Here’s a tip to managers of healthcare facilities: If Medicare officials drop by to see if they’re funding a high-quality organization, you’d better be sure you’re running one.
Facilities that aren’t up to snuff upon initial inspection are subject to revisits. And the Centers for Medicare & Medicaid Services announced in June that those facilities are subject to a new fee to cover the costs of additional inspections.
“We conduct a revisit only in the case that there are significant quality problems that come up in the standard survey,” said Thomas Hamilton, director of CMS’ Survey and Certification Group. Such problems may include systemic abuse and neglect, infection control that’s not up to required levels and specific issues such as failure to treat pressure ulcers.
“The purpose of the revisit is to verify that corrections are made,” Hamilton said. “Without the revisit we wouldn’t be able to continue Medicare funding.”
He said there are about 14,000 revisits to nursing and skilled nursing facilities each year.
The fee “simply defrays the cost of the revisit,” Hamilton said. Travel time, wages and benefits and travel expenses are all rolled into the hourly rate for the fee. CMS is starting with a flat fee – an average estimated visit time of 18.5 hours has been multiplied by $112 per hour to arrive at $2,072 per revisit.
“We thought we’d keep it as simple as possible for now, and we’ve noted our intention that we would differentiate the fee by size, facility and other factors,” said Hamilton. “The impact of the fee in 2007 is going to be very small.”
Long-term care associations have said the fees would hurt patient care at some facilities by redirecting money into administrative work. Additionally, they say, the fees give CMS a dubious source of funding.
“We really see it as CMS using this to generate more funds to get their job done, which we find inappropriate,” said Susan Feeney, vice president of public affairs for the American Health Care Association. “I think it provides an incentive for CMS to look for more reasons to revisit if they are short on funds.”
“We believe that the fees will provide a perverse incentive for CMS and the states to cite facilities because they get paid quite generously for revisits,” said Marsha Greenfield, senior legislative counsel for the American Association for Homes and Services for the Aging.
“We don’t support any poor performing facility, but the revisit doesn’t mean that they’re necessarily poor-performing,” Feeney said. She used Hurricane Katrina as an example of a situation in which many good long-term care facilities incurred revisits.
Hamilton said CMS’ decision to limit the fee just to those facilities that have significant quality problems creates a reinforcement incentive to promote quality in long-term care.
Greenfield said there are other options available to CMS to address quality performance that are more effective than fees, such as the Advancing Excellence Campaign.
This program is a collaborative effort of consumers, major nursing home groups, the Commonwealth Fund and CMS to improve nursing home care, Hamilton said. He pointed to other quality initiatives for long-term providers already in place, such as transparency Web sites and a program currently being developed by CMS, which will be similar to the Physician Quality Reporting Initiative.