FHCA AUGUST 2009

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Update

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FHCAFLORIDA HEALTH CARE ASSOCIATION

AUGUST 2009Florida Health Care AssociationP.O. Box 1459Tallahassee, FL 32302-1459

PRESRT STDU.S. POSTAGE

PAIDTallahassee, FL

Permit No. 1007

A Long Term Care Monitor of Nursing Home and Assisted Living Issues

InsideFlorida Facilities .................................... 7

Advancing Excellence Campaign ............ 8

RAC audit phase-in plan update ........... 9

MDS 3.0: Let’s Get Ready ................... 10

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HealthScreen new to Service Corp.FHCA Service Corporation President Sid Schiff announced the addition of HealthScreen to the roster of Service Corp-approved vendors. HealthScreen works with self-insured employers to manage employees and dependents diagnosed with certain chronic illnesses who are covered under the employers’s health plan. See the FHCA Service Corporation ad on page 18.

Report to Congress on Advance Care PlanningThe U. S. Department of Health & Human Services has released a Report to Congress on Advance Directives and Advance Care Planning, which focuses on the best ways to promote the use of advance directives and advance care planning among competent adults as a way to specify their wishes about end-of-life care. The Report includes a discussion of opportunities to enhance the effectiveness of advance care planning and advance directives, as well as analyses of key ethical and legal issues. Visit the What’s New section of the FHCA Web site at www.fhca.org for a complete copy of the Report.

Satisfaction in nursing homes reaches new highsReport identifies opportunities for improvement amidst high satisfaction levels

A recent report from My Innerview, Inc., a national independent research firm, shows nursing home consumer satisfaction has reached its highest level since 2005, while workforce satisfaction is at its highest level since 2006.

The 2008 National Survey of Consumer and Workforce Satisfaction in Nursing Homes shows a majority (85%) of consumers report their satisfaction as either “excellent” or “good.” Sixty-six percent of employees recommend their facility as a place to work as either “excellent” or “good.” Satisfaction statistics are at their highest levels since My InnerView began conducting research on these trends in 2005.

Seventeen employees from the campus of Village On The Isle recently received $3,000 each in scholarships thanks to funds donated by residents, the Village On The Isle Auxiliary and the Board of Trustees. Scholarships are awarded to employees who are undergraduate students and who have been accepted to an accredited university or college, a two-year college or other institution of higher education. Recipients include staff of Village on The Isle, both at the Luke Haven Health Care Center and the assisted living campus of Mark Manor, as well as food and dining services personnel.

Scholarship Recipients

Thirty-five Florida facilities honored nationally for commitment to quality.

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FHCA August 2009 Pulse 3

FROM the PRESIDENT

by Deborah Franklin

FHCA President

Deborah Franklin,President

J. Emmett Reed, CAE,Executive Director

Nina Willingham,Vice President

Scott Bell,Secretary

Scott Allen, Treasurer

FHCA PulseAugust 2009

FHCA Pulse is a monthly publication of the Florida Health Care Association, P.O. Box 1459, Tallahassee, FL 32302-1459. To contact FHCA, call (850) 224-3907.Editorial – To submit information, guest articles, press releases, etc., contact Kristen Knapp, APR, Director of Communications, at (850) 224-3907 or via e-mail [email protected]. Fax information to (850) 681-2075 and include your name, telephone number and e-mail address. Advertising – For information on Pulse advertising rates and availabilities, contact Ian Cordes at Corecare Associates at (561) 659-5581 or via e-mail at [email protected] articles and advertising are subject to editorial review.

Reflection: high marks at the halfway point

It’s hard to believe a year has gone by since my term began as president of the Florida Health Care Association. When I took office last August, I vowed to each of you that FHCA would work to earn back the respect we deserve for the challenging, yet compassionate care we give to Florida’s elders. My goal was to create a more unified voice for the Association, and through that shared vision we would achieve the respect of Florida’s legislators and members of the media, as well as our peers working in the long term care profession. In addition, I hoped for opportunities to improve our image across the state and the nation, showing the public that the providers we represent are dedicated to preserving quality care and quality of life for the residents they serve.

As I enter the halfway mark of my term, I believe we are well on our way to reaching those goals. Despite the tremendous challenges our state was facing economically this past year, FHCA proved its return on your membership investment with our ability to avert potentially devastating Medicaid funding cuts for Florida’s nursing home residents. The relationships developed with legislators before the session began, which included many of you taking the initiative to invite these lawmakers into your facilities for a tour and briefing on our long term care issues, played an important role. In addition, the collective efforts of FHCA members, staff and our lobby team along with representatives of Our Florida Promise working together throughout the special and regular legislative sessions, resulted in our ability to stave off any Medicaid funding cuts. In fact, we were instrumental in helping the state garner more federal dollars to fund nursing home care through the creation of the Quality Assessment Program.

On the Quality side, FHCA’s Quality Credentialing Foundation focused its efforts on advancing quality through a number of initiatives. We actively promoted the Advancing Excellence in America’s Nursing Homes campaign and the American Health Care Association’s Quality Awards program; shared lessons learned about facilities’ Quality Indicator Survey experiences; established a Senior Clinicians Council; and developed the National Nursing Home Quality Initiatives Crosswalk, all to help members access the resources available to help them with delivering the best care possible to their residents.

We continued to be a leader in emergency preparedness, developing a number of valuable tools and resources for facilities, hosting a National Evacuation Transportation Summit with key federal and state stakeholders and testifying before Congress on the importance of communication among long term care facilities and federal partners when it comes to disaster planning.

We enhanced our image through a proactive media relations campaign, not only during the legislative session but throughout the year, raising awareness to the positive impact that long term care facilities have on our state’s economy. We entered the realm of social networking to connect with our own members, as well as the general public in ways never before imagined. The positive exposure continued, as a tremendous number of our member facilities were recognized for high marks in quality of care and customer and workforce satisfaction at the national level.

