MichiganMichigan Department ofDepartment of Community HealthCommunity Health

Bureau of Health SystemsBureau of Health SystemsMike PembleMike Pemble

DirectorDirector

Joint Provider/Surveyor TrainingJoint Provider/Surveyor TrainingMarch 30, 2010March 30, 2010

Complaints VS. FRIsComplaints VS. FRIs

Intake HistoryIntake History

1092

274

1139 1031 1104

5135

1260

3646

1285

5644

1257

5063

0

1000

2000

3000

4000

5000

6000

FY 2004 FY 2005 FY 2006 FY 2007 FY 2008 FY 2009

Complaints FRI's

Source: ACO 3/22/10

Health SystemsHealth Systems

License, certify and regulate facilitiesLicense, certify and regulate facilities 443 Nursing Homes / 174 Hospitals443 Nursing Homes / 174 Hospitals 1,496 Substance Abuse Facilities1,496 Substance Abuse Facilities 571 Home Health Agencies (19% increase)571 Home Health Agencies (19% increase) 7,397 Clinical and Physician Office Labs7,397 Clinical and Physician Office Labs 10,080 Radiological Facilities10,080 Radiological Facilities

Complaint / Enforcement Activity (FY09) Complaint / Enforcement Activity (FY09) 2,657 Radiation Safety Violations (5% increase)2,657 Radiation Safety Violations (5% increase) 2,133 LTC Care Facility Investigations (28% increase)2,133 LTC Care Facility Investigations (28% increase) 3,422 Abuse Allegations (7% decrease)3,422 Abuse Allegations (7% decrease) 1,257 Complaint Intakes1,257 Complaint Intakes 5,063 Facility Reported Incident Intakes (10% 5,063 Facility Reported Incident Intakes (10%

decrease)decrease) 463 Standard Surveys (12% increase)463 Standard Surveys (12% increase)

Health SystemsHealth Systems Key AccomplishmentsKey Accomplishments

Reduced Reduced nursing home complaintnursing home complaint backlog 80% since beginning of backlog 80% since beginning of FY09 from 22 months (882 open intakes) to 3 months (177 open intakes) FY09 from 22 months (882 open intakes) to 3 months (177 open intakes) currently.currently.

2468

101214161820222426

Oct. 2008 Jan. 2009 July 2009 Dec 2009 Feb. 2010

Health SystemsHealth Systems Other Key AccomplishmentsOther Key Accomplishments

Innovative nurse recruitment techniques Innovative nurse recruitment techniques result in filling most health care result in filling most health care surveyor vacancies surveyor vacancies

Improved coordination and efficiencies Improved coordination and efficiencies in the survey process - Combined annual in the survey process - Combined annual and abbreviated surveysand abbreviated surveys

Improved communication with provider Improved communication with provider communitycommunity

Budget UpdatesBudget Updates

Furlough and banked leave days Furlough and banked leave days

State employee retirement proposalState employee retirement proposal

Health Systems Funding: 18% GF, 20% Licensing Health Systems Funding: 18% GF, 20% Licensing Fees, and 62% Federal (Title 18 and Title 19)Fees, and 62% Federal (Title 18 and Title 19)

One of eight states nationally to receive ARRA One of eight states nationally to receive ARRA grant to help reduce the spread of infections grant to help reduce the spread of infections acquired in outpatient surgery centers.acquired in outpatient surgery centers.

$1.4 million increase in Title 18 (Medicare) funding $1.4 million increase in Title 18 (Medicare) funding in FY10in FY10

Nursing Home Baseline Nursing Home Baseline

Survey Trends 2010Survey Trends 2010

Health Facilities Health Facilities Surveys & InspectionsSurveys & Inspections

Aging BuildingsAging Buildings Aging RoofsAging Roofs Minimally Sized Emergency GeneratorsMinimally Sized Emergency Generators Low Lighting LevelsLow Lighting Levels No Make-up Air to Resident RoomsNo Make-up Air to Resident Rooms Conversion of Required Day/Dining SpaceConversion of Required Day/Dining Space Elimination of RequiredElimination of Required Central Bathing Central Bathing

FacilitiesFacilities

Heating ConsiderationsHeating Considerations

Subzero WeatherSubzero Weather Cold Weather DesignCold Weather Design Building ConcernsBuilding Concerns

InsulationInsulation Single Pane WindowSingle Pane Window Metal FramesMetal Frames Leaks and InfiltrationLeaks and Infiltration

Baseline Surveys CompletedBaseline Surveys Completed Over 90 nursing Over 90 nursing homeshomes Over 10,000 licensed bedsOver 10,000 licensed beds Avg size NH surveyed - 115 bedsAvg size NH surveyed - 115 beds Oldest NH orig build date of 1927Oldest NH orig build date of 1927 47 had portions built before 196947 had portions built before 1969

Sprinkler Sprinkler SystemsSystems ByBy August 2013August 2013

SMOKING BAN SMOKING BAN May 1, 2010May 1, 2010 (House Bill 4377)(House Bill 4377)

Excerpt Section 12603 (1)Excerpt Section 12603 (1) An individual shall not An individual shall not smoke in a public smoke in a public place……..place……..

