Tom Ealey co-authored an article on upcoming changes in compliance (recommended by and soon to be mandatory) from the Office of the Inspector General (OIG).
http://ltlmagazine.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=90A70F27DC174BD797730522E24570BD
Friday, May 13, 2011
Wednesday, March 23, 2011
Obamacare Set Back
The Community Living Assistance Services and Support (aka C.L.A.S.S.) is a lesser discussed but important feature of Obamacare (PPACA).
The Act requires the feds to set up a quasi-insurance self-funding mechanism for long-term care services (for more details see my write up at http://www.issuu.com/
During testimony in February before the Senate Finance Committee DHHS Secretary Kathleen Sebelius admitted that as designed by Congress C.L.A.S.S. is not financially sustainable.
The battle now is whether or not Sebelius can 1) fix the Act via regulatory changes or 2) Congress must redesign the Act.
In the latest volley the Congressional Research Services says the regulatory powers are NOT broad enough for Sebelius to effectively rewrite the statute via regulation.
A bigger question remains for many of us, “can this program ever be financially sustainable?”
As predicted, with Obamacare the devil will be in the regulatory details.
Saturday, February 12, 2011
Social Media and Employee Speech
The National Labor Relations Board (NLRB) forced a settlement on American Medical Response of Connecticut Inc. after AMR fired an employee (and Teamsters member) who went home from work and profanely blasted her supervisor as being mentally ill on Facebook. Other employees posted responses supporting the employee.
The law protects the free discussion of working terms and conditions, and concerted activity, even in a crude and lewd manner in a public Internet space.
AMR agreed to loosen its Internet policies and a confidential settlement was reached with the former employee.
Since the employee posted from her home computer the issue of social media use on the job was not addressed, but it is another thorny problem.
In reviewing more than a dozen news reports, various attorneys had weighed in on the impacts of this ruling . It is likely we will need more cases to get a better definition of the boundaries, and there is no indication the ruling contradicts various laws protecting patient and customer privacy, intellectual property or prohibiting the dissemination of insider information. No indication how this might mesh with slander and defamation laws.
The NLRB announced the results of its settlement - on its Facebook page - of course.
The law protects the free discussion of working terms and conditions, and concerted activity, even in a crude and lewd manner in a public Internet space.
AMR agreed to loosen its Internet policies and a confidential settlement was reached with the former employee.
Since the employee posted from her home computer the issue of social media use on the job was not addressed, but it is another thorny problem.
In reviewing more than a dozen news reports, various attorneys had weighed in on the impacts of this ruling . It is likely we will need more cases to get a better definition of the boundaries, and there is no indication the ruling contradicts various laws protecting patient and customer privacy, intellectual property or prohibiting the dissemination of insider information. No indication how this might mesh with slander and defamation laws.
The NLRB announced the results of its settlement - on its Facebook page - of course.
Saturday, January 29, 2011
C.L.A.S.S. commentary
C.L.A.S.S. is the new long-term care financing mechanism in the PPACA health care reform act, a brief commentary is found at.
Commentary
January 2011
Commentary
January 2011
Tuesday, November 9, 2010
And take that!!
The National Labor Relations Board is suing an ambulance company for firing a worker. The company fired the worker after she posted derogatory comments about her supervisor on FACEBOOK (TM), from her home computer.
The company says the employee was fired for multiple reasons.
The NLRB says the company violated the employee's rights, and that further derogatory comments from her and other employees were "concerted activity" protected by federal labor laws.
The new and marvelous age of technology.
The company says the employee was fired for multiple reasons.
The NLRB says the company violated the employee's rights, and that further derogatory comments from her and other employees were "concerted activity" protected by federal labor laws.
The new and marvelous age of technology.
Friday, September 3, 2010
Nursing Shortage
As Labor Day approaches it is a good time to think about health care labor issues, some good news, some bad news.
A phenomena many of us have noticed over the years (hard to exactly quantify though) is that recessions pull nurses back into the labor market. Nurses (about 94% female) often have husband or significant others who lose jobs or hours.
Also, some of the staffing pressure is off at the hospital level because elective procedures are down and that takes pressure off the nursing staffing.
