Affordable Care Act « Off the Charts

Posts Tagged ‘Affordable Care Act’

Diabetes Plus Marijuana Plus Medical Errors Minus Nursing Blogs

January 12, 2012

What’s new in health care news this week?

Diabetes everywhere. There’s an entire Health Affairs issue devoted to the topic of “Confronting the Growing Diabetes Crisis.” It looks at many interrelated issues, such as the personal financial burden of having diabetes over the course of a lifetime, whether it’s best to put scarce health care resources into focusing on prevention or treatment, models for community-based lifestyle programs for those with type 2 diabetes, the positive effects of the Affordable Care Act on giving those with diabetes access to affordable health insurance and crucial care, genetic factors related to type 2 diabetes, and a great deal more. Inevitably, many of the articles focus on type 2 diabetes, which is so closely linked to America’s obesity epidemic.

by Jorge Barrios, via Wikimedia

Joint studies. The New York Times reported this week on a large government study showing that, whatever one believes about marijuana’s psychological effects or the efficacy of its various medical uses, long-term marijuana smoking—at least one joint per day, every day of the year—does not impair lung function or contribute to the development of COPD. Will this change anyone’s mind about whether this drug is evil, a panacea for all ills, or somewhere in between? Probably not.

Unreported harm. The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services issued a report last week stating that only 14% of medical errors and other events that harm Medicare patients were reported by hospital employees. The report calls for improving reporting systems and the creation of a list of ”potentially reportable events.” According to the New York Times story on the topic, adverse events that have gone unreported include ”medication errors, severe bedsores, infections that patients acquire in hospitals, delirium resulting from overuse of painkillers and excessive bleeding linked to improper use of blood thinners.”

Which leads us (or does it?) into nursing blogs. Many of the ones in our blogroll have been pretty silent in the past few months, or longer, and it’s not clear why. Some bloggers are taking a break, some have burned out or decided to use their time for other things (like going back to school), some have simply decided to spend more time on Facebook or sharing their thoughts by ’microblogging’ on Twitter (or are simply playing lots of Words With Friends on their smartphones). There are almost certainly many interesting new nursing blogs we don’t yet know about that are taking their places. If you know about them, please let us know. We need to take some time and do some digging. And we plan on doing a serious revision of the blogroll in the next few weeks.—JM, senior editor

Posted in patient safety | Tagged Affordable Care Act, bedsores, blogging, diabetes, Health Affairs, marijuana, nurses, Office of the Inspector General | 5 Comments »

Year-End Take: A Hopeful Trend in U.S. Health Care?

December 27, 2011

Photo by James Russo, via Flickr

Less Is Sometimes More
A hopeful trend that’s gained some serious momentum this year—and may be connected to both the recession and some provisions of the Affordable Care Act—is that we’re beginning to question whether we really need quite so many tests and drugs. By ‘we’ I mean researchers, some journalists, some nurses and physicians, and of course patients. The answers aren’t always clear, and there’s plenty of room for disagreement on many such issues, but at least we’re asking the right questions more often, rather than retreating in fear and simply hurling around the word “rationing”:

Who really benefits from prostate and breast cancer screening and who is more likely to be harmed, and why? When are you too young or too old to be likely to benefit from a certain type of screening? When does aggressive care at the end of life cease to make sense? Are we confusing a risk factor with a disease, an association with causation, relative risk with absolute risk?

Does that drug you see relentlessly marketed in advertisements during breaks in the network news actually help you? Which physicians are being paid as consultants in support of various drugs, tests, or treatments, and does this compromise their objectivity? And so on. The latest example of this kind of analysis I’ve stumbled across can be found here: “Disease Creep: How We’re Fooled Into Using More Medicine Than We Need.”

The Many Faces of Nursing
So, that’s one good sign as the year heads toward its close. Another is that nurses are making their voices heard and finding new roles and new ways to use their knowledge and skills as our system begins to slowly transform itself. And they are also blogging and sharing ideas on Twitter, organizing in support of safe staffing and fair wages, getting elected to Congress and assuming major leadership positions in health care organizations, providing essential primary care as nurse practitioners, spearheading quality improvement initiatives, learning new technologies, volunteering in disaster zones, doing exciting new research, providing crucial and compassionate bedside care, advocating for patients, and much more.

