Nursefriendly.com: medicare

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Tuesday, May 3, 2011

Action For Better Healthcare » Finally a roadmap for a coordinated approach to patient care

The Centers for Medicare and Medicaid (CMS) released their long anticipated regulations dealing with ten pages of the 2,200-page March 2010 Affordable Care Act. Those ten pages are really the crux of what healthcare reform is all about and it is to improve the way we provide healthcare in this country.

Although these regulations required another 400 plus pages of explanation at least patients, families and caregivers now have an “expectation roadmap” outlining how the care they receive can be better. For the first time we have clear-cut targets to help us successfully achieve two-thirds of the triple aim – improving the quality of care and improving patient/family satisfaction with their care. The third part of the triple aim, monetary savings, should occur as a byproduct of the above clinical improvements.

Many doctors, nurses and others I talk with find the proposed regulations overwhelming and confusing. But remember, CMS is looking to us now for suggestions on how the recommendations can be improved before they become final. So be sure to contribute your comments.

via actionforbetterhealthcare.com

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Friday, April 15, 2011

Centers for Medicare & Medicaid Services

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Monday, April 4, 2011

The five hospital factors that affect heart attack survival, Science Daily

Until now, little has been known about the factors that may influence this variation in death rates. The Yale team reviewed 11 hospitals through interviews and site visits. Those selected were among the best and worst performers, as rated by the federal agency that administers Medicare and Medicaid.

"Previous research looked at whether hospital characteristics like urban location, teaching status, geographical region, and socio-economic status of patients are related to acute myocardial infarction (AMI) mortality rates, but these factors don't explain much of the variation in mortality," said Leslie A. Curry, Ph.D., research scientist at the Yale Global Health Leadership Institute and lead author on the paper. "We were particularly interested in the roles of social interactions and organizational culture, which are difficult to measure using common research approaches like surveys."

Hospitals in the high- and low-performing groups differed substantially in five ways: organizational values and goals, senior management involvement, broad staff presence and expertise in AMI care, communication and coordination, and problem solving.

via sciencedaily.com

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Thursday, March 17, 2011

Don't cut Medicaid, fund it better - CNN.com

Editor's note: Dr. Aaron E. Carroll is an associate professor of pediatrics at the Indiana University School of Medicine and the director of the university's Center for Health Policy and Professionalism Research. He blogs about health policy at The Incidental Economist.

(CNN) -- You can't turn on the news these days without hearing about our budget crisis. We've also been told, over and over, that it's a problem with spending -- we're doing too much of it.

There's truth in that. Even if taxes were to be raised, it's nearly impossible that we can begin to tackle the deficit without addressing the spending on Social Security, Medicare and Medicaid. Together, they total well over a trillion dollars in spending.

via cnn.com

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Wednesday, March 16, 2011

Sisters accused of health fraud nabbed in Colombia | Reuters

Two sisters accused of falsifying health care claims to defraud the U.S. government of millions of dollars were nabbed in Colombia and returned to the United States, authorities said on Tuesday.

Caridad Guilarte, 54, and Clara Guilarte, 56, ran a clinic in Dearborn, Michigan, that billed about $9 million in claims for treatments patients never received, according to the U.S. Department of Health and Human Services website.
The sisters collected more than $4 million from Medicare for drug therapies that were never provided, according to the HHS website.
After the FBI interviewed them, the two sisters fled, said Barbara McQuade, the U.S. attor

via reuters.com

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Tuesday, March 15, 2011

$4 drug programs could save economy billions: study | Reuters

U.S. consumers could save billions of dollars by filling prescriptions for inexpensive generic drugs at stores such as Wal-Mart and Target, according to a new report.

A growing number of national chain pharmacies offer the generic form of a range of drugs - including anti-allergy medications, antidepressants, antibiotics and cholesterol-lowering drugs - for $4 for a 30 day supply. However, researchers found that less than 6 percent of people who could use such a program take advantage of it - costing both consumers and the government extra bucks.
All told, the US could save as much as $5.8 billion, according to the study

via reuters.com

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Monday, March 14, 2011

Hospitals Could Save Millions By Eliminating Five Hospital-Acquired Conditions

An average 200-bed hospital could save approximately $2 million annually if it eliminates common but high-cost hospital-acquired conditions among inpatients, according to the Healthcare Management Council, Inc. (HMC), a Needham, MA-based company focusing on hospital and healthcare performance improvement.

