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Perspective

Writing on medical-legal practice

Regulatory change, litigation trends and documentation practice, from the team that reads the records.

  • Blog

    Focus on Mobility in Senior Living

    Senior living communities are turning to technology to focus on the mobility of their residents—while also reducing risks related to falls.

  • Blog

    Human Oversight in the Age of AI

    As the growth of AI use continues, the synergy between AI and human experts is essential to ensuring quality outcomes, especially in high-stakes environments like healthcare and law.

  • Blog

    Alternative Models in Senior Living

    The aging population is driving up the senior housing market, with an emphasis on service quality, causing facilities to modify existing buildings.

  • Blog

    Technology Expectations of Seniors

    Technological expectations of residents and their families within long-term care facilities are rising causing more facilities to invest in digital technology to support overall healthcare.

  • Blog

    Record Retrieval Challenges – Electronic Medical Records

    Attorneys face significant challenges in retrieving and interpreting electronic medical records (EMRs) due to their complexity, variability across systems, legal and privacy regulations, and the need for collaboration with multiple departments to ensure accurate, complete, and legally admissible documentation in litigation.

  • Blog

    A Look Forward – Excelas’ Twentieth Anniversary and Beyond

    20 years of business has given the opportunity to reflect on where the company has been, the exciting projects completed, the innovative processes and products developed, and the outstanding individuals who have been part of this journey.

  • Blog

    Data and Continuity of Care

    Technology and regulatory changes can help LTC facilities with structured data sharing, allowing for better patient outcomes.

  • Blog

    Technology Trends 2024

    Higher expectations of residents and families, increasing documentation requirements due to MDS changes, looming minimum staffing requirements, and tightening reimbursement are all incentives to optimize technology use in long-term care. The category of technology solutions designed to meet the needs of seniors has recently been termed AgeTech. AARP has established the […]

  • Blog

    The Medical Record is the Medical Record… Supporting Defense Strategies

    Excelas is widely respected for its expertise in managing and evaluating medical records related to long-term care litigation. Our clients value the ability to incorporate our chronologies and analyses into their overall case assessment and defense strategy. It may not be as widely known, however, that Excelas’ expertise extends to other types of cases, product [...]

  • Blog

    Artificial Intelligence in Healthcare – Regulations, Standards, and Legal Issues

    The use of artificial intelligence is exploding. Concurrently, the healthcare sector, particularly long-term care, is facing ongoing workforce challenges. Artificial intelligence (AI) tools can potentially alleviate some tasks to allow medical staff to focus on direct patient care as well as augment clinical decision-making. Opportunities with, and concerns around, the use of AI are at [...]

  • Blog

    Strategic Senior Living Documentation

    Senior living providers, their insurers, and counsel who represent them understand that quality medical record documentation is critical in deterring survey citations, combatting predatory plaintiffs’ lawyers, and most importantly improving healthcare outcomes for residents. High quality medical record documentation also allows providers to contain the cost of claims and litigation through early dispute resolution. The [...]

  • Blog

    Regulatory Issues in Assisted Living

    There are over 30,000 assisted living communities in the United States which provide residents with assistance in activities of daily living, housekeeping, meals, medication management, and wellness programs. Some also provide Alzheimer’s/dementia care. While assisted living facilities do not provide 24-hour skilled nursing services, they do typically coordinate with other care providers, which requires integration [...]

  • Blog

    Responding to the Silver Tsunami

    An increase in the older population has led long-term care leaders to develop mitigation strategies to address staffing concerns.

  • Blog

    As COVID Cases Go to Trial…

    COVID cases are going to trial and Excelas’ Comprehensive Integrated Timeline Tool (CITT) can assist in defending COVID related cases.

  • Blog

    Medical Record and Document Management

    Excelas attended a webinar by the Adelman Law Firm on the importance of policies and procedures, compliance and training, and complaint response in record retention and release practices as part of a comprehensive risk management program

  • Blog

    Best Practices in Nursing Documentation

    Nursing documentation facilitates continuity of care between providers and supports clinical decision making. Medical record documentation impacts many aspects of healthcare, including, but not limited to, quality of care, patient outcomes, reimbursement, accreditation, and legal actions. The Ohio Health Care Association recently provided a seminar on Nursing Documentation to Support Services and Care Delivery to [...]

  • Blog

    Trends for 2023 – Health Information Management Industry

    The American Health Information Management Association presented a webinar titled “The State of the HI Industry: 2023 Key Trends.” Industry experts including Dr. Liz Kwo of Everly Health, Dr. David Marc of the College of St. Scholastica, and policy expert Dr. Chantal Worzala examined current issues facing health information managers. The panel discussed three key [...]

