What are your thoughts on the rising attention given to telemedicine? Are we more at risk, using clinicians miles away and viewing resident conditions and records off-site? What precautions or pre-conditions to adopting it should we take?

The use of telemedicine is rapidly on the rise across the country and across different providers. There are special rules in every state as to how they allow and regulate telemedicine, setting forth what you are required to do under the state laws to participate in telemedicine.  

This would be true of the state in which the provider is located, as well as the state in which the telemedicine provider may be located. 

You are at greater risk under telemedicine if you do not follow the rules and regulations set forth in the state laws and regulations specifically relating to telemedicine. The risk of using physicians or other healthcare professionals who are offsite may raise “standard of care” issues because they do not see the resident in person. Of course, if the physicians are specialists who are consulting with a local treating physician who is seeing the patient in person, your exposure would decrease.

There also are issues with respect to Medicare and telemedicine because Medicare billing does not ordinarily cover or pay for telemedicine. Medicaid payments depend on the state law in which the facility is located and may pay for telemedicine services. 

Telemedicine will continue to grow as healthcare providers and purchasers of healthcare continue to search for ways to reduce costs of care.

You should get legal advice from an expert in telemedicine in the states involved before you set up your policies and procedures and before you participate in such a program. 

A new tool has shown promise in predicting fracture risk among long-term care residents.

Researchers at Boston’s Hebrew SeniorLife developed the Fracture Risk Assessment in Long-term Care, or FRAiL. They used a cohort of nearly 420,000 nursing home residents, identifying which factors stood out as unique to facility-dwelling seniors. 

They found 15 characteristics were linked to an increased risk of hip fracture, including dementia severity, ability to walk independently, prior falls and wandering.

Findings appeared in The Journals of Gerontology. 

The federal website that informs consumers about specific nursing homes has “considerable” knowledge gaps, a pair of prominent Harvard University researchers asserted recently.

Nursing Home Compare fails to provide information on short vs. long nursing home stays, facility features or amenities, care coordination or the “culture and care philosophy” of the provider, criticized Brian E. McGarry, Ph.D., and David Grabowski, Ph.D, in a blog post in Health Affairs.

Many don’t even know the 19-year-old website exists, the authors noted.

They recommended adding the following to the website: physical plant age, photos, private room availability and, in strong agreement with providers, reviews from residents or family members.

“Recent evidence suggests that consumers are already turning to social media platforms such as Facebook to post facility feedback and obtain first-hand perspectives,” the researchers noted.

CMS could consider making it mandatory for Medicare beneficiaries to learn of Nursing Home Compare, they added. 

A potential hemorrhage of workers from the healthcare sector could be held off if a pathway to citizenship for Deferred Action for Childhood Arrivals arises out of a deal between President Donald Trump and Congressional leaders.

In early September, Trump pushed Congress to take up the issue, saying the White House would phase out DACA in six months.

Nearly one-fifth of the 800,000 people covered under DACA work in healthcare and education, causing potential problems for long-term care providers struggling to retain and recruit workers.

Democratic leaders Sen. Chuck Schumer (NY) and Rep. Nancy Pelosi (CA) released a joint statement Sept. 13 that indicated all three had agreed to “enshrine the protections of DACA into law quickly.” However, House Speaker Paul Ryan (R-WI) quickly asserted afterward that the meeting was “a discussion, not an agreement or negotiation.”  

Sen. Orrin Hatch (R-UT) has demanded information on nursing home abuse and neglect from the Department of Health and Human Services.

In letter to HHS Secretary Tom Price, M.D., in September, Hatch said a recent alert from the Office of Inspector General “troubled” him and highlighted the need for “a solution to protect seniors.” That report found that more than a quarter of potential abuse incidents go unreported to authorities. 

Hatch asked HHS for information on enforcement procedures, actions taken against facilities that didn’t report suspected abuse, and what Price would recommend Congress consider to help prevent incidents of abuse.

Hatch requested a response from Price by Oct. 6. 

Chances are pretty good that you or a loved one may have spent some time in a hospital. They can be places where miracles happen.

Some of the smartest and most compassionate people on our planet can be found there, treating injuries, illnesses, diseases and more. It’s a caring business.

Small surprise that many hospitals and the people who run them like to keep reminding us of that fact. Typical is a recent ad for Community Health Systems. “We walk in the shoes of our patients,” it proudly proclaims.

This message and others like it are pretty clear: Nothing matters more to hospitals than the wellbeing of the people they serve. Well, there may be one thing — money.

Maybe that’s why you’re unlikely to find any hospital commercials touting the remarkably loose ways they often define “observation status.” 

You might be under the impression that a person who spends days in a hospital hooked up to machines while receiving treatments from doctors and nurses is automatically considered an inpatient. You might also be wrong.

Like many head-scratching loopholes, this one helps hospitals stay more solvent. And that’s OK, except for what it can do to care recipients and their families. Namely, it may deny the latter access to Medicare Part A coverage.

But there are some hopeful developments concerning this unfortunate reality. Earlier this year, federal legislation kicked in that requires hospitals to at least let people know they are not inpatients. 

