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Bureau of Health Systems Joint Provider Surveyor Training Mike Pemble, Director September 18, 2012. Health Systems. License, certify and/or regulate facilities: 440 Nursing Homes equaling 46,890 licensed beds* 175 Hospitals equaling 26,397 licensed beds*
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Bureau of Health Systems Joint Provider Surveyor TrainingMike Pemble, DirectorSeptember 18, 2012
Health Systems • License, certify and/or regulate facilities: • 440 Nursing Homes equaling 46,890 licensed beds* • 175 Hospitals equaling 26,397 licensed beds* • 12 Psychiatric Hospitals / 48 Psychiatric Units within Hospitals* • 26 Psychiatric Partial Hospitalization Programs* • 9 Organ Transplant Facilities • 662 Home Health Agencies • 110 Hospice Programs and 21 Hospice Residences* • 170 End Stage Renal Disease (Dialysis) • 150 Rural Health Clinics • 120 Freestanding Surgical Outpatient Facilities/Ambulatory Surgical Centers* • 15 Comprehensive Outpatient Rehabilitation Facilities • 11 Portable X-Ray Facilities • 196 Outpatient Physical Therapy/Speech Pathology • 7,659 Laboratories* (not licensed since 1992) • 10,063 Radiation Machine Sites *Licensed
UPDATE:Bureau of Health Systems We are facing a perfect storm: • Nursing Home complaints increasing • Increased facility reported incidents (FRI’s) • No additional staff • “31” years: No license fee increases • Past 10 years: General funding cuts, unpaid furlough days, hiring freezes, early retirement incentives • The overall cost and number of staff necessary to regulate nursing homes has increased annually (insurance, travel, retirement, office space, etc.)
Nursing Home Citizen Complaints and Facility Reported Incidents (FRIs) • Facility Reported Incidents (FRI’s) of alleged abuse, neglect, misappropriation of resident property, and injuries of an unknown and suspicious origin are projected to increase 35% based on 1st 10-months FY12 actual data. • FY12 Citizen Complaints are projected to increase another 5% based on 1st 10-months actual data. • Citizen Complaints increased 11% in FY11.
Nursing Home Complaints & Facility Reported Incidents (FRIs)Immediate Jeopardy (IJ) Intakes: FY 2005 - 2011 Complaints and Facility Reported Incidents that have caused or are likely to cause serious injury, harm, impairment, or death to a nursing home resident (Immediate Jeopardy) increased by 78% in FY11. 10-months FY12 data projected for the year shows a continuation of this trend at 79% higher than FY10. The performance standard requires a surveyor onsite within 2 business days following receipt of the IJ intake.
Nursing Home Complaints & Facility Reported Incidents (FRIs) Harm Level Non-IJ High Intakes FY 2005 - 2011 Complaints and Facility Reported Incidents that have alleged harm to a nursing home resident, but no Immediate Jeopardy, increased by 41% in FY11. Based on 10-months FY12 data, these Priority 2 intakes are projected to increase by another 30% in FY12 (83% higher than in FY10). The performance standard is to be onsite to investigate within 10 business days of receipt.
Long Term Care - Total Number of Complaint Health Surveys Conducted Michigan is the only state within Region V reflecting a consistent pattern of increasing complaint investigations. MI is on a trend to have its nursing home complaints exceed those in states with nearly double the number of nursing homes. *(Total Number of Nursing Homes)
Total Number of Nursing Home Revisits ConductedRevisit Health SurveysIncludes Standard and Complaint Nursing Home Surveys *Projected – 9 months data
Nursing HomeComplaint/FRI Response Time Average Number of Days from Receipt of Intake to Surveyor Onsite Non IJ High Priority Complaints: • 2007 – 102.5 days • 2008 – 105.7 days • 2009 – 84.5 days • 2010 – 23.4 days • 2011 – 15.9 days Note: Complaints involving Immediate Jeopardy to a nursing home resident are initiated within 2 days of receipt
Health Systems Continuous Quality Improvement Efforts • LARA Process Improvement Staff and BHS Staff working together to evaluate opportunities for efficiencies • Continued effort to improve communication with Stakeholders - Workgroups initiated to discuss nursing home survey related issues including electronic medical records issues and quality improvement • Continued efforts to improve coordination and other efficiencies in the inspection process • Biannual Joint Provider Surveyor Training a continued success • 90% Survey Reports issued within 10 days in FY12 (up from 85%) • Significant progress made on development of program to allow electronic submissions of Plans of Correction – CMS Grant
Managing Facility Reports $3.5 million grant from CMS Web-based Case Management System Eliminate manual data entry Improve efficiency, clarity, and consistency System development lead by State of MI inter-departmental project assisted by CMS and input from a few additional states Piloted in MI (perhaps a few other states) Intended for national implementation
Keynote Address: Dr. Peter Lichtenberg, PhD, ABPP “Beyond Frailty: Nurturing Personhood in All Residents”