Long-Term Care Providers Assume a Starring Role in a Tough Healthcare Environment : Page 2 of 2

January 16, 2012

Quality Indicators and Quality Measures

In the 1990s, surveyors began using quality indicators in an attempt to ascertain a facility’s deficient practices before conducting an inspection. Previously, the survey process had always considered a facility “in compliance” prior to identifying an evidence-based deficiency while on site. Now, potentially deficient areas were being targeted before the surveyors had left their offices. 

Although these aren’t the only changes that occurred, they provide  a brief synopsis of life in LTC in the 1980s and 1990s, in which LTC providers met every demand and continued to thrive. We became proficient at scrutinizing the rules and regulations and developing mechanisms for success. It was difficult and painful, but we are proud of how we rose to the occasion and met the goals set for us.

Ushering in the Next Generation of LTC

Today’s new LTC providers are stepping into some big shoes as this next decade introduces new challenges. The 11.1% in budget cuts for fiscal year 2012 are record-breaking, and the growing focus on “payment accuracy” and audits to recoup “overpayments” is expected to be staggering. According to the government, the emphasis on payment accuracy and overpayments is to recoup money that facilities never should have been paid. The auditors—Medicare Administrative Contractors, Comprehensive Error Rate Testers, Recovery Audit Contractors, Zone Program Integrity Contractors, Medicaid Integrity Contractors, and Payment Error Rate Measurements—are all looking for money to reclaim. Now, more than ever before, LTC providers will be challenged to learn about proper diagnosis coding and documentation to support Resource Utilization Group categories.

With significant reimbursement cuts  for fiscal year 2012 and more cuts possibly looming on the horizon, it is important for LTC providers to get ahead of the game. They must make changes to prevent their facilities from losing additional money because of inadequate or incorrect documentation and improper diagnosis coding—money that has already been spent on providing care for their residents. Staying informed is essential for overcoming the challenges that lie ahead. Changes occur almost daily, and those who are aware of these changes are the ones most likely to be left standing.

One might expect LTC to fail in the face of such constant change. In reality, the last few decades of change have taught LTC providers to become increasingly resourceful and fiscally responsible as a matter of good business. The 2011 budget did not fail because of intentional fraudulent practice, but instead because budget predictions were astoundingly inaccurate. Further, LTC was not given credit for being able to respond to regulatory changes efficiently and effectively while continuing to function within the rules CMS put forth.

LTC providers have learned to fend for themselves the hard way, and facilities abide by the rules. Despite seemingly insurmountable opposition and reimbursement that is often inadequate, LTC facilities continue to provide care for residents who need it, making them real stars in the healthcare industry.


Ms. Mullins is director of research and development, The Compliance Store. She has more than 33 years of experience in healthcare, having held positions as MDS coordinator, state surveyor, state RAI coordinator, and OASIS education coordinator for the State of Alabama. She is also the author of The MDS Coordinator’s Field Guide and a clinical advisor for the AALTCN.