The Houston Chronicle has an article about the amount of money and influence that the nursing home lobbysit have in creating legislation to protect their industry.   The American Health Care Association spent about $1.7 million lobbying the government last year on a variety of bills affecting health care.  The AHCA, which represents nursing homes and assisted-living facilities, spent $860,000 in the first half of 2007 and $881,000 in the second half.  The organization also paid Patton Boggs LLP $160,000 in the second half to lobby the government.   The AHCA lobbied on a range of legislation including laws affecting Medicare and Medicaid, caps on damages, immunity for neglect and abuse, and compelling arbitration in nursing home cases. 

Brandunson.com has an article about Extendicare REIT reporting fourth quarter profits of $10.5 million.  Revenue in the quarter totalled $469.7 million, up from $453 million.

Extendicare REIT, through its owned subsidiaries, operates 269 nursing and assisted living facilities in North America as well as medical specialty services.

For the full year, Extendicare earned $70.4 million or $1 per diluted share on $1.8 billion in revenue. That compared with a loss of $35.7 million or 53 cents per diluted share on $1.73 billion in revenue in 2006. Shares in Extendicare, which released its results after the close of markets, were down 18 cents at $11.30 on the Toronto Stock Exchange.

This shows that nursing homes are very profitable even during bad economic times.  It also shows there is no need for ridiculous caps on damages.

KDBC in Texas ran a story about a new study that suggests the overuse of antibiotics in dementia patients contributes to drug-resistant germs.   In the study published in Archives of Internal Medicine, more than 200 people with advanced dementia were followed for 18 months. Almost half died before the study finished.  Researchers found 42% received antibiotics within two weeks of their deaths.

Antibiotic overuse spurs on the potentially fatal drug-resistant bugs like MRSA.  Past studies have suggested that nursing homes are favored stomping grounds for the super germs.   The study’s co-author says doctors should discuss antibiotics with family, just as they would discuss placing a feeding tube.

The Tennessean has a great editorial about the legislation that will protect nursing homes who abuse and neglect residents.  Below is a summary of the editorial.

Nursing home operators are begging the General Assembly to grant them special protections from lawsuits that might be filed by residents who are seriously wronged under their care.  What the owners want is a law that would allow nursing homes to force residents to waive their constitutional right to a jury trial and sign arbitration agreements as a prerequisite for being admitted, and they want caps on how much money a jury could award to a resident in a case against the nursing home.

This effort by the nursing home industry takes a lot of nerve. The state suspended admissions at 22 nursing homes in 2007, which was twice as many as in the previous year and three times the amount in 2005. Hundreds of residents were displaced last year because of serious health and safety violations that caused those homes to lose federal funds. Yet in this environment, the nursing home industry wants special protection from lawsuits. 

The North Country Gazette has an article about Eden Park nursing home in Glen Falls, NY.  It appears that the ursing home never registered with the State and therefore is doing business illegally.

On Sept. 19, 2007, according to the state Department of Health, Certificates of Need were issued to Glens Falls Crossings LLC  for the operation of the nursing homes doing business under the Eden Park name.   However, the DOS Division of Corporations told The North Country Gazette, there is no record of a limited liability company under the name of Glens Falls Crossings LLC “nor do we have a record of an assumed name filed under the name of Eden Park Health Care Center."

The Warren County Clerk’s office says there’s no record of Glens Falls Crossings LLC doing business in the county.

Prior to NCG’s article, if one performed a “Google” search for Glens Falls Crossings, they were led to a website at www.glensfallscrossings.com which said it was “under construction” and to “check back soon”. The website was supposedly “created” by Creative Genius of Saratoga Springs and the domain was registered by National Health Care of Lynbrook, LI in June 2007.

The domain registration says the title of the website is “Glens Falls Crossings Center for Nursing and Rehabilitation”, a non-existent entity with the Department of State. The domain registration says it is affiliated with Cold Spring Hills Center for Nursing and Rehabilitation which specializes in “skilled nursing services for patients and families seeking long term care with dignity and respect for their individualized needs”. But Cold Springs officials say they’ve never heard of it.

How can one do business in the state without being legally registered, especially a health care facility?

In the state of New York, all LLC’s formed or qualified to do business in the state, are required to publish a notice of formation. This requirement does not affect the good standing status of the LLC; however, an LLC is required to complete this requirement in order to have access to the New York State court system. The publication is made at the county level in two newspapers as assigned by the local county recorder, for six consecutive weeks.

According to the Department of State, the four “Crossings LLC” entities, supposedly operating Eden Park nursing homes in the state, are not registered with the state as required.   Eden Park has obtained its certificate of need from the state DOH to operate the facility under a bogus legal entity that is not registered with either the state or county.

U.S News & World Report has an article on the proposed Nursing Home Reform Bill.  Below is a summary of the article.

The byzantine world of the corporate nursing home industry may soon become a whole lot clearer. Republican Sen. Chuck Grassley and Democrat Sen. Herb Kohl seek to force nursing homes to provide more information about ownership and accountability.

The Nursing Home Transparency and Improvement Act would force nursing homes to clearly state ownership—something that has become increasingly complicated to figure out, as private investment groups have bought up nursing homes and enveloped them in labyrinthine legal structures. The opaque ownership makes it difficult for regulators to identify parties responsible for poor care and unfairly shields owners from complaints of neglect and abuse.

The bill also seeks to standardize complaint forms, improve reporting on staffing information, and replace some self-reported information with that gathered by independent audits. The primary goal is to make it easier for the public to compare nursing homes, a growing concern as baby boomers age.

The American Association of Homes and Services for the Aging, an industry group that represents not-for-profit nursing homes, applauds the bill.  The nonprofit sector is already required to produce information about finances and ownership to the IRS to qualify for its tax status.

