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
Bureau of Health Systems
Joint Provider Surveyor Training
Mike Pemble, DirectorSeptember 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. 2
Health Systems
License, certify and/or regulate facilities: 440 Nursing Homes equaling 46,890 licensed beds* 175 Hospitals equaling 26,397 licensed beds* 12 Psychiatric Hospitals / 48 Psychiatric Units within Hospitals* 26 Psychiatric Partial Hospitalization Programs* 9 Organ Transplant Facilities 662 Home Health Agencies 110 Hospice Programs and 21 Hospice Residences* 170 End Stage Renal Disease (Dialysis) 150 Rural Health Clinics 120 Freestanding Surgical Outpatient Facilities/Ambulatory Surgical Centers* 15 Comprehensive Outpatient Rehabilitation Facilities 11 Portable X-Ray Facilities 196 Outpatient Physical Therapy/Speech Pathology 7,659 Laboratories* (not licensed since 1992) 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.
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.)
UPDATE:Bureau of Health Systems
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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
0
1 00 0
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FY 2004 FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 FY 20 12P ro jec t ed
1 0 9 2 1 1 3 9 1 1 0 4 1 2 6 0 1 2 8 5 1 2 5 7 1 2 9 5 1 4 4 1 1 5 0 8
2 7 4 1 0 3 1
5 1 3 5
3 6 4 6
5 6 4 45 0 6 3
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6 1 6 5
C o m p la in ts F R Is
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 1st 10-months FY12 actual data.
• FY12 Citizen Complaints are projected to increase another 5% based on 1st 10-months actual data.• Citizen Complaints increased 11% in FY11.
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)Immediate Jeopardy (IJ) Intakes: FY 2005 - 2011
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F Y 2 0 0 5 F Y 2 0 0 6 F Y 2 0 0 7 F Y 2 0 0 8 F Y 2 0 0 9 F Y 2 0 1 0 F Y 2 0 1 1 F Y 2 0 1 2P ro je c t e d
C o m p la in ts 6 0 9 0 1 3 4 7 6 7 2 5 7 1 0 4 1 0 6
F R I s 5 9 1 1 3 1 2 8 8 2 5 4 7 6 1 3 3 1 3 2
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7 67 2
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5 9
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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 FY11. 10-months FY12 data projected for the year shows a continuation of this trend at 79% higher than FY10. 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. 6
Nursing Home Complaints & Facility Reported Incidents (FRIs) Harm Level Non-IJ High Intakes FY 2005 - 2011
0
500
1000
1500
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3000
FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 FY 2012Projected
Complaints 843 829 949 1051 1063 1174 1274 1325
FRIs 665 761 720 1206 841 1092 1928 2823
843 829 9491051 1063
11741274 1325
665761 720
1206
841
1092
1928
2823
Complaints and Facility Reported Incidents that have alleged harm to a nursing home resident, but no Immediate Jeopardy, increased by 41% in FY11. Based on 10-months FY12 data, these Priority 2 intakes are projected to increase by another 30% in FY12 (83% higher than in FY10). 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. 7
0
500
1000
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3000
FY 2007 2846 1584 555 411 2226 896
FY 2008 2742 1450 616 503 2452 858
FY 2009 2826 1443 721 516 2052 913
FY 2010 2430 1434 1503 511 2058 798
FY 2011 1755 1356 1578 216 1743 799
IL (788)* IN (503)* MI (429)* MN (386)* OH (955)* WI (390)*
Long Term Care - Total Number of Complaint Health Surveys Conducted
*(Total Number of Nursing Homes)
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.
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.
IL (788) IN (503) MI (429) MN (386) OH (955) WI (390)
FY 2007 1570 1044 637 445 1373 597
FY 2008 1630 1131 777 455 1514 618
FY 2009 1719 1032 845 460 1508 680
FY 2010 1592 1057 1034 474 1454 630
FY 2011 1418 975 1026 461 1403 646
FY 2012* 1241
0
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1600
1800
2000
Total Number of Nursing Home Revisits ConductedRevisit 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. 9
Nursing HomeComplaint/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. 10
Health Systems Continuous Quality Improvement Efforts
LARA Process Improvement Staff and BHS Staff working together to evaluate opportunities for efficiencies
Continued effort to improve communication with Stakeholders - Workgroups initiated to discuss nursing home survey related issues including electronic medical records issues and quality improvement
Continued efforts to improve coordination and other efficiencies in the inspection process
Biannual Joint Provider Surveyor Training a continued success
90% Survey Reports issued within 10 days in FY12 (up from 85%)
Significant 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.
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 inter-
departmental project assisted by CMS and input from a few additional states
• Piloted in MI (perhaps a few other states)• Intended for national implementation
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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
Keynote Address:
Dr. Peter Lichtenberg, PhD, ABPP
“Beyond Frailty: Nurturing Personhood in All Residents”