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.
Saturday, August 14, 2010
HIPAA Horrors
This has been a week for HIPAA horrors.
A reporter dropping some trash at a landfill in
Then a psychiatrist on the west coast left his laptop on the back seat of his car, and to his surprise (?) it was stolen, and the laptop contained demographic and billing information on thousands of patients.
Wednesday, August 11, 2010
Obamacare (PPAPA) Whistleblower Provisions
The Patient Protection and Affordable Care Act of 2009 (H.R. 3590, aka PPACA) includes a number of whistleblower clauses, with some focused specifically on long-term care.
The broadest provision (Act Section 1558) added whistle blower protection to the Fair Labor Standards Act, referenced only to Title I provisions in the bill (critics wonder why not Titles 2 – 9, but there are other pre-existing regs in the federal (and state) law).
Procedural and remedy sections are tied to and mirror the provisions in the Consumer Product Safety Improvement Act of 2008. These include a 180 day statute of limitations, initial complaints are filed with OSHA, options on litigation venues, a right to a jury trial, and a broad range of remedies. The causation and proof standards are very favorable to the employee, and may be an impossible standard for the employer .
Another Section, 6703(b)(3) creates an additional special responsibility for long-term care providers (on top of numerous other reporting regulations) to inform all officers, employees and contractors of mandatory reporting and whistleblowing situations.
Section 6105, specifically focused on long-term care adds a mandatory complaint form for each nursing home (more paperwork, yippee!) and a prohibition against retaliation. Each state must develop (another) process to track and investigate complaints.
Employer “gag order” policies are voided by employee free speech rights, although “gags” related to HIPAA privacy and related issues would appear to remain valid (whistleblowing should be done through government channels therefore not violating HIPAA regs).
Employers may not use mandatory arbitration clauses to bypass or void these statutory rights.
The broadest provision (Act Section 1558) added whistle blower protection to the Fair Labor Standards Act, referenced only to Title I provisions in the bill (critics wonder why not Titles 2 – 9, but there are other pre-existing regs in the federal (and state) law).
Procedural and remedy sections are tied to and mirror the provisions in the Consumer Product Safety Improvement Act of 2008. These include a 180 day statute of limitations, initial complaints are filed with OSHA, options on litigation venues, a right to a jury trial, and a broad range of remedies. The causation and proof standards are very favorable to the employee, and may be an impossible standard for the employer .
Another Section, 6703(b)(3) creates an additional special responsibility for long-term care providers (on top of numerous other reporting regulations) to inform all officers, employees and contractors of mandatory reporting and whistleblowing situations.
Section 6105, specifically focused on long-term care adds a mandatory complaint form for each nursing home (more paperwork, yippee!) and a prohibition against retaliation. Each state must develop (another) process to track and investigate complaints.
Employer “gag order” policies are voided by employee free speech rights, although “gags” related to HIPAA privacy and related issues would appear to remain valid (whistleblowing should be done through government channels therefore not violating HIPAA regs).
Employers may not use mandatory arbitration clauses to bypass or void these statutory rights.
Friday, August 6, 2010
Violating HIPAA at the Speed of Light
Rarely does a week go by without a story of how "social media"** have caused problems for an employer, often because of posting confidential information, photos or just nasty comments about some phase of the business operation or co-workers.
In health facilities the stakes are much higher.
Now is the time to develop policies and educate the staff, BEFORE something bad happens.
** Facebook, MySpace, Twitter, and of course email is also a problem.
In health facilities the stakes are much higher.
Now is the time to develop policies and educate the staff, BEFORE something bad happens.
** Facebook, MySpace, Twitter, and of course email is also a problem.
Wednesday, June 2, 2010
FTC Red Flags Delayed Again
The Federal Trade Commission has delayed the "red flag" identity theft rules for (most) health care providers. The rules originated in the Fair and Accurate Credit Transactions (FACT) Act of 2003.
The act defines most medical providers as creditors.
The new effective date is January 1, 2011.
Stay tuned.
The act defines most medical providers as creditors.
The new effective date is January 1, 2011.
Stay tuned.
Sunday, May 2, 2010
Email is Evil!
People will make comments in email they would never make in a formal letter or memo.