Want to stay up-to-date on FHCA news, events and activities?

Follow FHCA on Twitter at http://twitter.com/FHCA

or join our Florida Health Care Association Group

on Facebook at www.facebook.com.

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FHCA August 2009 Pulse4

by J. Emmett Reed, CAE

FHCA Executive Director

FROM THE DIRECTOR’S DESK

FHCA Web SiteEmergency Preparedness • Legislative • Membership • Press Center

Quality Improvement • Regulatory • Reimbursement • Seminars/Events

www.fhca.org

Ready to journey to Annual Conference

We’re just days away from the FHCA Annual Conference & Trade Show in Hollywood. The theme, Journey to Success...Pathways to Your Prosperity, could not resonate any more with me and my first-ever FHCA Annual Conference experience. The first few months of my tenure with FHCA have been quite a journey, and I have certainly seen how membership in this incredible association can help you prosper as a long term care professional.

If you’re planning on attending this year’s Annual Conference, you’re in for an incredible line-up. FHCA Annual Conference Chair Sid Schiff and his committee have been working hard for almost a year on what has shaped up to be one of the best conferences possible. There is literally something for everyone – no matter your expertise or years working in long term care. FHCA’s Annual Conference Committee diligently addressed feedback from our members and put together an agenda that is sure to give you what you asked for and then some. This year’s schedule is packed with professional development sessions, energetic speakers and networking opportunities to make sure you get what YOU need out of Annual Conference. And The Westin Diplomat Resort & Spa couldn’t be a better venue for such a fantastic conference experience.

If you’re not attending Annual Conference, we hope you’ll reconsider adding this incredible educational opportunity back on your schedule for next year, as it is one of the many benefits your FHCA membership has to offer. We know times are tough, but it’s during these uncertain economic times when you really can’t afford to miss the opportunity to make yourself more informed, more educated and more equipped to provide the highest quality care to your residents. It’s an investment in yourself, your staff and your facility, as everyone benefits from the experience you take back with you.

Keep your calendar open this fall, as well, as FHCA is working on a number of educational opportunities that you won’t want to miss. We’re looking at including several topics, from the business side of long term care (budgeting, workforce recruitment, customer service and ethics) to continuing trends in the profession (MDS, QIS and the Five Star Rating System). We’d love to hear your ideas on what information you’d like to see addressed during these meetings, so please e-mail me your suggestions at [email protected] so we can be sure to meet your needs.

Now, for my personal incentive... the first 5 Annual Conference attendees who introduce themselves to me and mention this article at the FHCA Kickoff Membership Meeting on Tuesday, August 11, 2009 at 2:00 p.m. in Hollywood will receive a special gift from me. How’s that for a Pathway to Prosperity?

See you at Annual Conference!

Return on your investmentWe understand members want a return

on their investment, and each year our goal is to ensure you can quantify the value of your membership in FHCA. I believe this past year is a reflection of the Association’s commitment to help you do just that.

Recently, I hosted a planning session with a strategic thinking group made up of leaders in our Association and our profession to develop goals that FHCA will use as guideposts to drive our success. This planning session helped to clarify, for each of us, the mission, vision and values of this incredible Association. During the FHCA Membership Meeting at Annual Conference in August, I will be asking each of you to think strategically about where you see the Association today and where you envision FHCA to be in three to five years, and I encourage you to embrace these goals as your own. If we want to remain the leading advocate for Florida’s long term care profession, we need to be forward thinkers so we can adapt to our needs as professionals, as well as the needs of our residents and staff in this changing long term care environment. I believe we are on the right track, and as I prepare to enter my second term as president of FHCA, I look forward to what lies ahead on this journey to our success.

Reflection: high marks at the halfway pointcontinued from page 3


LTC LEGAL ISSUES and TRENDS by Karen Goldsmith

Goldsmith &, Grout, PA

FHCA Legal Consultant

Sexual predators, criminals and other unsavory characters

Alas, there are a lot of unsavory characters out there in this world. Looking up your home address on the sexual predator registries will lead you to find a half dozen in closer proximity to your home than you would like.

When it comes to long term care facilities, the easiest way to deal with a sexual predator is, of course, not to admit him in the first place. Currently, many facilities do screen incoming residents on the various Web sites before admission. It is only a matter of time before this type of screening becomes federal law. Some of the facilities that do screen report problems such as angry hospital discharge planners, forgetful employees failing to screen or weekend admissions falling through the cracks. If you screen, it is important to anticipate these problems and be prepared to deal with them.

Sometimes facilities that normally refuse admission to people on the registries will admit residents who are bed-bound or appear comatose, only to find that the good care afforded to that individual results in him becoming more ambulatory and able to create issues. The problem, then, arises with attempting to discharge that person. It is a good practice to have a Registered Nurse (RN) look carefully at the medical history of such a resident to ascertain the likelihood of a significant recovery prior to admission.

Why? Because it is hard to discharge a resident once they are admitted. Start the process as soon as a hint of a problem arises and the decision is made to discharge or transfer that individual. Every day that passes is an opportunity for the resident to cause problems. The biggest hurdle you will have with discharging this individual is where he can be placed. Most likely your neighboring facilities will not welcome him with open arms. Assess his needs, be sure wherever you choose is a safe place and be

Points to consider if and when these residents enter your facilityprepared to support placement when you have to defend your position.

We are often asked if the homeless shelter is an appropriate placement. It can be, depending on the person’s condition and needs. Be sure to document, in detail, why you believe the shelter is appropriate. This will help you prevail if you have to go to a discharge hearing or support your decision to the surveyors. No matter where you send the individual, appropriate discharge planning should be done.