The information was compiled using federal Agency for Healthcare Research and Quality (AHRQ) indicators and recent proprietary cost-benchmarking information, according to Shelley Burns, HMC's director of knowledge management. HMC has reviewed the performance of hundreds of facilities ranging in size from 75 beds to more than 800 beds.

"The cost of quality is what we call it, but bringing that number [together] for our folks to see lets us align the financial side of the house and the clinical side of the house so they can work together [on this issue]," Burns says

via healthleadersmedia.com

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Monday, February 28, 2011

Governors: Medicaid More A Budget Buster Than Ever : NPR

The federal government and the states have shared the cost of Medicaid, the health insurance program for some 60 million low-income Americans, since it was created in 1965.

They've shared something else almost that long — arguments about who should foot how much of the ever-escalating bill.

"Medicaid cost growth has been a problem for time immemorial," says Alan Weil, executive director of the National Academy for State Health Policy.

But this time, he says, things are different.

For one thing, "the program is bigger, so growth on a larger base is more real dollars that's harder to find."

via npr.org

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Sunday, February 20, 2011

Medical News: Operation Targets $225M in Healthcare Fraud - in Public Health & Policy, Medicare from MedPage Today

By Joyce Frieden, News Editor, MedPage Today
Published: February 18, 2011

WASHINGTON -- The largest healthcare fraud operation in U.S. history has nabbed suspects accused of collectively defrauding Medicare of more than $225 million, according to officials from the Department of Health and Human Services (HHS) and the Department of Justice (DOJ).

The Medicare Fraud Strike Force charged 111 defendants in nine cities for their alleged participation in Medicare fraud schemes, officials announced on Thursday. Defendants included doctors, nurses, and healthcare company owners and executives, among others.

"With this takedown, we have identified and shut down large-scale fraud schemes operating throughout the country. We have safeguarded precious taxpayer dollars. And we have helped to protect our nation's most essential healthcare programs, Medicare and Medicaid," said Attorney General Eric Holder in a statement. "As [these] arrests prove, we are waging an aggressive fight against healthcare fraud."

More than 700 law enforcement agents from the FBI, the HHS Office of Inspector General, multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the operation.

via medpagetoday.com

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Sunday, February 6, 2011

Hospice Under Medicare | Accepting Hospice Under Medicare | Caring.com

Hospice is a type of care that focuses on relieving pain and other suffering for patients nearing the end of life. To qualify for Medicare-covered hospice care, a patient's treating physician must certify that the patient's illness is likely to be terminal within six months. Once hospice care is begun, there's no more medical treatment for the terminal illness itself.
Given this requirement of a prognosis of only six months to live, and the ending of treatment for the terminal disease, many people resist hospice because it seems like "choosing to die." Many people also fear hospice because they believe that all medical care will end. For several reasons, though, neither one of these fears should stop someone from choosing hospice care.
In the first place, the decision to choose hospice isn't final. If a patient's condition stabilizes or improves, he or she can give up hospice and return to regular Medicare coverage. All it takes is to have a change of mind about giving up treatment, or a doctor's advice to try a new treatment. Or for some reason the patient might not like hospice care and prefer to return to regular Medicare coverage. Patients don't have to give Medicare or the hospice provider a reason -- they can end hospice and return to regular Medicare coverage at any time.

via caring.com

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Thursday, February 3, 2011

CMS Initiative Will Link Incentives With Reduced Infections, Readmissions - California Healthline

CMS is planning a "major multi-year financial commitment" involving Medicare, Medicaid and private insurers that aims to curb hospital-acquired infections and readmissions, according to a confidential draft of a CMS document, Inside Health Reform reports.

The so-called National Patient Safety Initiative -- which is being developed by CMS' innovation center -- would link $70 billion in Medicare funds across 10 years to hospitals' ability to achieve new standardized performance metrics. Under the plan, 6% of hospitals' Medicare payments will be contingent on reporting errors and meeting safety measures, with the proportion of payments increasing to 9% by 2015.

By hiring state contractors, CMS will develop measures and monitor progress, and then use results to determine payments.
Medicaid and private insurance plans that chose to participate in initiative also will link a larger portion of payments to patient safety goals, affordability and patient-centered care.

