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The decision of the Trump administration to change the way nursing homes were punished led to a reduction in fines against many people who were endangered by the death or injury of residents.
Federal records show that the average fine fell to 28,405 dollars. from $ 41,606 in 2016, the last year of President Obama's office
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Reducing fines is one of the most striking examples of how Trump's administration recalls the aggressive regulation of health services in Obama.
The sister house industry, the Trump administration moved from home to inpatient nurses for every day when they were out of compliance – typically the Obama administration – with the issuance of a single fine for two-thirds of violations, reported records
This reduces the impact of punishment, critics say, giving nursing homes less incentive to fix faulty and dangerous practices before someone else is injured.
"It does not change behavior [at nursing homes]] as we want it," says Dr. Ashish Jah, a professor at Harvard University's Public Health School, School of Public Health. "For a small home for the elderly, this may be real money, but for the big ones are likely to be a mistake of rounding. "
Since joining the president, the administration has listened to complaints from the industry of the nursing home overseeing the possibility of a 18-month moratorium on punishment for violating the eight new health rules. I am also security. She also Cancellation of Obama's rule that prohibits individuals from requiring residents to file arbitration for dispute resolution, rather than go to court.
Reductions in total fines occurred even when Medicare & Medicaid Services Centers granted financial sanctions 28% more than Obama, an increase in the frequency of quotes with financial implications due to a policy that began at the end of Obama's term, which required regulators to Ata about & # 39; object whenever a resident was harmed rather than on your own.
Although this policy has increased the number of smaller fines, larger fines have become less widespread. The total sum collected under Trump dropped 10 percent over Obama's total in the last year – from 127 million dollars for Obama to 114 million dollars under the Trump. (We compared the penalties in 2016, Obama's last year at the office, with fines for Trump from April 2017 to March 2018, the last month for which federal officials claim that the data is reliably completed.)
CMS says it has revised numerous rules governing fines in both administrations in order to make punishment more fair, more consistent and better suited to improve care. "We will continue to analyze the impact of these combined events to determine if other actions are needed," said the CMS in a written statement.
Transition to smaller financial sanctions as a whole is consistent with the Trump administration. other policies that are conducive to industry in the healthcare sector. For example, the administration expanded the role of short-term health insurance policies that did not cover all types of services, provided States with more opportunities to change their Medicaid programs, and called on the Congress to allow doctors to open their own hospitals. 19659008] Bet Martino, spokeswoman for the American Association for Healthcare, a trade group for the elderly, says that the federal government "has returned to the use of fines in a way that stimulates problem solving" rather than punishment "
Guidance for punishment was strengthened in 2014, when the Obama administration ordered officials to contribute to daily fines, and this approach was applied in two thirds of the cases by 2016. These fines averaged $ 61,000  When Trump took on herself Indeed, the household industry complained that the penalties "went out of control" and became disproportionate to the shortcomings. "We observed a sharp increase [fines] in retroactive extradition and use as a punishment," said Mark Parkinson, president and CEO of the American Healthcare Association wrote in March 2017.
The CMS agreed that daily fines sometimes resulted in penalties that were determined by the random inspection time and not by the severity of the violation. If, for example, inspectors visited the building in April and found that in February an unlawful practice began, the accumulated daily fines would be twice as high as when the inspectors arrived in March.
– Penalties mean far fewer penalties, as penalties amount to $ 21,393, regardless of whether they are charged for each instance or day. Households who pay without a fine appeal receive a discount of 35 percent, meaning they now pay a maximum of $ 13,905.
These maximums apply even to those who detected a serious level of violations known as immediate danger, since the practice of childcare places the occupants at risk. For example, Mississippi's retirement home was fined $ 13,627 after the medication expired, as it relied on a pharmacy located 373 miles in Atlanta. The CMS also cut $ 54,600 in daily fines to a single fine of $ 20,965 for a New Mexico home, where employees have not properly disinfected equipment to prevent the spread of infectious diseases.
"This multi-million dollar company – $ 9,000 – is nothing," says Toby Edelman, Senior Policy Attorney at Advocacy Medica, a nonprofit organization in Washington.
are still issued when the post-citation violation has not been corrected at home. But even in these cases, CMS officials are allowed to make exceptions and to issue a single fine if there are no significant significant violations in the house.
The agency warned that the comparison of average fines is misleading, since the total number of inspections leading to fines under the Trump from 3.5% in 2016 to 4.7%. Circumstances that now require fines that have not been issued earlier entail penalties on the underside
. And when they were issued, the fines were on average 18 percent less than in 2016.
The frequency of immediate impending fines may decrease even more. The CMS told the inspectors in June that they no longer needed penalties if violations of immediate danger did not lead to "serious injury, damage, violation or death." Regulators still have to take certain measures, but it may be the mandate of the nursing home to organize training from an outside group or to establish specific changes in the work of the home.
Barbara Gay, vice president of public policy communication at LeadingAge, an association of non-profit organizations serving the older generation, including nursing homes, says that homes for the elderly "do not feel that they are being delayed" under Trump
"The fines should be large enough to change the behavior of professionals," said Robin Grant, director of public policy and propaganda at the National Consumer Voice for Long Term Care, a nonprofit company in Washington, DC.
Kaiser Health News is an independent information service supported by the Kaiser Family Non-Governmental Foundation. KHN is not affiliated with Kaiser Permanente. You can follow Jordan Rau on Twitter: @jordanrau .