Residents with criminal history

Given the economic crunch, we can expect to see the state prison system discharging more convicted criminals into the community where they may very well find their way into your facility. You may welcome them with open arms, or you may want to avoid them like the plague. At the very least, you should assess the person’s physical condition and his criminal history. The check forger will require different safeguards than the violent abuser. However, even the check forger may require special planning if that person is in good enough condition to practice his profession within the walls of your facility.

Some states are already sending prisoners into nursing homes. We have heard of a facility cited for handcuffing a resident to his bed (as ordered by the prison system sending him there) as a violation of the resident’s right to be free of restraints. Are we going to need some legislative help here? You betcha!

When considering taking any individual who currently is or previously has been in the criminal justice system, you must be aware of your area laws and ordinances. We have all heard about the Boca Raton ordinance which essentially precluded any nursing home from taking a sexual predator.

However, we have also heard of a judge in the area ordering a person to a nursing home who fit within that ordinance. If there is any question as to whether that person can legally be in your facility, have your corporate attorney look into it. Once the individual becomes a resident at your facility, a conflict between local law and licensure and certification requirements becomes your problem. While you most likely will find a way to discharge the individual, do you really want to deal with that challenge?

Young residentsAnother challenge to our facilities is

the young and angry resident. While not necessarily a criminal, this person can be your nemesis. Oftentimes a young person resents the older people who primarily populate most facilities. We hear stories about the young resident who verbally abuses other residents or staff. Some create hazardous conditions for the other residents as a means of getting attention. This creates a specific and difficult challenge to staff.

Pay particular attention to where a potential resident has been before and why they are not returning there. Several years ago, a young, chronically ill resident had made the circuit of facilities in a certain Florida city. In each facility, he filed complaints with the Agency for Health Care Administration (AHCA) regarding pain management, and several of these facilities received citations based upon these complaints. Our firm handled appeals for two different facilities that each received the same deficiency for the same resident. Coincidence? Of course not. A resident seeking attention? What do you think?

Young residents may not qualify for Medicaid because they may not be considered “disabled” under the social security definition. There may be no payer

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by Peggy Rigsby

FHCA Director of Government Services

Hot Topics: regulatory reminders to help you keep your cool

source shortly into their stay. “Oh good,” you say. “I can discharge for nonpayment.” Yes, you can, but placement is the issue. Since the individual is not legally disabled, the homeless shelter may be a viable option.

Some points to considerIf your company allows, prescreen potential problem residents and reject those who most likely will create problems;If your facility doesn’t screen or problems arise anyway, look for appropriate and legal ways to discharge or transfer the problematic resident. If you lose the discharge hearing, you have given that person an excuse to be even more disruptive and wasted time better spent on discharge planning and execution;Be creative in thinking where that person can go and document why you believe that the place to which you plan to send the individual is appropriate and safe; andIf you cannot discharge or transfer the person and he must remain in your facility, find creative ways to care for that resident; protect the others and still stay within the regulations. Good and thorough documentation will be the key.

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Summertime in Florida means rising temperatures, so this month we’re offering some reminders on hot regulatory topics.

NHA license auditsThe Department of Health recently completed their audit of licensed Nursing Home

Administrators renewing on or before September 30, 2008. Of the 479 Administrators, 299 were immediately passed through CE Broker without any problems. That left 180 who received audit letters, which then resulted in 73 failing the manual audit. These 73 Administrators are subject to disciplinary action, which includes a fine of $575.

It is interesting to note that the majority of those failing the manual audit did so as a result of being deficient in the two hours of Medical Errors continuing education, which is required each biennium. If you registered for the full FHCA Annual Conference this month, you can pick up a free correspondence copy of the Medical Errors Prevention course, which will help ensure this doesn’t happen to you.

Just a trimMany years back, federal regulators published a final regulation specifying what costs

are covered by Medicare and Medicaid per diem payment. Not long ago, a nursing home company in Tennessee had several facilities audited, and the findings are of interest. One of the services in question was haircuts. Remember that simple haircuts and trims performed by facility staff to maintain good resident hygiene and dignity are covered by the facility’s per diem, but services including permanent waves and coloring performed by a beautician who is not a facility employee are not covered.

Trust fundsFlorida law s. 400.162, F.S. requires a licensee to return all funds held in trust to the

resident’s personal representative at the time of the resident’s death. If there is not one, and no spouse or adult next of kin named in a beneficiary form, then any funds due to the resident shall be placed in an interest-bearing account in a bank or credit union until disbursed according to the Probate Code. In the event that the funds are not disbursed within two years of the death of the resident, the facility must send the funds to the Agency for Health Care Administration at 2727 Mahan Drive, Tallahassee, FL 32308, for deposit in the Health Care Trust Fund.

Sexual predators, criminals and other unsavory charactersdling legal matterscontinued from page 5

“This is important information that allows nursing home leaders to target quality issues and workforce retention efforts,” said Emmett Reed, FHCA Executive Director.

Despite high satisfaction levels, the report notes several areas that offer opportunities for improving satisfaction among residents and staff which leaders can focus on, including meeting resident choices and preferences and combating job stress among nurses and nursing assistants. Other highlights of the report include data that support the view of aligning financial incentives with organizational performance.

A copy of the 2008 National Survey of Consumer and Workforce Satisfaction in Nursing Homes can be found in the What’s New section of the FHCA Web site at www.fhca.org.

Consumer and workforce satisfaction in nursing homes reaches new highs continued from page 1


Thirty-five FHCA member facilities were recently praised nationally for their extraordinary commitment to quality care for frail elders and people with disabilities. The recognition comes from the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL), which in 2009 will present Quality Awards to nearly 500 long term care facilities across the country.

“Recipients of our Quality Award reflect the long term care profession’s commitment to meeting customers’ needs through a process of continuous quality improvement. Increasingly, through programs such as Advancing Excellence in America’s Nursing Homes campaign, providers recognize how this translates into enhanced quality of care and quality of life for their residents,” said AHCA/NCAL President and CEO Bruce Yarwood. “Recipients of this prestigious award know that the pursuit of excellence is a continuous journey, and that the satisfaction of residents, families and staff makes the journey worthwhile.”