And it looks like those who share our shoes may soon have an additional headache to contend with. A federal judge in Connecticut recently certified a class in a lawsuit that basically calls the “observational status” maneuver a sham. 

It is somewhat remarkable that the same people who spend so many marketing dollars telling us how much they care would be acting this way. But if nothing else, they have made their top priority abundantly clear. 

For many long-term care nurses, the idea of working only 40 hours a week, even with scheduled shifts, may seem laughable.

But consistently working between 61 to 70 hours a week increases the risk of coronary heart disease by 42%, a new study finds. Results in the American Journal of Industrial Medicine in September also found that working 71 to 80 hours increases the risk by 63%.

Korean researchers analyzed average working hours for more than 1,000 workers’ compensation cases. They looked at work hours during the week before the onset of illness and average working hours between eight days and three months before onset of cerebro-cardiovascular disease. 

Shift work for healthcare workers also has been linked to negative health, with a 2013 study finding that 32% of healthcare workers report not getting enough sleep. 

Shift work and long work hours also are associated with more obesity and reduced job performance.

Yet another study found women who worked 60 or more hours a week had more than triple the risk of heart disease and asthma, and nearly quadruple the risk of developing arthritis. n

Nursing home administrators perceive a better safety culture in their facility than clinical staff, according to a new report.

Researchers at University of Michigan, using nursing homes participating in the Agency for Healthcare Research and Quality’s Safety Program in Long-Term Care, found that nursing assistants gave the domains of teamwork, training and skills, communication openness, supervisor expectations and organizational learning worse ratings than administrators.

The largest gaps were found in communication openness, teamwork and supervisor expectations. 

More than 14,000 nursing home staff members from 170 facilities responded to the Nursing Home Survey on Patient Safety Culture.  

Ratings of safety culture tended to be highest for employees with minimal tenure and lowest for those who were not new employees, the researchers, led by Jane Banaszak-Holl, Ph.D., found. Nonprofit and chain ownership also skewed toward worse supervisor expectations and poorer organizational learning. Facility ownership in general had the strongest effect on the perception of safety culture.

Administrators should spend more time at the bedside with clinicians to understand resident safety, they wrote. 

Results appeared in the Journal of the American Geriatrics Society in late August. 

I heard that nursing homes can get cited for causing residents to have behavioral difficulties. Can you explain?

While other regulations related to Post Traumatic Stress Disorder take effect in 2019, starting this November, surveyors will check that facility staff are treating residents for trauma and PTSD, not causing these conditions. This initiative originates with the new F-Tag 743, “No Pattern of Behavioral Difficulties Unless Unavoidable,” which states that a resident who admits with no mental or psychosocial adjustment difficulty or documented history of trauma or PTSD should not develop these behavioral symptoms.

F743 is intended to protect all residents, not just war veterans and victims of, for example, recent abuse. Even residents with a recent stroke or CVA can develop trauma-related behavioral symptoms. It also includes residents who may have suffered potentially debilitating “transfer trauma” from being provided no individualized support to adjust to new surroundings. 

In addition to expanding the definition of at-risk residents, F743 underscores the nursing staff’s leadership responsibility in the effort to help residents adjust to and thrive in the facility.

Immediately after admission, residents should be assessed for trauma or PTSD. If they don’t have these diagnoses, the nursing staff should monitor to ensure that they don’t develop behaviors such as decreased social interaction or becoming increasingly withdrawn, angry, or depressed. If these behaviors develop, the nursing staff should assess carefully to determine whether they were unavoidable.

In its guidance to §483.40(b)(2), the Centers for Medicare & Medicaid Services lists steps facility staff must take to comply with the new regulation.

Fox Rehabilitation received at least $29.9 million in Medicare Part B payments for services that did not meet Medicare requirements, according to an August report by the Office of the Inspector General of the U.S. Department of Health and Human Services.

The Cherry Hill, NJ-based rehab facility provides outpatient physical, occupational and speech therapy services to geriatric patients who are chronically ill or have multiple comorbidities.

The OIG reviewed more than 400,000 Medicare Part B claims for outpatient therapy services, totaling $39.7 million, which Fox Rehab filed between July 2013 and June 2015. Medical and coding reviewers found that 85 of a random sample of 100 of these claims included services that were not medically necessary, the report alleged.

“For nearly all of these claims, the amount, frequency, and duration of services were not reasonable and consistent with acceptable standards of practice,” the report noted. “Further, some services did not require the skills of a licensed therapist or were not an effective treatment for the Medicare beneficiary’s condition.” 

The agency recommended that Fox refund the federal government $29.9 million and work to ensure future Medicare documentation and services are in accordance with program requirements.

Fox disagreed with the OIG’s findings and recommendations, asserting that its internal compliance program ensures that outpatient therapy services are provided and documented in accordance with Medicare requirements.

“For nearly 20 years, Fox Rehabilitation has been focused on helping our clients achieve optimal function and combat ageism,” Fox said in a statement. “We will appeal all of the claims that were denied by the OIG and we look forward to continuing to provide clinically excellent care and remain dedicated to using appropriate therapy to restore and rehabilitate lives.”