This is dangerous to your organization.
Every organization should have clear policies on email, text messages, and social media,
This is dangerous to your organization.
Every organization should have clear policies on email, text messages, and social media,
Email is Evil!
People will make comments in email they would never make in a formal letter or memo.
This is dangerous to your organization.
Every organization should have clear policies on email, text messages, and social media,
This is dangerous to your organization.
Every organization should have clear policies on email, text messages, and social media,
Saturday, April 17, 2010
CLASS Act
The health care reform bill included a new program to provide long-term care insurance, with automatic enrollment and then an opt-out provision. This program will phase in.
Sunday, March 21, 2010
A New Era Begins - 3/21/2010
An Editorial:
The passage of the health care reform bill is a major milestone for U.S. health care services.
With passage, we will need to unravel the bill and the real story and prepare for the intended and unintended consequences of this massive effort.
The legislation is neither as bad as the Republicans make it out to be, not as fabulous as the Democrats claim. The bill changes the health care system to an amazing depth and breadth, and despite the proclamation of economists, politicians and policy wonks, we do not really know the full impact of the bill.
Reform is needed, we will soon be hitting the point at which employers have trouble providing health insurance to employees at an affordable price, the alternatives being dropping coverage or taking more from employees pockets.
President Obama will be hammered by the political right for going too far too fast, and by the progressive left of his own party for being timid. The left wanted a single payer system, was willing to settle for a public option, but left the table with only hope reform will be revisited, as it will.
The amount of misinformation, over generalization and plain old hot air tossed around during the debate make a calm analysis difficult, and will leave citizens and patients confused and alarmed, probably more than required. The bill is full of slow phase-ins and long transitions as we attempt to turn around one-sixth of our economy and attempt to attain several seemingly contradictory goals.
A great deal of the debate has focused on the budget impacts, and specifically the positive or negative impact on the deficit over a ten year span. The bill is full of wiggles and gimmicks, and as the vote drew near the Congressional Budget Office (CBO) estimated a positive deficit impact of about $140 billion in ten years.
Truth be told no one has any real idea what the bill will do to the deficit over ten years. Anyone who has studied the history of Medicare and Medicaid knows the legislative budget estimates tend to melt in the face of annual politicking and lobbying.
There are problems needing immediate attention. State budgets, hammered by the recession will have to be cut Medicaid benefits, a backwards step. Medicare physician reimbursement formulas, problematic for a decade, are being patched again while Congress dances around a permanent solution. Private insurers and employers will have to adjust quickly to new regulations and cost structures. Changes in Medicare are inevitable.
We can improve coverage and contain cost, but the reforms have to be constructed so carefully it is unlikely any political process has or will do so.
Now we know when the journey begins and the direction it is going. The details will be tough to work out, and there are many battles ahead, but decision making improves as certainty increases. We may get a good place, but not without many bumps and bruises.
The passage of the health care reform bill is a major milestone for U.S. health care services.
With passage, we will need to unravel the bill and the real story and prepare for the intended and unintended consequences of this massive effort.
The legislation is neither as bad as the Republicans make it out to be, not as fabulous as the Democrats claim. The bill changes the health care system to an amazing depth and breadth, and despite the proclamation of economists, politicians and policy wonks, we do not really know the full impact of the bill.
Reform is needed, we will soon be hitting the point at which employers have trouble providing health insurance to employees at an affordable price, the alternatives being dropping coverage or taking more from employees pockets.
President Obama will be hammered by the political right for going too far too fast, and by the progressive left of his own party for being timid. The left wanted a single payer system, was willing to settle for a public option, but left the table with only hope reform will be revisited, as it will.
The amount of misinformation, over generalization and plain old hot air tossed around during the debate make a calm analysis difficult, and will leave citizens and patients confused and alarmed, probably more than required. The bill is full of slow phase-ins and long transitions as we attempt to turn around one-sixth of our economy and attempt to attain several seemingly contradictory goals.
A great deal of the debate has focused on the budget impacts, and specifically the positive or negative impact on the deficit over a ten year span. The bill is full of wiggles and gimmicks, and as the vote drew near the Congressional Budget Office (CBO) estimated a positive deficit impact of about $140 billion in ten years.
