

It pushed back against the suggestion it was keeping secrets, saying its nursing home website uses starred ratings that allow consumers to readily identify troubled facilities. Nursing homes with five stars have much better than average quality and nursing homes with a single star are considered to be much below average. Nationwide, there are about 2,900 of the latter.

Goodrich said starred ratings are the best way for consumers to get a sense of quality, but the senators’ report concluded that the ratings can be misleading. For example, nearly 3 in 10 of the 400 “candidate” nursing homes with problems had two stars out of five overall.

The government spends about $400 million a year on all Medicare-related inspections, and Goodrich said most of that goes for nursing home checks. The Trump administration has asked Congress for nearly $45 million more.

 

 

Organizers: Johns Hopkins Reaches Settlement With Nurses Seeking To Unionize

Posted on by • Posted in Health System, High Turnover, Hospital, Inadequate Equipment, Inadequate Staffing, Labor Union, Low Compensation, National Labor Relations Board, Nurses • Leave a comment

https://www.wbal.com/article/392993/3/organizers-hopkins-reaches-settlement-with-nurses-seeking-to-unionize


Johns Hopkins Hospital has reached a settlement with registered nurses seeking to unionize, their national organizing committee said.

“This settlement makes clear that nurses have the right to form a union, we have a right to speak with our coworkers about a union, and Johns Hopkins does not have the legal right to target and intimidate nurses who engage in union activity,” registered nurse Alex Laslett said in a statement. “We are organizing at Johns Hopkins because we know a union affords nurses the protection we need to advocate freely for the best care for our patients.”

Hopkins reached a settlement of claims filed by the National Nurses Organizing Committee/National Nurses United with the National Labor Relations Board. The board found that the hospital created the impression that union activity would lead to surveillance and unlawful surveillance. The hospital enforced a rule barring nurses access to break rooms in connection with union activity and prohibited nurses from talking about the union at work, the NLRB found.

The settlement requires management to post signs throughout the hospital affirming nurses’ right to unionize. Those signs must be in place by June 14.

“In Catholic social teaching, we teach and believe that all workers have a fundamental human right to organize and to form unions and when an employer such as Johns Hopkins violates this fundamental right, they are acting unjustly and must be held accountable,” Father Ty Hullinger, a pastor in East Baltimore and a member of the Coalition for a Humane Hopkins, said in a statement. “This settlement puts Johns Hopkins on notice that the community is watching their actions and holding them to a standard that is moral and just.”

Officials with the national union said nursing staff at Hopkins asked for help organizing a union to address high turnover due to poor staffing, inadequate equipment and low pay.

 

 

UPMC halts prepayment plan for Highmark Medicare Advantage members

Posted on by • Posted in Consent Decree, Emergency Care, Health Insurance Industry, Health System, Hospital, Medicare Advantage, Out of Network, Prepayment, State Dept of Insurance • Leave a comment

https://www.goerie.com/news/20190605/upmc-halts-prepayment-plan-for-highmark-medicare-advantage-members

Image result for upmc highmark

The plan would have required those members to pay in full for out-of-network visits to UPMC hospitals and physician offices.

Highmark Medicare Advantage members will not have to pay in advance for medical services at UPMC hospitals and physician offices that will be out of network if the UPMC-Highmark consent decrees are allowed to expire June 30.

UPMC officials informed the Pennsylvania Insurance Department of the change Wednesday, according to a news release on UPMC’s website. They had said in late 2018 that UPMC would require patients with out-of-network Medicare Advantage plans to pay in advance for any nonemergency treatment and then seek reimbursement from their insurer.

In addition, UPMC will accept direct payment from Highmark for out-of-network emergency care at the same rate UPMC Health Plan now pays Highmark’s Allegheny Health Network hospitals, including Saint Vincent Hospital.

“As the consent decrees near their end on June 30, our intent is to ensure that Highmark members can receive emergency and other care that they need without being caught in the middle of billing issues created by their insurer,” UPMC spokesman Paul Wood said in the news release.

UPMC’s decision came after federal officials said they might be taking a closer look at UPMC’s prepayment policy, the Pittsburgh Post-Gazette reported.

UPMC will bill Highmark directly for its Medicare Advantage members who use out-of-network services and will accept reimbursement at the Medicare fee schedule amount, UPMC said in the news release.

The announcement comes about a week before a Pennsylvania Commonwealth Court judge will hold a hearing in Harrisburg regarding the state attorney general’s office’s attempt to modify and extend the consent decrees past June 30. The hearing is scheduled for Tuesday and Wednesday.

 

 

Supreme Court rejects HHS’ Medicare DSH changes

Posted on by • Posted in 2020 Election Issues, Health Policy, Health System, Hospital, Hospital Industry, Medicare, Medicare Disproportionate Share Reimbursement, Supreme Court • Leave a comment

https://www.modernhealthcare.com/legal/supreme-court-rejects-hhs-medicare-dsh-changes?utm_source=modern-healthcare-alert&utm_medium=email&utm_campaign=20190603&utm_content=hero-readmore

The U.S. Supreme Court on Monday ruled that HHS improperly changed its Medicare disproportionate share hospital payments when it made billions of dollars in cuts.

