Nursing Homes Facility Reported Incidents Complaints Elaine Soong

  • Slides: 19
Download presentation
Nursing Homes. Facility Reported Incidents & Complaints Elaine Soong, CMS August 6, 2019 AHFSA

Nursing Homes. Facility Reported Incidents & Complaints Elaine Soong, CMS August 6, 2019 AHFSA Conference, New Orleans, LA

Overview • General issues related to complaints and facilityreported incidents • GAO/OIG reports and

Overview • General issues related to complaints and facilityreported incidents • GAO/OIG reports and Congressional activity • Data related to complaint surveys • Facility reported incidents- Reporting • Timelines for CMS guidance

General Comments and State Concerns • Uneven reporting – Over and under-reporting • Which

General Comments and State Concerns • Uneven reporting – Over and under-reporting • Which cases? • What information? • Staffing challenges in the state survey agencies • Responding timely to allegations

GAO Report – Nursing Home Abuse 1 Investigations in Oregon • Summary • In

GAO Report – Nursing Home Abuse 1 Investigations in Oregon • Summary • In Oregon, complaints and facility-reported incidents were investigated by Adult Protective Services, not the State Survey Agency. • What to expect • CMS will be reviewing State policies to assure that they are consistent with Federal requirements. 1 GAO. CMS Needs to Address Gaps in Federal Oversight of Nursing Home Abuse Investigations That Persisted in Oregon for at Least 15 Years. GAO-19 -313 R (Washington, DC: April 2019).

OIG Report –Using Medicare 2 Data to Identify Potential Abuse and Neglect • Summary

OIG Report –Using Medicare 2 Data to Identify Potential Abuse and Neglect • Summary • “CMS did not identify the Medicare claims that indicate potential abuse or neglect because, according to CMS officials, it did not extract data consisting of Medicare claims containing the 17 diagnosis codes related to abuse or neglect. The lack of a data extract impeded the ability of CMS or of public and patient safety organizations to pursue legal, administrative, and other appropriate remedies to ensure the safety, health, and rights of Medicare beneficiaries. ” 2 HHS-OIG. CMS Could Use Medicare Data to Identify Instances of Potential Abuse or Neglect. OIG-A-01 -17 -00513 (Washington, DC: June 2019).

OIG Report – Reporting of Potential 3 Abuse/Neglect in Nursing Homes • Summary •

OIG Report – Reporting of Potential 3 Abuse/Neglect in Nursing Homes • Summary • One in five high risk ER Medicare claims were the result of potential abuse/neglect. • SNFs failed to report incidents to SAs. • SAs failed to report substantiated abuse to local law enforcement. • CMS does not track referrals to law enforcement. 3 HHS-OIG. Incidents of Potential Abuse and Neglect at Skilled Nursing Facilities Were Not Always Reported and Investigated. OIG-A-01 -16 -00509 (Washington, DC: June 2019).

OIG Reports • What to expect • CMS is revising its interpretive guidance related

OIG Reports • What to expect • CMS is revising its interpretive guidance related to reporting potential abuse and neglect. CMS plans to provide examples and clarify existing guidance. Training will be updated accordingly. • CMS will review options for tracking incidents and SA referrals, including to law enforcement. • CMS is exploring options under the COPs for other provider types regarding reporting to law enforcement.

Volume of Complaint Surveys – National 59100 58600 58100 57600 57100 56600 FY 2016

Volume of Complaint Surveys – National 59100 58600 58100 57600 57100 56600 FY 2016 Source: QCOR (7/18/19) FY 2017 FY 2018

Average Number of Complaint Surveys Per Facility By State– FY 2018 14, 00 12,

Average Number of Complaint Surveys Per Facility By State– FY 2018 14, 00 12, 00 10, 00 8, 00 6, 00 National Average=3. 73 4, 00 2, 00 0, 00 Source: QCOR (7/18/19)

Percentage of Facilities with Deficiencies from Complaint Surveys, All S/S, By State– FY 2018

Percentage of Facilities with Deficiencies from Complaint Surveys, All S/S, By State– FY 2018 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Source: QCOR (7/18/19)

Percentage of Facilities with Deficiencies, S/S=G or Above-National 25% 20% 15% 10% 5% 0%

Percentage of Facilities with Deficiencies, S/S=G or Above-National 25% 20% 15% 10% 5% 0% FY 2016 FY 2017 Standard Source: QCOR (7/18/19) Complaint FY 2018

Percentage of Facilities with Deficiencies, S/S=J or Above-National 10% 8% 6% 4% 2% 0%

