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Friday, April 1, 2011

ANA Factsheet on Medicaid Reimbursement

Current laws regarding Medicaid reimbursement for nurse practitioners and clinical nurse specialists are extremely complicated in terms of which categories of these advanced practice registered nurses may be reimbursed. In fact, these laws are so confusing for carriers, providers and consumers that they have become a barrier to access to health care services in and of themselves.

Under current law, state Medicaid programs are required to provide direct reimbursement to pediatric nurse practitioners, family nurse practitioners and certified nurse midwives. Some states have opted to cover the services of other advanced practice registered nurses, while other states have chosen not to include services of advanced practice registered nurses beyond the current Federal mandate. Although states set their own reimbursement rates for Medicaid providers, payment levels must be adequate to ensure that Medicaid beneficiaries have access to services comparable to those enjoyed by the general population.

Millions of Americans each year go without the health care services they need because physicians simply are not available to care for them. This problem plagues rural and urban areas alike. Medicaid beneficiaries are particularly vulnerable, since in recent years an increasing number of health professionals have chosen not to care for them or have been unwilling to locate in the inner-city and rural communities where many of the beneficiaries live. Nurse practitioners and clinical nurse specialists are an exception to this trend; they frequently accept patients whom others will not treat and serve in areas where others refuse to work.

via nursingworld.org

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AHRQ Reports Declines in Diabetes Care - HealthLeaders Media

Care for people with diabetes, who are at higher risk for disease-related blindness, limb amputations and kidney failure, has been getting worse rather than better, according to an analysis taken from the Agency for Healthcare Research and Quality's latest National Healthcare Disparities Report .

For example, the agency said, the proportion of low income adults age 40 and older with diabetes who had annual recommended blood sugar levels tested, had their eyes examined for retinopathy and their feet examined for nerve damage and circulation issues declined from 39% to 23% between 2002 and 2007.

For middle-income adults, the situation remained the same, with slightly more than half, 52%, receiving those recommended yearly exams.

Racial disparities in getting these recommended screenings was pronounced. Blacks experienced an 11 percentage point drop, from 43% to 32%. The percentage of Hispanics who had all three exams dropped from 34% to 27%. And among whites, diabetes testing also declined, but by only 4 points, from 43% to 39%.

via healthleadersmedia.com

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MRSA Protocols- Are They Being Used In Practice? | Registered Nurse Blog

Posted: April 2nd, 2011

In Advance For NPs and PAs, a March 9, 2011 article was featured on the following study of protocols used by health care providers to treat MRSA infections. I was surprised to see that some providers were still using Keflex to treat these infections. Some providers still were not sending cultures on these infections. How can we adequately treat an infection without knowing what will actually kill the bacteria? My impression of the following information is that the protocol that I do is somehow a new treatment regimen. I have been doing incision and drainage with appropriate culturing with first line Septra for the last 3 plus years. I also use mupricion ointment to nares twice daily and Hibaclens during the regimen if they have had more than one outbreak within a 6 month period.

Taking Aim at MRSA
Protocol use by an NP-PA team
Anita D. Barnes is a family nurse practitioner who is an assistant professor of nursing at Stephen F. Austin State University in Nacogdoches, Texas.
A 2009 study reported a variety of approaches used by ED physicians to treat CA-MRSA SSTIs.6 The study surveyed 225 ED physicians nationwide: 56% reported always sending cultures for testing and 19% said they never did so. The physicians prescribed trimethoprim-sulfamethoxazole (TMP-SMX) 60% of the time, either alone or in combination with another antibiotic. Nineteen percent treated patients with cephalexin alone, and 13% prescribed cephalexin in combination with another antibiotic. Cephalexin is not recommended in the CDC protocol.

What are you doing as providers to treat MRSA infections? Do you find the information alarming that some providers are still not culturing infections?

via registerednurseblog.com

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Medicirc.org: Circumcision Information Site - A Lifetime of Medicial Benefits

Compelling medical data, much of it accumulated in the past 2 decades, have conclusively shown that a boy circumcised as a newborn has multiple lifetime health advantages compared to one with an “intact” foreskin. These include protection against serious kidney infections in infancy, sexually transmitted infections (STIs) including human immunodeficiency (HIV) infections, Chlamydia infection, human papilloma virus (HPV), syphilis, chancroid and herpes simplex in young men, and invasive cancer of the penis in middle and old age. In addition, all through life uncircumcised males are more susceptible to penile infections (balanoposthitis) and a variety of skin disorders of the penis such as eczema and psoriasis, as well as more difficulty maintaining good hygiene. About 1% of boys are born with only a pinpoint opening at the tip of the foreskin (phimosis) preventing retraction, leading to painful erections, and requiring future circumcision, at a time when the procedure is more difficult, risky and costly. Further, women sexual partners of uncircumcised men with HPV infection are at significantly greater risk of developing cervical cancer.