The innovation center also will fund studies that aim to determine how to disseminate best practices data, and support states and health systems that develop networked learning projects, Inside Health Reform reports (Inside Health Reform, 1/26).

via californiahealthline.org

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Friday, January 7, 2011

More young people are winding up in nursing homes - Yahoo! News

Adam Martin doesn't fit in here. No one else in this nursing home wears Air Jordans. No one else has stacks of music videos by 2Pac and Jay-Z. No one else is just 26.

It's no longer unusual to find a nursing home resident who is decades younger than his neighbor: About one in seven people now living in such facilities in the U.S. is under 65. But the growing phenomenon presents a host of challenges for nursing homes, while patients like Martin face staggering isolation.

"It's just a depressing place to live," Martin says. "I'm stuck here. You don't have no privacy at all. People die around you all the time. It starts to really get depressing because all you're seeing is negative, negative, negative."

The number of under-65 nursing home residents has risen about 22 percent in the past eight years to about 203,000, according to an analysis of statistics from the Centers for Medicare and Medicaid Services. That number has climbed as mental health facilities close and medical advances keep people alive after they've suffered traumatic injuries. Still, the overall percentage of nursing home residents 30 and younger is less than 1 percent.

Martin was left a quadriplegic when he was accidentally shot in the neck last year by his stepbrother. He spent weeks hospitalized before being released to a different nursing home and eventually ended up in his current residence, the Sarasota Health and Rehabilitation Center. There are other residents who are well short of retirement age, but he is the youngest.

via news.yahoo.com

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Wednesday, January 5, 2011

Hospital care easier, faster with standing orders - CNN.com

My patient one day, a spry 80-year-old, started to cough and feel short of breath during a blood transfusion: classic signs of a transfusion reaction. I stopped her IV, but she needed a steroid to bring her breathing back to normal.

Unable to reach her primary physician, we called in a rapid-response team. An ICU doctor, respiratory therapist, two ICU nurses, a nurse anesthetist, and MDs and RNs from the floor all rushed into the room . . . . to authorize giving my patient this one needed drug.

The patient did not need rescuing, just a dose of solumedrol, and I could have given her that dose, without wasting the time and energy of multiple nurses and doctors, if we had a protocol, or "standing order," in place in my hospital for treating transfusion reactions.

A standing order is a kind of treatment algorithm used in hospitals to expedite care. Protocols are designed by doctors and nurses, implemented by nurses, and are typically used either in specific emergencies or to deliver routine care. A protocol for treating low blood sugar is an example of treating an emergency; putting silver nitrate in a newborn's eyes counts as routine.

Protocols make a lot of sense, according to Nancy Foster, vice president for Quality and Safety Policy for the American Hospital Association. The AHA supports the use of standing orders because, Foster says, "Standardization is an effective way to make sure we do the right thing for the right patient at the right time."

via cnn.com

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Sunday, December 26, 2010

Guides help recovering patients find long-term care | The Salt Lake Tribune

An uncomfortable truth for anyone facing disability for a year or more: If you go into a nursing home, you might never get out.

Under patchwork Medicare provisions, says Utah Commission on Aging Director Maureen Henry, it is more convenient for hospitals to discharge patients to nursing homes than to figure out how they might live in their homes and communities.

But what looks like the easy solution can be costly. Nursing home bills may drive more people onto Medicaid, which costs taxpayers more, and the move can unnecessarily disrupt the community and impoverish the lives of patients, Henry says.

“You’re shifting residence; you’re shifting family structure out of the community and into the nursing facility,” she says.

Now, with the help of a $700,000 grant from the federal Administration on Aging, the Utah commission is linking hospital discharge staff with “options planners,” who help guide patients and their families through a complicated array of choices for extended care.

The way Medicare and Medicaid law works, people are guaranteed care in nursing homes. But there is no similar guarantee of coverage for care outside an institution, meaning family finances may limit the choices.

“People have the right to decide where and when they receive long-term care,” Henry says. “Our objective is to try to catch people before they are scrambling in a crisis, stop giving people the runaround.”

via sltrib.com

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Tuesday, November 16, 2010

Hospital care fatal for some Medicare patients - USATODAY.com

An estimated 15,000 Medicare patients die each month in part because of care they receive in the hospital, says a government study released today.