Percentage of Facilities with Deficiencies, S/S=J or Above-National 10% 8% 6% 4% 2% 0% FY 2016 FY 2017 Standard Source: QCOR (7/18/19) Complaint FY 2018

Percentage of Facilities with Defs at Abuse, Neglect, or Exploitation, All S/S 12% 10%

Percentage of Facilities with Defs at Abuse, Neglect, or Exploitation, All S/S 12% 10% 8% 6% 4% 2% 0% FY 2016 Source: QCOR (7/18/19), Tags F 223, F 224, F 600, F 0602, F 603 FY 2017 FY 2018

Percentage of Facilities with Defs at Abuse, Neglect, or Exploitation, All S/S, By State-FY

Percentage of Facilities with Defs at Abuse, Neglect, or Exploitation, All S/S, By State-FY 2018 30% 25% 20% 15% 10% 5% 0% Source: QCOR (7/18/19), Tags F 223, F 224, F 600, F 602, F 603

Percentage of Facilities with Defs Related to Responding to Alleged Violations, All S/S 25%

Percentage of Facilities with Defs Related to Responding to Alleged Violations, All S/S 25% 20% 15% 10% 5% 0% FY 2016 Source: QCOR (7/18/19), Tags F 225, F 609, F 610 FY 2017 FY 2018

Percentage of Facilities with Defs Related to Responding to Alleged Violations, All S/S, By

Percentage of Facilities with Defs Related to Responding to Alleged Violations, All S/S, By State-FY 2018 60% 50% 40% 30% 20% 10% 0% Source: QCOR (7/18/19), (7/18/19) Tags F 225, F 609, F 610

Facility Reported Incidents- Reporting • Examples of what is reported • Examples of what

Facility Reported Incidents- Reporting • Examples of what is reported • Examples of what information to include in the report

Timelines for CMS Guidance • Phase 2/3 Guidance-Appendix PP • Chapter 5 of the

Timelines for CMS Guidance • Phase 2/3 Guidance-Appendix PP • Chapter 5 of the State Operations Manual • Available training

Questions?

Questions?

Reported Speech Reported Questions Reported OrdersCommands Reported RequestSuggestionsReported Speech Reported Questions Reported OrdersCommands Reported RequestSuggestions
Complaints Me Understand the complaints process Complaints handlingComplaints Me Understand the complaints process Complaints handling
Incidents transfusionnels A Incidents Immunologiques B Incidents deIncidents transfusionnels A Incidents Immunologiques B Incidents de
Injuries in Nursing Homes u Nursing Homes areInjuries in Nursing Homes u Nursing Homes are
Elaine Comyn Elaine comyncastlebridge ie Elaine Comyn DataElaine Comyn Elaine comyncastlebridge ie Elaine Comyn Data
Reported Speech Reported Statement Reported Question Question wordReported Speech Reported Statement Reported Question Question word
REPORTED SPEECH Reported Speech Reported speech kalimat tidakREPORTED SPEECH Reported Speech Reported speech kalimat tidak
Reported speech Reported speech Reported speech 1 PastReported speech Reported speech Reported speech 1 Past
REPORTED SPEECH REPORTED STATEMENTS We use reported speechREPORTED SPEECH REPORTED STATEMENTS We use reported speech
REPORTED SPEECH SOME TIPS ON REPORTED SPEECH REPORTEDREPORTED SPEECH SOME TIPS ON REPORTED SPEECH REPORTED
REPORTED SPEECH REPORTED SPEECH 1 Reported speech 2REPORTED SPEECH REPORTED SPEECH 1 Reported speech 2
Customer Complaints January 2019 VOLUME OF COMPLAINTS BYCustomer Complaints January 2019 VOLUME OF COMPLAINTS BY
COMPLAINTS AND PALS AT UCLH Alison Glover complaintsCOMPLAINTS AND PALS AT UCLH Alison Glover complaints
epso complaints Results from the questionnaire epso complaintsepso complaints Results from the questionnaire epso complaints
Handling Complaints Complaints Why do people complain NotHandling Complaints Complaints Why do people complain Not
COMPLAINTS ANSWERS Consistency in Pleading n Complaints nCOMPLAINTS ANSWERS Consistency in Pleading n Complaints n
Customer Complaints March 2019 VOLUME OF COMPLAINTS BYCustomer Complaints March 2019 VOLUME OF COMPLAINTS BY
Customer Complaints April 2019 VOLUME OF COMPLAINTS BYCustomer Complaints April 2019 VOLUME OF COMPLAINTS BY