The AHCA/NCAL Quality Awards consist of an entry level, Step I Award, a more rigorous Step II Award, and a final Step III Award that mirrors the Baldrige National Quality Award criteria. The Quality Awards are independently judged by a Board of Overseers, who recently strengthened the program by developing 11 success factors that serve as a valuable framework and tool for facilities that are initiating a systems-based perspective to achieve sustainable levels of performance excellence. Recipient facilities have made quality outcomes and customer satisfaction top priorities.

Florida has 34 Step I award recipients and one Step II award recipient. Step I awardees developed solid vision and mission statements, and an awareness of their environment and customers’ expectations. Recipients at the Step II level addressed their approaches to the core values and concepts of visionary leadership, focus on the future, resident-focused excellence, management by fact, organizational and personal learning, valuing staff and partners,

Florida facilities earn national quality improvement recognitionThirty-five nursing homes honored for exceptional commitment to quality care

systems perspective and innovation, and focus on results and creating value.

“Florida long term care providers understand that quality is the cornerstone of their profession, and we are pleased that the American Health Care Association is recognizing these facilities and the staff for the incredible work they do each day to ensure our state’s frail elders receive the highest quality care they expect and deserve,” said Emmett Reed, FHCA Executive Director.

The Quality Award recipients will be honored for their achievement during the FHCA 2009 Annual Conference & Trade Show on Thursday, August 13, during the Association’s Quality Credentialing Foundation presentation. At the national level, Florida’s award recipients will be presented with their award during AHCA/NCAL’s 60th Annual Convention and Exposition in October in Chicago, IL.

STEP I Award Winners

Palm Garden of Gainesville, GainesvilleLife Care Center of Estero, EsteroPalm Garden of Aventura, AventuraPalm Garden of Clearwater, ClearwaterPark Summit Health Care, Coral SpringsPalm Garden of Pinellas, LargoPalm Garden of Jacksonville, JacksonvilleLife Care Center of Ocala, OcalaPalm Garden of Ocala, OcalaLife Care Center of Citrus County, LecantoLady Lake Specialty Care, Lady LakePalm Terrace of Lakeland, LakelandLife Care Center of New Port Richey, New Port RicheyPalm Garden of Largo, LargoNorth Beach Rehabilitation Center, North Miami BeachHawthorne Health and Rehab of Ocala, OcalaLife Care Center of Melbourne, MelbournePalm Garden of Orlando, OrlandoPalm Garden of Vero Beach, Vero BeachLife Care Center of Winter Haven, Winter Haven

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The Gardens Court, Palm Beach GardensLife Care Center of Palm Bay, Palm BayLife Care Center of Port St. Lucie, Port St. LucieLife Care Center of Punta Gorda, Punta GordaPalm Garden of Port St. Lucie, Port St. LuciePalm Terrace of St. Petersburg, St. PetersburgPalm Garden of West Palm Beach, West Palm BeachPalm Garden of Sun City, Sun City CenterRosewood Manor, PensacolaPalm Garden of Winter Haven, Winter HavenPalm Garden of Tampa, TampaTuskawilla Nursing and Rehab Center, Winter SpringsHealth Central Park, Winter GardenSpringwood Care and Rehab Ct., Sarasota

STEP II Award Winner

Morton Plant Rehabilitation Center, Bellair

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by LuMarie Polivka-West

FHCA Senior Vice President of Policy

Advancing Excellence in America’s Nursing Homes (AE) is a Web-based campaign designed to improve quality care and quality of life for residents and workplace settings for employees and to publicly recognize providers for these efforts. Enrollment in AE is a precursor for nursing homes to apply for the American Health Care Association/National Center for Assisted Living’s (AHCA/NCAL) Quality Awards program, which allows providers to demonstrate and be recognized for evidenced-based performance through a demanding three-tiered process. The Quality Awards were established by AHCA/NCAL in 1996, and this year, 35 facilities in Florida will be recognized with a Step I (34) and Step II (1) Award during the American Health Care Association national convention in Chicago, IL, in October.

According to AHCA Quality Committee Chair, Lonnie Bisbano, “The Quality Awards have served the long term care profession well. For individual providers, it has served to guide their understanding and use of a systematic, Baldrige-based approach to quality. While starting with nursing facilities, over time the program has been expanded to be inclusive of assisted living and residential care facilities for those with developmental disabilities, which strengthens its value to the association.”

In comparisonAdvancing Excellence is different from

other quality improvement efforts in that it represents providers, caregivers, researchers, government agencies, workers and

consumers alike, with a focus on specific quality improvement goals. The intent is to assist nursing homes with benchmarking, promote a partnership and reduce the adversarial perception of nursing home care.

Too often the media focuses on the negative stories. FHCA wants to change that perception and enhance the image of long term care, as well as raise awareness about the long term care workforce. Nurses and nurse assistants are at the frontline of providing good quality care to residents; and low staff turnover within a facility is a measure of good leadership and a caring environment. Advancing Excellence and the Quality Awards offer tremendous opportunity to recognize nursing homes for their commitment to quality care, drawing attention to the improvement gains we know providers are making on behalf of their residents each and every day.

Information needed already being reported

Advancing Excellence measures nursing home quality by setting measurable “clinical” and “process” goals. Participating nursing homes voluntarily work on at least three of eight measurable quality goals, which include areas related to creating a culture of person-centered, individualized care and an empowered workforce in nursing homes. Campaign Goals 1 through 4 relate to reducing pressure ulcers and restraints and improving pain management in long term and post acute care. Nursing homes are already reporting this information through the Minimum Data Set (MDS) submissions, and it is publicly reported through the Nursing Home Compare’s Web site.

