LTC giant hit with quality mandates; hospitals next?
LTC giant hit with quality mandates; hospitals next?
The Department of Health and Human Services’ Office of Inspector General (OIG) announced a broad corporate integrity agreement (CIA) with Sun Healthcare Group last week. The agreement marks the second time the OIG has used an integrity agreement to impose sweeping quality-of-care requirements on a major long-term care provider. Now the question is whether the OIG will begin using the same tactic with other health care providers, including hospitals.
Stuart Gerson of the law firm Epstein, Becker and Green in Washington, DC, says the chances are significant that qualitative requirements will continue to surface in CIAs. "Whether it is hospitals or other places, we will see it again," he says. "CIAs are ever-expansive," he adds. "They have gone up in years and gone up in depth, and we now have a broader coverage of issues.
According to Gerson, the OIG takes the position that it can enforce quality issues even if that is not the central issue in the case at hand.
That theory has never been tested, he adds. "Nobody has ever taken it on because of the exclusion power of the OIG," he explains.
Marie Infante, a health care attorney with Mintz Levin in Washington, DC, says that quality-of-care issues in CIAs would be a "startling new development" for hospitals to cope with. But it is altogether possible that certain quality issues may creep in, she says.
There already are signs that quality-of-care issues are showing up more often on hospital radar screens, in general. For example, when the Centers for Medicare and Medicaid published new Conditions of Participation two years ago, it included restraints and seclusion and other related issues. Hospitals also are facing more frequent surveys as well as new self-reporting and sentinel-event requirements.
Despite those factors, and despite last year’s publicity regarding the number of patient deaths attributed to medical errors, Infante says that nursing homes are still in a class by themselves when it comes to vulnerability over quality-of-care issues.
What sets nursing homes apart is the survey process, explains Infante. "Nursing homes don’t have the insulation of deemed status," she says. "That makes them much more accessible and open to creating the kind of public information that the survey reports represent under much stricter scrutiny."
Infante also points out that the OIG’s guidance for nursing homes highlights quality of care, resident rights, abuse, and neglect as significant risk areas.
The CIA for Sun, one of the nation’s largest operators of nursing homes and long-term care services, is part of the resolution of ongoing investigations of the company by the OIG and the Department of Justice and modeled after the OIG’s agreement last year with Vencor, another long-term care giant.
Like Vencor, Sun has filed for protection from its creditors under Chapter 11 of the bankruptcy code. In order to be discharged from bankruptcy, the federal government must acquiesce in the plan of discharge, and the government has not been shy about using that leverage. The CIA itself will not be made public until that process is complete.
The five-year CIA requires Sun to engage a team of independent monitors selected by the OIG to provide an ongoing assessment of these systems and quality-of-care measures. In addition, the company will be required to conduct training every year for all employees and operate a confidential disclosure program for its employees, contractors, patients, and families.
Sun also must perform a semiannual screening of all employees and contractors to determine their eligibility to participate in federal health care programs and create a comprehensive internal audit and review mechanism that reviews that adequacy of its system of internal financial controls, accounting practices, financial reporting practices, and other internal audit and review functions.
It also must engage an independent review organization to perform financial and compliance reviews in conjunction with its own staff that are aimed at identifying and eliminating payment errors.
Quality-of-care only will be one of the many issues debated next week at an invitation-only roundtable discussion organized by the OIG that will include dozens of government and private-sector experts with a stake in how CIAs are being developed and implemented.
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