Bureau of Health Systems Joint Provider Surveyor Training

Bureau of Health Systems Joint Provider Surveyor Training Mike Pemble, Director September 18, 2012 C U S T O M E R D R I V E N. B U S I N E S S M I N D E D. 1

Health Systems Ø License, certify and/or regulate facilities: ü 440 Nursing Homes equaling 46, 890 licensed beds* ü 175 Hospitals equaling 26, 397 licensed beds* ü 12 Psychiatric Hospitals / 48 Psychiatric Units within Hospitals* ü 26 Psychiatric Partial Hospitalization Programs* ü 9 Organ Transplant Facilities ü 662 Home Health Agencies ü 110 Hospice Programs and 21 Hospice Residences* ü 170 End Stage Renal Disease (Dialysis) ü 150 Rural Health Clinics ü 120 Freestanding Surgical Outpatient Facilities/Ambulatory Surgical Centers* ü 15 Comprehensive Outpatient Rehabilitation Facilities ü 11 Portable X-Ray Facilities ü 196 Outpatient Physical Therapy/Speech Pathology ü 7, 659 Laboratories* (not licensed since 1992) ü 10, 063 Radiation Machine Sites *Licensed C U S T O M E R D R I V E N. B U S I N E S S M I N D E D. 2

UPDATE: Bureau of Health Systems We are facing a perfect storm: Nursing Home complaints increasing Increased facility reported incidents (FRI’s) No additional staff “ 31” years: No license fee increases Past 10 years: General funding cuts, unpaid furlough days, hiring freezes, early retirement incentives • The overall cost and number of staff necessary to regulate nursing homes has increased annually (insurance, travel, retirement, office space, etc. ) • • • C U S T O M E R D R I V E N. B U S I N E S S M I N D E D. 3

Nursing Home Citizen Complaints and Facility Reported Incidents (FRIs) • Facility Reported Incidents (FRI’s) of alleged abuse, neglect, misappropriation of resident property, and injuries of an unknown and suspicious origin are projected to increase 35% based on 1 st 10 -months FY 12 actual data. • FY 12 Citizen Complaints are projected to increase another 5% based on 1 st 10 -months actual data. • Citizen Complaints increased 11% in FY 11. C U S T O M E R D R I V E N. B U S I N E S S M I N D E D. 4

Nursing Home Complaints & Facility Reported Incidents (FRIs) Immediate Jeopardy (IJ) Intakes: FY 2005 - 2011 Complaints and Facility Reported Incidents that have caused or are likely to cause serious injury, harm, impairment, or death to a nursing home resident (Immediate Jeopardy) increased by 78% in FY 11. 10 -months FY 12 data projected for the year shows a continuation of this trend at 79% higher than FY 10. The performance standard requires a surveyor onsite within 2 business days following receipt of the IJ intake. C U S T O M E R D R I V E N. B U S I N E S S M I N D E D. 5

Nursing Home Complaints & Facility Reported Incidents (FRIs) Harm Level Non-IJ High Intakes FY 2005 - 2011 Complaints and Facility Reported Incidents that have alleged harm to a nursing home resident, but no Immediate Jeopardy, increased by 41% in FY 11. Based on 10 -months FY 12 data, these Priority 2 intakes are projected to increase by another 30% in FY 12 (83% higher than in FY 10). The performance standard is to be onsite to investigate within 10 business days of receipt. C U S T O M E R D R I V E N. B U S I N E S S M I N D E D. 6

Long Term Care - Total Number of Complaint Health Surveys Conducted Michigan is the only state within Region V reflecting a consistent pattern of increasing complaint investigations. MI is on a trend to have its nursing home complaints exceed those in states with nearly double the number of nursing homes. *(Total Number of Nursing Homes) C U S T O M E R D R I V E N. B U S I N E S S M I N D E D. 7

Total Number of Nursing Home Revisits Conducted Revisit Health Surveys Includes Standard and Complaint Nursing Home Surveys *Projected – 9 months data C U S T O M E R D R I V E N. B U S I N E S S M I N D E D.

Nursing Home Complaint/FRI Response Time Average Number of Days from Receipt of Intake to Surveyor Onsite Non IJ High Priority Complaints: • 2007 – 102. 5 days • 2008 – 105. 7 days • 2009 – 84. 5 days • 2010 – 23. 4 days • 2011 – 15. 9 days Note: Complaints involving Immediate Jeopardy to a nursing home resident are initiated within 2 days of receipt C U S T O M E R D R I V E N. B U S I N E S S M I N D E D. 9

Health Systems Continuous Quality Improvement Efforts üLARA Process Improvement Staff and BHS Staff working together to evaluate opportunities for efficiencies üContinued effort to improve communication with Stakeholders Workgroups initiated to discuss nursing home survey related issues including electronic medical records issues and quality improvement üContinued efforts to improve coordination and other efficiencies in the inspection process üBiannual Joint Provider Surveyor Training a continued success ü 90% Survey Reports issued within 10 days in FY 12 (up from 85%) üSignificant progress made on development of program to allow electronic submissions of Plans of Correction – CMS Grant C U S T O M E R D R I V E N. B U S I N E S S M I N D E D. 10

Managing Facility Reports $3. 5 million grant from CMS Web-based Case Management System Eliminate manual data entry Improve efficiency, clarity, and consistency System development lead by State of MI interdepartmental project assisted by CMS and input from a few additional states • Piloted in MI (perhaps a few other states) • Intended for national implementation • • • C U S T O M E R D R I V E N. B U S I N E S S M I N D E D. 11

Keynote Address: Dr. Peter Lichtenberg, Ph. D, ABPP “Beyond Frailty: Nurturing Personhood in All Residents” C U S T O M E R D R I V E N. B U S I N E S S M I N D E D. 12