The study is the first of its kind aimed at understanding "adverse events" in hospitals — essentially, any medical care that causes harm to a patient, according to the Department of Health and Human Services' Office of Inspector General.

Patients in the study, a nationally representative sample that focused on 780 Medicare patients discharged from hospitals in October 2008, suffered such problems as bed sores, infections and excessive bleeding from blood-thinning drugs, the report found. The federal Agency for Healthcare Research and Quality called the results "alarming."

"Reducing the incidence of adverse events in hospitals is a critical component of efforts to improve patient safety and quality care" in the U.S., the inspector general wrote.

The findings "tell us exactly what some of us have been afraid of, that we have not made much progress," said Arthur Levin, director of the independent Center for Medical Consumers and a member of an Institute of Medicine committee that wrote a landmark 1999 report on medical errors. "What more do we have to do to make sure that sick people can rest assured that they're not going to be harmed by the care they're getting?"

Among the findings in the report obtained by USA TODAY:

•Of the 780 cases, 12 patients died as a result of hospital care. Five were related to blood-thinning medication.

Two other medication-related deaths involved inadequate insulin management resulting in hypoglycemic coma and respiratory failure resulting from oversedation.

•About one in seven Medicare hospital patients — or about 134,000 of the estimated 1 million discharged in October 2008 — were harmed from medical care.

•Another one in seven experienced temporary harm because the problem was caught in time and reversed.

About 47 million Americans are enrolled in Medicare, a government health insurance program for people 65 and older and those of any age with kidney failure.

The adverse events found in the study weren't necessarily due to medical mistakes, said Lee Adler, a University of Central Florida medical professor who was involved in the study. For example, he said, an allergic reaction to a penicillin injection is an adverse event, but it's a medical error only if the patient's allergy was known prior to the shot.

Among the problems identified in the report were Medicare patients who had excessive bleeding following surgery or a procedure. For example, one patient had excessive bleeding after his kidney dialysis needle was inadvertently removed, which resulted in circulatory shock and an emergency insertion of a tube to allow breathing.

When the tube was removed the next day, the patient inhaled foreign material into his lungs and needed lifesaving medical help, the report said.

Peter Pronovost of Johns Hopkins University, co-author of the book Safe Patients, Smart Hospitals, said medical mistakes are "an enormous public- health problem."

"We spend two pennies trying to deliver safe health care for every dollar we spent trying to develop new genes and new drugs," Pronovost said. "We have to invest in the science of health care delivery."

via usatoday.com

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Monday, November 15, 2010

Doctors who order tests for their own financial gain-KevinMD.com

Doctors who order tests for their own financial gain
6 comments
in Physician practice
by Kohar Jones, MD
“What a shame,” said my eighty eight year old Armenian grandmother, shaking her head with sorrow, and I had to agree. “US officials charge 73 people, mostly Armenians, over a massive fraud against the country’s medical insurance system,” read the BBC headline.
A (mostly) Armenian crime syndicate set up 115 sham clinics in the United States, using real doctors’ names and real patient information, stolen from different systems, to generate false Medicare claims.
Dermatologists examined hearts. ENT doctors performed pregnancy ultrasounds. (And Medicare beneficiaries, it must be noted, are usually past child-bearing age.)
At some point, $35 million later, someone noticed the discrepancies. How broken is our health care payment system that an interstate, international mafia could steal $35 million from US taxpayers via false Medicare claims? How broken is our health care payment systems than an upstart Armenian mafia would even decide that Medicare should become the new black market, filled with low-hanging fruitful ways to make an easy buck? Whatever gave them the idea?
Perhaps they learned from low-level not-quite-gangsters racketeering their way to easy profits—the real doctors in real storefront clinics seeing real patients, for example, who happen to have high blood pressure– performing EKGs every three months for no good medical reason. Should we call it a scam when real doctors refer real patients to the imaging sites down the road in which the doctors have partial ownership, to perform imaging studies for no strong medical indication? How might this contribute to a “massive fraud” of medical overutilization?
The Armenian Medicare Mafia brings shame to my ethnicity. Doctors who order for their own financial gain, I believe, bring shame to my profession.
Three cheers for shame-free doctoring! Let us give patients what patients need, no less and certainly no more.
Kohar Jones is a family physician who blogs at Progress Notes.

via kevinmd.com

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