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"Medicare discloses lapses at U.S. nursing homes,
including 74 in Inland area"

The Press–Enterprise

By Lora Hines
10:00 PM PST on Wednesday, February 6, 2008

Almost half of California's nursing homes don't meet federal standards in rates of using patient restraints or preventing bedsores and could be targeted for more oversight.

For the first time, the Centers for Medicare and Medicaid this week released lists of nursing homes and hospitals nationwide that have fallen below benchmarks set for patient restraints, bedsores and surgical infections. It will be up to the private quality-improvement organizations that Medicare and Medicaid hires in each state to perform better oversight during the agency's next three-year contract period, starting Aug. 1.

Medicare and Medicaid has budgeted nearly $1.1 million for the contracts.

San Francisco-based Lumetra has monitored quality standards at California health care facilities that receive Medicare payments since 1984. Medicare and Medicaid spokesman Peter Ashkenaz said his agency released its facility lists to hold companies such as Lumetra more accountable for the work they do.

Medicare and Medicaid's previous contracts did not specify how contractors were to choose facilities for quality improvement, he said.

"This list is a tool to manage the quality-improvement organizations," Ashkenaz said. "This is not about facilities. This does not mean these are bad facilities."

The new contracts will require its quality-management organizations to spend 80 percent of their oversighton the identified facilities, Ashkenaz said.

Medicare and Medicaid's nursing-home list identifies 674 out of an estimated 1,400 California facilities that need improvement regarding restraint use and bedsore prevention.

Nearly 71 percent of the Inland area's 105 nursing homes are on the list. Medicare and Medicaid identified 34 facilities in Riverside County and 40 in San Bernardino County that need improvement.

"This is terrible," said Pat McGinnis, executive director of California Advocates for Nursing Home Reform, a consumer advocacy group. "I've never seen a list like this before."

Medicare and Medicaid also named 18 Inland hospitals that failed to meet federal surgical-infection standards.

Lumetra spokeswoman Laura Marshall referred questions to Medicare and Medicaid. She said she didn't immediately know how much Lumetra received in its last three-year contract.

Lumetra is among eight of Medicare and Medicaid's quality-monitoring organizations that will have to bid for their next three-year contract because they don't qualify for automatic renewal. Lumetra failed to meet performance guidelines in its last contract, according to Medicare and Medicaid.

Betsy Hite, spokeswoman for the California Association of Health Facilities, said she was surprised to see so many nursing homes on Medicare and Medicaid's improvement list. Her organization represents nursing homes statewide.

Association officials on Wednesday still were analyzing how the list was developed and how to respond to their members, she said.

Ken August, spokesman at the California Department of Public Health, said all nursing-home providers should be focused on improving care for their patients. Department employees inspect and license state health care facilities, including nursing homes and hospitals.

McGinnis, the consumer advocacy group's executive director, said the list probably wouldn't be so long if Lumetra had done what it was supposed to do. She said she doubts release of the list will lead to substantial change because facilities rarely are held accountable for bad care.

"I'd be surprised if 100 nursing homes participate," McGinnis said.