This blog will probably be pretty quiet until the New Year. Be well.—JM, AJN senior editor/blog editor

Posted in health care reform, nursing perspective | Tagged Affordable Care Act, aggressive medicine, association vs. causation, breast cancer, direct marketing, end of life care, prostate screening | 3 Comments »

Bad News, Good News: Berwick, a Casualty of Politics, Succeeded at CMS Helm by a Nurse

November 30, 2011

By Shawn Kennedy, MA, RN, editor-in-chief

Marilyn Tavenner

When Donald Berwick steps down from his post as administrator of the Centers for Medicare and Medicaid Services (CMS) on December 2, he’ll turn the reins over to Marilyn Tavenner, MHA, BSN, RN. Tavenner is not a new face at CMS—she served as acting administrator prior to Berwick’s July 2010 appointment by President Obama and has been principal deputy administrator at CMS since February 2010.

As noted by an article in The Washington Post, Berwick is stepping down in the face of organized opposition to his nomination by Republicans in Congress, who have vowed to block the confirmation he’d need to continue after his recess appointment expires on December 31.

On November 23, President Obama announced his intent to nominate Tavenner for the top post. In her e-mail to CMS staff (carried on the Kaiser Health News site), Kathy Sebelius, secretary of Health and Human Resources, says of Tavenner, “Her career as a nurse, hospital administrator, and Virginia Secretary of Health and Human Resources give her unique insights that position her well to serve as Administrator.”

I certainly hope so. Berwick’s reputation and track record for pinpointing problems in our health system—and more importantly, working to do something about them through the Institute for Healthcare Improvement—was stellar, and he carried this zeal into his government position as he grappled with the daunting task of implementing reforms in the Affordable Care Act. Read the rest of this entry ?

Posted in Uncategorized | Tagged Affordable Care Act, Centers for Medicare and Medicaid Services, CMS, Donald Berwick, nurse, Tavenner | 2 Comments »

Health Care Reform Works—If You Work It

April 22, 2011

Image by urbanbohemian via Flickr

By Gail M. Pfeifer, MA, RN, AJN news director

My husband and I both recently had preventive screening colonoscopies, which are now covered under the Affordable Care Act (ACA) as preventive care for adults over 50. That coverage, if you purchased a new health insurance plan on or after September 23, 2010, which we did, means you do not have to pay a copayment or coinsurance or meet a deductible if you use an in-network provider (here’s a full list of preventive services covered under the new law). You would think that medical office billers and insurance companies would know that by now.

Although some plans have clauses that let them off the hook on this rule, ours does not—these tests should have been covered. Lucky for us, we knew it when the bills came in. To make a long story short, I was billed for the “surgery” and for the anesthesia. So I first called the billing department of the GI specialist’s office and asked them to rebill the procedure correctly, as preventive screening. No further bills from them, for me, but shortly afterward, my husband was billed by the same office for “surgery” occurring months later—same doc, same procedure, same billing office. He’s following up with phone calls as I write.

I next called the anesthesia billing office, which said our insurance company had denied the claim. I called the insurance company, which looked at our plan and found that, indeed, anesthesia should have been covered; they promised to issue a new claim number. Three weeks later, I got not one, but three, invoices from the anesthesia biller for the same deductible amount. I called them again, and they explained that, because “it takes 30 days for the new claim number to be received,” and “our system automatically sends” out invoices, I was mailed another bill (although they couldn’t explain the threesome). Seriously? Read the rest of this entry ?

Posted in health care reform, nursing perspective, patient perspective | Tagged ACA, Affordable Care Act, colonoscopy coverage, deductible, health care reform, Health insurance, inaccurate billing, preventive care | 2 Comments »

On the Web: A Tragic Choice, Wasting Berwick, Cost Control, A Nurse’s Comfort Zone

March 8, 2011

Obama Speaks to Congress on Health Care/Image via Wikipedia

An estimated 60% of American bankruptcies result from overwhelming medical costs. My uncle’s tale illuminates the dual tragedy of suffering catastrophic illness and being uninsured.

Read the rest of this troubling post at The Health Care Blog by surgeon John Maa if you doubt that we need health care reform in this country.

A measure of how unserious we are about fixing the problem of health care quality and costs in the U.S. can be found in reports that Don Berwick, President Obama’s choice to run the Centers for Medicare and Medicaid Services (CMS), continues to have an uphill battle for confirmation, despite being widely acknowledged within the medical community as the best choice for the challenging job.

Since we’re talking policy, there’s an incisive post at the Health Affairs Blog on where our energies should—and should not—be going in controlling costs. Here’s an excerpt:

The current cry to reduce Federal deficits and debt growth by reducing Medicare and Medicaid entitlements is totally missing the key issue: the need to moderate all health care inflation. This should be the time for a national debate on how to best tackle the underlying cost problem, for the sake of our future, the economy, and access to health care.

