Washington, D.C.—Good morning, ProviderNation. Congratulations to all of you who bought Mark Parkinson stock early: On Thursday, the AHCA/NCAL overlord was named to The Hill’s “Top Influencer” list for the third year in a row.
“The nursing homes group led by the former Democratic Kansas governor was an early supporter of Congress’ ‘doc fix’ legislation, which eliminated a decade-old automatic payment cut,” The Hill says in its accolade.
Meanwhile, Parkinson has picked up some more allies in his critique of CMS’ proposed “requirements of participation” rulemaking. In an editorial in the latest edition of JAMDA, a trio of experts is pushing against proposed rules that would require a doctor to evaluate any care center resident before he or she could be taken for an unscheduled trip to the hospital.
‘Neither Safe Nor Feasible’
“Although we agree that an appropriate evaluation of a … patient before an unscheduled transfer is highly desirable and may prevent unnecessary transfers, the nature and timing of such cannot and should not be legislated,” say Florida State University geriatrician Paul Katz, University of Maryland nursing Professor Barbar Resnick, and Florida Atlantic Univeristy School of Medicine Professor Joseph Ouslander.
The trio say they’re worried the proposed rule would “create a burdensome and unfunded mandate that is neither safe nor feasible.”
“Rather than mandated on-site examinations,” their op-ed says, “other more practical approaches should be considered. Might a ‘bigger bang for the buck’ be had by requiring improved communication between hospitals” and nursing homes (NHs)? “For example, requiring direct clinician-to-clinician communication and/or explicit and timely transfer of critical clinical data before transfer from hospital to NH or vice versa? Such an approach recognizes that NHs do not operate in isolation and are significantly dependent on the adequacy of information provided by their acute care hospital partners.”
Back To The Drawing Board
As provider advocates have done almost in unison, Katz et al. argue that regulators deserve credit for trying, but really ought to go back to the old drawing board.
“Preventing unnecessary transfers and their related complications and costs is a desirable goal, but is not an end in itself,” they say. “The underpinnings of unnecessary hospital transfers are multifactorial in nature and reflect core workforce issues, patient-centered decision making, and financial and regulatory incentives that affect care in the NH setting.” The experts say they encourage people at the Department of Health and Human Services to “deepen their investment around these issues in their quest to improve the quality of care in U.S. NHs over the next several years.”