How convincing is the scientific evidence of circumcision advantages? Overwhelming in the cases of infant kidney infections, penile cancer and local disorders, and compelling for HIV, Chlamydia, HPV and risk to female partners of uncircumcised men with HPV infections. In the mid 1980’s, Dr. Tom Wiswell, a military pediatrician initially opposed to newborn circumcision, examined the United States (US) Armed Forces records of over 200,000 newborn boys and to his surprise found that uncircumcised boys were 10 to 20 times more likely to develop severe kidney infections in the first year of life. Since then a dozen published reports confirm this protective effect of circumcision against infant urinary infections and explain how these infections occur. The warm, tight, moist undersurface of the infant foreskin provides an ideal home for the harmful fecal bacteria that cause kidney infections. These bacteria (“uropathic, fimbriated E. Coli”) have tentacles which attach to the foreskin and then climb up the urinary tract to the kidney. The resultant infection leads to kidney scarring in almost half the cases, as well as body salt loss and hormonal changes in some instances. Although there is no proven long-term evidence so far of permanent kidney damage, these renal effects are disturbing.

via medicirc.org

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Body Measurement Tracker | HealtheHuman

Body Measurement Tracker

Use the Body Measurements Tracker to keep track of your measurements over time. The tracker records height, weight, neck, chest, waist, hip, bicep, forearm, thigh, calf, and foot measurements, and automatically runs the calculations for BMI, Waist-to-Height, and Waist-to-Hip and other key ratios. How is your new fitness routine impacting the fit of your clothes? Find out where you are getting the most change and definition in your body by logging often and reviewing the results in the charts feature. Set goals to keep you on track and motivated. Whether you are training with a structured fitness program or just want to watch your weight during the holidays, you can do it all in the body measurements tracker.

Track Your Body Measurements
When you input data in the body measurement tracker, we will automatically calculate key metrics for you. Just input a few measurement and we can provide you with many valuable health stats to keep you on track. Our tracker also provides helpful hints on how to get the most accurate and consistent measurements each time.

With the body measurements feature, you can track:

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Study Finds Conflicts of Interest Among Medical Panelists - NYTimes.com

Doctors with private financial conflicts of interest dominated some of the panels that wrote guidelines on cardiovascular health in recent years, according to a medical journal study released on Monday.

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Penn Medicine

Dr. James N. Kirkpatrick, the study's senior author.

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University of Miami Health System

Dr. Ralph L. Sacco, president of the American Heart Association.

The guideline panels are the select groups of experts who are assigned to evaluate science independently and issue their advice to other doctors on what to do in clinical practice. The guidelines influence medical care, product choice, insurance coverage, government policy and malpractice cases.
The study, published in the Archives of Internal Medicine, found that conflicts of interest were reported by 56 percent of 498 people who helped write 17 guidelines for the American Heart Association and American College of Cardiology, from 2003 through 2008.

via nytimes.com

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Cancer patients get better care than patients in primary care

Why do my patients with cancer get better care than my patients in primary care? As the senior resident on my hospital’s inpatient leukemia service recently, this question troubled and intrigued me daily.
Despite the sheer complexity of treating leukemia (administration of chemotherapy, bone marrow biopsies, stem cell transplantation), the resources required (transplantation routinely costs $1 million), and the severity of the illness (patients with little to no functional immune system), I couldn’t help but marvel at how coordinated, integrated, and patient-centric the care was.
From the first day I saw that things in leukemia worked differently. Most inpatient ward teams consist of an attending, a senior medical resident, one or two interns, and medical students. Each member of the team is “on service” for 2-4 weeks after which they rotate to different parts of the hospital or to the outpatient or research setting. As a result a patient admitted to general medicine today is taken care of by a completely different team than took care of her 3 months earlier when she came in for the same problem. On leukemia, our medical team included an advanced practice nurse (APN) who did not rotate off and on service.

via kevinmd.com

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Cuts Leave Patients With Medicaid Cards, but No Specialist to See - NYTimes.com

Eight-year-old Draven Smith was expelled from school last year for disruptive behavior, and he is being expelled again this year. But his mother and his pediatrician cannot find a mental health specialist to treat him because he is on Medicaid, and the program, which provides health coverage for the poor, pays doctors so little that many refuse to take its patients.

