1. Michigan Department of Licensing and Regulatory Affairs (LARA) Bureau of Health Systems Mike Pemble, Director September 13, 2011 For Joint Provider Surveyor Training

2. Health Systems  License, certify and/or regulate facilities: 442 Nursing Homes 442 Nursing Homes 174 Hospitals 174 Hospitals 10 Psychiatric Hospitals / 50 Licensed Psychiatric Programs 10 Psychiatric Hospitals / 50 Licensed Psychiatric Programs 9 Organ Transplant Facilities 9 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 Centers 54 Ambulatory Surgical Centers 19 Comprehensive Outpatient Rehabilitation Facilities and 11 Portable X-Ray Facilities 19 Comprehensive Outpatient Rehabilitation Facilities and 11 Portable X-Ray Facilities 209 Rehabilitation Facilities (formerly Outpatient Physical Therapy) 209 Rehabilitation Facilities (formerly Outpatient Physical Therapy) 7,397 Clinical and Physician Office Labs 7,397 Clinical and Physician Office Labs 10,038 Radiological Facilities 10,038 Radiological Facilities

3. 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

4. Health Systems  Key Accomplishments: Eliminated long standing nursing home complaint backlog (continuous challenge to maintain) Eliminated long standing nursing home complaint backlog (continuous challenge to maintain) Innovative nurse recruitment techniques assist in filling health care surveyor vacancies (10 currently) Innovative nurse recruitment techniques assist in filling health care surveyor vacancies (10 currently) Improved coordination and efficiencies in the survey process (e.g. combined revisits) Improved coordination and efficiencies in the survey process (e.g. combined revisits) Improved Timing of Survey Report Issuance Improved Timing of Survey Report Issuance Biannual Joint Provider-Surveyor Training Attendance at All Time High (835 today) Biannual Joint Provider-Surveyor Training Attendance at All Time High (835 today) Improved communication with provider community Improved communication with provider community

5. CMS Region V – Chicago Total All Provider Types Ohio – 12,993Nursing homes: 955 Illinois – 12,219Nursing homes: 788 Michigan – 9,450Nursing homes: 428 Indiana – 7,218Nursing homes: 503 Minnesota – 4,676Nursing homes: 386 Wisconsin – 4,509Nursing homes: 390 Source: OSCAR

6. 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.

7. Complaint Response Time Average Number of Days from Receipt of Complaint to Surveyor Onsite Non IJ High Priority Complaints: 2007 – 102.5 days 2008 – 105.7 days 2009 – 84.5 days 2010 – 23.4 days 2011 to date – 15.9 days

8. IL - 788IN - 503MI - 428MN - 386OH - 955WI - 390 FY 2007770422335389870358 FY 2008789483409392880398 FY 2009773532463390891373 FY 2010757521461390895330 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.

9. Source: ACTS 11/17/2010

10. 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.

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

12. 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.

13. Issuance of 2567 Reports Time period evaluated – 5/30/11 thru 9/9/11 (15 wks) Target is to issue all reports within 10 business days BHS issued 604 reports in this time frame 84% of all reports were issued within 10 days Average for all reports was 8 days Reports that went beyond 10 days averaged 17 days

14. Initiatives and Goals Consistency Work Group Consistency Work Group Electronic Plan of Correction Electronic Plan of Correction Posting of Survey Reports Posting of Survey Reports Hot Weather Issues: Baseline Physical Hot Weather Issues: Baseline Physical Plant Surveys Plant Surveys Continued Improvement for Report Timeliness Continued Improvement for Report Timeliness Elder Justice Act: Reporting of Crimes Elder Justice Act: Reporting of Crimes Independent IDR / PPACA Independent IDR / PPACA Continued Collaborative Provider Relations Continued Collaborative Provider Relations

15. Reporting of Events to BHS

16. Nursing Home Sprinkler Status Federal deadline: August 13, 2013 Federal deadline: August 13, 2013 Number of certified MI NH’s: 428 Number 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 responses 148 letters sent 8/10/11; 77 responses

17. Keynote Address Dr. Chuck Gokoo, MD, CMO, CWS, FACCWS “A Clinical Guide to the F314 Tag”