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The Trump administration's decision to endangered or injured residents.
Federal records show the average fine dropped to $ 28,405 under the current administration, down from $ 41,260 in 2016, President Obama's final year in office.
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The decline in fines is one of the strongest examples of how to do it in response to industry prodding the trump administration is rolling back Obama's aggressive regulation of health care services.
Encouraged by the nursing home industry, the Trump administration has switched from financing to housing for each day they were out of compliance – as the Obama administration typically said – the issuing a single fine for two-thirds of infractions, the records show.
That reduces the impact of the penalty, critics say, giving incentives to fix faulty and dangerous practices before someone gets hurt.
"It's not changing behavior [at nursing homes] In the way that we want, "says Dr. Ashish Jha, a professor at the Harvard TH Chan School of Public Health." For a small nursing home, it could be real money, but for bigger ones, it's more likely to be a rounding error . "
Since President Trump took office, the administration has received complaints from the nursing home industry about zealous oversight. It has been granted 18-month moratorium from being penalized for violating eight new health and safety rules. It also revoked Obama-era rule barring the facilities from pre-emptively requiring residents to submit to arbitration to settle disputes rather than go to court.
The reduction in total fines occurred even as the Centers for Medicare and Medicaid Services issued financial penalties 28 percent more than it did Obama. The increase in the frequency of citations with financial consequences a policy started near the end of the month that is required to be resident.
While that policy has increased the number of smaller fines, larger fines became less common. Trump fell 10 percent compared to the total in Obama's final year – from $ 127 million under Obama to $ 114 million under Trump. (We compared penalties during 2016, Obama's last year in office, with prisoners under Trumps from April 2017 through March 2018;
CMS says it has revised multiple rules governing fines under both administrations to make its punishments fairer, more consistent and better tailored to prod nursing homes to improve care. CMS said in a written statement "We are continuing to analyze the impact of these combined events.
The move towards smaller financial penalties is broadly consistent with trump administration's other industry-friendly policies in the health care sector. Medicare programs and has urged to increase their role in health care policies.
Beth Martino, a spokeswoman for the American Health Care Association, says the federal government has "returned to a method of administering fines in a way that incentivizes solving problems rather than penalizing" that are trying to do the right thing. "
Penalty guidelines were toughened in 2014 when the Obama administration instructed officials to favor daily fines. By 2016, that approach was applied in two-thirds of cases. Those fines averaged $ 61,000.
When Trump took over, the nursing home industry complained that the fines had spun "out of control" and had become disproportionate to the deficiencies. "We have seen a dramatic increase in [fines] "Retroactively issued and used as a punishment," Mark Parkinson, President and CEO of the American Health Care Association, wrote in March 2017.
CMS agreed that daily fines sometimes resulted in punishments that were determined by the random timing of an inspection rather than the severity of the infraction. If inspectors visited a home in April, for instance, and had discovered that it had started in February, the accumulated daily fines would have been twice as much.
Fines are much smaller penalties, since fines are capped at $ 21,393 or they are levied per instance or per day. Nursing homes that pay without contesting the 35 percent discount, they currently pay at $ 13.905.
Those who apply for the maximum risk of harm, which are known as immediate jeopardy because of the nursing home's practices. For instance, a Mississippi nursing home was fined $ 13,627 after it ran out of medications because it had been relying on a pharmacy 373 miles away, in Atlanta. CMS thus reduced $ 54,600 in daily fines to a single fine of $ 20,965 for a New Mexico home where workers have not been properly disinfecting equipment to prevent infectious diseases from spreading.
On average, per-instance fines under Trump were below $ 9,000, records show.
"These are multimillion dollar businesses – $ 9,000 is nothing," says Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy, a nonprofit in Washington.
Big daily fines, averaging $ 68,080, are cited. But even in those cases, CMS officials are entitled to make exceptions and issue a single fine if the home has no history of substantial violations.
Trump, from 3.5 percent in 2016 to 4.7 percent. The circumstances now warranting penalties on the lower side.
However, Kaiser Health News found that financial penalties for immediate jeopardies were issued in trump cases. And when they were issued, the fines averaged 18 percent less than they did in 2016.
The frequency of immediate-jeopardy fines may decrease even more. CMS told inspectors in June that they were "immediate injury, harm, or death." Regulators still take some action, but that could be the nursing home to arrange training from an outside group or mandating specific changes to the way the home operates.
Barbara Gay, vice president of public policy communications at LeadingAge – an association of nonprofit organizations that provide elder services, including nursing homes – says that they are "under the hood".
But consumer advocates say penalties have reverted to levels too low to be effective.
"Robin Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care, is a non-profit based in Washington, D.C. "When that's not the case and the fine is inconsequential, care generally does not improve."
Kaiser Health News is an editorially independent news service supported by the nonpartisan Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente. You can follow Jordan Rau on Twitter: @jordanrau,