531 deficiencies found in 80 Kentucky nursing homes in first quarter of 2012; worst one had 29; five had none

State inspectors found 531 deficiencies in 80 Kentucky nursing homes in the first quarter of this year, with one facility accounting for 29 of them alone: Life Care Center of Morehead. In five nursing homes, no deficiencies were found.

The information was released by Kentuckians for Nursing Home Reform, a nonprofit organization that advocates for nursing home residents and obtains the data regularly through open-records requests to the Cabinet for Health and Family Services and distributes it statewide. The information is posted as part of Medicare's nursing-home comparison data.

According to the Centers for Medicare and Medicaid Services, the average number of deficiencies for a nursing home inspected in the U.S. is eight and the average in Kentucky is seven. Inspections assess a facility on the care of residents and how that care is administered; on how staff and residents interact; and on its environment. Certified nursing homes must meet more than 180 regulatory standards. The state Office of Inspector General website has more data, such as the results of inspections and the ownership of each facility.

Nursing homes with 10 or more deficiencies in the first quarter were:
• Life Care Center of Morehead (29 deficiencies)
• Kindred Transitional Care & Rehab-Fountain Circle in Winchester (24)
• Signature Health of Pikeville (19)
• Hearthstone Place in Elkton (15)
• Martin County Health Care Facility in Inez (14)
• Wesley Manor Nursing Center in Louisville (13)
• Pembroke Nursing & Rehabilitation Center in Pembroke (13)
• Highlands Nursing & Rehabilitation Center in Louisville (11)
• Mountain Manor of Paintsville (11)
• Cumberland Valley Manor in Burkesville (10)
• Klondike Care and Rehabilitation Center in Louisville (10)

The five nursing homes with no deficiencies were:
• Clark Regional Medical Center in Winchester
• Nazareth Home in Louisville
• Essex Nursing and Rehabilitation Center in Louisville
• Barren County Health Care Center in Glasgow
• Cardinal Hill Rehabilitation Center in Lexington (initial inspection; under new ownership)

For more information about Kentuckians for Nursing Home Reform, click here.

Chiropractic clinic to pay $650K for Medicaid and Medicare fraud

A chiropractic clinic in Williamsburg will pay $650,000 to settle claims it improperly billed Medicare and Medicaid, reports Trent Knuckles for The News Journal of Corbin. (News Journal graphic)

Ho Medical Clinic, Kenneth Ho and Ana Moreno allegedly filed false claims when they billed for physician services, though they were performed by a chiropractor (chiropractors are not medical doctors); billed for unnecessary and unreasonable MRI and X-ray services; billed for work performed by unqualified personnel; and received funds for being a rural health clinic when it did not meet Medicare requirements.

Of the $650,000, $525,000 will go to the Medicare and Medicaid trust fund. The remaining sum will go to Danette Freeman, who sued the company under the False Claims Act. The investigation was conducted by the Kentucky attorney general's office, the Department of Health and Human Services' Office of Inspector General and the U.S. attorney's office. (Read more)

Kentucky hospitals say they gave back $1.67 billion to their communities in 2010, mostly by absorbing losses and bad debts

By Tara Kaprowy
Kentucky Health News

With the downturn in the economy part of the reason, Kentucky's hospitals say they gave back a whopping $1.67 billion to their communities in 2010, mainly by providing care for which they were never paid.

That's 13 percent more than the hospitals reported last year, and just one of many figures in the latest annual report from the Kentucky Hospital Association, which runs a little over a year behind because it takes a long time to compile the data from more than 100 hospitals.

KHA's 2010 Community Benefits Report shows hospitals absorbed $435.5 million in bad debt in 2010, which accrued when patients came to the hospital and were treated but did not pay their bills.

Shortfalls in Medicare and Medicaid payments cost even more — $456.2 million — because the federal government reimburses Kentucky hospitals for about 85 percent of the cost of Medicaid patients and 95 percent for those on Medicare. That's big, because 71 percent of patient days in Kentucky are covered by one of these programs, said Pam Mullaney, KHA's director of membership services. Hospitals also gave $274 million to charity-care programs that are set up to include free or discounted care to people who are unable to pay. Those three categories of losses increased by more than $158 million over 2009. KHAcalls them community benefits because "you're not getting any type of margin," Mullaney said.

