ZPICs: Dangerous and ready to take down providers

Share this article:
Elizabeth Newman, McKnight's Senior Editor
Elizabeth Newman, McKnight's Senior Editor
Healthcare reform: No matter how much you may loathe it, there's no way around how certain ideas, like pay for performance, aren't going away.

“We don't want to believe healthcare reform is happening, but it's happening,” said Pathway Health Services vice president Lisa Thomson, BS, LNHA on Monday at the National Association of Directors of Nursing Administration/Long-Term Care keynote presentation in Nashville.

This was a far different tune than those sung by some of the politicians at the American Health Care Congressional Briefing a few weeks ago in Washington. Rep. Nan Hayworth (R-NY) said then that the House GOP's fight to repeal the Affordable Care Act was not “symbolic, because it's the will of the American people.”

Of course, politicians have a different agenda than consultants or clinical leaders. But I'd also argue that long-term care folks like presenters who give concrete ways to cope with the reality that exists today, as opposed to the future they hope would happen with a President Romney and a Republican Senate.

Still, if there is one thing that politicians, administrators, and DONs agree on, it's that Zone Program Integrity Contractors are something to be concerned about — especially if you are in Florida (Zone 7) or California (Zone 3).

If MAC and RAC contractors are seen as Godzilla or invasive aliens – scary villains that can be brought down with the right team  — than Zone Program Integrity Contractors (ZPICs) are like TV's fictional super-bad guys, Walter White or Avon Barksdale: They can destroy you easily. A big difference is, though, ZPICs will do it with data and the backing of the federal government rather than illicit drugs or guns.

Or as Thomson pointed out, “If a ZPIC sees something and sends it to the OIG [Office of the Inspector General], which sends it to the DOJ [Department of Justice], you are going into a federal investigation. You don't want to get burned.”

One facility that was the subject of a ZPIC had payment suspended for 24 months, she noted. Even a six-month suspension of payment, of course, can be the undertaker's calling card for a SNF.

It's no secret that stakeholders, especially in Florida, are pushing for ZPICs to be toned down. But if there's anything to take away from NADONA, it's Thomson's checklist of what to look out for in your facility, such as a sudden change or spike in billing, high error rates, compromised identities and RUG changes.

“You don't want ZPIC audits to happen,” she summarized succinctly.

You can see her entire presentation by clicking here. The NADONA meeting and exhibition continues through Wednesday at the Gaylord Opryland in Nashville.

Share this article:

Next Article in Daily Editors' Notes

Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.


    More in Daily Editors' Notes

    Maybe this sector's bankers need to start taking their own advice

    Maybe this sector's bankers need to start taking ...

    First and foremost, the NIC conference is a conduit that links those with money to those who need it. The event also features informative educational sessions that delve into where ...

    ICD-10 is around the corner, for real this time

    ICD-10 is around the corner, for real this ...

    There's a looming massive report on all the hospital readmissions data in your area and the strategic plan your facility needs to pursue. It involves talking to lots of employees, ...

    The sweet irony of a nursing home report card

    The sweet irony of a nursing home report ...

    It's said that politics, among other things, makes for strange bedfellows. Add long-term care quality improvement efforts to the list.