In a 7-1 decision, the justices said HHS needed a notice-and-comment period for the Medicare DSH calculation change. Justice Neil Gorsuch wrote in the decision that HHS’ position for not following the procedure was “ambiguous at best.”

“Because affected members of the public received no advance warning and no chance to comment first, and because the government has not identified a lawful excuse for neglecting its statutory notice-and-comment obligations, we agree with the court of appeals that the new policy cannot stand,” Gorsuch wrote.

The case was highly technical, and hinged on a dueling interpretations of agency activity that constitutes a “substantive legal standard” in a payment policy change to Medicare.

Under the new Medicare DSH formula, the CMS began to lump Medicare Advantage enrollees in with traditional Medicare enrollees to calculate a hospital’s DSH payment.

But Medicare spending is about $700 billion per year, and the program covers nearly one-fifth of Americans.
“Not only has the government failed to document any draconian costs associated with notice and comment, it also has neglected to acknowledge the potential countervailing benefits,” Gorsuch wrote. “Notice and comment gives affected par-ties fair warning of potential changes in the law and an opportunity to be heard on those changes—and it affords the agency a chance to avoid errors and make a more informed decision.”

The majority opinion also emphasized the size and scope of Medicare, noting that “even seemingly modest modifications to the program can affect the lives of millions.” “As Medicare has grown, so has Congress’s interest in ensuring that the public has a chance to be heard before changes are made to its administration,” Gorsuch wrote.

During oral arguments in the case in January, Gorsuch and Justice Sonia Sotomayor doubled down on the economic magnitude of the change, which HHS estimated to be between $3 billion and $4 billion between fiscal 2005 and 2013.

Justice Stephen Breyer dissented from the majority, and Justice Brett Kavanaugh recused himself because he participated in the U.S. Court of Appeals for the D.C. Circuit ruling that the Supreme Court upheld.

Breyer wrote he believed the government had the legal grounds to skip the public comment period in this policy.
“The statutory language, at minimum, permits this interpretation, and the statute’s history and the practical consequences provide further evidence that Congress had only substantive rules in mind,” he wrote. “Importantly, this interpretation of the statute, unlike the court’s, provides a familiar and readily administrable way for the agency to distinguish the actions that require notice and comment from the actions that do not.”

 

 

 

Will you get your Money’s Worth?

Posted on by • Posted in C-Suite, Compliance Issues, Financially Distressed, Health System, Hospital, Independent Contractor, Interim CEO, Interim CFO, Interim Executives, Interim Resources, Leadership, Recruiting, Talent Management, Unexpected Problems, Value Proposition • Leave a comment

Will you get your Money’s Worth?

InterimCFO

All about Interim Executive Services in healthcare administration.

Will you get your Money’s Worth?

Abstract: This article is a continuation of the series on the value proposition of Interim Executive Consulting.  In this article, I look at the value proposition from the consultant’s perspective.

Recently, I was discussing an interim opportunity in a smaller hospital with a referral source.  The prospective argument was that the client did not have the capacity (did not want) to pay a market rate fee.  You never hear hospitals argue with their lawyers or other consultants on this point, but I digress.

Based on my experience, there are two things that you can be sure of in any interim engagement.  One is that as soon as you think you have an idea of what is going on around you, you had better get ready for a big and sometimes very nasty surprise.  The other is that you are going to find challenges and problems in the situation that the client either intentionally withheld or that the client had no idea of in the first place.  Some clients have told me after skeletons started falling from closets that they harbored the fear that if they were fully transparent that an interim consultant would refuse the gig.  What they do not know is that as professional Interim Executives, we usually do not get the call until the situation is challenging and that if we are distressed by the surprises and uncertainty that characterize Interim Executive Services, we would have found something else to do.  Remember, firefighters run toward a fire when everyone else is running away.

Another principle of doing interim work in my experience is that there is no correlation between the size of the organization and its capacity to produce drama, challenges, and vexing problems.  An argument can be made, and my on-point experience confirms that the risk is higher the smaller the organization because smaller organizations do not have the intellectual and bandwidth resources necessary to avoid creating or falling into serious problems.  If the issues have anything to do with compliance, the potential risks to the interim executive increase exponentially, especially if they are going to be executing documents or making representations on behalf of the organization.  Compliance related signatory authority risk is a risk that cannot be insured by either the consultant or the client. I told the referral source that if anything, there should probably be a significant premium associated with going into a smaller place.