A 2009 Thomson Reuters study showed the average U.S hospital reported an operating profit margin of 3.7 percent. The average operating margin at Kentucky hospitals was 2.44 percent in 2009. Forty percent of hospitals lost revenue from patient services that year, Mullaney said. Still, reported community benefits increased by 13 percent, a total of $190 million.

This is the third year of the report, which was based on a voluntary survey to which 104 of 123 hospitals responded (Eight hospitals were not surveyed because they treat limited types of patients, such as veterans, children or psychiatric cases.) Mullaney said the number of hospitals turning in figures "has grown a little bit each year, but it’s not consequential."

Hospitals are asked to describe and put a value on the programs and activities they provide at or below cost that help their community. Though community benefits are "the greatest single affirmation of not-for-profit hospitals' tax-exempt status," Mullaney said data show Kentucky's 26 for-profit hospitals "do every bit as much as the not-for profits."

In the past two years, Pikeville Medical Center has absorbed $70 million in charitable care and bad debt. The Murray-Calloway County Hospital is in the ninth healthiest county in Kentucky, but has felt the crunch too. From 2010 to 2011, bad debt increased from $7 million to $7.8 million and charity care increased from $5.1 million to $6.2 million.

T.J. Samson Community Hospital in Glasgow has also seen bad debt increase and business decrease when the economy crashed and then stagnated. "Our elective procedure volumes have come down. Patients often wait until they're sicker before they come in," said Laura Belcher, director of planning, marketing and development. The hospital has responded by cutting costs, adopting the "lean philosophy" of eliminating waste and streamlining processes.

Interestingly, the hospital is also pushing for more preventive care since the economy went south. "People ask us, 'Aren't you putting yourself out of business?' But we really want people to be proactive about their health. We've done a lot more health fairs, more screenings," Belcher said.

Indeed, the report shows Kentucky hospitals spent $500 million in 2010 to actively help their communities, through such activities as health screenings, support groups, research, training of nurses and doctors, addiction recovery and neonatal intensive care, or simply donating money to community functions. Many of these programs "are provided at no cost or at a financial loss and would not be provided if the decision was based on monetary decisions," Mullaney said.

Realizing there was a need in the area for children with special needs, the Glasgow hospital set up C.A.M.P. T.J. Kids, a weeklong day camp in the summer for children with special needs. "These children often receive services through school and during school," Belcher said. "But we found many of the families could not afford or handle the transportation to get here during the summer. This is almost like a summer booster."

The camp falls under the umbrella of the Discovery Academy, funded by the hospital and money raised by volunteers. The academy also hosts an annual overnight camp for children with autism. While the children swim in the hotel pool or interact with each other, parents are "in a conference setting to learn about ways they can learn to be better parents" to kids with autism, Belcher said. "In the evening, while children are being supervised, the parents get to go for a quiet, romantic dinner."

When tornadoes struck Kentucky March 2, Pikeville Medical Center kicked into high gear and co-hosted a radio-a-thon that raised $200,000. "We allowed our employees to donate their vacation time, which we converted to actual dollars based on their rate of pay, and we offered employees the ability to do payroll deductions to contribute to the cause," said Cindy Johnson, director of public relations and the Medical Leader, the hospital's community newspaper.

The Murray hospital has increased its community outreach efforts and adopted a mission to provide the local school system with athletic trainers, whose salaries are paid entirely by the hospital, as well as school nurses, which are partly hospital funded. The goal is to promote health and wellness, said marketing director Melony Bray.

The KHA's Mullaney said the annual report reminds people what their hospital does. "A lot of times people think of their hospital as a place to go when they need emergency help," she said. "They don't think of the hospital as one of the big providers in the community for health fairs, health professional education, types of efforts in the community to help improvements like playgrounds and common spaces. Those are things that hospitals often get overlooked for but they do that because they are part of the community."