A majority of facilities are already carrying out Goal 6, the measurement of resident and/or family satisfaction. Goal 7, workforce turnover, is a basic quality

improvement measurement and Goal 8, consistent assignment, as an optional goal, may inform the public of your facility’s adoption of “culture change.”

Goal selectionWhile it is up to the facility to select the

three goals they will track in the Campaign, at least one must be from the four clinical goals (which measures how well a nursing home cares for residents with certain common conditions) and at least one from the four process-related goals. A facility may select the first three Campaign goals if they do not want to commit to any additional work at all. Goals 1 through 4, as we noted earlier, are already publicly reported on Nursing Home Compare.

Supporting Advancing Excellence

The key to Advancing Excellence is to demonstrate that long term care providers are dedicated to improving quality of care in our nation’s nursing homes. The influence of participating providers helps bring along others who may not have the resources of clinicians to provide onsite education. Facilities can access a number of clinical resources and training products through the Advancing Excellence Web site.

Participants of Advancing Excellence are also seeing improvements to quality care, with new data released by the Campaign showing a drop in the number of pressure ulcers and the use of physical restraints and improved pain management for both long-term and short-term stays over a two-year period. In addition, it has been suggested that the Advancing Excellence Campaign may assist facility staff in understanding the coming of a “pay-for-performance,” value-based system.

Advancing Excellence Campaign continues to show improvement in nursing homes’ quality efforts

Florida participation rate remains at 38.8 percent

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LTCBUSINESS

NEWS

by Steven R. Jones, CPA and Lorne Simmons

Moore Stephens Lovelace

RAC audit phase-in plan: an update

The Centers for Medicare & Medicaid Services (CMS) recently updated the Recovery Audit Contractor (RAC) permanent program phase-in strategy. CMS has not released a strategy by provider type, but all provider types are available for RAC review once provider outreach has occurred in a state. According to the CMS provider outreach schedule, most of Region C (which includes Florida) should be completed by August 5, 2009.

According to the plan, Automated Reviews were to begin in June 2009, followed by DRG validation and coding errors (Complex Reviews) in August/September 2009. Durable Medical Equipment and Medical Necessity reviews are slated for 2010. Although the pilot RAC program focused primarily on hospitals (remember, these folks are getting paid based on the dollars of improper payments they find!), there will no doubt be impact on long term care before the year is over. As of the writing of this article, there were no CMS-approved audit issues posted on the Conolly Consulting RAC Web site (www.connollyhealthcare.com), but the validation of issues was scheduled to begin in July.

Therapy cap exceptions process continues through December 31, 2009

The Medicare Improvements for Patients and Providers Act of 2008 (enacted July 15, 2008) extended the effective exceptions process for therapy caps to December 31, 2009. Remember that for therapy services that exceed the cap furnished on or after July 1, 2008, claims must be submitted with the KX modifier. The 2009 limits are $1,840 for physical therapy and speech language pathology combined, and $1,840 for occupational therapy. Also remember that these amounts include all copayments, and the 2009 Part B deductible of $135.

Proposed physician fee schedule releasedThe CMS recently released a Proposed Rule updating the Medicare Physician Fee Schedule for

calendar year 2010. According to the Proposed Rule, the Sustainable Growth Rate (SGR) formula used to determine the physician update will result in a conversion factor of $28.3208 and a Physician Fee Schedule update of minus 21.5%. The SGR formula has resulted in reductions to the fee schedule since 2002 but Congress has typically enacted legislation to eliminate the changes. Expect that Congress will once again repeal the Medicare fee schedule reduction in either health reform legislation or in a separate Medicare bill later this year.

FHCA’s Quality Credentialing Foundation hopes to improve Florida’s participation in the Advancing Excellence Campaign, which today is just over one-third of our state’s nursing homes. In August, QCF Chair David Sylvester and FHCA Vice President Nina Willingham will recognize those facilities enrolled in Advancing Excellence, along with our AHCA/NCAL Quality Award winners, during the Annual Conference in Hollywood.

To learn more about how your facility can sign up to participate in Advancing Excellence, or see a list of Florida facilities already enrolled, visit www.nhqualitycampaign.org.

Advancing Excellence Campaign continues to show improvement in nursing homes’ quality effortscontinued from page 8


In addition to all FHCA members and associate members, FHCA Pulse is also mailed to legislators, opinion leaders, reporters and state/federal regulators in Florida. The wider distribution allows others to better understand long term care and the daily challenges faced by the long term care providers we represent.

Note to FHCA Pulse readers

By Jan Blake, RN,

BSN, RAC-CT

Moore Stephens Lovelace-Broussard Clinical Consultants

Five star ratings: a moving target

Advertise in FHCA Pulse Contact Ian Cordes at Corecare Associates, exclusive sales agent

ph: (561) 659-5581 fax: (561) 659-1291

e-mail: [email protected]

Art from the HeartFHCA is currently accepting artwork

from residents in member facilities for the 2010 Art from the Heart program. Entries from this year’s program will be featured in area museum exhibits, on the FHCA Web site and in the Association’s promotional materials to help raise awareness about Florida’s long term care profession and the important work providers do in caring for nursing home and assisted living residents across the state. In addition, Tallahassee art curators will judge the entries this fall and select the winning pieces to be featured in the 2010 Art from the Heart calendar, which will be printed and distributed by year’s end.

Proceeds from calendar sales will benefit FHCA’s Quality Credentialing Foundation, which provides member facilities with tools and resources for continuous quality care improvement programs for residents and staff. Companies and individuals can join the effort to promote long term care in Florida by supporting the Art from the Heart program through a variety of sponsorships. If your company is interested in sponsoring the 2010 Art from the Heart program, please contact Tracy Achey at (850) 224-3907 or [email protected].

