An Un-Mistake-able Slippery Slope
“May you live in interesting times” is a familiar Chinese phrase that passes through my mind almost daily. Whether I’m reading or learning about people, politics, money, family, or national/world events, this thought is inescapable.
This also applies to dominant themes across most of my living days – baseball and the nursing home business.
To me, while cliché, baseball is a metaphor for life. There are rules, e.g., a runner is out when the ball beats them to first base, unwritten customs, e.g., thou shalt not steal bases if their team is up big in late inning, and remedies for breaches in process or conduct ranging from minor to career-ending.
Yes, much like playing the game of life. Same is true in the nursing home business. There are rules, remedies, and unwritten customs, many of which I’ve written about previously.
I’m beginning to see, however, a theme within my lifelong profession which has the potential to develop into an increasingly slippery slope, involving the definition of “mistake.”
Fascinating stuff. I’ll explain.
A recently published article caught my attention, as its title referenced “…mistakes that land nursing homes on the CMS (Center for Medicare and Medicaid Services) ‘radar.’” Clicking through, I initially noticed this remark.
“mistakes that will easily draw scrutiny from regulators and auditors”
And this specific mistake - “…maximizing the number of Medicare-covered days to get that 100th day of coverage — regardless of diagnosis or the reason why they need skilled care.”
Before returning to these items, here’s a quick punch list of “mistakes” in the nursing home business…
· Placing Fred Jones’ paperwork in Frannie Jones’ file
· Not washing hands or changing gloves when indicated
· Failing to use a “Caution Wet Floor” sign when mopping up spills
The baseball corollary are missing a coach’s sign while at-bat, throwing to the wrong base, and not knowing the count or number of outs. While there are plenty of others, lapses in concentration (aka: mental mistakes) or execution (aka: physical mistakes) occur daily in each environment.
This is what oftentimes makes the challenge of taking care of people or taking care of an opponent on the diamond incredibly interesting. Eliminating mistakes increases the chances of success — or victory.
Nevertheless, we most certainly do live in interesting times when misfires in process, oversight, or governance become classified as in the same realm as misfiling Fred Jones’ paperwork.
Now…back to the items which draw regulator and auditor scrutiny, like “maximizing” and exhausting a nursing home patient’s 100 days of Medicare coverage. The rules are available at www.medicare.gov, and easily accessible for anyone with questions about application or administration. Intentionally, and contrary to baseball, there are no unwritten customs. The rulebook governs the behavior of the nursing home and the expectation of the patient.
Why? To eliminate the slippery slope of misfires in process, oversight, or governance being defined as “mistakes.”
Having read this article several times, I continue to play “Where’s Waldo” to identify the “mistake” in this coverage and eligibility issue. It is binary — either the patient meets the criteria for eligibility and continued Medicare coverage for one-hundred days…or they don’t.
The best news of all is that nursing home caregivers and decision-makers, nurses and therapists, and physicians (or other health care providers) have between 1 and 100 days to figure this out.
For every single Medicare patient.
And among nursing homes exercising superior practices in process, oversight, and governance of Medicare programming on behalf of its patients, their salutation to auditors and regulators should be…
“Welcome! How can we help you?”
Will the audit results be as pure as the driven snow? Of course not. It doesn’t work this way. But doing the right thing or doing things the right way…won’t be viewed as “mistakes.”
Comments are welcome below, or at www.davedevereaux.com. Thanks.