The June 13-19, 2009 Economist editorialized: “America has the most wasteful [health] system on the planet. Its fiscal future would be transformed if Congress passed reforms that emphasized control of costs as much as the expansion of coverage that Barack Obama rightly wants.”

Why should any of this matter to nurses? Here’s a post reminding us why nurses have a stake in health care reform.

But back to nursing proper, nursing in the trenches, nursing not in the abstract but in its inescapable dailiness. Read the rest of this entry ?

Posted in Uncategorized | Tagged Affordable Care Act, catastrophic illness, Donald Berwick, HCR, health care reform, medical bankruptcy | 1 Comment »

Nurses, Hospitals, and Social Media: It Depends What Business You’re In

January 19, 2011

By Julianna Paradisi, RN

Zuckerberg/via Flickr, World Economic Forum

Before the placenta picture posted on Facebook made national news, I read Time Magazine’s “Person of the Year 2010,” by Lev Grossman. Born in 1984, Mark Zuckerberg, the inventor of Facebook, is decades younger than the average working nurse. According to the article, so many people now belong to Facebook that if the Web site were a country “it would be the third largest, behind only China and India.” To refuse to recognize the social impact of Facebook is to miss the boat.

Throughout the nurse blogosphere, nurses are demanding that hospitals create policies about the use of social media. Some hospitals have. Not surprisingly, these documents state that no unauthorized photographs of staff, patients, or patient care areas should be taken, let alone posted on the Internet.

Hospitals with social media policies are not necessarily squelching their employees’ right to freedom of speech. They don’t want to spend time and money in court defending their public image. They already spend lots of money on marketing. They are in the business of patient care, not entertainment. So hospitals with social media polices take the position that you can post or tweet to your heart’s content, but should keep in mind the following:

Nothing you post is private.
If your online behavior disrupts patient care or creates hospital liability, the hospital reserves the right to fire you.

Consider your personal commitment to your own rights. Do you really want to catch every ball that’s thrown to you? Hospitals don’t want to spend their time and money on social media lawsuits. Do you?

Social media is not going away. One of Mark Zuckerberg’s profitable insights is that people like reading about and seeing their friends and friends of friends online. A few years ago, many of us were upset when the Patriot Act made it possible to force libraries and bookstores to report which books their patrons read. Now we want everyone to know what books we “like,” and no one seems to mind that Amazon tracks what we read, then focuses ads according to our purchases.

My own concept of privacy is changing. Read the rest of this entry ?

Posted in art and nursing, ethical issues, health care reform, media depictions of nursing, patient perspective, social media, writing and nursing | Tagged Affordable Care Act, ethics, Facebook, HIPAA, Mark Zuckerberg, Patient Protection and Affordable Care Act, Patriot Act, privacy, social media | 6 Comments »

HCR: Been There, Done That

January 18, 2011

By Maureen ‘Shawn’ Kennedy, AJN editor in chief

I was doing some research in the AJN archives and came across an editorial written in November 1993 by Virginia Trotter Betts, then-president of the American Nurses Association. “The Best Buy in Health Care” (click through to the PDF option; article will be free until July 18) reads like it was written with the Institute of Medicine’s Future of Nursing report in mind. Here’s an excerpt for those who don’t have access to the AJN archives (a shameless plug: subscribers have full access to ALL the issues of AJN, back to the very first issue in 1900—a treasure trove of nursing history):

“But we must also face the fact that such reform will require significant changes in nursing. Nurses will have to operate with greater autonomy and deliver care to a broader clientele. To foster enhanced roles for nurses as case managers and team leaders, nursing administrators must alert the work environment to offer a continuum of care on site and off site. Nurse educators will need to offer innovative programs, curricula, and clinical placements that prepare nurses for careers characterized by critical thinking and maximum flexibility. Nurse researchers will need to add more health care system, economic and policy studies to their repertoire.”

And another:

“Nurses want to do more in a reformed system to facilitate access at a reasonable cost. We want to do what we are educated to do – provide basic health services like well and ill baby care, immunizations, and health screenings; manage chronic conditions; care for the sick and dying using both technology and interpersonal techniques; and a multitude of other essential services that are well within our expertise. We want to educate our client and our communities and form a health care partnership with them. We are team players and are ready to try to make new systems work for consumers.”

If only nurses ruled the world . . .

