Special report on reimbursement. HCFA enacts new enforcement remedies covering nursing facilities

While the regulations are revolutionary in their use of "substantial compliance," the interpretation and application of HCFA's new remedial scheme are still uncertain, as states are given broad discretion in defining important terms and in applying and interpreting the criteria to select remedies. Further complicating the issue is the fact that some states, including California, intend to seek waivers from HCFA to substitute their own state enforcement systems for most, if not all, of the new federal system. Based upon these uncertainties, the enforcement of nursing facility standards will likely be in a state of flux for some time to come.     

Dealing with Uncertain Budget Forecasts

The article reviews the history of past budget projections by the Congressional Budget Office (CBO). The projections have been extremely inaccurate because of errors in the choice of economic and technical assumptions. The errors grow rapidly as the projection's period is lengthened. The projections are unlikely to get better soon. Therefore, the question becomes how CBO, the Congress, and the media should react to the extraordinary uncertainty that must be attached to the budget outlook. Among other things, the author suggests de-emphasizing projections made for periods longer than five years, because such projections are only a little better than random noise. He also points out the futility of aiming for rigorously enforced numerical targets for the budget balance, as was done in Gramm-Rudman and as has been proposed in various types of "lock box" legislation. The targets move around too rapidly to ever be hit.     

Book Review

Book reviewed in this article: Corrupt Exchanges: Actors, Resources, and Mechanisms of Political Corruption by Donatella della Porta and Alberto Vannucci. Corruption and Government: Causes, Consequences, and Reform by Susan Rose‐Ackerman.     

Joint Commission completes transition to functional standards

The Joint Commission's new emphasis on performance-based standards led it to identify functions it believed were likely to have the most significant impact on patient outcomes. Carrying out these functions requires an interdisciplinary team approach to patient care. Thus, the old strategy of handing out one manual chapter to each department head and asking him or her to implement the standards in that chapter will not work in 1995. Rather, providers will have to allocate already stretched human and financial resources to redesign their methods of assessing and improving patient outcomes in order to comply with yet another major revision of the Accreditation Manual for Hospitals. To ensure an adequate understanding of and compliance with Joint Commission standards, organizations should make the entire CAMH "required reading" for its leadership and make it available in strategic areas of the hospital for review by all employees. While the Joint Commission recognizes that its new functional approach will take some time to implement, all providers that want to ensure that they remain accredited should begin now to orient their leadership, staff, and employees to the new functional standards in the CAMH and the ways in which those standards affect patient outcomes.