MichiganMichigan Department ofDepartment of Licensing Licensing and Regulatory Affairs (LARA)and Regulatory Affairs (LARA)

Bureau of Health SystemsBureau of Health SystemsMike Pemble, DirectorMike Pemble, DirectorSeptember 13, 2011September 13, 2011

ForFor

Joint Provider Surveyor TrainingJoint Provider Surveyor Training

Health SystemsHealth Systems License, certify and/or regulate facilities:License, certify and/or regulate facilities:

442 Nursing Homes 442 Nursing Homes 174 Hospitals 174 Hospitals 10 Psychiatric Hospitals / 50 Licensed Psychiatric Programs10 Psychiatric Hospitals / 50 Licensed Psychiatric Programs 9 Organ Transplant Facilities9 Organ Transplant Facilities 581 Home Health Agencies 581 Home Health Agencies 111 Hospice Programs and 22 Hospice Residences 111 Hospice Programs and 22 Hospice Residences 196 End Stage Renal Disease (Dialysis)196 End Stage Renal Disease (Dialysis) 153 Rural Health Clinics 153 Rural Health Clinics 70 Freestanding Surgical Outpatient Facilities (26 licensed only)70 Freestanding Surgical Outpatient Facilities (26 licensed only) 54 Ambulatory Surgical Centers54 Ambulatory Surgical Centers 19 Comprehensive Outpatient Rehabilitation Facilities and 11 19 Comprehensive Outpatient Rehabilitation Facilities and 11

Portable X-Ray FacilitiesPortable X-Ray Facilities 209 Rehabilitation Facilities (formerly Outpatient Physical Therapy) 209 Rehabilitation Facilities (formerly Outpatient Physical Therapy) 7,397 Clinical and Physician Office Labs7,397 Clinical and Physician Office Labs 10,038 Radiological Facilities10,038 Radiological Facilities

BHS Staffing

2010 Early Retirement Incentives

75 Vacancies since 10-1-10 (33%)

Filled 58 Positions

17 Remain Vacant

Approximately 1 Year HCS Independence

Potential Worker Concessions FY12

Health SystemsHealth Systems

Key Accomplishments:Key Accomplishments:

Eliminated long standing Eliminated long standing nursing home complaintnursing home complaint backlog (continuous challenge to maintain)backlog (continuous challenge to maintain)

Innovative nurse recruitment techniques assist in filling Innovative nurse recruitment techniques assist in filling health care surveyor vacancies (10 currently)health care surveyor vacancies (10 currently)

Improved coordination and efficiencies in the survey Improved coordination and efficiencies in the survey process (e.g. combined revisits)process (e.g. combined revisits)

Improved Timing of Survey Report Issuance Improved Timing of Survey Report Issuance Biannual Joint Provider-Surveyor Training Attendance Biannual Joint Provider-Surveyor Training Attendance

at All Time High (835 today) at All Time High (835 today) Improved communication with provider communityImproved communication with provider community

CMS Region V – ChicagoCMS Region V – ChicagoTotal All Provider TypesTotal All Provider Types

Ohio – 12,993Ohio – 12,993 Nursing homes: 955Nursing homes: 955Illinois – 12,219Illinois – 12,219 Nursing homes: 788Nursing homes: 788Michigan – 9,450Michigan – 9,450 Nursing homes: 428Nursing homes: 428Indiana – 7,218Indiana – 7,218 Nursing homes: 503Nursing homes: 503Minnesota – 4,676Minnesota – 4,676 Nursing homes: 386Nursing homes: 386Wisconsin – 4,509Wisconsin – 4,509 Nursing homes: 390Nursing homes: 390

Source: OSCARSource: OSCAR

Total Number of Surveys Conducted - All Providers (Standard, Complaints, Revisits, LSC)

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

FY 2007

FY2008

FY 2009

FY 2010

FY 2007 9083 6515 2800 3022 8577 2929

FY2008 9437 6736 3065 3204 9109 3021

FY 2009 8979 6854 3395 3091 8882 3194

FY 2010 7673 6301 4044 2976 7930 2563

IL IN MI MN OH WI

Source: CASPER 11/29/2010

Michigan is the only state in Region V that shows an increase in the number of surveys conducted in FY 2010.