Recessions are not the desired means of correcting the shortage though.
The discussions on the shortage go back at least 20 years, and amazingly little progress has been made during that time.
There are some new and expanded programs, but a big problem now is the lack of nursing faculty. Unlike many PhD qualified professors, nursing professors are in big demand for management positions, usually in hospitals and health systems. So we are cannibalizing our own nursing pipeline.
University nursing programs are labor intensive, resource intensive and not nearly as prestigious as producing more MBAs, lawyers and economists.
While universities will get into bidding wars over top flight business, science or law professors, the willingness to play in the nursing salary market seems muted (perhaps if nursing was 94% male???).
The shortage will persist; the average age of RNs is climbing, the boomer nurses are heading for the exit while the boomer patients are becoming seniors, clinical skill requirements are accelerating, tighter reimbursements leave providers with less flexible budgets, and at times up to half of all licensed nurses are not working in direct care nursing - - all which seems to be a perfect storm.
We can send a man to the moon, but we can't figure out how to solve this problem in a country where lots of people need new careers (and yes, lots of people are not suited for nursing). Maybe when we have to shut a lot of hospitals?
A phenomena many of us have noticed over the years (hard to exactly quantify though) is that recessions pull nurses back into the labor market. Nurses (about 94% female) often have husband or significant others who lose jobs or hours.
Also, some of the staffing pressure is off at the hospital level because elective procedures are down and that takes pressure off the nursing staffing.
Recessions are not the desired means of correcting the shortage though.
The discussions on the shortage go back at least 20 years, and amazingly little progress has been made during that time.
There are some new and expanded programs, but a big problem now is the lack of nursing faculty. Unlike many PhD qualified professors, nursing professors are in big demand for management positions, usually in hospitals and health systems. So we are cannibalizing our own nursing pipeline.
University nursing programs are labor intensive, resource intensive and not nearly as prestigious as producing more MBAs, lawyers and economists.
While universities will get into bidding wars over top flight business, science or law professors, the willingness to play in the nursing salary market seems muted (perhaps if nursing was 94% male???).
The shortage will persist; the average age of RNs is climbing, the boomer nurses are heading for the exit while the boomer patients are becoming seniors, clinical skill requirements are accelerating, tighter reimbursements leave providers with less flexible budgets, and at times up to half of all licensed nurses are not working in direct care nursing - - all which seems to be a perfect storm.
We can send a man to the moon, but we can't figure out how to solve this problem in a country where lots of people need new careers (and yes, lots of people are not suited for nursing). Maybe when we have to shut a lot of hospitals?
Saturday, August 28, 2010
Resident Rights versus Caregivers Rights
In 1987 the federal government passed a comprehensive "bill of rights" for nursing home patients. Most states followed.
The law gives nursing home residents wide protection, including (when mentally able) the ability to refuse care, meals and just about anything else they please.
Resident care preferences regularly create all sorts of difficult issues though, including:
can white residents refuse care from black nurses and nurse aides? ( a common problem)
can female residents refuse care from male caregivers? (the courts say yes on privacy grounds)
can residents request care from specific employees (a latino requesting a latino)?
can residents request care from specific employees just because they like the employee?
According to a recent federal court decision in an Indiana case, if a white resident requests "no blacks" and the facility accommodates (apparently following Indiana law) the facility has discriminated against the employee.
This appears to be a no-win situation, but is probably not a settled issue yet.
The law gives nursing home residents wide protection, including (when mentally able) the ability to refuse care, meals and just about anything else they please.
Resident care preferences regularly create all sorts of difficult issues though, including:
can white residents refuse care from black nurses and nurse aides? ( a common problem)
can female residents refuse care from male caregivers? (the courts say yes on privacy grounds)
can residents request care from specific employees (a latino requesting a latino)?
can residents request care from specific employees just because they like the employee?
According to a recent federal court decision in an Indiana case, if a white resident requests "no blacks" and the facility accommodates (apparently following Indiana law) the facility has discriminated against the employee.
This appears to be a no-win situation, but is probably not a settled issue yet.
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