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Michael Stravato for The New York Times

Dr. Rachel Chatters, right, with Ana Smith, says she begs specialists to see Medicaid patients.

Related

Arizona Asks to Set Fines for Health Risks (April 2, 2011)

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Michael Stravato for The New York Times

Ms. Smith said she has tried for more than a year to find a psychiatrist to treat her son Draven, 8, who is on Medicaid.

The problem is common here and across the country, especially as states, scrambling to balance their budgets, look for cuts in Medicaid, which is one of their biggest expenditures. And it presents the Obama administration with a major challenge, since the new federal health care law relies heavily on Medicaid to cover many people who now lack health insurance.
“Having a Medicaid card in no way assures access to care,” said Dr. James B. Aiken, an emergency physician in New Orleans.

via nytimes.com

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Unnamed 04/02/2011

How safe is your hospital? - chicagotribune.com

Warning flags: How safe is your hospital? (Chicago Trib) http://bit.ly/eQpcwD #pt safety

tags: pt
Suzan Macco RN,CNHP (NurseForHealth) on Twitter - nursefriendly's posterous

Suzan Macco RN,CNHP (NurseForHealth) on Twitter http://post.ly/1pMUv
Conflicts Of Interest In Guideline Development: A Dirty Little Secret Gets Aired Again | The Health Care Blog

Conflicts Of Interest In Guideline Development: A Dirty Little Secret Gets Aired Again http://is.gd/KhZTEJ
When life knocks you to your k

When life knocks you to your knees, just remember you’re in the perfect position to pray.
Hospital worker had deadly blood infectionhttp://b

tags: pt

Hospital worker had deadly blood infectionhttp://bit.ly/fKykNx #pt safety

Posted from Diigo. The rest of my favorite links are here.

‘A True Art’: Strategies for Feeding Patients with Dementia-Registered Nursing Blog – Info for Nurses

Feeding difficulties in people with dementia are common, but the way such difficulties manifest can vary widely, and there is no single, one-size-fits-all solution. Nurse researchers Chia-Chi Chang and Beverly L. Roberts open their April CE article, “Strategies for Feeding Patients with Dementia,” with some disturbing statistics that make clear the scope of the problem:

People with dementia constitute roughly 25% of hospital patients ages 65 and older and 47% of nursing home residents. And more than half of them lose some ability to feed themselves, which puts them at high risk for inadequate food intake and malnutrition. Patients who are unable to eat independently must rely on caregivers to assist them . . . Unfortunately, caregivers may be unable to identify the various types of feeding problems that accompany dementia or unaware of the feeding practices required to address them.

In an earlier literature review published in the Journal of Clinical Nursing, Chang and Roberts evaluated three tools used to assess feeding difficulties in people with dementia, then created a conceptual model depicting such difficulties, contributing factors, and outcomes. Now, in this CE article, the authors take their work a step further. They describe a range of assessment and intervention practices, matched to specific feeding difficulties and observed behaviors, that caregivers can try. For example:

if a patient refuses or displays an aversion toward food, as evidenced by pushing the feeder or the food away, spitting out food, or refusing to open her or his mouth,

then strategies might include feeding the patient at another time, seeking help from another nurse or nursing assistant, offering verbal encouragement, sitting down and making eye contact with the patient, and offering familiar foods.

via registerednurseblog.com

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Friday, April 1, 2011

ANA Factsheet on Medicaid Reimbursement

AHRQ Reports Declines in Diabetes Care - HealthLeaders Media

MRSA Protocols- Are They Being Used In Practice? | Registered Nurse Blog

Medicirc.org: Circumcision Information Site - A Lifetime of Medicial Benefits

Body Measurement Tracker | HealtheHuman

Body Measurement Tracker

Study Finds Conflicts of Interest Among Medical Panelists - NYTimes.com

Penn Medicine

University of Miami Health System

Cancer patients get better care than patients in primary care

Cuts Leave Patients With Medicaid Cards, but No Specialist to See - NYTimes.com

Michael Stravato for The New York Times

Related

Arizona Asks to Set Fines for Health Risks (April 2, 2011)

Michael Stravato for The New York Times

Unnamed 04/02/2011

‘A True Art’: Strategies for Feeding Patients with Dementia-Registered Nursing Blog – Info for Nurses

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