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Electronic health records are helping nurses provide better care, big study finds

Electronic health records are helping nurses get better health outcomes and are improving nursing care, the first big study on the subject has found.

The study conducted by the University of Pennsylvania School of Nursing involved 16,000 nurses at 316 hospitals in California, Florida, Pennsylvania and New Jersey. It found that "implementation of an EHR may result in improved and more efficient nursing care, better care coordination, and patient safety," wrote lead author Ann Kutney-Lee, a health-outcomes researcher at Penn Nursing.

The study, which was published in the Journal of Nursing Administration, also found, "having a basic EHR was associated with better outcomes independently of nurse staffing, indicating that they both play an important role in quality of care."

Nurses in hospitals that had comprehensive EHR systems were "significantly less likely to report unfavorable patient safety issues, frequent medication errors, and low quality of care," research-reporting service Newswise reports.

The most current estimates show just 12 percent of U.S. hospitals have an EHR system in place, but that will change with the Health Information Technology for Economic and Clinical Health Act. Starting in 2011, hospitals and physicians received incentive payments from Medicare and Medicaid to switch over to EHRs. The study did not measure outcomes in rural vs. urban settings "although we do know from other studies that hospitals that used electronic health records during this time period were less likely to be in rural areas," Kutney-Lee said. (Read more)

Several pieces of federal health reform law taking effect in 2012

At the beginning of the new year, family doctors started facing a 1 percent cut in Medicare reimbursement if they hadn't nixed their paper-based prescription pads in favor of an electronic version. The change is part of another piece of the federal health-care reform law taking effect, USA Today reports.

"There will be a significant number of folks that will incur the penalty," said Robert Tennant, senior policy adviser with the Medical Group Management Association.

E-prescribing, which allows physicians to generate, transmit and file patient prescriptions, is part of the federal government's effort to get doctors to use electronic health records. Last year, doctors received bonuses from Medicare and Medicaid to set up EHRs, but this year they will start being penalized if they haven't already done so — 1 percent this year, 1.5 percent in 2013 and 2 percent in 2014.

Another piece of the federal health care reform law that will begin falling into place in 2012 involves Medicare's Shared Savings Program, "under which groups that qualify as accountable care organizations will be eligible for shared savings in 2013," USA Today reports. "Under the program, savings from participants in an ACO — including hospitals and doctors working together to improve patient care and reduce costs — would be shared between Medicare and the providers."

One study showed Kentucky already has three ACOs established, though several Kentucky experts have said no ACOs have been formed in the state yet.

Jan. 1 also marked the beginning of consumers being eligible for rebates if their insurer spent less than it should have on medical care. As per the new law, insurers have to spend 85 percent for large group plans and 80 percent for small groups and individuals on medical care as opposed to administrative and other costs. Kentuckians will not be privy to these rebates this year, however. Kentucky got a one-year break from the rule after applying for an exemption. (Read more)

Doctor report cards will be as big a failure as No Child Left Behind, physician contends in op-ed piece

Tying physicians' reimbursements to how well they score on a Medicare report card is akin to the federal government having schools submit to No Child Left Behind, asserts Dr. Barry Schumer, a Lexington-based internal medicine physician. As the federal education-reform effort resulted in teachers "teaching to the test," the Physician Quality Reporting Initiative will only result in doctors treating to one, Schumer's op-ed piece in the Lexington Herald-Leader reads.

"The idea that a check-list of dos, don'ts and test scores will result in an upgrade of care delivery is reminiscent of the government supposition that it alone could legislate the teacher-student relationship in the interest of improving education outcomes," Schumer writes. "It didn't work in education, and it won't work in health care."

Schumer contends the program "did not ask patients what they believe are the key elements of a high-quality doctor-patient relationship, nor was their input or opinion sought on whether they want their physician financially penalized for non-compliance with these mandates." Also ignored, he says, were primary-care providers, "any of whom could easily describe how increasing government regulations, mandating the purchase and use of expensive technology, and the threat of stiff financial penalties will not only detract from the care of patients but, worse yet, will drive already overwhelmed providers out of practice altogether." (Read more)

Pat Boone commercial about Medicare has many inaccuracies

A television commerical misleads seniors into believing the federal health-care reform law will ration and deny care and contains other inaccuracies, according to FactCheck.org, a non-partisan, non-profit service based at the University of Pennsylvania.

