The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services Office of Inspector General (OIG) issued today two highly anticipated final rules to reform the Stark Law and Anti-Kickback Statute (AKS) regulations.
Efforts to modernize and clarify the fraud and abuse laws began in 2018 as part of the Regulatory Sprint to Coordinated Care Initiative. The initiative is aimed at removing regulatory barriers that may hamper innovative arrangements for coordinating care consistent with a shift to a value-based health care system.
The agencies emphasized that the final rules offer health care providers more flexibility to coordinate and improve care for patients, while maintaining important guardrails that prevent overutilization and fraud and abuse.
The Stark final rule creates new, permanent exceptions to the Stark Law for value-based arrangements, according to CMS. These exceptions will apply broadly to care provided to all patients, not just Medicare beneficiaries, CMS said.
Source: American Health Law Association
The two U.S. senators who last year released a “secret” list of nursing homes under consideration for inclusion on a formal list of facilities with major quality issues are now calling for expanded oversight of poorly performing skilled nursing facilities in the wake of the COVID-19 pandemic.
Sens. Pat Toomey and Bob Casey, both of Pennsylvania, last June released a list of more than 400 nursing homes considered candidates for the Centers for Medicare & Medicaid Services’ (CMS) Special Focus Facilities (SFF) program in June of last year.
On Tuesday, the bipartisan pair — Toomey is a Republican, Casey a Democrat — announced a bill that would expand the SFF program, ensuring that all candidate facilities would receive “additional oversight and enforcement, as well as technical assistance and educational programming,” according to a press release and summary of the legislation.
Source: Skilled Nursing News
WASHINGTON (AP) — Despite Trump administration efforts to erect a protective shield around nursing homes, coronavirus cases are surging within facilities in states hard hit by the latest onslaught of COVID-19.
An analysis of federal data from 20 states for The Associated Press finds that new weekly cases among residents rose nearly four-fold from the end of May to late October, from 1,083 to 4,274. Resident deaths more than doubled, from 318 a week to 699, according to the study by University of Chicago health researchers Rebecca Gorges and Tamara Konetzka.
Equally concerning, weekly cases among nursing home staff in surge states more than quadrupled, from 855 the week ending May 31, to 4,050 the week ending Oct. 25. That rings alarms because infected staffers not yet showing symptoms are seen as the most likely way the virus gets into facilities. When those unwitting staffers test positive, they are sidelined from caring for residents, raising pressures on remaining staff.
The administration has allocated $5 billion to nursing homes, shipped nearly 14,000 fast-test machines with a goal of supplying every facility and tried to shore up stocks of protective equipment. But the data call into question the broader White House game plan, one that pushes states to reopen while maintaining that vulnerable people can be cocooned, even if the virus rebounds around them.
Federal authorities announced Wednesday afternoon that they will be distributing about $333 million in first-round performance payments to more than 10,000 nursing homes for their results battling COVID-19.
The funds will be distributed next week, officials said. The rewards are being given to 10,631 nursing homes (more than 77% of the 13,795 eligible). Overall, the recognized nursing homes “contributed to 5,000 fewer COVID-19 infections in nursing homes” in September than in August, officials said.
In addition, against both the infection control and mortality criteria, 10,501 nursing homes (76%) qualified for payments and contributed to 1,200 fewer COVID-19 related nursing home deaths between August and September.
The performance-based payment structure rewards nursing homes that keep new COVID-19 infection and mortality rates among residents lower than the communities they serve, as analyzed against CDC data.
“These $333 million in performance payments are going to nursing homes that have maintained safer environments for residents between August and September,” said Health and Human Services Secretary Alex Azar. “We’ve provided nursing homes with resources and training to improve infection control, and we’re rapidly providing incentives to those facilities that are making progress in the fight against COVID-19.”
A long-term care facility in Montana has been sued after health officials said its staff was negligent and allowed the coronavirus to spread through the facility in Whitefish earlier this year.
The lawsuit was filed Tuesday by the estates of three residents at Whitefish Care and Rehabilitation who died because of complications caused by COVID-19, the Missoulian reported.
The lawsuit represented the estates of Alton Johnson, Berton Pew and Stanley Webber, and argued that at least 13 people died at the facility because of the outbreak. The county had 23 coronavirus-related deaths.