The Centers for Medicare & Medicaid Services (CMS) Five Star Rating System has been posted on the Internet since the end of 2008 and is updated monthly by CMS. By capturing this information within a statistical program, we can listen to the process as its impact rolls out within the long term care markets. The question we wanted answered was: What types of changes are being reported for Florida five-star ratings and what is the frequency?

Changes in the 679 Florida facilities were analyzed by looking at overall Five Star ratings for March 2009 through June 2009, and the following results are rounded to the nearest one percent.

Overall during this period, 24 percent of Florida’s facilities changed their overall star rating, with 12 percent (83) gaining stars, and 12 percent (79) of Florida facilities losing stars.

Gains/losses at each Star level (1-Star, 2-Stars, etc.)

CATEGORY GAINS LOSSES

1 Star 23%

2 Stars 14% 13%

3 Stars 19% 12%

4 Stars 5% 16%

5 Stars 21%

If these trends continue throughout the year, we would expect about 71 percent of Florida’s facilities to change their star ratings. Approximately 36 percent would gain stars and about 35 percent would lose.

These data make it clear that the Five Star Rating System allows for change. Which direction is your facility headed?

Analysis provided by Larry R Vinson, PhD: Director of Research Services: MSL Broussard Healthcare Consultants



LABOR RELATIONS

COUNSEL

by Mike Miller

Kunkel, Miller & Hament FHCA Labor

Relations Consultant

Employer case studies: from piercings to promotions Religious accommodation dispute over nose ring

A federal court in the Middle District of Florida recently decided a case involving a dispute between an employee and her employer over whether the employee should be allowed to wear a nose ring at work. The local employer had a policy (imposed by its parent company) that prohibited the wearing of all facial jewelry, but the plaintiff claimed that wearing the nose ring was a bona fide religious practice, and she asked to be excused from the Company policy. The employer refused, but did offer two other alternatives: 1) a flesh colored band-aid to cover up the nose ring; or 2) that plaintiff could be excused from work whenever the parent company inspector came around (the local employer had no real objection to plaintiff wearing the nose ring but did not want to get in trouble with the parent company by allowing violation of the policy). The plaintiff ultimately refused these options and was terminated after she reported to work wearing the nose ring. The Equal Employment Opportunity Commission (EEOC) brought suit on her behalf, arguing that the employer failed to accommodate her religious needs and, therefore, violated federal law.

The court began by noting the obligation of an employer to reasonably accommodate an employee’s religion by eliminating the conflict between a religious practice and an employment requirement, if such conflict could be accomplished without undue hardship to the employer’s business. The court found disputed issues of fact on every material relevant issue. With respect to whether the wearing of the nose ring was “religious” in nature, the employer had no evidence that it was (it had asked for a note from plaintiff ’s minister or a page from a religious text evidencing the requirement to wear the nose ring, but the plaintiff only provided a note from herself and her mother), and the plaintiff claimed protection based on her Nuwaubian beliefs. This dispute could not be resolved at the summary judgment stage. On the issue of accommodation, it was disputed whether the flesh colored band-aid was effective or whether it would “abnegate” the plaintiff ’s religious need to wear the nose ring. The second option (allowing plaintiff leave to avoid contact with the inspector) was not reasonable, held the court, because it encouraged subterfuge and fraud.

The court then moved on to the undue hardship issue and could not find in the employer’s favor on that issue either. First, the local employer could not claim undue hardship because it did not really care whether plaintiff wore the nose ring. The only thing the local employer cared about was avoiding detection by the parent company’s inspector and being found in violation of the policy prohibiting facial jewelry. There also was no evidence (as has been found in other cases that ruled in favor of employers) of a legitimate hardship, such as loss of ability to protect the company’s public image, interference with its product or service or a legitimate safety or security concern. Indeed, the parent company appeared amenable to allowing a deviation from its rule in this case if the plaintiff had only provided the requested note from her minister or the page of religious text. The court was unable to conclude—as a matter of law on a summary judgment motion—that the employer had a legitimate defense to its refusal to allow plaintiff to wear the nose ring at work. As a result, a trial would be necessary to decide the issue.

Supreme Court ruling on throwing out results of promotional examIn the news lately were published accounts of the United States Supreme Court’s recent ruling that

the City of New Haven, Connecticut violated Title VII when it threw out the results of a promotional exam for firefighters because the results showed that too few minority candidates passed the exam (the Court did not reach the constitutional issue raised by the parties). This led a group of largely white candidates to bring a lawsuit challenging the City’s action, and after losing at the district and appellate court levels, they ultimately prevailed in the Supreme Court. It was undisputed that the City had spent a lot of time and money to come up with a fair, unbiased test, but the challenge came when the results of the exam led to a statistically disparate impact on minorities (well under the 80% ordinarily used as the benchmark to gauge disparate impact). The Court opined that it was required to balance the statutory demand that race not be used to make employment decisions against the statutory requirement that facially neutral policies not result in a racially disparate impact. The Court

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struck this balance by creating a new standard for employers who want to change a decision because of an apparent disparate impact. It cannot do so, held the Court, without “a strong basis in evidence” to believe that it has acted illegally. The precise boundary was, of course, not delineated in the Court’s decision, but it did say that the “fear of litigation alone cannot justify an employer’s reliance on race to the detriment of individuals who passed the examinations and qualified for promotion.” The Court’s decision offers little solace for employers, who will continue to be caught in the middle and who must tread as lightly as possible to avoid using race intentionally to remedy perceived racial disparities, while at the same time acting to prevent racial disparities from occurring in the first place.

Promoting the highest quality care in the post acute care continuum

The Florida Medical Directors Association (FMDA) was formed in 1990 to help medical directors, attending physicians and other providers practicing in post acute care navigate their way through the continuum of care spectrum. FMDA is the official state affiliate of the American Medical Directors Association and in the last few years, the association has grown rapidly. Today FMDA has nearly 350 members representing medical directors, attending physicians, physician assistants, and advanced registered nurse practitioners in Florida’s post acute care continuum.