What is a client to do?  I try to mitigate this risk for my client by offering a no-notice, no-fault termination clause in my contract.  The day that the client decides that I am not providing value, I am out of there.  I do not wish to become a perceived burden to an organization during what is already likely an awkward transition.  I have not been released from an interim engagement.  To the contrary, the opposite is true.  In every one of my interim engagements, the timeline has been extended, extensively in some cases once the client appreciates the value proposition.  My average ’90 – 120′ day gig lasts around nine months, and my longest has been over two years.

I have stated repeatedly in these articles that I do not follow bad people and I stand by that contention.  However, this does not mean that there will not be serious problems in an organization.  I followed a CFO that was compelled to resign among other things for digging in over what he believed was a non-compliant acquisition of a physician practice that had millions of dollars of goodwill baked into the deal along with lavish estimates of the value of furniture, fixtures, and equipment.  In another situation, the CEO had been overridden on multiple occasions by a Board that was determined to do non-compliant deals with physicians.  I could go on and on about these types of challenges.

Problems do not have to be compliance related to be challenging and of high potential value.  During the course of every engagement, I am routinely asked, “Is this the worst you have ever seen?”  Most of the time the answer is no, and in every case, it is situation specific.  I was engaged by a hospital to assess the revenue cycle.  Other than the AR being currently fairly valued following multiple unfavorable audit adjustments, about everything else in the revenue cycle process was broken as the client had expected.  The resulting intervention increased cash collections more than $10 million in the next year on around $300 million of revenue.  As an aside, in an organization of this size with a typical operating margin in the 3% range, this intervention more than doubled operating income so, in context, it was a pretty big deal.  This organization was trying to save money by doing things like buying thinner tongue depressors and cutting the amount of soap housekeeping could put in mop buckets while it threw away all of the savings and more in the revenue cycle.  It was the worst revenue cycle operation I have seen measured by results or lack thereof.  This same organization had some of the strongest and highest performing functions in other areas that I have experienced.  Even in the revenue cycle, I got to meet some of the smartest, most dedicated people I have ever known.  They were handicapped by a dearth of leadership and decrepit systems.  None of this supported a conclusion that the organization was terrible or on balance, it was the worst I have ever seen although the revenue cycle concerns did have something to do with the prior CFO being ‘freed up to seek other opportunities.’

What is a consultant to do?  My advice is to the degree possible and reasonable, stand your ground on your professional fee.  It would be nice if you knew you were going to a cake-walk that would mainly be a paid vacation and that you could confidently offer a come-on rate to land the gig.  You know the reality is that you are probably going into a complicated, high-stress situation that is going to tax all of your physical and mental capacity.  This situation is exacerbated by desperate or ignorant consultants and firms that will take any gig at any rate when they have an unsophisticated buyer or just to have something to do.  I have considered offering such a price based on not finding any problems.  For example, I could offer a 30% – 50% discount for a lush sabbatical that would be reversed if (when) issues begin to emerge.  Maybe I could even bargain to double my rate upon discovery of the first compliance problem.   Unfortunately, the world does not work this way, and if you are up against an unsophisticated or ignorant potential client, there is an excellent chance you are going to be undercut by an equally ignorant potential consultant.  You have to decide for yourself how much risk you are willing to take on.  How much is it worth to you to put yourself, your net worth and your family’s livelihood into play in a situation where you may be exposing yourself to the risk of becoming the target of a government compliance investigation?  In a bad case scenario, you could become a witness in a hostile position vis-a-vis the client. The government is currently pursuing multiple felony charges against John Holland (look him up on the internet) even though he alleges and there is apparently little evidence that he benefited directly or indirectly from compliance problems that occurred in organizations he served.  By the way, John may and probably did inherit some of the issues that resulted in criminal charges, i.e., the problems were present in the organization when he started.  Tell me again Mr. cut-rate consultant or firm how anxious you are to get yourself into a situation like this?  By the way, if you are placed by a firm and compliance problems emerge, you are going to be on your own.  Do not forget this.

If you are a decision maker and you are getting resistance to rate discounting from interim executive services providers, it is probably because of their prior experiences and bias about potential problems in your organization.  Instead of dismissing them for something cheaper, you might want to understand better where they are coming from and how that might translate into risk you are bearing that you might not even recognize.  You have to accept the fact that you would not be seeking interim services if you did not have a significant challenge on your hands.  Your best defense against getting into a deal that could make the situation worse is to negotiate an agreement that can be exited rapidly and without recourse. You may have problems that are as yet undiagnosed.  Your run in your current situation could be riding on the ability of the interim executive you choose to pull your bacon out of a fire and potentially save many of your direct reports’ jobs in the process.  What is that worth to you?

Contact me to discuss any questions or observations you might have about these articles, leadership, transitions or interim services.  I might have an idea or two that might be valuable to you.  An observation from my experience is that we need better leadership at every level in organizations.  Some of my feedback is coming from people that are demonstrating an interest in advancing their careers, and I am writing content to address those inquiries.

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