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Healthcare providers continue to be confronted with multiple challenges

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 compliance
• 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 the following:

• evaluation
• education
• 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.

Compliance TodayRead 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.

David Hoffman and Associates brings legal and clinical expertise in addressing these difficult issues
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What's New
What's new in quality care through compliance
September 18, 2014: Hoffman Presenting Overview of the Elder Abuse "Grand Rounds" Training Program at Southeastern PA LTC Healthcare Professionals Meeting in Plymouth Meeting, PA >

March 30, 2014: Hoffman Moderating Panel at Health Care Compliance Association's 18th Annual Compliance Institute >

March 20, 2014: Hoffman Moderating Panel at the Whistleblower Laws in the 21st Century: Greater Rewards, Heightened Risks, Increased Complexity conference >

March 14, 2014: Hoffman Speaking at Pennsylvania Bar Institute's 20th Annual Health Law Institute >

February 20, 2014: Hoffman Speaking at 2014 American Health Lawyers Association's Long Term Care and the Law Conference >

November 19, 2013: Hoffman Lecturing to Nursing Home Administrators >

August 15, 2013: Hoffman Testifies on Alzheimer's Disease and Elder Abuse >

June 20, 2013: Hoffman Presenting at PA Health Care Association (PHCA)/Healthcare Financial Management Association (HFMA) Long Term Care Seminar >

June 11, 2013: Hoffman Serving as Panelist at Health and Aging Policy Fellows' Spring Symposium in Washington, DC >

April 20, 2013: Hoffman Leading Panel on Compliance at 2013 HCCA Compliance Institute in Washington, DC >

April 18, 2013: Hoffman Moderating Panel on the Use of Psychotropic Medications in Long-Term Care >

March 12, 2013: Hoffman Co-Presenting Session at 19th Annual PA Bar Health Law Institute >

February 19, 2013: Hoffman Lecturing to Nursing Home Administrators >

October 10, 2012: Hoffman Presenting at PBI's A Day on Health Law >

October 9, 2012: Hoffman Teaching Nursing Home Administrators >

September 22, 2012: Hoffman Presenting at US Oncology Research Annual Community Oncology Research Forum >

June 27, 2012: Hoffman Presenting at LeadingAge PA Annual Conference >

June 15, 2012: Keynote Address at Elder Justice: Protection and Advocacy Conference >

June 14, 2012: Medicare/Medicaid Fraud Presentation at PANAC Association Annual Conference >

May 22, 2012: Hoffman is Keynote Speaker at the William J. Neff Sr. Symposium >

May 8, 2012: Hoffman to Present Keynote Address at Elder Justice: Protection and Advocacy Conference >

April 29-30, 2012: Hoffman Presenting at the HCCA Compliance Institute in Las Vegas >

March 13, 2012: Hoffman Presenting on Medical Necessity at PBI Health Law Institute >

February 21, 2012: Hoffman Educates Nursing Home Administrators >

September 26, 2011: Hoffman Speaking at AHLA Fraud and Compliance Conference >

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March 2012: Mr. Hoffman co-authored an article titled "PCO Appointment: Whose Facts? The Case for Ombudsman Appointment" which was published in the American Bankruptcy Institute (ABI) Journal. This article analyzes the determining factors for appointment of a patient care ombudsman when a healthcare facility files for bankruptcy.

September 2011: Mr. Hoffman co-authored an article titled "Medical Necessity Review: Compliance in a New Era of Accountability" which was published in the September 2011 issue of Compliance Today.

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Faculty Appointments

January 2013: Hoffman Appointed As An Adjunct Professor in Temple University's Beasley School of Law >

February 2012: Hoffman to Teach Law Students and Nursing Doctoral Students on Patient Safety >

February 2012: Mr. Hoffman has been appointed Dean's Professor at the Mayes College of Healthcare Business and Policy at the University of the Sciences.

August 2008: Mr. Hoffman serves as an Adjunct Professor of Law for the Earle Mack School of Law at Drexel University. >


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