Pay for performance begins

Medicare has begun a long-awaiting nursing home pay-for-performance demonstration in four states. Nursing homes are being asked to sign up for the program, called the Nursing Home Value-Based Purchasing demonstration, in Arizona, Mississippi, New York, and Wisconsin. Anticipating that as many as 100 nursing homes will sign up in each state, CMS has devised an annual scoring system to determine which homes will receive the extra payments. Criteria will include staffing, appropriate hospitalization, MDS-based outcomes and state survey performance. A control group of the volunteer nursing homes will be randomly selected and expected to operate as usual, without the scoring criteria applied. The difference, if any, in performance between the experimental and the control group will be tallied every year in terms of cost savings, and the savings will form the reward pool. This will make the Medicare initiative budget-neutral. The demonstration will run through 2012, at which point it will be determined whether Medicare skilled nursing reimbursement methods should be modified accordingly.

‘Red Flags Rule’ affects long-term care

Unbeknownst to many administrators, the Federal Trade Commission’s ‘Red Flags Rule’ will have taken effect on May 1, targeting long-term care facilities in the process.

The rule is intended to reduce identity theft, protecting consumers’-or in this case, residents’-sensitive information that could be fraudulently used without consent. In healthcare settings, the act aims to shield a resident’s medical identity, which can be stolen by swiping insurance information to obtain or make false claims for goods and services.

In the rule, the term “red flags” implies a detection and response system that must be set up by financial institutions or creditors that collect consumers’ personal information. Because of the way this broad-based law defines a creditor-“any entity that regularly extends, renews, or continues credit; any entity that regularly arranges for the extension, renewal, or continuation of credit; or any assignee of an original creditor who is involved in the decision to extend, renew, or continue credit”-some long-term care facilities are now held responsible for setting up a red flags system.

While the ruling maintains that even long-term care facilities have to create an identity theft protection program, compliance is loosely defined. The program must: identify and detect, in writing, relevant warning signs of identity theft; describe appropriate responses and preventions to the crime, with plans to update accordingly; and assign employees for appropriate staff training and oversight of the program itself.

The rule allows penalties of up to $2,500 per violation, which are only administered when a facility knowingly violates its own policy. The government’s How-to Guide on complying with the law is located at


Heard at Spring AAHSA Meeting, April 20-22, Washington, D.C.

“There’s no greater joy than giving your life away to others.” David Stoddard, Leaders Legacy, Inc., Atlanta, Georgia, on being a mentor.

“You need funds to act strategically.” David Scruggs, CFO, Montereau in Warren Woods, Tulsa, Oklahoma, on maintaining operational efficiencies to grow from a position of strength rather than cutbacks.

“Target salaries and benefits to be around 40% to 45% of all revenues.” Dan H. Gray, president, Continuum Development Services, Signal Mountain, Tennessee, in a presentation on trimming costs for operational efficiency


The peril of contaminated peanut products continues

Continuing to receive reports of nursing home resident deaths due to contaminated peanut products, a Salmonella outbreak that occurred six months ago, The Centers for Disease Control & Prevention (CDC) is asking nursing homes to check whether peanut products on their shelves have been subject to voluntary recalls. Products would include peanut butter, cookies, crackers, cereal, candy and ice cream. The Food and Drug Administration has made available a listing of the recalled products at Otherwise, call the consumer hotline number on the product packaging for information directly from the manufacturer.

In November 2008, The CDC warned of an outbreak of a Salmonella strain in peanut butter and peanut paste products. The source of the outbreak was traced to a Georgia plant and consumers were advised to discard or return the recalled products.

A final note particular to nursing homes allowing pets on the premises: many pet foods, including dog biscuits and bird food, might contain peanut butter.


Until alternatives are developed, the FDA is allowing liquid sulfate oral solution 20 mg/ml to be produced despite never being approved

Recent revisions to the CMS interpretive guidelines for state surveyors include culture change language that supports ‘homey’ nursing home environments

Long-Term Living 2009 May;58(5):12

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