Quality of Care Standards

News & Analysis as of

Hospital Conversion to For-Profit Status Improves Health (i.e., Financial Health)

For years the debate has raged: Does conversion of a nonprofit hospital to for-profit status result in a decline in clinical quality? An improvement? More efficient operations? A decrease in the volume of indigent and...more

Colorado Supreme Court Protects Quality Management Privilege for CDPHE-Licensed Providers

Colorado hospitals and other licensed and certified health care facilities scored a significant victory on October 14, when the Colorado Supreme Court issued its en banc ruling in Simpson v. Cedar Springs Hospital, Inc. (2014...more

Prepare for Changes to CMS’ Five Star Quality Rating System for Nursing Homes

Choosing a nursing home can be a daunting task for consumers who often have myriad questions regarding the quality of care available at the nursing homes in their areas. To help answer these questions, CMS has created the...more

CMS to Modernize Home Health Regulations - Proposed rule targets quality of care, more flexible procedures

On October 9, 2014, the Centers for Medicare and Medicaid Services (CMS) issued a Proposed Rule revising current conditions of participation (CoPs) that home health agencies (HHAs) must meet in order to participate in the...more

Analysis and Impact of the Improving Medicare Post-Acute Care Transformation Act of 2014

This week, President Obama signed into law the Improving Medicare Post-Acute Care Transformation Act of 2014 (the “IMPACT Act” or “Act”). The IMPACT Act’s provisions will affect a broad range of post-acute care (“PAC”)...more

CMS Announces Changes to Five-Star Quality Rating System for Nursing Homes

On October 6, the Centers for Medicare and Medicaid Services (CMS) announced plans to expand and bolster Medicare’s Five-Star Quality Rating System (Five-Star System) for nursing homes, provided to the public on the Nursing...more

The Evolution of Efficiencies and Treatment of Quality of Care Defenses in Light of Changing Health Care Industry Dynamics

The consolidation of health care markets and the impact of this consolidation on prices, costs, and quality, has been a hotly debated topic in the health care industry. Hospitals across the country are merging and acquiring...more

Early Report on Value-Based Purchasing: Less to It Than Meets the Eye?

Medicare’s Value-Based Purchasing (VBP) program produced no improvement in either quality of care or patient satisfaction during its first nine months of operation. That’s the finding of a study led by Andrew Ryan, of the...more

Nursing Facility Survey Trends - Directed Plans of Correction, Privacy Violations and FTag 520 Quality Assurance Committee...

Directed Plans of Correction, or DPOCs, have long been part of the arsenal of enforcement sanctions available to the Centers for Medicare & Medicaid Services for survey deficiencies, just like civil money penalties (CMPs);...more

Anatomy of an Independent Primary Care ACO – Part II

Our Secret Weapon and Our Biggest Disappointment - In our last column, we highlighted the Rio Grande Valley Health Alliance, an accountable care organization in McAllen, Tex., composed of 14 independent primary care...more

Worthless Services/Substandard Quality of Care Criminal Prosecutions May Be on the Rise

If you are an operator of a skilled nursing facility (SNF), you might have faced the reality of insufficient medical staff and how it impacts your ability to deliver quality patient care to your residents. Or, you might have...more

Health Care E-Note - June 19, 2014

In This Issue: - Report Ranks U.S. Last Out of 11 in Health Care System Quality - Analysis Identifies Un-Tracked Avoidable Hospital Complications - Number of Doctors Employed by Hospitals Grew 34% Over 10...more

OIG Compendium of Priority Recommendations—Are You Ready?

What’s Happening? The U.S. Department of Health and Human Services (“HHS”), Office of Inspector General (“OIG”) recently released the Compendium of Priority Recommendations (the “OIG Compendium”). This annual...more

Recent Nursing Facility CON Decision Creates Controversy - What Is “Past Quality of Care” in a CON Review?

A recent decision in the Wake County nursing facility certificate of need (CON) case includes a new take on quality of care in the CON context that might well impact future applications and reviews. The case arose from...more

Doctors Going To Jail: Criminal Prosecutions For Quality Of Care And Fraud

When I was growing up (and probably for generations), every proud parent wanted their son or daughter to go to medical school....more

OIG Recommends Increased CMS Enforcement of SNF Standards

Amid alleged failures of skilled nursing facilities to meet care and discharge planning requirements, OIG identifies substantial payment errors....more

Oklahoma, OK and Not OK: The Right and Wrong Paths to Provider Joint Contracting

In the view of the FTC and the Justice Department, competing health care providers can contract jointly with third-party payers only if the providers integrate clinically (or financially) so that gains in efficiency and...more

Illinois Jury Found Nursing Home Liable For $28.1 Million In Whistleblower Case Alleging Substandard Care And Resident Abuse

An Illinois district court jury in United States v. Momence Meadows Nursing Center, Inc. recently issued a verdict on February 11, 2013 imposing $28.1 million in civil penalties on the operators of a nursing home. The nursing...more

Protecting Your Hospital From Over-Utilization Prosecutions

The government has been increasing its focus on healthcare fraud involving “quality” of care. This is an extremely difficult issue, especially for prosecutors. It is very difficult to define “quality” standards and then...more

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