Posted in from the archives, health care reform, nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged Affordable Care Act, American Nurses Association, HCR, scope of practice | Leave a Comment »

On the Road to the Future of Nursing

November 29, 2010

By Shawn Kennedy, interim editor-in-chief

by wfyurasko/via Flickr

I’m writing this on the train to Washington, DC, heading to the National Summit on Advancing Health through Nursing, which is taking place November 30 and December 1. This is the next step of the Robert Wood Johnson Foundation’s Initiative on the Future of Nursing (see my October 8 blog post) and will launch the Campaign for Action—the plan for implementing the recommendations of the Institute of Medicine’s report, The Future of Nursing. (You’ll be able to access the webcast and a live chat of webcast users on November 30 here.)

If you haven’t read anything about this initiative, do so. If you’re a nurse and plan to be working for the next 10 years, the recommendations from this report, if implemented, will affect you in some way. Expect to see changes in the following areas, to name just a few:

how and where nurses practice
undergraduate and graduate curricula
licensing and certification criteria
reimbursement policies

Other nursing initiatives have come and gone, some more successful in achieving their goals than others. AJN will cover the progress of this initiative as it attempts to evolve from a written report to an active process that creates sustainable change. As a start, in the December issue, now available at ajnonline.com, AJN brings you a guest editorial by Susan Hassmiller, director of the Initiative on the Future of Nursing. There’s also a summary and analysis of the report in AJN Reports, and a podcast interview with Marla Weston, CEO of the American Nurses Association, discussing the recommendations. And I’ll be posting updates here on the blog.

The weight of the IOM, the Affordable Care Act mandating health reform, the aging of America, and the numbers of Americans living with chronic diseases—all have come together to create the “perfect storm” for significant change. This is perhaps the best opportunity nursing will have in our lifetime to become a decision maker in shaping health care delivery in this country. Here’s hoping . . .

Posted in media depictions of nursing, nursing shortage, patient safety, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged Affordable Care Act, American Nurses Association, Institute of Medicine, IOM Report on the Future of Nursing, Robert Wood Johnson Foundation | 1 Comment »

AJN Webnotes: Anatomizing Medical Errors; Insurance Rebates; Social Media and Nurses

November 22, 2010

The most popular article in last week’s New England Journal of Medicine did not tout the discovery of a novel gene, nor describe a cardiology clinical trial with a clever acronym as its title. Rather, it was the report of a case in which a surgeon at the Massachusetts General Hospital performed the wrong operation on a 65-year-old woman.

So begins a nicely engaging summary post at The Health Care Blog of the main points of an NEJM article describing how a medical error occurred—and yes, nurses play a major role in the story too.

Feel like your insurance company spends too much time trying to weasel you out of your money? Kaiser Health News reports today that the Affordable Care Act may soon result in a little payback, in the form of rebates:

Millions of Americans might be eligible for rebates starting in 2012 under regulations released Monday detailing the health care law’s requirement that insurers spend at least 80 percent of their revenue on direct medical care.

“I have nothing listed under my work experience, yet Facebook somehow knows where I work,” cries Not Nurse Ratched, in a post called “Latest Facebook creepiness rant.” Such surprises are worth considering for anyone who might forget that information has a life of its own on the Web. Speaking of social media and nurses, A Nurse Practitioner’s View gives a quick survey of social media networking platforms available to nurse practitioners, then makes this important observation about participation:

It’s obvious that social (and professional) networking sites aren’t going anywhere anytime soon (FaceBook touts 500 million uses). However, there needs to be increased participation and discussion for them to be meaningful before people give up on them altogether – at least from a professional standpoint.

Which is a good lead in to this: please leave us a comment. We’d like to know what you think. Or yes, you can visit our Facebook page (click image above) and let us know your opinion there.—JM, senior editor/blog editor

Posted in health care reform, patient safety | Tagged Affordable Care Act, Facebook privacy concerns, medical error, NEJM, nurse practitioners online, patient safety, surgical mistake, The New England Journal of Medicine | Leave a Comment »

Off the Charts

Posts Tagged ‘Affordable Care Act’

Diabetes Plus Marijuana Plus Medical Errors Minus Nursing Blogs

Year-End Take: A Hopeful Trend in U.S. Health Care?

Bad News, Good News: Berwick, a Casualty of Politics, Succeeded at CMS Helm by a Nurse

Health Care Reform Works—If You Work It

On the Web: A Tragic Choice, Wasting Berwick, Cost Control, A Nurse’s Comfort Zone

HCR: Been There, Done That

On the Road to the Future of Nursing

AJN Webnotes: Anatomizing Medical Errors; Insurance Rebates; Social Media and Nurses

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