Two recent cases – one in Georgia and the other in Pennsylvania – enforce nursing home quality of care standards through actions by United States Attorneys.   In neither case had the regulatory agencies cited deficiencies for the significant care problems at the three facilities in question.   In addition, two of the three facilities have high … Read more

According to an analysis by the Center for Medicare Advocacy (the Center) few sanctions are imposed for the poor care provided by nursing facilities identified by the Federal Government as among those providing the poorest quality of care and quality of life to residents – Special Focus Facilities (SFFs).  The Center's analysis documents an enforcement … Read more

As discussed in last week’s Alert, the current Medicare Annual Enrollment Period lasts until December 7th.[1]  During this time period, Medicare beneficiaries can choose a Medicare Advantage (Part C) or Part D plan for 2013.  This Alert discusses Part C and D plan quality ratings for 2013, and special enrollment periods related to these ratings.  … Read more

On April 6, 2012, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 17, which revises and creates new procedures for the review of quality of care concerns[1] by Quality Improvement Organizations (QIOs).[2] Effective May 7, 2012, the new procedures apply to QIO review of the quality of services "among different cases and settings … Read more

Two websites that help Americans make informed choices about hospitals and nursing homes have been redesigned and will make more information available to the public, CMS announced on July 19, 2012. The two sites – Hospital Compare and Nursing Home Compare – have been enhanced to make navigation easier by users, and have added important … Read more

This week, the Obama Administration launched a National Alzheimer's Plan to help the more than 5 million Americans with Alzheimer's disease and their 15 million caregivers. Consisting of funding for clinical research, provider education and outreach, data collection, a public awareness campaign, and proposed funding for caregiver support, the plan provides needed investment and vision … Read more

When research conducted a decade ago documented that mortality rates actually increased when employment rates increased, health economists sought to identify the cause.  Focusing on employed workers did not explain the increased mortality rates.  A new analysis by the Center for Retirement Research at Boston College – focused on who was actually dying when employment … Read more

Reducing hospital readmissions is generating lots of confusion.  The rules are complicated.  In addition, some hospitals, facilities, and health care networks have adopted protocols, and have in place some level of procedures for reduction in hospital readmissions in advance of the requirements set forth in the Affordable Care Act (ACA). In general, the Centers for Medicare … Read more

Nursing Facilities Participating in Advancing Excellence Still Among Worst Performers Many nursing facilities that are identified by the federal government as among the facilities providing the poorest quality of care to residents in the country – the Special Focus Facilities (SFFs) – participate in the nursing home industry's voluntary quality improvement campaign, Advancing Excellence in … Read more

Each month, the Centers for Medicare & Medicaid Services (CMS) identifies nursing facilities that are among the facilities providing the poorest care to their residents, as determined by federal deficiencies cited in the prior three years.   These facilities, called Special Focus Facilities (SFFs), receive special attention from state survey agencies – at least two surveys … Read more

UNITED STATES SENATE SPECIAL COMMITTEE ON AGING OVERPRESCRIBED: THE HUMAN AND TAXPAYERS' COSTS OF ANTIPSYCHOTICS IN NURSING HOMES November 30, 2011 Testimony of Toby S. Edelman Senior Policy Attorney Center for Medicare Advocacy The misuse of antipsychotic drugs as chemical restraints is one of the most common and longstanding, but preventable, practices causing serious harm … Read more

Hospitalists are defined as physicians who are based full-time in acute care hospitals and who provide care to hospitalized patients.  The past decade has witnessed a rapid growth in hospitals' use of hospitalists, who have been shown to lead to reduced lengths of inpatient hospital stays.  A new study, however, finds that decreased inpatient costs … Read more

On April 4, 2011, the Center for Medicare Advocacy (the Center) filed comments on a proposal by the Centers for Medicare & Medicaid Services (CMS) to establish a new condition of Medicare participation (CoP) for certain Medicare service providers.  These providers would be required to give Medicare beneficiaries notice of the right to seek review … Read more

For more than a year, the Center for Medicare Advocacy has been outspoken about the overpayments made to the private insurance plans in the subsection of the Medicare program called "Medicare Advantage." [1]During this same time period, the proponents of Medicare Advantage (MA) have operated what can best be described as a fierce campaign against … Read more

By January 1, 2012, the Secretary of Health and Human Services (the Secretary) must establish a Medicare Shared Savings Program (MSSP) that promotes accountability for a defined patient population, coordinates items and services under traditional Medicare Parts A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service … Read more

This is the seventh in a series of Alerts by Center for Medicare Advocacy regarding the Patient Protection and Affordability Care Act of 2010 (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA). This Alert focuses on changes in PPACA that address measuring the quality of care that is received by Medicare … Read more

The Patient Protection and Affordable Care Act of 2010 (PPACA), the health care reform legislation enacted earlier this year, provides a new opportunity to strengthen and improve federal oversight mechanisms for nursing homes. Implementation of new statutory requirements for public reporting of nursing home ownership information and for Ethics and Compliance Programs in all facilities … Read more

President Obama signed into law Pub.L.111-148, the Patient Protection and Affordability Care Act of 2010 (PPACA), on March 23, 2010, and Pub. L. 111-152, the Health Care and Education Reconciliation Act of 2010 (HCERA), on March 30, 2010. These two laws will change both the availability of health insurance and how health care is delivered … Read more

The Center for Medicare Advocacy is pleased that there is renewed interest in the Congress for establishing a coordinated care benefit in the traditional Medicare program. Any health care reform, including Medicare reform, must embrace a coordinated care benefit. The absence of such a benefit has been detrimental to Medicare beneficiaries for too long. In … Read more

Beneficiary Satisfaction Measure is Not Used to It's Fullest Extent Unlike report cards that use clinical measures, The Consumer Assessment of health care Providers and Systems (CAHPS) reports patient ratings of their experience with care.  The CAHPS surveys were designed to provider consumers of health care with more information and to enable the consumer to … Read more

When beneficiaries receive Medicare coverable health care, there is an expectation that the provider will listen to their concerns and assess and provide appropriate medical care. What can beneficiaries do if they believe that the prescribed medical care is inadequate or incorrect in some way? In Medicare, beneficiaries can request a “quality of care review” … Read more

The following is an executive summary. You can also view the full report here and the appendices here in .pdf form. The Center for Medicare Advocacy performed a study entitled Tort Reform and Nursing Homes that deflates the myths that pervade the nursing home industry’s discussion of tort litigation. It found that cases about nursing home … Read more