The ad features singer Pat Boone and is being aired repeatedly in Ohio (and presumably in Northern Kentucky) by the conservative 60 Plus Association. It claims the Patient Protection and Affordable Care Act will create the Independent Payment Advisory Board, made up of elected bureaucrats who "can ration care and deny certain Medicare treatments so Washington can fund more wasteful spending."Boone says,"Unaccountable bureaucrats should never have the power to deny you the care you deserve."

The board is neither made up of bureaucrats, nor can it ration care. "The IPAB is tasked with finding ways to reduce the growth in Medicare spending," FactCheck reports. "Its 15 voting members won't be bureaucrats, according to the health care law (see page 502); they will be doctors and medical professionals, economists and health care management experts."

The law also says proposals from the IPAB "shall not include any recommendation to ration health care, raise reveneues or Medicare beneficiary premiums ... increase Medicare beneficiary cost-sharing (including deductibles, coinsurance and copayments), or otherwise restrict benefits or modify eligibility criteria."

The ad says the law will cut $500 billion from Medicare, but fails to mention that cut is in the future growth of Medicare over 10 years and will come from the supplemental Medicare plans seniors can buy.  Moreover, though Boone suggests seniors should object to the $500 billion in cuts, they are meant to extend the funding of Medicare Part A by 12 years.

The ad also states Medicare will be bankrupt in nine years. "The truth is that Medicare Part A — the hospital insurance trust fund, one of four parts of Medicare — is expected to be insolvent by 2020, according to the projections from the Congressional Budget Office, or perhaps 2024, according to the Social Security and Medicare Boards of Trustees," FactCheck reports. "Shortfalls have been projected for Part A 'almost from inception,' says a Congressional Research Service report," but Congress has always found a way to extend the program. (Read more)

PIkeville Medical Center agrees to pay $36,000 to settle claim that it improperly billed Medicare

Pikeville Medical Center has agreed to pay more than $36,000, but does not have to admit any wrongdoing, to settle a lawsuit that accused it of improperly billing Medicare.

The suit was brought by Dr. Michael Fletcher, director of the pain management clinic from May 2005 to July 2007. "The hospital used improper billing codes for the pain management clinic, which indicated services were provided in a private physician's office, rather than a clinic," reports Brett Barrouquere of The Associated Press.

Fletcher alleged the same was being done at the hospital's radiation oncology and medical oncology units and told hospital administration as much, but nothing was done. Fletcher will receive $7,228 as part of the settlement of the suit, filed under the federal False Claims Act. (Read more)

Justice Dept. accuses Erlanger nursing home of collecting on 'worthless services;' suit is first of its kind in Kentucky

The U.S. Justice Department has filed a civil complaint against Villaspring Health Care and Rehabilitation in Erlanger and its parent company, Carespring Health Care Management, claiming they "billed Medicare and Medicaid for services purportedly provided to its residents despite knowing that the services were so inadequate that they were essentially worthless," Valarie Honeycutt Spears of the Lexington Herald-Leader reports.

The complaint was the first in Kentucky alleging that a nursing home violated the federal False Claims Act. "Today's filing represents an important milestone in the effort to ensure effective care for Medicare and Medicaid recipients in long-term care facilities," U.S. Attorney Kerry Harvey said.

The list of allegations include failures to follow physicians' orders, treat wounds and pressure sores, update resident care plans, give enough to drink, give regular baths and monitor diabetics' blood-sugar levels, Spears reports. The complaint alleges there were numerous injuries and at least five deaths from 2004 to 2008 due to improper care.

Officials of the nursing home officials invited journalists to tour the facility and denied any wrongdoing. "We do not feel that the government's case has any merit, and we will defend ourselves vigorously," Carespring spokeswoman Kim Majick said. "Villaspring has consistently provided high-quality care to the residents of Kenton County and looks forward to doing so in the future." (Read more)