FMDA hosts a highly-successful and nationally-recognized annual educational program and trade show every October, which features the newest trends and challenges addressed by some of the top long term care experts in the country. This year’s Annual Meeting takes place October 30-November 1, with an emphasis on “Best Care Practices in the Geriatrics Continuum 2009.” The educational program is designed to provide a review and update of major geriatric diseases, illnesses, and risks found in nursing home patients, residents of assisted living facilities, and seniors living at home. Topics range from the clinical relevance of advanced wound healing techniques; a lecture on dementias; and depression and mood disorders in the elderly with a focus on assessment and treatments; the latest treatments for diabetes, movement disorders, geriatric ophthalmology; and a look at the state of improving nursing home care by reducing potentially avoidable hospitalizations. The faculty includes national and regional authorities in the fields of medical direction, senior care pharmacology, as well as long-term care and geriatric medicine.

In its 18th year, this annual educational program has evolved into a national gathering for physicians, nurse practitioners, senior care pharmacists, directors of nursing, nurses, and administrators, all working in long term care, assisted living, home care, and in academia. It provides a unique opportunity to network and enjoy educational seminars from the top experts in their fields.

To learn more about educational programming for the Best Care Practices conference or submit a poster presentation, or learn about membership in FMDA, go to www.fmda.org, or call Ian Cordes, FMDA executive director, at (561) 659-5581. More specific information concerning the Best Care Practices conference is also available at www.bestcarepractices.org.

Employer case studies: from piercings to promotionscontinued from page 12

By Ian Cordes, MBA, NHA;

Executive Director, FMDA

Spotlight on Florida Medical Directors Association

Study to address nurse supplyThe Florida Center for Nursing is conducting a study of Florida’s hospitals, skilled nursing facilities, home health agencies, hospices and public health departments to better understand both the nurse supply and contributions to that supply made by the state’s nursing programs. Administrators in Florida’s skilled nursing facilities are currently being asked to complete a brief survey describing their current and future need for nursing personnel, including vacancies, turnover, future demand for nurses, recruiting difficulty encountered over the past year and consequences they face as a result of an inadequate nurse supply. The information compiled from these responses will help the Center better understand the extent of the state’s nursing shortage, as well as what can be expected in the short-term future. Results from the study are expected in early 2010.


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NEWS FROM ACROSS FLORIDA

FHCA Pulse welcomes news items, photos, or guest articles of up to 500 words or less. For information, call (850) 224-3907 or e-mail [email protected].

Happy Retirement Bill

FHCA staff hosted a retirement

celebration for Bill Phelan (back center)

at the Association headquarters.

Facility ToursTop left, FHCA Executive Director Emmett Reed (center) visited Hawthorne Health & Rehab of Brandon, where he toured the facility and met many of the staff and residents. Show here with Hawthorne DON Gwen Crumbly (left), FHCA President Deborah Franklin (left center), Administrator Vern Zeger (right) and Administrator in Training Britney Wright.

Bottom left, Rep. Paige Kreegel (right) of Sarasota toured Englewood Health & Rehabilitation Center with administrator Michael Allen (center). Along with meeting residents and staff, Rep. Kreegel had a chance to catch up on what’s impacting long term care in Florida.

Life Safety TrainingMacclenny Nursing & Rehab staff conducts regular fire safety trainings with their local fire department.



FHCA Welcomes New Members

New Nursing Home MemberThe Home Association, Inc., Tampa

New Associate MembersAccessible Systems, LLC, Minneapolis, MN

America Laboratory Service Corporation, Hialeah

Digital Pen Applications, Inc., Deerfield Beach

Innovative Service Solutions, Orlando

Interdyn - CFO Consulting, Orlando

Kreg Therapeutics, Inc, Chicago, IL

Laser Services, Pompano Beach

Loraine Salamone, Boca Raton

MedCure, Inc., Portland, OR

Primus Medical, LLC, Boardman, OH

TeleHealth Services, Raleigh, NC

The Scrubs Bus, Winter Garden

VITAS Innovative Hospice Care, Miami

Out of this worldIn July, Indian River Center resident, Stanley Colson,

was visited by retired Apollo astronaut Tom Stafford, who served as commander for the Apollo 10 mission. The meeting was prompted by a number of news stories surrounding the 40th anniversary of the Apollo 11 mission and Mr. Colson, a former quality control official for the Saturn V stage 1 rocket that sent Americans to the Moon. Indian River Center Administrator Randy Blue noted that following the initial Florida Today article that ran about Mr. Colson, a number of media outlets, including TV crews and the BBC, visited the facility to conduct additional interviews with Mr. Colson to hear his perspective about the anniversary of this historical event.

From left to right: Stanley Colson, Indian River Center administrator Randy Blue and Lt. General Tom Stafford


American Health Care Association and National Center for Assisted LivingAHCA/NCAL offer hundreds of long term care professional development resources. Categories include Care Practice, Compliance & Regulation, Staffing & Retention, Consumer Resources, Nurse Aid Training, Assisted Living and many more. Go to www.ahcapublications.org or call (800) 321-0343 Monday - Friday, 9 am - 6 pm to place an order.

Edge Information Management Inc.Since becoming an approved service corporation company for FHCA in 1993, Edge has helped over 250 FHCA members meet their background screening requirements and kept them informed of pertinent legislative issues. Edge offers a variety of background checks including: drug screening, fingerprints, criminal, sexual offender, license verifications and references. Call (800) 725-3343.

FMS Purchasing & ServicesFMS has a full line of products and services in its Group Purchasing Program. FMS services member needs by ensuring maximum savings and service. Six area managers throughout the state assure members an immediate response. Our services include: audits, a toll-free number, cost analysis, service reports and the Manufacturers Value Incentive Program. Call (800) 456-2025.

