Healthcare providers continue to be confronted
with multiple challenges: higher acuity levels, shrinking
reimbursement, a national nurse staffing shortage, more stringent
and complex regulations, and increased litigation. As a result,
the struggle to maintain compliance with regulatory requirements
often appears to be an uphill battle. This is especially frustrating
to owners, administrators, clinical staff, and researchers
who aim to go beyond compliance to provide innovative care
and services. In some instances, patients in institutional
settings, such as hospitals, nursing homes or assisted living
facilities, may be at risk based upon the failure of providers
to adequately address basic care needs.
David Hoffman & Associates provides a
proactive approach to compliance, viewing
clinical and financial operations as well as clinical research
programs through a legal lens to:
• create a culture of compliance
• conduct an evaluation to assess the degree of compliance
• collaborate with the provider to develop a plan for
• identify organizational strengths and develop an action
plan that helps
organizations realize their fullest potential
Creating a culture of compliance is accomplished
through a customized plan that includes varying degrees of
• customized action plans
• discussions with regulators
The development of systems to provide quality
care to vulnerable populations requires meaningful quality
improvement efforts that systemically monitors organizational
and clinical processes of care and is constantly revising
these processes based upon clinical and regulatory outcomes.
David Hoffman & Associates brings legal and clinical expertise
in addressing these difficult issues.
Mr. Hoffman is the President for The Eastern Pennsylvania Geriatrics Society (EPGS), a multidisciplinary group of health professionals including physicians, nurses, social workers and attorneys, and is the regional affiliate of the American Geriatrics Society (AGS). EPGS is dedicated to the goal of advancing high standards of clinical care and quality of life for elderly individuals.
Read Mr. Hoffman's columns each month in Compliance Today:
October 2014: Plans of Correction:
The role of the compliance officer
A colleague of mine and I were recently discussing the role of the compliance officer in the development of a Plan of Correction (POC) for nursing facilities. It is important to note that a Plan of Correction is an important legal document that facilitates continued payments from federal payers, and that the knowing submission of false information in a POC may subject the facility to liability under federal fraud statutes. Additionally, many personal injury suits attempt to use the deficiency statement and Hoffman accompanying POC as evidence of negligence against the facility.
September 2014: Adverse drug reactions in hospitals: Effective reporting
The Pennsylvania Patient Safety Authority recently published an advisory titled "An Analysis of Reported Adverse Drug Reactions" which used data accumulated over the course of a year. In total, 4,875 adverse drug reaction events were reported to the Safety Authority. The number one adverse drug reaction was linked to contrast agents. Specifically, 851 reports were contrast-related and the reactions included headache, nausea, vomiting, itching, rash, and sensation of heat all of which are consistent with product labeling for contrast agents. In an additional 484 cases, there were severe reactions; and in 130 cases, the patient had a documented history of an allergy to a contrast agent (106 cases had a premedication protocol documented).
August 2014: Top 10 patient safety concerns
The ECRI Institute recently published its "Top 10 Patient Safety Concerns for Healthcare Organizations 2014." Karen Zimmer, MD, the Medical Director for the Institute's Patient Safety, Risk, and Quality Group and the ECRI PSO, noted in the report, "[t]he list is partly based on more than 300,000 patient safety events, custom research requests, and root-cause analyses submitted to our federally designated patient safety organization, ECRI Institute PSO, for evaluation and analysis." So what are the Top 10 concerns?
July 2014: Functional quality measures: Another quality/compliance tool?
CMS has contracted with RTI International to "develop functional status quality measures for inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs), and skilled nursing facilities (SNFs)." As noted on the CMS website, nursing home quality measures have four intended purposes...
June 2014: Time spent and
the quality connection
I have stayed away from analyzing legal cases in this column, but an interest- ing case that was just decided has made it too difficult not to mention. In the case of United States v. Associates in Eye Care, P.S.C. and Dr. Phillip Robinson, the District Court issued an opinion denying defendants' motions to dismiss the complaint. The government alleged that: Dr. Robinson [an optometrist] provided routine eye examinations to nursing home residents that were unnecessary, and that on certain days he claimed to examine such a high number of patients that either he could not possibly have provided such services under the circumstances, and/or such services were so cursory that they were worthless....[t]he Complaint further alleges that... he could not have spent more than
a few minutes at most with each one, and/or establishes that the billing codes he used did not accurately reflect the services provided.
May 2014: Third-Party Monitoring: It is not an illusion
I have just returned from Las Vegas, after attending a conference on longterm care and the law. As a panelist of a session titled "Meet the Monitors," I copresented with two very talented clinicians on our collective monitoring experiences. The topic of monitoring is extremely popular these days, especially when the government's enforcement activity involves alleged patient/resident harm and the unyielding government demand for a monitor is made as a condition of settlement. As such, our panel presen tation focused on how monitors are appointed, their roles and responsibilities, how they communicate with facility staff, the cost, and most importantly, how to make a monitoring project (no matter how or why it was created) work to protect residents/patients and improve care.
April 2014: Failure of care: 20 years later
Twenty years ago I visited William Young, an 82-year-old man, at a Philadelphia hospital. He had been transferred there from a local nursing home and his clinical condition included 28 pressure ulcers, a gangrenous foot, and his eyes were swollen shut. He was the first victim in what later became the first "quality of care" case brought by the United States Attorney's Office in Philadelphia against a nursing home owner and management company.
March 2014: Falls and medications
How bad are falls? According to the Centers for Disease Control and Prevention, one out of three adults age 65 or older falls yearly and among this population, falls are the leading cause of injuries. One of the major known contributors to falls in the elderly is medications.
February 2014: Smile, you're on Candid Camera!
These days, "undercover" cameras are becoming the mechanism whereby unsuspecting alleged
abusers or neglecters are being captured committing fraudulent conduct as it pertains to the provision of care. A recent New York Times article, "Watchful Eye in Nursing Homes," discussed the pros and cons of the use of undercover cameras.
January 2014: Compliance as a means to achieving "high reliability"
In preparing for a lecture to my Regulating Patient Safety class at the Earle Mack School of Law at Drexel University, I came across a very interesting article titled "High- Reliability Health Care: Getting There from Here." High-reliability science is the study of organizations in industries like commercial aviation and nuclear power that operate under hazardous conditions while maintaining safety levels that are far better than those of healthcare.
December 2013: What did we do to deserve this?
As I write this column, I am sitting at my desk, only a few blocks from a closed Independence National Historical Park in Philadelphia, the birthplace of our nation. All I can think about is: How could the government be shut down by lawmakers who do not like a law that has been upheld as consti- tutional by the Supreme Court of the United States?
November 2013: Discharge planning, Part 2: The patient/resident ping-pong effect
On countless occasions, I have seen patients transferred to nursing homes with information that is inaccurate or incomplete, thereby placing the patient (soon to be resident) at risk for harm, while also placing the nursing home in a position where care needs cannot be met. Similarly, I have seen nursing home providers send residents back to the hospital for care needs that should have been addressed by the nursing home.
October 2013: Hospital readmissions
and discharge planning: Part 1
CMS recently issued guidance to state survey agency directors pertaining to hospital discharge planning (the Guidance). The Guidance should be reviewed by discharge planners, social workers, nursing staff, physicians, and compliance officers in order to understand fully the goals and objectives
of a compliant hospital discharge program.
September 2013: Why monitoring
use of antipsychotics is a compliance function
Welcome to the new monthly column where topics that intersect compliance and quality will be discussed. The first topic that I thought I would tackle pertains to the use of antipsychotic medications for the elderly in long-term care.