From Mcknights - The Centers for Medicare & Medicaid Services has made more information about nursing home deficiencies available online. CMS began posting deficiency report information on the Nursing Home Compare and Five-Star Nursing Home Quality Rating System websites last July. The online materials, based on data from Form CMS-2567, Statement of Deficiencies and Plan of Correction, currently include the most recent standard health survey report and complaint surveys going back 15 months.

CMS has made older information available and is providing more detail about the deficiencies identified in these reports, according to a March 22 memo from Thomas E. Hamilton, director, Survey and Certification Group.

"We plan to expand the time period for which CMS-2567 reports are published (from the current single survey cycle to a period encompassing the preceding three standard health surveys and three years of complaint surveys)," Hamilton wrote. "Further, to improve the public's ability to interpret CMS-2567 findings, we also plan to add indicators for the scope and severity of each deficiency cited on the forms."

CMS does not post plans of correction (PoCs) online, and demand for these will likely increase as more deficiency information is made public, according to the memo. People can request the PoCs from CMS State Survey Agencies or directly from facilities, and federal law mandates the plans must be provided upon request. However, states already are supposed to post facility PoCs online, and CMS does link to state websites through Nursing Home Compare.

Obviously these reports should be on concern because consumers will use them in evaluating and choosing care so in many respects they become a marketing tool. The experience of care after all is the marketing.

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A study by Jacques Donzé, M.D., M.Sc., of Brigham and Women's Hospital, Boston, and colleagues suggests that a prediction model can identify before discharge the risk of potentially avoidable 30-day rreadmission in hospitalized patients.

The study at an academic medical center analyzed all patient discharges from any medical services between July 2009 and June 2010.

Potentially avoidable 30-day readmissions to three hospitals were identified using a computerized algorithm based on administrative data. Among 10,731 eligible discharges, 2,398 discharges (22.3 percent) were followed by a 30-day readmission, of which 879 (8.5 percent of all discharges) were identified as potentially avoidable, according to the study results.

The prediction score identified seven independent factors, referred to as the HOSPITAL score: hemoglobin at discharge, discharge from an oncology service, sodium level at discharge, procedure during the index admission, index type of admission, number of admissions during the last 12 months and length of stay.

"This score has potential to easily identify patients who may need more intensive transitional care interventions," the study concludes.

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Long-term care financing system for consumers must be revamped within five years to meet the needs of aging baby boomers, according to The SCAN Foundation. In eight reports the organization laid out policy recommendations for taking pressure off government programs while increasing the availability and affordability of long-term care financing for consumers.

The SCAN Foundation's policy brief series entitled, Shaping Affordable Pathways for Aging with Dignity, provides an updated body of intellectual capital on LTC financing options and approaches to facilitate a national policy dialogue. These papers build on various policy concepts developed over the last two decades, and account for recent health policy changes that are reshaping the current LTC financing discussion. Authored by an independent set of well-known experts, the papers accomplish four critical tasks:

• outline the state of LTC financing choices Americans have available today
• define opportunities to improve uptake of LTC financing mechanisms
• clarify the role of Medicaid spend-down and its effect on Medicaid financing
• propose a range of policy pathways that could increase the availability and uptake of LTC financing risk protection for middle-income Americans.

The overview brief linked to highlights the current state of LTC, describes the need for a set of affordable and accessible LTC financing solutions, links LTC financing to the ensuing entitlement reform debate, and provides a summary of each paper in the series.

"The current private long-term care insurance market is effectively broken, as it has never held more than 10% of the potential market and many insurers have stopped offering these policies altogether," stated Gretchen E. Alkema, Ph.D., vice president of policy and communications at The SCAN Foundation. "Reasons for lack of uptake are many: lack of public understanding and interest, high monthly premiums, and underwriting standards that make it difficult for individuals to qualify for coverage."

Almost one-third of all Medicaid spending in 2011 went to long-term care, according to National Health Policy Forum numbers cited by SCAN. Instituting a mandatory long-term care insurance program for workers is one option for bringing down this government spending without limiting access to care. A mandatory program of this type would bring Medicaid spending down $49 billion over 15 years, while a voluntary program would reduce spending by only $5.6 billion, according to an Avalere Health report funded by SCAN.

However, "recent debates over the design of the ACA highlight that there is little taste for new mandated benefits," wrote researchers from Harvard University and LifePlans Inc., in another of the SCAN reports. These researchers put forward a number of policy changes they believe are more realistic.

Simplifying long-term care insurance products and mandating that employers and other institutional purchasers offer this insurance along with standard healthcare packages will increase consumer understanding and demand they say. Private insurers should explore options for bringing down premiums, such as offering one or two-year deductible periods in addition to the standard 90-day period.

A robust consumer education program to raise public awareness of this issue is also a must, according to SCAN President and CEO Bruce Chernof, M.D. Along with devising "a new set of tools" for financing long-term care, addressing this "knowledge deficit" should be the top priority of the Congressional Commission on Long-Term Care, Chernof told McKnight's.

Perhaps the good people from SCAN have not looked at the economy recently. Mandated insurance should have been rolled out with the Affordable Care Act. Sailing that ship twice will be difficult. However I do agree that a great deal of education needs to take place. The public is fairly clueless about aging issues and more in denial of them than anything else. We all have a part in changing that.

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Assisted living regulations, statutes, and policies in 18 states were changed, according to the 2013 edition of "Assisted Living State Regulatory Review" published by the National Center for Assisted Living (NCAL).

"Nine states made major changes to their assisted living regulations last year. Colorado, Michigan, and New Jersey made innovative changes to their survey processes," said Karl Polzer, NCAL's senior policy director and the report's author. "Continuing a multi-year trend, more than one-third of states refined or developed assisted living regulations."

The annual report summarizes state assisted living regulations across 21 categories including life safety, physical plant requirements, medication management, and move-in/move-out criteria. The NCAL report is the only source that summarizes the assisted living regulations in 50 states and the District of Columbia that is published to inform the public.

An analysis accompanying the report identified several trends such as expanding disclosure and reporting requirements in five states--California, Florida, Ohio, Oregon, and Washington. The life safety or physical plant standards were changed in Missouri, North Dakota, Oregon, and West Virginia.

"State regulators work closely with NCAL and eagerly await this report to identify trends and find out what other states are doing," says David Kyllo, NCAL's executive director. "NCAL is proud to provide this complimentary and unique resource to consumers, regulators, legislators, assisted living professionals, aging organizations, media, and researchers."

The report also provides contact information for state agencies that oversee assisted living; and includes each agency's website address. The report along with an analysis of trends and state-by-state highlights is available online at NCAL.org.