The OIG established new requirements for the Self-Disclosure Protocol in what experts believe is an attempt to clear smaller cases from the OIG's plate. But legal experts say providers might find their own plates are filling up with violations they cannot disclose.
The OIG released an open letter to providers that put new limitations on the types of violations that could be reported using the Self-Disclosure Protocol. The OIG will no longer accept Stark Law violations that do not implicate the anti-kickback statute, and it also established a minimum settlement amount of $50,000.
"It's shocking" said Robert A. Wade, Esq., partner at Baker & Daniels, LLP, in South Bend, IN.
Wade said the new guidance seems to contradict the message the OIG originally sent when it established the Self-Disclosure Protocol in 2006. The Self-Disclosure Protocol was designed to create a means for providers to voluntarily bring violations to the government's attention without fear of further litigation.
The OIG not only allowed, but used to encourage providers to use the Self-Disclosure Protocol for Stark Law violations, according to Wade, but now the OIG has said it will not accept straight Stark violations.
That means a provider could potentially discover a multi-million dollar Stark violation, but if it doesn't also include "colorable violations of the anti-kickback statute" the provider cannot come clean to the government using the Self-Disclosure Protocol.
These changes have left some providers scratching their heads. Wade said he and a client were preparing to disclose a violation via the Self-Disclosure Protocol, but that violation no longer meets the OIG's new requirements.
However, Wade said providers have two options for violations that do not meet the new self-disclosure requirements—neither of which provide the same closure as the self-disclosure protocol.
The first option is to treat the violations like overpayments, and attempt to return the money through a Medicare carrier/fiscal intermediary.
Wade points out that carriers/fiscal intermediaries are not equipped to perform the duties necessary to ensure that the provider did its due diligences. This includes making sure the audit that discovered the violation was thorough, complete, and within an acceptable time frame. Wade said carriers/fiscal intermediaries must address this issue.
The second option providers have is to disclose the violation to the Department of Justice. This option also does not guarantee no further action, and Wade said this option is "not one you prefer to use."
Until further guidance comes advising providers what to do with theses lesser violations, they will need to either choose between these two options, or choose to do nothing and hope for the best.
Ben Amirault is an Editorial Assistant for the revenue cycle division of HCPro. He manages the Compliance Monitor e-newsletter and has developed a number of online learning modules. He can be reached at bamirault@hcpro.com.
When Rochester (NY) General Health System determined to cut down on Methicillin resistant Staphylococcus aureus (MRSA) in its cardiothoracic unit, the organization didn't just see the number of cases shrink—there has not been a MRSA case in the unit since January of 2008.
"It's all about execution," says Linda Greene, RN, MPS, CIC, director of infection prevention and control for the New York hospital system.
The organization pursued this goal as part of the Association for Professionals in Infection Control and Epidemiology's (APIC) Targeting Zero campaign.
"Since 2006, APIC has been promoting a Targeting Zero philosophy," says Liz Garman, the association's director of communications. "In keeping with APIC's mission and vision for 2012, Targeting Zero is the philosophy that every healthcare institution should be working toward a goal of zero (healthcare-associated infections) HAIs. While not all HAIs are preventable, APIC believes that all organizations should set the inspirational goal of elimination and strive for zero infections."
Why MRSA?
The primary reason behind targeting MRSA for a zero infection rate is and was patient safety. But the secondary factors are hard to ignore: Average length of stay jumps from 7.6 days to 25.6 days for a MRSA patient, and the average case costs $40,000 more to treat than a non-infected patient.
"That's not the driving force for from a quality perspective, but this information is important," says Greene. "When you're doing a risk assessment, you're looking at those things—what is the end result and what are opportunities for improvement."
The question was: Were these infections inevitable, or preventable? A large amount of infections are preventable, says Greene. In fact, targeting MRSA in one unit had an interesting fringe benefit.
"What we did in 2008 drove all our infection rates down," says Greene. Implementing and hardwiring improved practices caused an across-the-board lowering of infection rates in the cardiothoracic unit.
The facility looked at infections from the perspective of the science of epidemiology.
"Infections are preventable. We know they're not all preventable, but how many are? Have we done enough?" says Greene.
Bi-directional change
"One of the reasons we chose this population—which is a high risk population—is that the people working in this area are innovators," says Greene. "At the beginning it is important to engage key people."
Because MRSA is such a high-profile topic, it was also easier to engage and leverage administrative support.
"We needed some early wins," says Greene. "While it's a really high-performing unit anyway, we found that it's all about execution—incorporating changes into the routine standard of care."
This sort of change is bi-directional, Greene says.
"Top down and bottom up—we need the executives on our side but also the stakeholders," she says.
To this end, they made it a point to drive home individual consequences. For example, education was provided to environmental services staff to demonstrate how their actions could eventually have an effect on the patient.
Rochester's MRSA efforts fit in with its overall accreditation activities because Targeting Zero falls in line with the Joint Commission's National Patient Safety Goals and new governmental regulations (e.g., CMS regulations reducing reimbursement if an infection occurs during a hospital stay)
"There are institutions that have managed to greatly reduce and even eliminate certain infections—showing that zero is possible," Garman says. "It's changing a mindset that these are the inevitable consequence of more complicated care to one where these can be avoided in many cases."
Japan has announced its biggest-ever economic stimulus plan, a $154 billion package of subsidies and tax breaks that aims to stem a deepening recession in the world's second-largest economy. The new stimulus plan involves emergency spending of to protect jobs and retrain unemployed workers, as well as improving health and child care.
Millions of National Health Service patients in the UK are still being treated in "substandard" conditions in temporary buildings outside hospitals, according to a health spokesman for the Conservative political party, which obtained the figures under the Freedom of Information Act. In response to the findings, a spokesman for the Department of Health said: "temporary buildings are subject to the same requirements as permanent buildings in relation to safety and quality and cleanliness."
Several representatives from the South Korean government and the healthcare industry visited Kuwait to promote the medical tourism sector. Baeho Kim, Regional Director of the South Korean Tourism Organization, headed a team of medical tourism delegates from three well-known South Korean hospitals, and the group met with several Kuwaiti officials and introduced their newest Medical Tourism facilities.
The Indian tourism ministry is finalizing a plan where a tourist visiting the country for a particular medical treatment will be offered an additional treatment free of cost for a smaller ailment. The plan is part of a strategy implemented by the government to increase foreign tourist arrivals during the global slowdown, a senior official in the tourism ministry said.