Legal Nurse Consultant Analysis Of Wound Cases In The Nursing Home Setting
South Carolina AALNC 2016 Conference
"It’s All About The Benjamin’s"
Atlanta legal nurse consultant Liz Buddenhagen attended the 2016 South Carolina American Association of Legal Nurse Consultants (SC AALNC) conference in Hilton Head, SC on February 20, 2016.
Wound Cases in the Nursing Home Setting:
Charlene Pearman, BSN, RN, CLNC, presented legal nurse consultant analysis of wound cases in the nursing home setting.
Pearman started with “it’s all about the Benjamins” and according to AHRQ (Agency for Healthcare Research and Quality) pressure ulcers cost the United States healthcare system between $9.1-11.6 billion annually.
She said there are 20 hospital acquired conditions (HACs) that CMS (Centers for Medicare and Medicaid Services) won’t pay for any longer including Stage III or IV pressure ulcers.
In 2015, the Hospital Acquired Condition Reduction Program (HACRP) went into effect. Poor performance (bottom 25%) on hospital acquired conditions equal 1% reduction of all Medicare reimbursements.
Nursing homes have been under OBRA (Omnibus Budget Reconciliation Act) federal regulations since 1987. Nursing homes who participate in Medicare and/or Medicaid must comply with requirements spelled out in the Code of Federal Regulations (CFR) Title 42, Part 483, Subpart B.
Regarding pressure sores, it says “based on the comprehensive assessment of a resident, the facility must ensure that:
(1) a resident who enters a facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable and
(2) a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing.
Nursing Home Litigation:
Medical malpractice or ordinary negligence?
A lot of nursing home cases are not filed as medical malpractice but as ordinary negligence, personal injury cases.
If the claim does not arise from medical treatment involving professional skills and judgment but instead arises from an injury caused by the simple negligence of a medical professional in the course of the routine interaction with a patient, it is an ordinary negligence claim.
Pearman said nursing home cases are a popular arena for plaintiff firms because the laws, regulations and CMS survey reports make it easy to show the deficiencies compared to the regulations. This makes nursing home cases challenging for the defense.
For more information about the South Carolina AALNC, go to sclegalnurse.org.
Atlanta Legal Nurse Consultant:
Liz Buddenhagen, RN, is a 30-year hospital nurse assisting Atlanta attorneys with medical legal cases since 2005. For more information, email Liz@BuddenhagenLNC.com , view Legal-Nurse-Consutlant-LNC.com or call 770-725-2997.
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- Contact Information
- Liz Buddenhagen, RN
- Buddenhagen and Associates
- (1) 770-725-2997
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