The Heenan and Cook firm of Billings and McGarvey Law in Kalispell are representing each of the estates.
The lawsuit named the 100-bed long-term care facility and its administrator Reid Crickmore. Crickmore did not respond to an email or phone message from The Associated Press on Wednesday seeking comment.
Montana Public Radio reported that the Centers for Medicare and Medicaid Services issued a report in September saying the facility's noncompliance had placed the health and safety of its residents at risk. The Daily Inter Lake then reported that the agency rated the facility in “immediate jeopardy.”
Source: U.S. News
As skilled nursing operators gather themselves together to prepare for their new era in the wake of a pandemic that has upended their sector in particular and society more broadly, there are significant lessons to be learned from the COVID-19 era, according to the leader of the largest trade organization for nursing homes in the U.S.
Though more resources on the governmental level are necessary for operators to continue in the midst of the pandemic, there are some bright spots, Mark Parkinson, the president and CEO of the American Health Care Association (AHCA), told Skilled Nursing News on October 8.
Those include better access to testing and personal protective equipment (PPE) and improved knowledge on how to care for COVID-19 patients in the event of an outbreak.
But the lessons from the hard first months of COVID-19 extend beyond the immediate; for Parkinson, the industry will have to reflect on a range of reforms for the years to come, not just the months.
Source: Skilled Nursing News
World Mental Health Day on 10 October to highlight urgent need to increase investment in chronically underfunded sector
The COVID-19 pandemic has disrupted or halted critical mental health services in 93% of countries worldwide while the demand for mental health is increasing, according to a new WHO survey. The survey of 130 countries provides the first global data showing the devastating impact of COVID-19 on access to mental health services and underscores the urgent need for increased funding.
The survey was published ahead of WHO’s Big Event for Mental Health ̶ a global online advocacy event on 10 October that will bring together world leaders, celebrities, and advocates to call for increased mental health investments in the wake of COVID-19.
WHO has previously highlighted the chronic underfunding of mental health: prior to the pandemic, countries were spending less than 2 per cent of their national health budgets on mental health, and struggling to meet their populations’ needs.
And the pandemic is increasing demand for mental health services. Bereavement, isolation, loss of income and fear are triggering mental health conditions or exacerbating existing ones. Many people may be facing increased levels of alcohol and drug use, insomnia, and anxiety. Meanwhile, COVID-19 itself can lead to neurological and mental complications, such as delirium, agitation, and stroke. People with pre-existing mental, neurological or substance use disorders are also more vulnerable to SARS-CoV-2 infection ̶ they may stand a higher risk of severe outcomes and even death.
“Good mental health is absolutely fundamental to overall health and well-being,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “COVID-19 has interrupted essential mental health services around the world just when they’re needed most. World leaders must move fast and decisively to invest more in life-saving mental health programmes ̶ during the pandemic and beyond.”
A major hospital chain has been hit by what appears to be one of the largest medical cyberattacks in United States history.
Computer systems for Universal Health Services, which has more than 400 locations, primarily in the U.S., began to fail over the weekend, and some hospitals have had to resort to filing patient information with pen and paper, according to multiple people familiar with the situation.
Universal Health Services did not immediately respond to requests for comment, but posted a statement to its website that its company-wide network “is currently offline, due to an IT security issue. One person familiar with the company’s response efforts who was not authorized to speak to the press said that the attack “looks and smells like ransomware.”
Ransomware is a type of malicious software that spreads across computer networks, encrypting files and demanding payment for a key to decrypt them. It’s become a common tactic for hackers, though attacks of this scale against medical facilities aren’t common. A patient died after a ransomware attack against a German hospital in early September required her to be moved to a different hospital, leading to speculation that it may be the first known death from ransomware.
Source: NBC News
Rose Konecky has been able to see her 80-year-old father only once since March, when his assisted living facility near Fort Worth, Texas, stopped regular visits because of the coronavirus pandemic.
Her father, who has Alzheimer’s disease, can’t understand why his family has stopped coming to see him. “He doesn’t remember — all he knows is that we really don’t come and visit. It’s really sad,” she said.
Konecky had already been planning to support Joe Biden in November. But her family’s wrenching experience had made her vote more urgent.
