Survey & Certification Notices Posted Late December 2017

By Mary Madison, RN, RAC-CT, CDP, Clinical Consultant – Briggs Healthcare®

CMS posted these S&C notices the last week of December 2017:

S&C 18-10-ALL – Texting of Patient Information among Healthcare Providers (2 pages) – December 28, 2017

  • Texting patient information among members of the health care team is permissible if accomplished through a secure platform.
  • Texting of patient orders is prohibited regardless of the platform utilized.
  • Computerized Provider Order Entry (CPOE) is the preferred method of order entry by a provider.

“CMS recognizes that the use of texting as a means of communication with other members of the healthcare team has become an essential and valuable means of communication among the team members. In order to be compliant with the CoPs or CfCs, all providers must utilize and maintain systems/platforms that are secure, encrypted, and minimize the risks to patient privacy and confidentiality as per HIPAA regulations and the CoPs or CfCs. It is expected that providers/organizations will implement procedures/processes that routinely assess the security and integrity of the texting systems/platforms that are being utilized, in order to avoid negative outcomes that could compromise the care of patients.”

S&C 18-08-NH –  An Initiative to Address Facility Initiated Discharges that Violate Federal Regulations (4 pages) – December 22, 2017

  • Federal regulations allow facilities to initiate discharges of residents only in specific instances. Despite these protections, discharges which violate Federal regulations continue to be one of the most frequent complaints made to State Long Term Care Ombudsman Programs.
  • The Centers for Medicare & Medicaid Services (CMS) has begun an initiative to examine and mitigate facility-initiated discharges that violate federal regulations. CMS is examining State survey agency’s intake and triage practices for these type of discharge complaints, developing examples of inappropriate and appropriate discharges for surveyors, identifying best practices for nursing homes, developing training and evaluating enforcement options for these types violations.
  • Civil Money Penalty (CMP) Reinvestment Projects Assistance. CMS is encouraging States to pursue CMP-funded projects that may help prevent facility initiated discharges that violate federal regulations.

“Facility-initiated discharges continue to be one of the most frequent complaints made to State Long Term Care Ombudsman Programs. In FY 2015, ‘‘discharge/eviction’’ was the most frequent nursing facility complaint category processed by the Long-Term Care Ombudsman Programs nationally.

Discharges which violate federal regulations are of great concern because in some cases they can be unsafe and/or traumatic for residents and their families. These discharges may result in residents being uprooted from familiar settings; termination of relationships with staff and other residents; and residents may even be relocated long distances away, resulting in fewer visits from family and friends and isolation of the resident. In some cases, residents have become homeless or remain in hospitals for months.

The reasons for non-compliant discharges can vary. Analysis of federal deficiencies indicate that some discharges are driven by payment concerns, such as when Medicare or private pay residents shift to Medicaid as the payment source. The most commonly reported reason that residents are discharged is due to behavioral, mental, and/or emotional expressions or indications of resident distress. Sometimes facilities discharge residents while the resident is hospitalized for health concerns unrelated to the behaviors that form the alleged basis for the discharge.

CMS is evaluating facility initiated discharge issues in nursing homes and considering a variety of interventions, including surveyor and provider training, intake and triage training, CMP funded projects that may help prevent facility initiated discharges that violate federal regulations, and enforcement.”