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January 13–February 17, 2020 8 Working Nurse l WorkingNurse.com ON THE QUICK Nursing & Healthcare News Unequal Care Report highlights California's racial health disparities D espite significant improvements in healthcare quality and access, a recent California Health Care Foundation (CHCF) report warns that California still suffers sub- stantial health disparities by race/ethnicity. A Pattern of Harm Working Nurse recently wrote about the California Legislature's efforts to address the alarming racial gap in pregnancy-associ- ated deaths. Consider that between 2013 and 2015, Black women comprised only 5.6 percent of the women who gave birth in California, but accounted for 21 percent of maternal mortality cases. (See WorkingNurse.com.) Now, CHCF's 2019 California Health Care Almanac report on health disparities offers further data on racial health disparities. "The report tells us where in California people of color dis- proportionately face barriers to healthcare and bear a heavier burden of illness," explains CHCF President and CEO Sandra R. Hernandez, M.D. "It also reveals a pattern of harm that is espe- cially devastating to the people in our Black communities." Lack of Care Is Not the Problem One disparity that should grab hospital administrators' atten- tion is in 30-day hospital readmission rates. In 2017, California's overall readmission rate was 14.6 percent, similar to the nation- al average. However, the readmission rate for Black Californians was 18.6 percent — 4.6 percentage points higher than for white Californians. Preventable hospitalization rates tell a similar story. For instance, in 2015, California's congestive heart failure hospitaliza- tion rate was 237.3 admissions per 100,000 population for white residents, 295.1 per 100,000 for Latino residents and 708.9 per 100,000 for Black residents. Many of those hospitalizations could have been avoided through better outpatient care. These disparities appear to reflect unequal quality of care rather than a lack of care. Black residents are actually signifi- cantly more likely than white or Latino Californians to have annual checkups, and are less likely to report difficulty finding primary care or specialty providers. Facing the Facts Hernandez thinks California's healthcare system should use this data to make strategic changes. "In every case, all of us need to ask ourselves what unique challenges racial and ethnic groups face in getting the care and help they need, and then target improvement efforts to address those structural realities," she says. You can download the full report at www.chcf.org. WN For direct links to the websites cited, find these articles at WorkingNurse.com FIGHTING FRAUD Tough new Medicare rules target risky affiliations T he Centers for Medicare & Medicaid Services (CMS) recently implemented tough new rules intended to crack down on fraud, including penalties for being affiliated with individu- als or organizations that violate Medicare, Medicaid or Children's Health Insurance Program (CHIP) rules. Risky Business Imagine that you're a nurse practitioner in a Medicare-enrolled joint practice with another NP whose previous business ven- ture is still appealing an unpaid Medicare debt, or lost its Medicare billing privileges for some reason. Under new rules that took effect November 4, CMS could revoke your joint practice's Medicare enrollment if the agency determined that your affiliation with your business partner "poses an undue risk of fraud, waste or abuse" — even if you'd done nothing wrong. You could also be penalized if you failed to dis- close such a potentially risky affiliation. Warning for Providers You don't have to have a partnership or ownership interest to run afoul of the new rules. For instance, if you're a Medicare- enrolled provider, just seeing patients at a facility that violates Medicare program rules could now cost you your billing privi- leges if CMS determined that you "knew or should have known" the facility was out of compliance. Cracking Down Providers or organizations that are kicked out of Medicare, Medicaid or CHIP will also find it harder to reenroll. CMS can now prohibit a provider or supplier from reap- plying for up to 10 years — or up to 20 years if enrollment was revoked more than once. There are also penalties for trying to reapply under a new name or corporate entity to circumvent the rules. Administrator Seema Verma, MPH, says the goal is to crack down on "fraudsters [who] temporarily disappear into complex, hard-to-track webs of criminal activities, and then reemerge under different corpo- rate names." WN