“It’s made it much more of an emotional choice. Every night before I go to bed, I write postcards to voters,” Konecky, 38, who blames the Trump administration for failing to contain the virus, said. “The pandemic is one of these issues where the politics become personal — to an extreme extent.”
The fallout from the virus is only one of the headline issues that voters are weighing. But the pandemic’s devastating effect on older Americans could make it harder for President Donald Trump to win re-election, according to new polling in swing states, which found that older voters are broadly worried about contracting the virus and more likely to trust Biden to manage the pandemic.
Source: NBC News
Recommendations from the Coronavirus Commission on Safety and Quality in Nursing Homes were released on Wednesday and, as expected, they contain a laundry list of steps that both providers and regulators can take for future pandemic conditions or public health emergencies.
The panel included comments that kept its sponsor, the Centers for Medicare & Medicaid Services, on the spot. Report authors said that in some cases, “CMS will need to assume a greater leadership role working with its federal partners and state, local, tribal and territorial” authorities to better sort out which will have the authority to accomplish the commission’s recommendations.
SAN DIEGO COUNTY, Calif. — Content warning: This story contains details of alleged abuse and neglect and may be disturbing to some readers.
Nearly two dozen criminal charges were announced Thursday against the operator of three San Diego independent-living facilities, who prosecutors say neglected his clients, and was running the facilities despite previously being banned by the state from doing so.
Source: CBS News
Since March 2020, approximately 4,219 Covid-19 related cases have been filed across the United States, including:
Every day the number of new cases continues to climb, with employment-related cases jumping 43 percent in June. For business owners, a look at the most common personal-injury type claims asserted against businesses by employees can offer critical insights into mitigating potential litigation. In addition, the most common claims by customers against businesses, not involving subscription accounts, season ticket holders or canceled events, also can provide important perspective as Covid-19 remains an evolving situation.
Personal injury claims against employers are primarily claims for wrongful death, unsafe working conditions/exposure to Covid-19 and public nuisance claims for outbreaks at facilities. The common themes through these claims are allegations that the employer: (1) failed to timely and properly implement local and national workplace safety guidance for preventing the spread of Covid-19; (2) failed to require employees to report positive test results; (3) failed to provide adequate personal protective equipment (PPE); (4) failed to inform employees when co-workers tested positive; (5) failed to require self-quarantines for workers who tested positive for Covid-19; and (6) discouraged employees from taking sick leave during the pandemic.
Three notable examples of wrongful death claims include:
Source: JD Supra
SEATTLE — King County Superior Court says it’s ready to resume jury trials this month, but in a drastically altered format, thanks to the coronavirus pandemic.
The court hasn’t had a jury trial since March, and in an announcement Thursday it said there’s a backlog of 800 criminal trials and “countless” civil trials.
Among the key changes is that the Meydenbauer Center, an event space and theater in Bellevue, has been enlisted as a temporary courthouse to provide more space for social distancing.
Court spokeswoman Amy Roe wrote that jurors will no longer report for jury duty in groups, but will complete an orientation and answer case-specific questionnaires online.
Jury selection will be done largely by video conference.
Source: King5 News
Here are the rates of positive COVID-19 tests in each state, along with the number of new cases most recently reported and number of tests conducted per 1,000 people. Data points for rates, cases and tests were last updated July 22 and are seven-day moving averages. This information cited is from Johns Hopkins' Coronavirus Resource Center. States are arranged in descending order of test positivity rates.
Source: Becker's Healthcare
Coronavirus task force member Dr. Anthony Fauci issued a stark warning on Tuesday to lawmakers on Capitol Hill, telling them he wouldn't be surprised if the US sees new cases of coronavirus rising to a level of 100,000 a day.
The international outbreak of COVID-19 poses a serious public health threat that has severely affected social, community, and business activities. With prolonged periods of social distancing, the coming of summer, and the need to engage in more social and commercial activities, Americans must consider how to continue to reduce risk. This webinar from CDC’s Emergency Partners Information Connection will discuss the current status of the pandemic in the U.S., factors to consider when deciding to participate in activities outside of the home, and special considerations for the upcoming Fourth of July weekend. Closed captioning will be available.
Two ranking U.S. Senators are calling out the federal government for releasing “incomplete data” on COVID-19 in nursing homes.
