Only two of Utah's Medicare and Medicaid certified nursing homes have been fined in the past 18 months. But more than two-thirds of the facilities have had to correct problems ranging from very mild to serious.
State inspectors visit nursing homes that receive Medicaid or Medicare funding - in Utah, that's 95 facilities - at least once every 15 months, according to Allan Elkins, director of the Bureau of Medicare-Medicaid Program Certification and Resident Assessment. The bureau oversees the inspections. Only three nursing homes are licensed but not certified to receive Medicaid or Medicare because they have other revenue sources.Medicaid is a program where the federal government matches every dollar Utah contributes with about $3. It provides health care to people who are very low income and also fit into other categorically eligible categories, like having a disability or being elderly. Medicare is the federal health-insurance program for senior citizens, who pay premiums and deductibles.
Between July 1, 1995, and Nov. 1, 1996, Elkins' teams surveyed 104 nursing homes, which included repeat visits to about nine.
"The tremendous majority of facilities in Utah have relatively minor problems, even if they were found to be out of compliance," said Elkins.
Surveyors look at several hundred items to decide if a facility meets federal and state standards. The spectrum of items checked include simple things like whether a facility gives patients and families notice of their rights and the services available under Medicare or Medicaid when they enter the nursing home to how well fed and cared-for the patients are.
Most of the issues revolve around whether a facility assesses and meets patient health-care needs, environmental safety and professional services that must be delivered. More attention is now being paid to patient outcomes, as well.
In the 104 inspections, the surveyors found 16 facilities with problems severe enough that civil fines could be imposed. But 14 of the facilities corrected the problems and avoided the fines. One received a hefty fine and another is appealing its monetary sanction.
Still, in the 104 inspections, 72 facilities were found "not in complete compliance," Elkins said. "We had to require some sort of action on their part: sometimes proposing a fine or requiring a plan of correction be done or threatening with termination of the Medicare or Medicaid contract."
Emphasis, he said, from both the federal and state levels is placed on solving the problems, rather than closing facilities. Exceptions occur when patients are in immediate and serious jeopardy or facilities that are "poor performers," based on significant repeat deficiencies.
Only 32 of the facilities were found to be in substantial compliance and "even they generally have a few lesser problems," Elkins said.
But everything is ranked by scope and severity of the deficiencies. Four of the 104 facilities were found to have substandard care.
Elkins' inspectors propose sanctions in any case where Medicare funding is at stake, but the federal government actually imposes the penalty.
In Medicaid cases, information is provided to the Division of Health Care Financing, which administers Medicaid, but Elkins' office has authority to act on the penalties. If a facility receives both types of funding, the Medicare rules apply.
Of the 95 nursing homes, 17 received Medicaid funding only, with no Medicare component. Most receive both.
An estimated 73 percent of the people in nursing homes are paid for by Medicaid, while about 11 percent receive Medicare funding.