Section 12601 (1) (q) “Public place”, except as otherwise provided in subsection (2), means any of the following:

(i) An enclosed, indoor area owned or operated by a state or local governmental agency and used by the general public or serving as a meeting place for a public body, including an office, educational facility, home for the aged, nursing home, county medical care facility, hospice, hospital long-term care unit, arena meeting room, or public conveyance.

(ii) An enclosed, indoor area that is not owned or operated by a state or local governmental agency, used by the general public, and is any of the following:

A home for the aged, nursing home, county medical care facility, hospice, or hospital long-term care unit.

Average Number of DeficienciesAverage Number of DeficienciesStandard SurveysStandard Surveys

8.49

8.17.8

6.9

0

1

2

3

4

5

6

7

8

9

10

CY2004 CY2005 CY2006 CY2007 CY2008

Source: CMS Nursing Home Data Compendium 2009

Michigan Michigan LTC Complaints/FRIs Prioritized as Immediate LTC Complaints/FRIs Prioritized as Immediate

JeopardyJeopardy

121

252

140117

188

927461

90

50

100

150

200

250

300

FY2001

FY2002

FY2003

FY2004

FY2005

FY2006

FY2007

FY2008

FY2009

Source: PPM Reports

Analysis of Disputed Citations Analysis of Disputed Citations FY 09FY 09

Total of all health citations 4,419Total of all health citations 4,419

Total number of standard survey citations 3,847Total number of standard survey citations 3,847

(Average 8.5 per survey)(Average 8.5 per survey)

Total number of complaint survey citations 572 Total number of complaint survey citations 572

(Average .9 per survey)(Average .9 per survey)

Number of health citations appealed through the IDR Number of health citations appealed through the IDR process 305 (7% of total)process 305 (7% of total)

BHS NH Survey Report - October 2009

Informal Deficiency Review Statistics Informal Deficiency Review Statistics 20092009

Total tags reviewed 305Total tags reviewed 305BHS=195 (64%) MPRO=110 (36%)BHS=195 (64%) MPRO=110 (36%)

195

110

0

50

100

150

200

BHS MPRO

Source: BHS-Enforcement Data

Informal Deficiency Review StatisticsInformal Deficiency Review Statistics20092009

Total tags supported 200 (66%)Total tags supported 200 (66%)

Source: BHS-Enforcement Data

BHS= 124 (64%) MPRO= 76 (69%)

37

21

2824

27 28

32

3

0

5

10

15

20

25

30

35

40

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

BHS MPRO

Informal Deficiency Review Statistics 2009Informal Deficiency Review Statistics 2009Total Tags Amended 40 (13%)Total Tags Amended 40 (13%)

BHS=27 (14%) MPRO=13 (12%)BHS=27 (14%) MPRO=13 (12%)

6

8

3

1

12

3

6

1

0

2

4

6

8

10

12

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

BHS MPRO

Source: BHS-Enforcement Data

Informal Deficiency Review Statistics 2009Informal Deficiency Review Statistics 2009Total Tags Deleted 65 (21%)Total Tags Deleted 65 (21%)

BHS=44 (23%) MPRO=21 (19%)BHS=44 (23%) MPRO=21 (19%)

56

11

7

14

6

14

2

0

2

4

6

8

10

12

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

BHS MPRO

Source: BHS-Enforcement Data

U.S. CensusU.S. Census The Department of Community Health is pleased to The Department of Community Health is pleased to

support the efforts of the 2010 Census.support the efforts of the 2010 Census.

The Census is a count of everyone living in the The Census is a count of everyone living in the United States. Most people should be counted in United States. Most people should be counted in the residence in which they sleep. The 2010 the residence in which they sleep. The 2010 Census data is used to apportion seats in Congress Census data is used to apportion seats in Congress and directly affects how more than $400 billion per and directly affects how more than $400 billion per year in federal funding is distributed to state, local year in federal funding is distributed to state, local and tribal governments. and tribal governments.

According to the Census Bureau, Census staff will According to the Census Bureau, Census staff will visit each nursing home and complete the Census visit each nursing home and complete the Census form for each resident. form for each resident.

Keynote Speaker:Keynote Speaker:

Dr. Larry LawhorneDr. Larry Lawhorne

“Managing Residents “Managing Residents on on

Psychoactive Drug Therapy”Psychoactive Drug Therapy”