Complaint Response TimeComplaint Response Time

Average Number of Days from Receipt of Average Number of Days from Receipt of Complaint to Surveyor OnsiteComplaint to Surveyor Onsite

Non IJ High Priority Complaints:Non IJ High Priority Complaints:

2007 – 102.5 days2007 – 102.5 days

2008 – 105.7 days2008 – 105.7 days

2009 – 84.5 days2009 – 84.5 days

2010 – 23.4 days2010 – 23.4 days

2011 to date – 15.9 days2011 to date – 15.9 days

  IL - 788 IN - 503 MI - 428 MN - 386 OH - 955 WI - 390

FY 2007 770 422 335 389 870 358

FY 2008 789 483 409 392 880 398

FY 2009 773 532 463 390 891 373

FY 2010 757 521 461 390 895 330

Total Number of Surveys Conducted Long Term Care – Standard Health Surveys

Source: CASPER 1/3/2011

The number of LTC standard surveys in FY 2010 has decreased in four of six states in Region V. However, Michigan standard surveys held steady for the year. The number of completed standard surveys in Michigan for FY10 is 38% higher than FY07.

1092

274

1139 1031 1104

5135

1260

3646

1285

5644

1257

5063

1295

4443

0

1000

2000

3000

4000

5000

6000

FY 2004 FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 FY 2010

Complaints vs. FRI's Intake History - Michigan

Source: ACTS 11/17/2010

Source: CASPER 11/29/2010

Michigan is the only state in Region V that shows an increase in the number of complaint surveys conducted in FY 2010.

Total Number of Surveys Conducted, Long Term Care - Complaint Health Surveys

0

500

1000

1500

2000

2500

3000

FY 2007

FY 2008

FY 2009

FY 2010

FY 2007 2846 1584 555 411 2226 896

FY 2008 2742 1450 616 503 2452 858

FY 2009 2826 1443 721 516 2052 913

FY 2010 2430 1434 1503 511 2058 798

IL IN MI MN OH WI

Root Cause Analysis of IncidentsRoot Cause Analysis of Incidents

““Why” (vs. How) did this incident occur?Why” (vs. How) did this incident occur?Are any other residents at risk for similar Are any other residents at risk for similar occurrences?occurrences?What can be done differently so this What can be done differently so this doesn’t happen again to any resident?doesn’t happen again to any resident?Implement new plan.Implement new plan.Monitor Closely to Determine Monitor Closely to Determine Effectiveness.Effectiveness.Modify as Needed.Modify as Needed.

Total Number of Surveys Conducted Long Term Care – Revisit Health Surveys

Source: CASPER 1/03/2011

MI has increased the numbers of revisits by 52% since 2007. No other state in Region V shows this type of increase.

0

200

400

600

800

1000

1200

1400

1600

1800

FY 2007

FY 2008

FY 2009

FY 2010

FY 2007 1570 1044 637 445 1373 597

FY 2008 1630 1131 777 455 1514 618

FY 2009 1730 1040 867 467 1520 692

FY 2010 1506 1052 968 458 1428 575

IL IN MI MN OH WI

Issuance of 2567 ReportsIssuance of 2567 Reports

Time period evaluated – 5/30/11 thru 9/9/11 (15 wks)Time period evaluated – 5/30/11 thru 9/9/11 (15 wks)

Target is to issue all reports within 10 business daysTarget is to issue all reports within 10 business days

BHS issued 604 reports in this time frameBHS issued 604 reports in this time frame

84% of all reports were issued within 10 days84% of all reports were issued within 10 days

Average for all reports was 8 daysAverage for all reports was 8 days

Reports that went beyond 10 days averaged 17 daysReports that went beyond 10 days averaged 17 days

Initiatives and GoalsInitiatives and Goals

Consistency Work GroupConsistency Work Group Electronic Plan of CorrectionElectronic Plan of Correction Posting of Survey Reports Posting of Survey Reports Hot Weather Issues: Baseline Physical Hot Weather Issues: Baseline Physical

Plant SurveysPlant Surveys Continued Improvement for Report TimelinessContinued Improvement for Report Timeliness Elder Justice Act: Reporting of CrimesElder Justice Act: Reporting of Crimes Independent IDR / PPACAIndependent IDR / PPACA Continued Collaborative Provider RelationsContinued Collaborative Provider Relations

Reporting of Events to BHSReporting of Events to BHS

Nursing Home Sprinkler StatusNursing Home Sprinkler Status

Federal deadline: August 13, 2013Federal deadline: August 13, 2013

Number of certified MI NH’s: 428Number of certified MI NH’s: 428

NH’s fully sprinklered: 325 (76%)NH’s fully sprinklered: 325 (76%)

NH’s NOT fully sprinklered: 103 (24%)NH’s NOT fully sprinklered: 103 (24%)

148 letters sent 8/10/11; 77 responses148 letters sent 8/10/11; 77 responses

Keynote AddressKeynote Address

Dr. Chuck Gokoo, MD, CMO, CWS, Dr. Chuck Gokoo, MD, CMO, CWS, FACCWSFACCWS

““A Clinical Guide to the F314 Tag”A Clinical Guide to the F314 Tag”