Clinton's plan to revise nursing home inspections draws mixed reaction.

Industry representatives and local patient advocates had opposite reactions last week to a proposal by the Clinton administration to scale back government inspections of nursing homes.

The proposed move - which would reduce the degree, though not the number of inspections carried out by the federal government each year - would generate little if any savings for taxpayers. That's because the manpower saved would be redirected to more-intensely probe facilities with the worst records.

Industry representatives warmly supported the move.

"One of the things that gets my goat is when people say, 'If you reduce how closely you (inspect the nursing homes), things automatically are going to fall apart,'" complained Katharine Holland, a spokeswoman for the California Association of Health Facilities, which represents the state's nursing homes. "That's definitely not true."

Holland called the Clinton proposal "long overdue," and said California facilities would welcome the chance to work with federal inspectors in a less-adversarial relationship.

"We'd like to see it where an inspector says, 'Hey, I went into a facility in Northern California and here's how they did it,' rather than 'You did it wrong, here's a fine, goodbye,'" she said.

In California, nursing homes generate revenues of about $4 billion a year, with 250,000 people being temporary or permanent residents of the state's 1,250 facilities (one-third in Los Angeles County) in any given year.

The state and federal governments spend about $45 million each year inspecting the facilities in California, more than two-thirds of which fail to fully comply with federal standards.

Currently, California "surprise-inspects" every nursing home in the state about once a year, spending an average of 200 to 300 hours determining whether the facilities comply with the more than 900 state and federal regulations.

Federal inspectors then sample about 5 percent of those facilities to confirm the results. Nursing homes which consistently score poorly risk losing their Medicare and Medicaid funding, the lifeblood of eldercare.

Under the Clinton proposal, federal reviews of medical records and other documents - such as menus, patient contracts and accident reports - would be scaled back, as would the number of interviews with patients themselves. Instead, federal inspectors would spend more time probing specific nursing homes that had been found by state inspectors to not be in compliance with government regulations.

Patient advocates said the proposed changes could make the federal inspection process too perfunctory to determine if less-egregious flaws in care exist. Also, the proposed move could be the first step in a roll-back of needed nursing home regulations built up over the last decade, advocates warned.

"It doesn't necessarily sound bad being after bad apples, but the issue is whether this will have any ramifications on quality assurance in nursing home settings," said Ailene Harper, director of direct service programs at the Los Angeles Center for Health Care Rights. "(Patient) advocates have fought long and hard on improving nursing home protections. No one (here) would want to see any action that would eliminate the safeguarding of (nursing home) patient rights."

Harper said she and other patient advocates are especially concerned about the proposal in light of efforts in the U.S. Congress last year to "gut" nursing home regulations as part of Medicare and Medicaid budget negotiations.

The Clinton administration said last week it has made no final decision on whether or not to move forward on implementing the proposal, provision of which would appear in a federal manual issued to state inspectors. The proposed changes are not subject to Congressional approval.

HMO report card online

Just in time for the renegotiating of employer health plans this winter and spring, the Pacific Business Group on Health has made its annual survey of California HMOs available to the public for the first time, via a site on the World Wide Web.

The site (http://www.healthscope.org) includes several dozen criteria on which to compare various HMOs and hospitals, ranging from the organization's customer satisfaction and accreditation status to rankings of the quality of prenatal care, the number of doctors with whom the HMOs contract for services and the efficiency with which the plans pay claims.

The 7-year-old PBGH is a coalition of 33 public- and private-sector groups that pools information on health care plans for members to use in negotiating separate, or collective contracts. In L.A., such corporate giants as Southern California Edison, Atlantic Richfield Co. and Hughes Aircraft Co. contribute to the program.

Love-o-gram

Getting in one the healthiest retail shopping season in recent memory, Brotman Medical Center in Culver City is selling "gifts of love" in the form of $45 certificates for mammograms. Correctly identifying the coupon as "the gift she would rarely think to give herself," the medical center will accept the certificates for a full mammogram - or breast-cancer screening - from recipients for up to a year after the coupon is purchased.

City of Angels

The story of an accountant at the Sylmar Health and Rehabilitation Center who was robbed of $5,000 of patients' Christmas shopping money apparently touched the better angels amongst Los Angeles residents.

A group of local FBI agents pledged to have $5,000 for the facility by Dec. 22, police in Monterey Park raised $5,000 for the cause, actress Helen Hunt wrote the center a $5,000 check, as did an unidentified L.A. couple.

"People have just walked in off the street and given $10, which is just incredible," said Todd Polk, the center's clinical director.

The original $5,000 in cashed Social Security checks was to have been used by the 205 residents of the psychiatric health facility for Christmas shopping. The shopping trip is one of the excursions allowed the patients, who must be kept under constant supervision.

Briefly

Foundation Health, a subsidiary of Foundation Health Corp., signed a one-year contract with the Talbert Medical Group, giving Foundation members access to the group's 19 medical centers and 2,000 physicians in L.A., Orange and Riverside counties. Foundations recently received government approval to expand its Medicare services, and the Talbert partnership will help it meet corresponding increases in local demand, the companies stated.