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Office of Health Facility Complaints (OHFC) Legislative Report March 2006 Minnesota Department of Health.

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Presentation on theme: "Office of Health Facility Complaints (OHFC) Legislative Report March 2006 Minnesota Department of Health."— Presentation transcript:

1 Office of Health Facility Complaints (OHFC) Legislative Report March 2006 Minnesota Department of Health

2 OHFC Budget And Staffing History Fed Fiscal Year InvestigatorsSupervisor Managers Intake Staff Admin. Staff Total Staff OHFC Funding FFY051522524 Total Oper. Budget: $2,266,286 Medicare 38.60% Medicaid 29.20% State Licensure 32.30% FFY041322522 Total Oper. Budget: $1,910,796 Medicare 37.30% Medicaid 28.90% State Licensure 33.80% FFY031422523 Total Oper. Budget: $1,776,396 Medicare 37.10% Medicaid 30.70% State Licensure 32.30%

3 Nursing homes represent approximately 52% of OHFCs complaints in FY05 Nursing homes represent approximately 83% of OHFCs facility reported incidents in FY05 No significant change in number of nursing home complaints between FY03 and FY05 Significant decreases in number of nursing home facility reported incidents between FY03 and FY05

4 Table 2: Complaints & Facility Reported Incidents by Facility Type FY03, FY04, FY05 Complaints ReceivedFY03FY04FY05 Nursing Home835838866 Hospital398316340 Home Health294324362 Other Licensed Entities104124105 * Total Complaints Received163116021673 Facility Reported IncidentsFY03FY04FY05 Nursing Home461337852849 Hospital220156169 Home Health311303318 Other Licensed Entities10792112 ** Total Facility Reported Incidents Received525143363448 *** Grand Total688259385121

5 All complaints and facility reported incidents receive an initial OHFC review Only a small proportion require further review (15% in FY05) OHFC onsite investigations decreased and referrals to survey increased in FY05

6 Table 7: Complaints and Facility Report Incidents Assigned for further Review FY03 FY04 FY05 FY03FY04FY05 ONSITE509516474 Desk121152146 Refer to Survey5764148

7 An onsite investigation is required for OHFC to make a finding that an allegation is substantiated Of the 5,121 complaints and facility reported incidents received by OHFC in FY05, only 165 (3.2%) resulted in findings of a substantiated allegations The proportions of substantiated, inconclusive and unsubstantiated findings have remained relatively consistent between FY03 and FY05

8 Table 8: Results of completed Onsite Investigations FY03 FY04 FY05 FY03FY04FY05 NumberPercentNumberPercentNumberPercent Substantiated18336.019237.216534.8 Inconclusive20339.916532.017236.2 Un-substantiated 12324.115930.813729.0 Total 509100516100474100

9 Areas of Focus for FFY 06 Comparison with Region versus state Accuracy and consistency Training

10 Comparison Region v State Minnesota is an outlier within Region V, with far fewer complaint surveys than facilities CMS is reviewing our processes, including triage methods MDH staff are collecting information from other states as to number of staff assigned to complaints, prioritization of complaints, and complaint procedures

11 Table 13: FFY05 Complaint Surveys in Region V by State & Nursing Home Count as of 9/30/05 Illinois 3,075 surveys (807 nursing homes) Indiana 1,461 surveys (511 nursing home) Michigan 742 surveys (429 nursing homes) Minnesota 272 surveys (403 nursing homes) Ohio 2,078 surveys (971 nursing homes) Wisconsin 782 surveys (401 nursing homes) Region V 8,410 surveys (3,522 nursing homes) Source: Federal CASPER (Certification & Survey Provider Enhanced Reporting) System

12 Table 14: FFY05 Deficiencies by Scope and Severity Issued as a Result of a Complaint Survey in Region V by State S/S BCDEFGHIJKL Total Region V 1711062,5717381007332201863824 4,689 Illinois 81637481132621820881617 1,372 Indiana 1115032592226317013121 1,102 Michigan 6034795910510410 583 MN 0144601610410 73* Ohio 61306021323364001621 941 WI 12113271331067104845 618

13 Source: Federal CASPER (Certification and Survey Provider Enhanced Reporting) System Table 14 does not include 9 deficiencies included in the Departments count of 82 deficiencies issued in FFY05, as 7 of the deficiencies were subject to IIDRs, all of which have been subsequently withdrawn by the nursing home. The remaining 2 deficiencies are subject to a pending IIDR.

14 The MDH is aware there is a pending report on the complaint process to be issued by the Department of Health and Human Services Office of Inspector General, and it is possible that the report may recommend additional changes to the federal complaint process. As noted in a General Accountability Office report issued in December 2005, CMS is working on revised definitions of actual harm and immediate jeopardy that might alter the triaging decisions currently utilized by OHFC.

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