GAO report triggers all-out assault on nursing homes
GAO report triggers all-out assault on nursing homes
Stinging criticism from the Government Accounting Office over how HCFA oversees the country’s 17,000 nursing homes has re-ignited a bidding war between Congress and the White House over who can inflict tougher sanctions on the industry.
Days before the Senate Special Committee on Aging was set to hear the GAO’s latest criticisms last month, HCFA Administrator Nancy-Ann Min DeParle unleashed a barrage of new measures designed to ratchet up enforcement of federal and state nursing home standards. Senate Special Committee on Aging Chairman Charles Grassley (R-IA) described HCFA’s pre-emptive strike as a replay of last summer when the Administration sought to headoff bad news about a GAO investigation in California with a similar package of initiatives.
"What is going on here is that the President and the Congress have both tasked HCFA with fixing enforcement problems," said Scott Parkin, spokesman for the American Association for Services and Homes for the Aging, in Washington, DC, "and the HCFA Administrator is on the hot seat right now."
Health Care attorney Marie Insante of the Washington, DC, firm Pyles Powers Sutter & Verville is not sanguine about what these accelerating agendas mean for the industry. "What you have is a lot of enforcement mentality driving policy in the wrong direction," Insante asserted. "The government is sitting on this like a 1,000 pound gorilla and the system is going to collapse under its own weight."
HCFA deputy administrator Michael Hash was set to appear before Grassley’s committee along with the GAO March 22 but pulled out when HCFA learned the first panel would include private citizens recounting nursing home horror stories.
"You might note that HCFA is no longer on the witness list for today’s hearing," Grassley declared at the hearing. "I hope this is not an indication of an arrogant attitude toward citizen input."
Hash’s statement, submitted in absentia, proved that HCFA is ready to up the ante. While generally accepting the GAO’s recommendations, Hash outlined a series of measures already under way to address these problems.
Hash reported that HCFA has directed all state survey agencies to investigate all complaints alleging harm to a resident within 10 working days and all claims alleging immediate jeopardy within two days.
He also pointed to HCFA’s regulation published March 18 that lets the agency impose Civil Monetary Penalties up to $10,000 for each serious violation it finds.
Hash also asked Congress for an additional $60 million next year to implement HCFA’s new initiatives. According to Hash, HCFA wants $50 million to beef up state inspection and enforcement efforts and another $10 million in order to double the number of Administrative Law Judges and speed the sanctions process.
For its part, the GAO charged that HCFA’s "limited guidance" over nursing homes has created "a yo-yo pattern" in which homes cycle in and out of compliance. The agency cited serious deficiencies in more than a quarter of the country’s roughly 17,000 nursing homes.
The GAO asserted that while CMPs have "a potentially strong deterrent effect," their effectiveness has been limited by a growing backlog of appeals. There are currently more than 700 cases awaiting decision, said the GAO. Worse yet, only 37 of the 115 monetary penalties imposed on the 74 homes examined by the GAO have been collected and many of those were settled at reduced fines.
According to the GAO, HCFA’s other major anti-fraud tools — denial of payments for new admissions and termination — have also been enforced weakly. The agency reported that HCFA rescinded 55% of payment denials and 72% of terminations before they ever took effect.
Just days after the GAO report was released, Deputy Inspector General George Grob poured fuel on the fire when he told Grassley’s committee that an investigation of nursing homes in the country’s 10 largest states revealed an increase in 13 of 25 quality of care deficiencies including lack of supervision and improper care for pressure sores.
To remedy these problems, Grob suggested a broad agenda that focused largely on improvements in the survey and certification process. He said the existing survey process is too predictable and plagued by ineffective enforcement. As evidence, he noted that 47% of all substantiated complaints receive no action.
An aide to Grassley confirms that he is not likely to cede the field to HCFA. Senate Aging spokeswoman Jill Gerber reports that Grassley has met frequently with the GAO and plans to keep the spotlight on nursing homes.
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