| David S. Barmak, Esq. |
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Licensed to practice law in the States of New Jersey, New York, Connecticut and Pennsylvania
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| Are DMEPOS Suppliers Permitted to Substitute for SNF Discharge Planners and Case Managers? |
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I was recently asked if a Skilled Nursing Facility (SNF) may outsource its discharge planning and case management role to a homecare agency in exchange for referring the patient to that homecare agency for homecare services. The same may be asked of a Distributor of Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) supplier that provides post-operative training in the SNF and assists in the discharge planning and case management process while the patient is still an in-patient at the facility. The short answer is "no".
Many years ago, I developed a one stop shop homecare program called "Allcare" for a number of orthopedic surgeons attending to patients at numerous hospitals in New York City. The program involved pre-operative homecare visits by a registered nurse to assess the home environment and to pre-operatively instruct the patient on the use of a walker and a cane; to follow up with the patient during the hospital stay, to provide DMEPOS in the hospital for home use upon discharge, and to provide immediate nursing and therapy follow-up in the home upon discharge. The most difficult challenge along this full continuum of care was to persuade the hospitals to refer the patient to the homecare agency and DMEPOS suppliers participating in the "Allcare" program. The hospitals were accustomed to referring patients to homecare agencies that literally substituted personnel for the hospitals' own discharge planning and case management departments. Short-staffed, underfunded, overworked discharge planning and case management departments favored only those homecare agencies that would shoulder the burden of participating in the discharge planning process, including initial implementation of discharge plans, subsequent modification of discharge plans, and communication of all necessary medical information.
Well, how times have changed! It appears clear from a Special Fraud Alert published in August of 1995, issued by the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services, the enforcer for the federal government of fraud and abuse issues involving Medicare and Medicaid, that post-acute providers (and by logical extension post-acute suppliers) are not permitted to provide services for discharge planners and case managers that the SNF is supposed to provide through its discharge planners and case managers. It is clear from the OIG Special Fraud Alert that homecare agencies and DMEPOS suppliers are engaging in prohibited kickback activity if they provide SNF with "discharge planners, home care coordinators or home care liaisons in order to induce referrals". It is very likely that this prohibition would also extend to the home care agency and DMEPOS supplier paying a third party, unrelated to the SNF, to do that which if the home care agency and DMEPOS supplier were to do would be considered a kickback. In other words, bear the burden, financial and labor, of relieving discharge planners and case managers of the efforts involved with the discharge process. If you need additional information contact our office, at (609) 688-0055 or email me, David S. Barmak at david@barmak.com. |
| 1st In New Jersey - Green Hill
The Green House® Homes
A revolutionary skilled model of nursing assisted living care for seniors |
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Toni Lynn Davis grew up exploring the hallways of Green Hill Senior Living Center in West Orange. Her mother was the Executive Director for 46 years. Now, Toni is Executive Director and President, leading the 143 year old facility on the cutting edge of specialized senior care.
Green Hill is setting a new standard for senior care, and skilled nursing in New Jersey with the ground breaking of The Green House® Homes. The first of its kind in New Jersey, The Green House Homes are a revolutionary, non-institutional skilled nursing model for seniors.
Each Green House is a self-contained home for ten (10) residents who enjoy private bedrooms and bathrooms centered by a living area with a hearth, an open kitchen and dining area. With the look and feel of a real home, The Green House model combines small homes with a full range of personal care and clinical services. The model's operation and design is crafted to de-institutionalize skilled long-term care, and return dignity and a sense of well-being to residents, their families, and staff.
The six (6) state-of-the-art Green House Homes slated to be completed by December 2010 at Green Hill, Inc, meet all state and federal regulatory, and reimbursement criteria for licensure as skilled nursing facilities, and will replace the current fifty-seven (57) Medicaid/Medicare certified skilled nursing beds.
"For over 20 years my career focus has been to create a homelike environment for seniors in nursing care, built on the premise that senior care can, and should maintain ones dignity, nurture a sense of family and community, all while serving the unique medical needs of the aging", said Toni Lynn Davis, Executive Director, President, Green Hill Inc. "With this revolutionary concept in senior nursing care we can create a skilled nursing unit in a home, bringing our most revered elders back home where they belong!"
For more information about The Green House Homes extraordinary new concept in senior care in New Jersey, contact Toni Lynn Davis, Executive Director/President Green Hill at Tlynn@green-hill.com or (973) 325-6008, or log on to http://www.green-hill.com |
| In the Spotlight |
| Cheryl L. Nippins is the Director of Nursing at Crystal Lake Healthcare and Rehabilitation in Bayville, New Jersey.
Question: What is the most important quality for a CNA and nurse to have in order to be considered "professionals?"
Answer: "The most important thing for a CNA as well as a nurse to have is Heart".
Question: What does that mean?
Answer: "Heart" means having dedication to the resident. It means treating the resident as a human being. It's easy to say that we look at every resident as a human being but really that is very hard. Often nurses and CNAs see a diagnosis and not a human being to be cared for. The key is to feel empathy for the residents and to really understand where they are coming from - not just now that they are in the nursing home but where they came from before coming to the nursing home.
The residents of Crystal Lake are unique in the fact that most residents have mental illness or developmental disabilities on top of the normal challenges of our aging population. Their mood and behaviors can be unpredictable. Many residents have no family that is active with their care. Our staff understands the mistrust the residents feel and start building relationships with the residents upon admission. They do this by being available to the residents, doing what they say they will do and by always treating them with the deepest respect.
Each Resident is also individually care planned to incorporate not only the goals we as caregivers would like to see them demonstrate, but the resident's personal wishes. The Work Program is just one way to provide meaningful activities while restoring the resident's sense of self-worth by being productive. The program consists of jobs or tasks that the resident feels she/he would like to engage in with a small reward given for "A Job Well Done."
It truly takes a community of staff always willing to talk, encourage, and most importantly listen to our residents to keep this one-of-a-kind facility providing the best care!
Thank you, Cheryl for your participation and viewpoint.
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| Mission Statement - Reduce Your Risk Now |
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Our firm is dedicated to helping health care providers, in particular long term care facilities and their insurers, reduce costs by minimizing the risk of adverse events.
We do this by being proactive (pre-litigation strategies). This includes training and education of employees, review of policies and procedures, implementing communication channels, getting feedback through interviews and focus groups, and continuous monitoring and auditing. Vital to employee education is documentation training and effective communication training.
If an adverse event occurs, our response is promptly reactive (pre-litigation strategies). Mandatory, non-binding mediation is utilized whenever possible. Our goal is to quickly resolve disputes before they escalate and require resolution through the judicial system.
If a lawsuit is filed, the risk that existed has been realized (litigation strategies). Defense analysis, expert witnesses, focus groups, and mock trials are all part of litigation defense. Finally, we implement post-litigation risk management strategies to remedy the situation. To avoid a repeat occurrence, we continue staff training and education with a focus on prevention, as well as review and revise policies and procedures for greater effectiveness.
A comprehensive Compliance Program (also known as a Risk Management Program) focuses on early intervention through training, communication, and policy review. Monitoring and auditing are key elements to reduce medical liability exposure and improve patient safety.
David S. Barmak, Esq. received his JD from Cornell University and BA from Duke University. He is licensed to practice and serves clients in the States of New Jersey, New York, Connecticut and Pennsylvania. Before making your choice of attorney, you should give this matter careful thought. The selection of an attorney is an important decision. The recipient may, if the newsletter is inaccurate or misleading, report the same to the Committee on Attorney Advertising.
For more information, please contact us:
Telephone (609) 688-0055
Fax (609) 688-1199
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