Hamilton Insurance AgencyHamilton Insurance Agency has 25 years experience, with an emphasis on the healthcare industry, and is proud to provide the best and most economical services available in the industry to its customers. Offering commercial, health, personal and a variety of specialty services like Risk Management consulting, COBRA and Workers’ Compensation. Contact Geoffrey Shisler at (877) 260-9468 or via e-mail, [email protected].

HealthScreenHealthScreen works with self-insured employers to manage those employees and dependents covered under the employer’s health plan diagnosed with chronic illnesses such as asthma, diabetes, hypertension, etc. The expertise we have developed in working with the chronically ill has allowed us to successfully stabilize the healthcare costs of these individuals, which translates into identifiable direct dollar savings to the employer. Unlike many vendors in this industry, HealthScreen is strictly a Pay for Performance organization. HealthScreen will provide employers with 1,000 or more covered employees a Net Guaranteed Return on Investment (ROI) of 125 percent at the end of the first twenty-four (24) months of the program. HealthScreen will put up to twenty-five (25) percent of fees at risk to support this guarantee. HealthScreen also provides one of the most unique and successful smoking cessation programs available today. For more information contact Mack Bryson at [email protected] or call 877-223-4325. Visit our website at www.ehealthscreen.com

MED-PASS, Inc. (Heaton Resources)MED-PASS is a nationally known company specializing in the research and development of documentation solutions, policy and procedure manuals, regulatory guides and in-service training programs for the longterm care professional. Our manuals and guides are comprehensive, easy-to-use and continuously updated. Our forms and resources offer peace of mind and quality and better than competitive prices. Visit us at www.med-pass.com, or call (800) 438-8884.

Office DepotOffice Depot offers Florida Health Care Association members extra discounts and services due to the cooperative purchasing power of FHCA. We offer a wide variety of benefits, including 50 items which have been reduced based on volume ordering up to 80 percent off the list prices (the “High Use Item List”); next-day delivery on everyday office products; an award-winning Web site which links you to your pricing and into the warehouse and keeps 12 months of tracking information at your fingertips. Call (800) 422-2654 for information or to set up an account; call (800) 386-0226 to place an order.

RXPERTS PharmacyRXPERTS is Florida’s premier pharmacy providing pharmaceuticals and infusion services to nursing homes and assisted living facilities. We are the only pharmacy to print the patient/resident’s digital photo on the Rx label, POS, MAR and all other forms. RXPERTS participates in all third party billing, including all approved Medicare Part D PDPs. Call Jeff Wilkes, Director of Sales and Marketing at (813) 579-7042.

Senior CrimestoppersThe Senior Crimestoppers program is a proven, effective, proactive crime prevention system that combines proven components to help provide safe, crime-free facilities for residents, staff, visitors and vendors. Personal lock boxes for use by residents and/or family members, an around-the-clock, completely anonymous “tip line” call center, cash rewards of up to $1,000 posted on any and all incidents that occur and educational materials for residents, families, management and staff members are a few of the components that make up the program. More details can be found at www.seniorcrimestoppers.org or contact Kay Joest at (800) 529-9096 for more details.

FHCA SERVICE CORPORATION SAVES YOU MONEYWe are proud to recommend these fine vendors who provide quality goods and services.

They help keep you and FHCA on top!


Some meetings noted herein may also carry CE credits. Additional information and registration can be found at www.fhca.org. Click on “Seminars/Events”

Classified Ads“Help wanted” and “situations wanted” classified ads are free to FHCA members. You can also post your ad on the FHCA Web site at www.fhca.org. Click on “Job Board.”

Interim Administrator/Prudent Manager – Available statewide. Successful companies need prudent management in difficult economic times as they strive toward operational effectiveness; namely, focus and accountability. As a seasoned professional who has both management and consulting experience in the operation of health care facilities, you will get both a licensee and an opportunity to “fine tune” your operation. Contact Doug Eitel at (813) 843-6250, or via e-mail, [email protected].

Interim Administrator/Executive Director or RVP – Excellent problem solver and communicator. Knowledgeable on LTC regulations (state and federal). Given excellent evaluations for management and leadership. Licensed in Florida. For your needs, call Fred Taylor at (727) 534-0726, or via e-mail, [email protected].

Get Involved!FHCA members interested in participating on a committee or task force are encouraged to complete the Activity Preference Form distributed at the 2009 Annual Conference & Trade Show and return it to FHCA by August 31, 2009. For a copy of the Activity Preference Form, please contact Venetia Croy at FHCA at [email protected].

Continuing Education/Training

FHCA CNA Train-the-Trainer SessionWednesday, September 168:30 a.m. – 12 NoonHawthorne Village of Brandon

Class size is limited to 25 RNS from FHCA/FCAL member facilities only.

Meetings/EventsFHCA 2009 Annual Conference & Trade ShowTuesday, August 11 – Friday, August 14Trade Show is August 11 - 12The Westin Diplomat Resort & SpaHollywood, FLVisit www.fhcaconference.org for details

American Health Care Association Quality Plus 2009 Annual Convention & ExpoSunday, October 4 – Wednesday, October 7McCormick PlaceChicago, ILVisit www.ahcancal.org for details

Family Forum“We appreciate the job you are doing [with Jeffrey]. You make him feel special and we also felt

special at the Mother’s Day Brunch and the Family Dinner. Thank you for all you do”.

– From Jan and Jerry Joyce to administrator Bob Murphy and the staff of Habana Health Care Center in Tampa.

Send FHCA a photocopy of your favorite card or letter from a satisfied resident or resident’s family member. Mail to FHCA, P.O. Box 1459, Tallahassee, FL 32302, fax to (850) 681-2075 or e-mail [email protected]. The best will be excerpted in FHCA Pulse.

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Documents

FHCA AUGUST 2009