The fight over nursing home reform will continue as the bill works its way through Congress. Proponents like the bill’s chances, in part because it’s authored by the respected Grassley, who is the senior Republican on the Senate Finance Committee.  Even the AAHSA wants some provisions removed, such as the bill’s call for an increase in civil penalties of up to $100,000 for a deficiency resulting in death. Delays likely to come from those and other proposed changes mean, for those waiting for nursing home reform, it could be 21 years and counting.

There is a NY Times article discussing the litigation against certain insurance companies for cheating patients and doctors from reasonable reimbursement based on an investigation of the industry’s arcane procedures for calculating “reasonable and customary” rates.

The investigation, by the New York State attorney general, Andrew Cuomo, indicates that  procedures used by insurance companies to determine what they will pay when patients visit a doctor is rigged to shortchange the beneficiaries.

When patients get treated by certain doctors, insurers agree to pay 80 percent of the "reasonable and customary rate" in the same geographic area. The patient pays the difference.  The rate always falls short of what their own doctor is charging.   The numbers are compiled by an obscure company known as Ingenix, which is owned by UnitedHealth Group, one of the nation’s largest health insurers. This system is abused for profit.

UnitedHealth and subsidiary Ingenix  both have a strong financial interest in cheating insured by keeping reimbursement rates low and making patients pay the difference.  Ingenix is unwilling to stand behind its numbers.  In licensing its database to insurers, it stresses that the data is “for informational purposes only” and does not imply anything about “reasonable and customary” charges. Yet that is precisely what the health insurers use the data for, as Ingenix knows. 

The  American Medical Association, which has a long-standing suit filed against Ingenix and various UnitedHealth companies, claim that the data is manipulated. They claim that health insurers and Ingenix disproportionately eliminate high charges, thus skewing the numbers for customary charges downward.   Ingenix uses outdated information, which would guarantee that reimbursement rates will always lag behind medical inflation. 

It is clear that the system for calculating “reasonable and customary” charges ought to be reformed by making it truly independent and objective. No consumer can reasonably trust numbers generated by a company whose loyalties and financial interests lie with the health insurers.

McKnight’s website has an article about Medicare overpayments (i.e. fraud) to nursing homes and estimate that the amount could be $130 million. Where did all the money go?

The federal investigation into these overpayments state that the Medicare program might have paid too much for hospital and laboratory services including double payments for services.  As a result of its findings, OIG recommended (not ordered) that the Centers for Medicare & Medicaid Services instruct payment contractors to "re-examine" records for overpayments and then move to recover them where appropriate. It also suggested CMS test and refine payment system protocols designed to identify such overpayments.
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The full audit report is available at http://www.oig.hhs.gov/oas/reports/region1/10600503.pdf.

 KSPR News has an article about a nursing home in Kansas that has introduced the video game Nintendo Wii to the residents.  This assists them in mobility, activity, and social interaction.  The activities director says a group of nursing home residents stay young by playing a game meant for their grandkids.  The activity room at the Ozark Nursing and Care Center is packed when it’s time for Wii.   When they play Wii, a light weight controller allows them to play a game they normally couldn’t.   There are more than physical benefits.  It gives the residents a sense of life outside the skilled nursing center.  

 The activities director says they’re sticking with bowling for now because it’s the easiest. They’d like to slowly introduce boxing and Guitar Hero. I hope this becomes universal in all nursing homes.

The NY Times has an informative article on the multi-disciplinary approach needed to prevent pressure ulvers in nursing home residents. 

The article defines a pressure ulcer as an area of skin breakdown that occurs when sustained pressure cuts off blood circulation — usually in patients confined to their beds nursing homes — a bedsore can result in a wound so deep (sometimes to the bone) and painful that some patients require narcotics. If a bedsore becomes infected, the complications can be fatal.

Experts estimate that two million Americans suffer from pressure ulcers each year, usually through some combination of immobility, poor nutrition, dehydration and incontinence.  New research requires a team approach, enlisting everyone from nurses and nursing assistants to laundry workers, nutritionists, maintenance workers and even in-house beauticians.

In a study of a collaborative program involving 52 nursing homes around the country, The Journal of the American Geriatrics Society reported last August that team efforts had reduced the number of severe pressure ulcers acquired in-house by 69 percent. 

Dr. Joanne Lynn, who helped begin the project when she was a senior natural scientist with the RAND Corporation (she has since joined the Medicare centers), said the goal was to educate nursing home workers in bedsore prevention and to encourage them to come up with creative, low-tech solutions of their own. “It was a combination of education, cheerleading and something like systems engineering,” Dr. Lynn recalled.

Nutrition including additional protein, special mattresses made of high-density foam to reduce pressure in key areas, keeping feet elevated, repositioning frequently, keeping incontinent residents dry with routine changes, and proper fitting clothes are easy low tech solutions to preventing the developement or worsening of pressure ulcers. 

Clinicians document four stages of pressure ulcers, in which Stages 1 and 2 are superficial sores and Stages 3 and 4 are deep wounds that result from death of the skin and underlying tissues.

Dr. Horn, of the Institute for Clinical Outcomes Research, praised the collaborative as “the first major national effort driven by Medicare to reduce pressure ulcers.” But she said that better outcomes could be achieved if more nursing homes improved their documentation, so that all of the information on a given resident, including details on eating, urinary and bowel function, appeared on a single sheet, with key reminders to nursing assistants and other staff members about best practices.

Bedsores are “a major quality-of-life issue, and a self-esteem issue,” said Joanie Jones, a nurse at David Place in Nebraska. “No one wants to have sores on their bottom. I don’t care how old you are. You still want your skin intact.”