<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-0468fbefd953d2cd668addb4ce3f5587f78d8c68-s100.jpg "class =" img lazyOnLoad "alt =" Medicare Reduces Payments to Nursing Homes whose Patients Return to the Hospital  The Reductions in total fines also occurred when the Medicare & Medicaid Services centers were 28 percent more fined than under Obama, and this increase in the frequency of citations with financial implications stems from
policy towards the end of Obama's term and forced the regulators to punish an asset every time a resident was injured instead of leaving it to their discretion.
While this policy increased the number of smaller fines, larger funds were paid . S rare, the total amount that was collected Trump, fell compared to Obama last year by 10 percent – of 127 million dollars under Obama to 114 million dollars under Trump. (We compared the penalties in 2016, Obama's last year in office, with the punishments under Trump from April 2017 to March 2018, the last month for which federal officials find the data reliable.)
CMS says it has revised several fines rules in both administrations to make the sanctions more equitable, consistent and better targeted at nursing homes to improve care. "We continue to analyze the impact of these combined events to determine if other measures are needed," CMS said in a written statement.
Turning to lesser financial sanctions is broadly in line with the Trump administration's other industry-friendly policies in the healthcare sector. For example, the administration has broadened the role of short-term health insurance, which does not cover all types of services, giving governments more leeway to change their Medicaid programs, and has called on Congress to allow physicians to open their own hospitals.  Beth Martino, a spokesperson for the American Health Care Association, a nursing home trading group, says the federal government has "returned to a method of applying fines in a way that creates incentives for problem solving," instead of punish, "" the strenuous institutions do the right thing.
Criminal law guidelines were tightened in 2014, when the Obama administration ordered officials to support daily fines, and this approach was applied in two-thirds of cases by 2016. These fines averaged $ 61,000.
Als Trump took over the acquisition, lamenting the nursing home industry that the fines were "out of control" and had become disproportionate to the deficiencies. "We have seen a dramatic increase in [fines]which was retroactively imposed and punished," wrote Mark Parkinson , President and CEO of the American Health Care Association, in March 2017.
CMS agreed that daily fines sometimes led to penalties caused by the random timing of one Inspection and not determined by the gravity of the infringement For example, if ectors visited a home in April and found that an inadmissible practice had begun in February, the accumulated daily fines would be twice as high as if the inspectors arrived in March.
But a preference for per-instance fines means much lower penalties, as fines are limited to $ 21,393, regardless of whether they are levied per instance or per day. Nursing homes that pay without contesting the fine receive a 35 percent discount, meaning they currently pay a maximum of $ 13,905.
These limits also apply to entities that have committed the most serious levels of offenses known as immediate threats. Nursing home practices directly endanger the residents. For example, a $ 13,627 fine was imposed on a Mississippi nursing home after he ran out of medication because he had relied on a pharmacy in Atlanta in Atlanta. CMS also cut its daily fines by $ 54,600 to a $ 20,965 fine for a New Mexico home where staff had not properly sanitized the equipment to prevent the spread of infectious diseases.
On average, Trump's fines per case were below $ 9,000 under Trump. Show records.
"These are multi-million dollar businesses – $ 9,000 are nothing," says Toby Edelman, a senior lawyer at the Center for Medicare Advocacy, a nonprofit organization in Washington.
Large daily fines of an average of $ 68,080 Still spent when a home has not corrected a violation after being cited. But even in these cases, CMS officials can make exceptions and impose a single fine if there were no serious violations in the home.
The agency warned that the comparison of average fines was misleading, as the total number of controls that led to fines increased under Trump from 3.5 percent in 2016 to 4.7 percent. The circumstances that now lead to fines that have not been issued before are punishable.
Kaiser Health News noted, however, that in fewer cases Trump imposed fines for immediate threats. On average, the fines were 18 percent lower than they were in 2016.
The frequency of imminent fines may even go down further. CMS informed the inspectors in June that they would no longer have to commit to plant abatement unless immediate injury resulted in "serious injury, injury, injury or death". The regulators still need to do something, but that could lead the nursing home to arrange for training from an outside group or to make certain changes to the way the home works.
Barbara Gay, vice president of public relations at LeadingAge – an association of non-profit organizations offering elderly services, including nursing homes – states that nursing homes under Trump "do not feel deferred".
But consumer advocates say the penalties have fallen to low levels to be effective.
"The fines must be large enough to change the institution's behavior," said Robyn Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care, a non-profit organization based in Washington, DC , In that case, care generally does not improve. "
Kaiser Health News is an editorially independent news service supported by the impartial Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente. You can follow Jordan Rau on Twitter: @jordanrau .