The American College of Health Care Administrators (ACHCA) hosted a unique CEO Leadership Panel at its recently concluded Annual Convocation. The Panel engaged the top leaders of all the major long term health care associations in a dialogue about the challenges to providing care to older adults and disabled individuals in a time of tightening resources, fewer workers and an influx of patients. View the CEO Leadership Panel for free. Viewers can also earn 1.75 hours of free CE credits.

"The CEOs discussed the impact of a troubling demographic for long term health care," Marianna Kern Grachek, President and CEO of ACHCA said. "Namely, there will be 34 million fewer people between the Baby Boom generation and Generation X. This 'people' gap will intensify the shortage of revenues that fund Medicaid and Medicare, while shrinking the already shallow pool of available caregivers and other staff."

The CEO Leadership Panel was part of ACHCA's 46th Annual Convocation and Exposition in Nashville, Tennessee. Panelists included:

• Mark Parkinson, President & CEO, American Health Care Association/National Center for Assisted Living (AHCA/NCAL)
• Dr. Larry Minnix, President and CEO, LeadingAge
• Rick Grimes, President and CEO, Assisted Living Federation of America (ALFA)
• Randy Lindner, President & CEO, National Association of Boards of LTC Administrators (NAB)
• Marianna Kern Grachek, President and CEO, ACHCA
• Dan Farley, Ph.D., President and CEO, Glenwood Park Retirement Village and clergy with the United Methodist Church

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This is something you rarely think about - aging prisoners. And how they are like the rest of society when it comes to aging. That is why this New York Times article in fascinating. It takes a look into a world we seldom pay attention to ourselves.

According to the Times, "Dementia in prison is an underreported but fast-growing phenomenon, one that many prisons are desperately unprepared to handle. It is an unforeseen consequence of get-tough-on-crime policies -- long sentences that have created a large population of aging prisoners. About 10 percent of the 1.6 million inmates in America's prisons are serving life sentences; another 11 percent are serving over 20 years.

Experts say that prisoners appear more prone to dementia than the general population because they often have more risk factors: limited education, hypertension, diabetes, smoking, depression, substance abuse, even head injuries from fights and other violence. And that means they are more prone to falling and other mishaps, resulting in hospitalization and rehospitalizations.

Prisons are unprepared. Some are using other inmates to care for the dementia patients. That is what the bulk of the article covered.

Others would like to transfer inmates to nursing homes. I'd like to see how that would go over. New York State has built their own skilled nursing units.

So this brings up an interesting topic - inmates as a business opportunity. I am not trying to be harsh but the harsh reality is that these elders need help. Do they deserve help? Not for me to say. Could their unchecked dementia and Alzheimer's be exacerbated and affect us? Certainly since we are paying for their care.

So if taking care of this population becomes more of a priority, who better to do it than the industry that has the expertise in it.

I am not sure if New York State partnered with a skilled provider or consulted with them to build a unit but it would seem that this type of expertise is needed.

It is not a new phenomenon. A good friend of mine runs lab services for prisoners based in a hospital nearby. So clearly hospitals have seen business opportunity in prison populations.

The moral and ethical dilemma is clear and everyone will have their own take. But there is no doubt that the business opportunity is growing.

Alzheimer's currently affects 5.4 million Americans, a number expected to double by 2040. Experts believe that Alzheimer's disease in prisons could grow two or three times as fast.

What do you think?

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@Bill Fritsch,Getty Images

When a beneficiary begins home health care, and at regular intervals thereafter, a registered nurse or rehabilitation therapist conducts a comprehensive assessment of the beneficiary using the OASIS, a standardized dataset. Home Health Agencies (HHAs) use the OASIS to assess patients' continuing need for home care and to identify patients' medical, nursing, rehabilitative, social, and discharge-planning needs.

A recent report by the Office of Inspector General evaluated OASIS data submission from 2009 and the extent to which CMS oversaw the accuracy and completeness of OASIS data that HHAs submitted. They also evaluated whether the 2-percent payment reduction for HHAs was enforced and compared claims from 2009 against OASIS data submission.

The analysis found that HHAs were deficient in meeting two Federal reporting requirements for OASIS data: that HHAs submit OASIS data for all Medicare beneficiaries they serve and that they submit them within 30 days from the date of the patient assessment.

Medicare reimbursement and consumer information presented on CMS's Web site depend on accurate and timely submission of OASIS data. In addition, State survey staff use OASIS data in surveying and certifying HHAs to ensure that HHAs are meeting all Conditions of Participation (CoP) required by Medicare.

CMS requires HHAs to submit OASIS data to their States for all Medicare beneficiaries they serve. State agencies are responsible for collecting and managing OASIS data. An HHA's failure to submit data should result in a 2-percent payment reduction to its home health market basket index increase for a year. CMS works with Medicare contractors to identify HHAs that have submitted claims but have not transmitted any OASIS data.

• HHAs did not submit required OASIS data for 6 percent of claims in 2009, which represented over $1 billion in Medicare payments. Submitting OASIS data did not become a Medicare condition of payment until January 1, 2010.


• Eight-five percent of HHAs did not submit OASIS data for at least one claim. Over half of those HHAs did not submit OASIS data for at least 10 claims in 2009.


• From 2007 through 2010, CMS penalized only 199 HHAs by assessing the 2-percent payment reduction for not submitting OASIS data. CMS officials told OIG it penalizes only those HHAs that failed to submit any OASIS data for that year. An HHA needs to submit only one OASIS out of potentially hundreds or thousands during the yearlong reporting period to avoid the 2-percent payment penalty.


• HHAs submitted 15 percent of OASIS datasets late.


• States showed that they provided training and support for OASIS and that most restricted access to the data. However, they conducted limited data analysis or review of the data's accuracy. Forty-seven States reported that they did nothing beyond CMS automated checks. Only three States reported that they further validated data by checking for missing data and reconciling duplicate patients. No States reported conducting analyses to ensure that the OASIS data accurately reflected patients' conditions at the time of assessments.


• CMS did not review OASIS data collected by States for accuracy or completeness.


• CMS did not validate States' processes for monitoring submitted OASIS data.

The OIG recommend that CMS:

1. Identify all HHAs that failed to submit OASIS data and apply the 2-percent payment reduction to them.


2. Establish and implement enforcement actions for HHAs that submit OASIS data after the 30-day deadline.


3. Develop clear guidelines that delineate expectations for States regarding timely and accurate OASIS data.

CMS concurred with the first recommendation, but it did not concur with the second and third recommendations. CMS is pursuing a plan of action consistent with the first.

The OIG recommended that CMS should work with States outside the survey process and develop guidelines that States could follow to improve the quality and accuracy of OASIS data.

With increased scrutiny of home health care and more measurements emerging to track home care, the industry seems poised for a shakeup, weeding out the bad apples and keeping top performers. Consumers will get wise to all of this as well and will be shopping on quality, price and overall experience.

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@Getty Images

Our colleagues at Advance for Long-Term Care Management recently published their expanded annual salary survey to include more professional titles in long-term care. The average salary, which includes all long-term care titles, was $85,036, up from $83,563 last year.

I particularly like the infographic style of presentation, which you will see when you download the report.

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