The data doesn’t “come close” to providing a complete picture on what’s needed to sufficiently respond to outbreaks in long-term care facilities, according to Sen. Bob Casey (D-PA) and Ron Wyden (D-OR).
“The data is shockingly sparse, and lacks reporting by almost one in five nursing homes. Nursing homes were not required to submit data on cases and deaths before May 1, meaning we may never know the full scope of this tragedy,” the lawmakers said in a statement.
The COVID-19 nursing home figures were released Monday by the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention. The figures revealed that nearly 26,000 residents and 450 workers in U.S. nursing homes have died from COVID-19. Overall, more than 60,000 residents and 34,400 workers have gotten sick in the U.S. from the virus.
TAMPA, Fla., May 01, 2020 (GLOBE NEWSWIRE) -- BRP Group, Inc. (“BRP Group” or the “Company”) (NASDAQ: BRP), a rapidly growing independent insurance distribution firm delivering tailored insurance solutions, today announced that a subsidiary of BRP Group has acquired the assets comprising the risk assessment and consulting business of Pendulum, LLC (“Pendulum”), an Albuquerque, New Mexico-based firm that provides innovative risk assessment and reduction protocols utilizing advanced software tools. The business acquired from Pendulum generated annual revenues of approximately $2.0 million.
Pendulum offers expertise in the long-term care and senior living markets through a full range of consulting services, including its network of highly skilled risk control consultants, its technological applications and its training materials, to manage risk and strengthen defensibility. Its 30+ consultants service all healthcare settings, with a specialized focus on senior housing. Following this Partnership, Pendulum will continue operating under its current brand and will become part of Connected Risk Solutions, BRP’s Specialty Wholesale platform within its Specialty Operating Group.
“We are excited to complete our Partnership with Pendulum, which both broadens our expertise and our product offerings in the senior living market, and further expands our opportunities for growth,” said Brian Daly, President of Connected Risk Solutions. “With the addition of Pendulum, we are now able to offer an entire range of healthcare services related to insurance and risk management, effectively creating a one-stop shop for our existing and prospective agents and their clients.”
“We are delighted to be joining with BRP Group and Connected Risk Solutions, as we believe our offerings and suite of risk solutions dovetail well with the growing platform, allowing us to provide a unique, integrated service offering for our clients,” said Ric Henry, President of Pendulum. “We expect to smoothly integrate within Connected Risk Solutions given the anticipated synergies, and look forward to being a valuable contributor to the expansion of the brand and its market share.”
(Full story) Source: GlobeNewswire
A new respiratory disease – coronavirus disease 2019 (COVID-19) – is spreading globally and there have been instances of COVID-19 community spread in the United States. The general strategies CDC recommends to prevent the spread of COVID-19 in LTCF are the same strategies these facilities use every day to detect and prevent the spread of other respiratory viruses like influenza.
ORANGE PARK, Fla. — One nursing home in Orange Park faces multiple complaints of malpractice as the daughter of one of its patients plans to file a lawsuit against the facility in the coming months.
Vivian Wright's father, Frank Wright, was placed in assisted living after two strokes, the first of which was in 2013. It was a difficult decision for Wright, but she hoped he would receive the daily care he needed to stay healthy.
This health advisory notifies clinicians that influenza activity remains high in the United States. Ongoing elevated activity is due to influenza B/Victoria viruses, increasing circulation of influenza A(H1N1)pdm09 viruses, and low levels of influenza B/Yamagata and influenza A(H3N2) viruses. CDC’s influenza forecasts suggest that national influenza activity will remain elevated for several more weeks.
From a physician charged with murder suing an Ohio hospital for defamation to patients suing an Alabama health system after a ransomware attack, here are the latest healthcare industry lawsuits and settlements making headlines.
Atlanta - A state Senate committee adopted an ambitious set of recommendations Tuesday aimed at curbing jury awards in medical malpractice, personal injury and product liability lawsuits.
Named after its ultimate goal, the Reducing Georgia’s Cost of Doing Business Study Committee embraced a series of tort reform proposals, including capping punitive damage awards, long sought by business groups and their Republican allies in the General Assembly.
CDC established National Influenza Vaccination Week (NIVW) in 2005 to highlight the importance of continuing flu vaccination through the holiday season and beyond.