1 / 32

Charting the Course of Post-Acute and Long-Term Care Medicine

Explore the role of OHCQ and strategies for medical directors to prevent deficiencies in clinical care in post-acute and long-term care facilities.

thomasrichardson
Download Presentation

Charting the Course of Post-Acute and Long-Term Care Medicine

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Charting the Course of Post-Acute and Long-Term Care Medicine Mid-Atlantic Medical Directors Association November 10, 2018

  2. Update: Office of Health Care Quality Rachelle Pierre-Mathieu, MD, MPP Medical Director November 10, 2018

  3. Disclosures I have no financial or ethical disclosures in preparation or delivery of this presentation.

  4. Learning Objectives • Review the role of OHCQ and present updates in monitoring, licensing, and certification of care facilities •  Identify strategies for medical directors to implement to prevent deficiencies in clinical care.  

  5. OHCQ Functions • Issue licenses, authorizing the operation of a business in Maryland • Recommend certifications to CMS, authorizing participation in the Medicare and Medicaid programs • Conduct surveys to determine compliance with State and federal regulations, which set minimum standards for the delivery of care • Educate providers, consumers, and other stakeholders

  6. What is OHCQ’s role? Trust the provider, but verify compliance with the regs

  7. OHCQ Oversees 42 Provider Types

  8. Number of OHCQ Licensees as of July 1, 2016, 2017, and 2018

  9. Quality, Safety, and Oversight GroupMemorandumsSurvey and Certification (S & C) is now Quality, Safety, and Oversight (QSO)

  10. QSO 18-08-NH An Initiative to Address Facility Initiated Discharges that Violate Federal Regulations • Discharges which violate Federal regulations continue to be one of the most frequent complaints made to Ombudsman Programs. • CMS initiative: CMS is examining State survey agency’s intake and triage of discharge complaints, developing examples of inappropriate and appropriate discharges, identifying best practices, developing training, and evaluating enforcement options. • Civil Money Penalty (CMP) Reinvestment Projects Assistance: CMS is encouraging States to pursue CMP-funded projects that may help prevent facility initiated discharges that violate federal regulations.

  11. QSO 18-15-NH Specialized Infection Prevention and Control Training for Nursing Home Staff in the Long-Term Care Setting • CMS and CDC are collaborating on the development of a free on-line training course in infection prevention and control for nursing home staff in the long-term care setting.

  12. QSO 18-18-NH Final Revised Policies Regarding the Immediate Imposition of Federal Remedies • When the current survey identifies immediate jeopardy that does not result in serious injury, harm, impairment or death, the CMS Regional Offices may determine the most appropriate remedy. • Clarified that Past Noncompliance deficiencies are not included in the criteria for Immediate Imposition of Remedies. • For Special Focus Facilities, S/S level “F” citations under tags F812, F813, or F814 are excluded from immediate imposition of remedies.

  13. SB 108 - Regulation of Health Care Programs, Medical Laboratories, Tissue Banks, and Health Care Facilities - Revisions • Permitted the Department to issue non-expiring licenses and eliminate licensure fees for all provider types, allowing providers to reinvest in their business and enhance the quality of services. • Allowed OHCQ to focus on licensure, certification, and survey activities, thereby strengthening the oversight of providers. • Initial licensure applications are processed faster, providing greater access and choice for consumers.

  14. Benefit to Small Business This law particularly benefits the 2,600 small businesses overseen by OHCQ by decreasing start-up costs, speeding initial licensure, issuing a non-expiring license, and eliminating licensure and relicensure fees.

  15. SB 386 - Maryland Nursing Home Resident Protection Act of 2018 • OHCQ shall annually receive 10 new full–time merit positions related to the survey, licensure, discipline, or regulation of related institutions, including assisted living programs, to protect vulnerable residents served by the related institutions, which positions will be received by the Office of Health Care Quality for each fiscal year beginning in fiscal year 2020. • By fiscal year 2024, OHCQ will have 50 new positions.

  16. FY 18 Data

  17. Nursing HomesActivities from FY 16 to FY 18

  18. Most Frequently Cited Federal Deficiencies in Nursing Homes in FY 18

  19. Nursing Home Enforcement Activitiesfrom FY 16 to FY 18

  20. Number of Actual Harm and Immediate JeopardyNursing Home Deficiencies by Federal Tag in FY 17

  21. Number of Actual Harm and Immediate Jeopardy Nursing Home Deficiencies by Federal Tag in FY 18 *Due to the new federal regulations implemented in November 2017, regulatory tags and groupings were revised

  22. Regulatory Groupings for Actual Harm andImmediate Jeopardy Deficiencies in LTC in FY 18 *Due to the new Federal Regulations implemented in November 2017, regulatory tags and groupings were revised.

  23. Nursing Homes - Informal Dispute Resolutions • In FY 18, there were 96 federal tags that were disputed in 27 IDRs and 1 federal tag in 1 independent IDR. • The IIDR resulted in no changes to the tags. • The IIDR results were not included in the next two slides.

  24. Outcomes of Nursing Home Informal Dispute Resolutions by Federal Tag in FY 18

  25. Reasons for Nursing Home Informal Dispute Resolution Decisions in FY 18

  26. Health Care Quality Account Grants

  27. Health Care Quality Account Grants • Funds collected from civil money penalties imposed by CMS or OHCQ to nursing homes and by OHCQ to assisted living programs • Support activities that improve the quality of life of individuals who reside in NHs and ALPs • Three non-lapsing special funds: • Federal nursing home account • State nursing home account • State assisted living account

  28. Grant Applications • Applications are accepted throughout the year • Grants are awarded on a rolling basis, contingent on funding • Committee reviews the applications: • OIG, OAG, and OHCQ (Executive Director, Chief Fiscal Officer, Deputy Director of Federal Programs, Deputy Director of State Programs, and Chief Nurse) • CMS must approve the use of federal funds

  29. Available Funds for HCQA GrantsOctober 1, 2018

  30. Medical Director Pearls • Process of notifying concerns to the medical director • Clarify facility expectations for health care practitioners • Ex. physician visits, response to notification, documentation... • Process of monitoring providers and intervening on inconsistent standards of care (including practicing medical director) • Be available for difficult cases or medical reviews • Assist and coordinate educational programs for all types of medical providers

  31. CASE

  32. THANK YOU! Rachelle Pierre-Mathieu, MD, MPP 410-402-8183 rachelle.pierre-mathieu@maryland.gov

More Related