  • Blog

    Communication between LTC Providers and Emergency Departments Avoiding Unnecessary ER Transfers

    Although the Centers for Medicare & Medicaid Services (CMS) has determined the use of Skilled Nursing Facility readmission data for Value Based Purchasing will be suppressed in FY 2023 due to the continuing effects of COVID-19 on the data, acute care facilities face payment reduction based on unplanned hospital readmissions under the Hospital Readmissions Reduction [...]

  • Blog

    Healthcare Provider Perspectives on Telehealth

    The American Health Information Management Association (AHIMA) recently reviewed the “nuances of health information and telehealth” in ambulatory care from the perspective of nurses, physicians, and overall management of health information. The pandemic vaulted the use of telehealth; however, the rapid increase in utilization brought with it challenges in implementation, acceptance, privacy, and security. Nursing [...]

  • Blog

    Industry Experts: Long-Term Care Issues Post-COVID

    In the DRI Long-Term Care and Senior Living session titled “Post-COVID Headwinds: An Overview of Senior Living and Long-Term Care Challenges,” industry experts reviewed the impact of the White House Nursing Home Initiative, trends in insurance claims and litigation, and CMS initiatives. The following summarizes the insightful overview provided by Tara Clayton of Marsh, Christopher [...]

  • Blog

    Nursing Home Ownership and Quality of Care

    The Fact Sheet issued in February by the White House addressed improving safety and quality of care in nursing homes. The statement cited studies that nursing homes owned by private equity firms tended to have “significantly worse outcomes for residents,” which is disputed by the nursing home industry. Regardless of ownership structure, long-term care facilities are facing significant staffing and economic pressures. Whether public or private, for-profit or not-for-profit, providing high quality care to residents is the primary focus in this time of unprecedented challenges.

  • Blog

    Staffing Crisis in Long-Term Care

    Across the country, nursing homes are limiting admissions due to staffing shortages. Hospitals and families are being impacted as seniors face restricted access to appropriate care. Long-term care leaders are asking lawmakers for resources to help expand staffing options; however, looming federal mandates on staffing minimums are predicted to make the situation worse.

  • Blog

    PREP Act in Long-Term Care Settings Update

    Due to state statute of limitations, many firms are rushing to file claims related to incidents from the early days of the pandemic. As of June 2022, the Hunton Andrews Kurth COVID-19 Complaint Tracker reports 541 suits have been filed against healthcare providers, with wrongful death cases accounting for over 66% of those cases. Defense attorneys have argued that COVID-related cases fall under the PREP Act and should be heard in federal court. To date, judges in U.S. District and in Court of Appeals have consistently remanded cases to state courts.

  • Blog

    Arbitration Agreements in Long-Term Care March 2022

    As reported by McKnights Senior Living in February, recent court cases have been decided based on who signs an arbitration agreement. CMS ruled in 2019 that residents are not required to sign binding arbitration agreements as a condition of admission or to receive care, and this regulation was upheld in October 2021 by the 8th U.S. Circuit Court of Appeals. Nursing homes are permitted to use these agreements if they are explained to, and acknowledged by the resident or family member that the contents are understood.

  • Blog

    The COVID Challenge: Part Three

    Excelas’ COVID-19 Comprehensive Integrated Timeline Tool can be used to assist in the preparation for and defense of COVID-19 claims.

  • Blog

    The COVID Challenge: Part Two

    Collecting, storing, and organizing COVID-19 guidance will be crucial to protect a facility’s patients, residents, staff, and business. Excelas can help make the process more efficient.

  • Blog

    The COVID Landscape: Part One

    The latest data on resident and staff vaccination rates, vaccine mandates, and staffing shortages in nursing homes during the pandemic.

  • Blog

    Trends in LTC: Vaccine Mandates

    An increase in COVID-19 cases due to the Delta variant have led many to consider mandating the vaccine for Long-Term Care workers.

  • Blog

    The PREP Act and State Laws: COVID-19 in Long-Term Care Settings

    As of June 2021, the Hunton Andrews Kurth COVID-19 Complaint Tracker reported that 255 wrongful death suits have been filed against healthcare providers, with LTC providers accounting for at least 20% of those cases. California, Florida, Texas, New Mexico and Kansas account for over half of these claims. Many states have implemented immunity provisions for healthcare facilities, including senior living, as a result of the pandemic. In addition, the Public Readiness and Emergency Preparedness Act (PREP Act) provides some immunity to facilities on the federal level. However, the PREP Act and state immunity provision have not preempted state tort claims in all cases to date.

  • Blog

    Telehealth Access After the Public Health Emergency

    While HHS has renewed the Public Health Emergency (PHE) through July 19 and is expected to remain in effect through the end of the year, many states are allowing their public health emergency orders to expire. The expiration of these PHE orders will impact the use of telehealth in all settings, including long-term care.

