A federal rule buried in a host of other proposed Medicare and Medicaid changes has nursing home administrators in Kansas — and other states — shaking their heads.
Released in July, the rule would require nursing homes and other long-term care facilities to have residents examined by a doctor, physician’s assistant, nurse practitioner or clinical nurse specialist before they are transferred to a hospital. Failure to comply could cause a “deficiency” mark in the nursing home’s annual Centers for Medicare and Medicaid Services review. Such marks can lead to fines, withheld payments and downgrades in a facility’s publicly available CMS rating.
Each nursing home has a contract with a medical director who meets the level of expertise required by the hospital transfer rule, but in most cases that director is off-site. Few facilities have medical personnel of that level on staff.
The goal of the proposed rule is to prevent unnecessary hospitalizations. But Reginald Hislop, who operates a nursing home in Wichita, said it’s just not practical.
“That is going to be impossible to comply with,” Hislop said. “I don’t care who you are. I don’t care where you are. Unless you’re connected to a hospital, with hospitalists right next to you, I don’t know how you’re going to comply.”
Hislop is not alone in his concerns.
Blair Jackson is vice president of public affairs for the American Health Care Association, an advocacy group for long-term care providers.
Jackson said the hospital transfer rule is one of many red flags in the CMS proposal that his association’s members are discussing.
“It’s definitely an area of concern nationally,” he said.
Jackson noted that the rules have yet to be approved. His organization is encouraging members to file public commentswith CMS before the Sept. 14 deadline.
William Polglase, who works in media relations for CMS, declined to comment on the hospital transfer requirement except to say that it is part of proposed rules and that input on them is encouraged.
“CMS will carefully consider all comments,” Polglase said.
Jackson said the hospital transfer rule will be especially difficult for facilities in rural areas, where the few health care providers often must travel long distances to see residents in person.
Hislop’s nursing home, Larksfield Place Retirement Community, is in a metropolitan area and licensed for a total of 170 nursing home and assisted living residents. But even in Wichita, he said, getting a doctor to the facility during the day would take about an hour. Getting one in the middle of the night would be nearly impossible.
“In terms of after hours, it’s just not going to happen,” Hislop said.
The proposed rule provides an exception for “emergency situations where the health or safety of the individual would be endangered” but does not define those situations.
Hislop said that leaves too many unknowns for staff to determine before a hospital transfer. A resident complaining of chest pains could have heartburn or a heart attack. One complaining of abdominal pain could have gas or acute appendicitis.
Hislop said he will submit comments directly to CMS and through his advocacy group LeadingAge Kansas. He has notified the Kansas congressional delegation of his concerns.
CMS announced the 100-plus pages of proposed rulesfor long-term care facilities July 13, saying it was the first major revamp of the regulations since 1991. After CMS officials receive and consider the comments, they will decide whether to adjust the regulations and then will issue a “final rule.” There’s no timeline yet for when that might happen.
Sylvia Burwell, secretary of the U.S. Department of Health and Human Services, said the proposal would prevent unnecessary hospitalizations and infections and increase the quality of care for 1.5 million Americans living in nursing homes, including 16,000 Kansans as of 2013.
“This proposal is just one part of the administration’s overall commitment to transform our health system to deliver better quality care and spend our health care dollars in a smarter way,” Burwell said in a prepared statement. “Today’s measures set high standards for quality and safety in nursing homes and long-term care facilities. When a family makes the decision for a loved one to be placed in a nursing home or long-term care facility, they need to know that their loved one’s health and safety are priorities.”
The CMS regulations proposed in July are in addition to new regulations imposed on Medicare and Medicaid providers by the federal Affordable Care Act.
Cindy Luxem is president and CEO of the Kansas Health Care Association, which represents for-profit nursing homes statewide.
Luxem called the entire July Medicare proposal “the biggest unfunded mandate our providers have ever faced.”
“It’s the put-us-out-of-business rule,” she said. “Because the federal government is reaching way too far into our world of health care. … I don’t know how the providers can get ahead of anything.”
Hislop’s facility is a nonprofit. He said the CMS proposal reflects a lack of understanding of the current shortage of health care professionals. The hospital transfer rule, in particular, assumes a world in which doctors and nurses are available to evaluate residents at a moment’s notice.
But Hislop said many nursing home residents struggle to find a primary care doctor, even in urban areas.
“If you’re out in Russell, Kansas, what are you going to do?” he asked. “How many doctors do you think are out there?”
Andy Marso is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.
