<img src = "https://media.npr.org /assets/img/2018/11/30/gettyimages-629416761_sq-0468fbefd953d2cd668addb4ce3f5587f78d8c68-s100-c15.jpg "data-original =" https://media.npr.org/assets/img/2018/11/30/gettyimages- 629416761_sq-0468fbefd953d2cd668addb4ce3f5587f78d 8c68-s100.jpg "class =" img lazyOnLoad "alt =" Medicare lowers payments to nursing homes whose patients return to the hospital  The reduction of total fines also occurred when Centers for Medicare & Medicaid Services issued financial penalties 28 percent more frequently than under Obama. The increase in the quote rate with economic consequences arose due to a policy that began near the end of Obama's term which required regulators to punish a facility every time a resident was injured, rather than leaving it at his own discretion.
While the policy increased the number of minor fines, major fines became less common. The total amount collected during Trump fell by 10 percent over the total in Obama's final year – from $ 127 million during Obama to $ 114 million under Trump. (We compared the punishment in 2016, Obama's last year in the office, with penalties under Trump from April 2017 through March 2018, the last month for which federal officials say data is reliably complete.)
CMS says that it has revised several rules for fines under both administrations to make their penalties more reasonable, more consistent and better tailored to produce nursing homes to improve care. "We continue to analyze the effects of these combined events to determine whether other measures are necessary," CMS said in a written statement.
Moved to smaller financial penalties is broadly consistent with the Trump Administration's other industry-friendly healthcare policies. For example, the administration has expanded the role of short-term health insurance that does not cover all types of services, has given states more room to change their Medicaid programs, and has urged Congress to let doctors open their own hospitals. 19659008] Beth Martino, a spokeswoman for the American Health Care Association, a nursing home trading group, says that the federal government has "returned to a method of applying fines in a way to solve problems" rather than punishing "attempting facilities. To do the right thing. "
The criminal principles were tough in 2014 when the Obama administration instructed officials to favor daily fines. In 2016, this method was used in two-thirds of the cases. These fines averaged $ 61,000.
When Trump took over, the healthcare company complained that fines had spun out of control and had become disproportionate to the deficiencies. "We have seen a dramatic increase in [fines] being issued retroactively and used as a punishment," writes Mark Parkinson, President and CEO of the American Health Care Association, in March 2017.
CMS agreed that daily fines sometimes resulted in penalties determined by a random timing of an inspection rather than the severity of the infringement. If inspectors visited a home in April and discovered that an incorrect exercise had begun in February, the accumulated daily fines would be twice as much as if the inspectors had arrived in March.
But switching to a preference for per instance fine means much less punishment, as the fine is limited to $ 21,393, regardless of whether they are charged per instance or per day. Hospitals that pay without punishing the fine get a 35 percent discount, which means they currently pay a maximum of $ 13,905.
These maxims also apply to plants found to have committed the most serious infringement, which is known as immediate danger, because the nursing home's practice provides residents with immediate risk of injury. For example, a Mississippi nursing home was fined $ 13,627 after it stopped taking drugs because it had been dependent on a drugstore 373 miles away, in Atlanta. CMS also reduced $ 54,600 in daily fines to a single $ 20,965 fine for a New Mexico home where workers had not properly disinfected equipment to prevent the spread of infectious diseases.
On average, fines under Trump were under $ 9,000, record shows.
"This is multimillion dollar business – $ 9,000 is nothing," said Toby Edelman, a senior political attorney at the Center for Medicare Advocacy, a nonprofit in Washington.
Large daily fines, on average $ 68,080, are still issued when a home has not corrected an infringement after being quoted. However, even in these cases, CMS officials may make exceptions and issue a fine if the home has no history of material breach.
The agency warned that the comparison of average fines is misleading since the total number of inspections that resulted in fines increased during Trump, from 3.5 percent in 2016 to 4.7 percent. The circumstances that justify fines not issued before tend to penalize the bottom.
However, Kaiser Health News found that financial penalties for immediate dangers were issued in fewer cases under Trump. And when they were issued, the fine was on average 18 percent smaller than they did in 2016.
The frequency of immediate risks can decrease even more. CMS told inspectors in June that they no longer needed nice facilities unless immediate violations resulted in "serious injury, damage, deterioration or death". Regulators still need to take action, but it may be to arrange the nursing home to arrange training from an outside group or to make specific changes to the way the home operates.
Barbara Gay, vice president of public policy communications at LeadingAge – a union of nonprofit organizations providing senior services, including nursing homes – says nursing homes "don't feel they've been given a release" under Trump.
But consumer advocates say sanctions have returned to levels too low to be effective.
"Fines must be large enough to change plant behavior," said Robyn Grant, head of public order and advocates at the National Consumer Voice for Quality Long Term Care, an ideal base in Washington, DC "When that is not the case and the fines are insignificant, care is usually not improved. "
Kaiser Health News is an editorial independent news service supported by the non-partisan Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente. You can follow Jordan Rau on Twitter: @ Jordanrau .