  • Blog

    Managing Expectations: End-of-Life Care

    Our staff had the opportunity to attend a discussion on Setting Realistic Expectations for Collaborative End-of-Life Care Planning in Senior Living Communities presented by the Adelman Law Firm. Rebecca Adelman and her team have developed “Expectations Management” programs that have been implemented in senior living communities throughout the country. These programs have been central to mitigating risk, improving quality of care, quality end-of-life care and enhancing staff satisfaction, while reducing turnout. This case study relates to a professional negligence claim arising at an Assisted Living Facility (ALF).

  • Blog

    A Corporate COVID-19 Timeline – An Employer’s Defense Against Claims

    While employers did their best to act quickly and execute on the recommended health and safety protocols for COVID-19, we may now be witnessing a new wave of issues – lawsuits filed by employees who do not feel their employers “did enough” to keep them safe. Excelas, LLC can help you defend COVID-related claims and/or litigation by preparing and displaying your company response to this global pandemic.

  • Whitepaper

    The Rationale for a Medical Literature Chronology Database

    Risk managers, industry experts, and long-term care leaders have been discussing the importance of the following in defending COVID-19 claims and litigation cases: • Federal Guidance • State Guidance • Local Guidance • Company Response to the Guidance • Facility Response to the Guidance Excelas, LLC has been instrumental in developing a way to memorialize all this information in an easy to use, cloud-based system. Will this be all we reference? We believe there is an additional layer to the already voluminous amount of information individuals and providers were being forced to evaluate on a daily basis – the medical treatment expectations, and how they were changing throughout 2020. Through our software, all information can be merged into an individual patient or resident’s medical chronology to exhibit a comprehensive, sequential record of all relevant standards and expectations at a specific point in time. Sharon Ezzone, MBA, Excelas, LLC., Vice President, Operations

  • Blog

    ACI hosts 2nd National Forum on COVID-19 Liability for Long-Term Care & Senior Care Providers

    This February, our Founder and President, Jean Bourgeois, attended the ACI’s 2nd National Forum on COVID-19 for Long-Term Care and Senior Care Providers. With outstanding and diverse panels, this one day event covered the many challenging issues relating to best practices for COVID claims and litigation defense, federal and state immunity protections, the threat of class actions, and current challenges in the long-term care insurance industry.

  • COVID-19 New Direction and Collaboration Excelas Medical Legal Solutions
    Blog

    COVID-19 demands collaboration and new directions

    The conversations and collaboration among friends and colleagues locally, nationally, and here within Excelas have been the foundation I needed to take action, optimistically look toward, and plan for the future.

  • COVID-19 Record Review Excelas Medical Legal Solutions
    Blog

    COVID-19 Record Review

    Healthcare has been threatened as a result of COVID-19 and your facility may have been impacted by high rates of COVID-19 among your residents and/or staff.

  • Blog

    Disproving Understaffing in Fall Claims

    If allegations of negligence arise, the Staffing Scorecard shows whether or not there were fluctuations or inconsistencies in staffing levels during a certain period of time.

  • Blog

    Assisted Living Challenges Lead to Rise in Litigation

    The increase of assisted living claim payouts, lack of a consistent regulatory structure, and predominance of the for-profit business model attracts plaintiff counsel to bring creative actions against assisted living facilities.

  • Blog

    Best reads of the week, 12-20

    Topics: nutrition, Amazon’s transcription service, healthy traveling, employee cyber security risks

  • Blog

    Telemedicine: Considerations for Documentation and Medical Records

    The rapidly growing telemedicine industry is on track to transform the way healthcare is delivered. With new technologies generating large amounts of patient data across multiple platforms, there is a direct impact to health information management and documentation. What is Telemedicine? Telemedicine, or telehealth, is a means to connect patients to health care services and [...]

  • Blog

    Best reads of the week, 12-13

    Topics: Future health innovations, physician privilege disclosures, Amazon insurance risks, loneliness

  • Blog

    Best reads of the week, 12-6

    Topics: Telehealth, ergonomics and opioid-related deaths, living-donor transplant campaign, illegal nursing home evictions

  • Blog

    A Note of Gratitude: Scalerator

    With Thanksgiving a day away, we wanted to reflect on an experience we had this year for which we are very grateful.

  • Blog

    Best reads of the week, 11-22

    Topics: 401(k) limit increase, $3 million HIPAA settlement, Ohio pharmacy closures, issues facing nursing

  • Blog

    Best reads of the week, 11-8

    Topics: Seasonal affective disorder, 4-day work week experiment, insurance risk landscape, and courtroom confirmation bias.