Truth be told no one has any real idea what the bill will do to the deficit over ten years. Anyone who has studied the history of Medicare and Medicaid knows the legislative budget estimates tend to melt in the face of annual politicking and lobbying.
There are problems needing immediate attention. State budgets, hammered by the recession will have to be cut Medicaid benefits, a backwards step. Medicare physician reimbursement formulas, problematic for a decade, are being patched again while Congress dances around a permanent solution. Private insurers and employers will have to adjust quickly to new regulations and cost structures. Changes in Medicare are inevitable.
We can improve coverage and contain cost, but the reforms have to be constructed so carefully it is unlikely any political process has or will do so.
Now we know when the journey begins and the direction it is going. The details will be tough to work out, and there are many battles ahead, but decision making improves as certainty increases. We may get a good place, but not without many bumps and bruises.
Monday, January 4, 2010
The Feds Are Coming
After 8 years of lethargy the Department of Labor is gearing up to vigorously enforce both wage-and-hour and OSHA regulations.
The wage-and-hour regs are complex and widely misunderstood. The OSHA rules are better understood but often ignored.
Details on both topics will follow.
The wage-and-hour regs are complex and widely misunderstood. The OSHA rules are better understood but often ignored.
Details on both topics will follow.
Tuesday, December 15, 2009
Take Resident Complaints More Seriously (?)
A quarrel between a 98 year old and her 100 year old roommate in a Dartmouth Mass. nursing home led to the 98 year old being charged with second degree murder, for the September death of the 100 year old.
The defendant, who is alleged to have suffocated her roommate, has been placed in a mental hospital for evaluation.
The defendant, who is alleged to have suffocated her roommate, has been placed in a mental hospital for evaluation.
Thursday, October 29, 2009
HIPAA Security Alert
HIPAA Horrors
The Blade (Toledo) reports on October 28th an imaging technician was arrested in Ohio for driving infractions and possession of marijuana.
During the arrest the police scanned his cell phone.
In his phone were photos of dozens of partially clad patients preparing for imaging tests, including minors.
Wow.
The penalties and lawsuits are likely to be massive.
The Blade (Toledo) reports on October 28th an imaging technician was arrested in Ohio for driving infractions and possession of marijuana.
During the arrest the police scanned his cell phone.
In his phone were photos of dozens of partially clad patients preparing for imaging tests, including minors.
Wow.
The penalties and lawsuits are likely to be massive.
Thursday, September 10, 2009
Health Care Reform Part 2
President Obama's speech yesterday was "hitting the reset button" for health care reform.
First impressions - the numbers do not add up.
And every President since Nixon has promised to reduce "waste, fraud and abuse" from Medicare and Medicaid.
Game on!
First impressions - the numbers do not add up.
And every President since Nixon has promised to reduce "waste, fraud and abuse" from Medicare and Medicaid.
Game on!
Wednesday, August 26, 2009
HIPAA Security Social Nightmares
Facebook ™, Myspace ™, Twitter ™ and millions of web logs (“blogs”) are connecting people worldwide, and that includes your employees.
Some business organizations are using these social networks, some not, but either way it is a good bet your employees are using these sites to connect with and expand their social networks.
That can be a huge problem!
Employees used to flashing every aspect of their lives on-line are very likely to discuss work on-line as well.
Social networks sites create a huge risk for HIPAA violations, and also for employee problems (some of the comments posted can be incredibly vicious),
HIPAA is 24/7!
No, you cannot control your employees lives, EXCEPT as it relates to work.
Every health care organization should develop policies and procedures on the use of social networking sites for the broadcast of work related information. Soon.
Some business organizations are using these social networks, some not, but either way it is a good bet your employees are using these sites to connect with and expand their social networks.
That can be a huge problem!
Employees used to flashing every aspect of their lives on-line are very likely to discuss work on-line as well.
Social networks sites create a huge risk for HIPAA violations, and also for employee problems (some of the comments posted can be incredibly vicious),
HIPAA is 24/7!
No, you cannot control your employees lives, EXCEPT as it relates to work.
Every health care organization should develop policies and procedures on the use of social networking sites for the broadcast of work related information. Soon.
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