Posts Tagged ‘Medicare’

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From the Blogs: Negotiating Medicare, Nurses Doing Research, Reader Comments

November 29, 2011


Medicare is confusing for providers who aren’t yet familiar with it. Here’s a Nursetopia post that draws attention to its complexity and notes the useful video above (it’s one of a series of videos on different aspects of Medicare). Those of you who know all about it already: Drop by her thoughtful (and consistently updated!) blog and let her know your own tips on handling the ins and outs of Medicare and Medicaid.

EBP matters. Terri Schmitt at Nurse Story has a frank and engaging post on evidence-based practice (EBP): “Translation of EBP: Why Creating Nurse Scientists is the Way to Improve Patient Outcomes.” Here’s what she promises to cover in it:

  • Research is sometimes far removed from bedside nurses
  • Research is COOL!
  • Research is about PATIENTS and not fame/fortune of researcher
  • Research is critical to practice and there are big gaps that nurses need to fill
  • Bedside nurses may be the most crucial link in research ideas, translation, and practice.

(Shameless plug for related AJN content: See our recent, amazingly useful step-by-step CE series on how nurses can get involved in evidence-based practice.)

Plus a brief note on reader comments: we’ve been getting a lot of great comments lately on this blog, and we’re grateful for that. So thank you. A fair number of the comments were on posts from previous months, such as this post comparing U.S. and Australian health care systems. Is somebody by chance teaching a nursing course that requires students to leave thoughtful, respectful, engaged comments in the blogosphere? If so, bless you!—JM, senior editor/blog editor

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Military Metaphors, Unnecessary Admissions, New Blogs, Keeping Secrets

September 29, 2011

It’s a common scenario: a 90-year-old resident of a U.S. nursing home — call her Ms. B. — has moderately advanced Alzheimer’s disease, congestive heart failure with severe left-ventricular dysfunction, and chronic pain from degenerative joint disease. She develops a nonproductive cough and a fever of 100.4°F. The night nurse calls an on-call physician who is unfamiliar with Ms. B. Told that she has a cough and fever, the physician says to send her to the emergency room, where she’s found to have normal vital signs except for the low-grade fever, a normal basic-chemistry panel and white-cell count, but a possible infiltrate on chest x-ray. She is admitted to the hospital and treated with intravenous fluids and antibiotics. During her second night in the hospital, Ms. B. becomes confused and agitated, climbs out of bed, and falls, fracturing her hip. One week after admission, she is discharged back to the nursing home with coverage under the Medicare Part A benefit. The episode results in about $10,000 in Medicare expenditures, as well as discomfort and disability for Ms. B.

There is an alternative scenario, however . . .

That’s from an article in NEJM called “Reducing Unnecessary Hospitalizations of Nursing Home Residents.” In any health care system of as much complexity as ours, there’s bound to be a huge amount of waste. The article gives a good example of how the skills of NPs might be put to excellent use both saving a lot of money for Medicare and making the lives of nursing home residents a whole lot nicer. It may be cheaper, but it’s not “rationing”—it’s rational.

Now a matter of language rather than money: the Viewpoint essay by Kathleen Thies in the October issue of AJN is about the use of military language to refer to nursing staff. Here’s how it begins, and you can click the link to read the whole article, including the author’s suggestion for an alternative terminology. We’d love to know whether the author’s perspective resonates with you:

How often have you heard the term frontline staff used to refer to direct care nurses and others working at a patient’s bedside? It conjures images of the great world wars, of soldiers marching across battlefields to fight the enemy. The infantry are invariably young, dispensable, interchangeable. Commands are issued by generals and passed down through the ranks. No questions are asked.

Blog roll update: We’ve added some interesting new blogs to our blogroll (they’re not new blogs, actually, just new to our blogroll). A few of them are by MDs, such as The Carlat Psychiatry Blog and Movin’ Meat, and a couple of are by nurses, such as madness: tales of an emergency room nurse, which has a good short post about why it doesn’t always help to be a nurse when your family member is in the hospital (there have been a few posts on this topic lately in different venues, I think?). Also added: The Nursing Ethics Blog, which is run by two people, a nursing professor/ethicist and a philosopher. It should be interesting to explore.

As the editor of the Reflections column (and this blog), I read hundreds of submissions each year about dying patients, with a subgenre of submissions devoted to dying infants or miscarriages. Read the rest of this entry ?

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To Err is Human . . . To Improve Elusive?

December 1, 2010

Hospital Bed-2/Timm Suess, via Flickr

Peggy McDaniel, BSN, RN, is an infusion practice manager and occasional blogger

As a nurse working in the quality improvement and patient safety arena, I’m not surprised that the title of a recent article at Fierce Healthcare got my attention: “Hospitals Are Bad for Your Health.” The article highlights a recently released report from the Department of Health and Human Services Office of Inspector General based on a study of Medicare patients discharged in 2008. Among other things, it revealed that “44% of adverse or temporary harm events were clearly or likely preventable.” The usual culprits were to blame:

  • infections
  • medication errors
  • surgery-related errors
  • patient care issues

Most of these have been previously labeled as “never events” by the Centers for Medicaid and Medicare Services (CMS), and currently hospitals are not being reimbursed for the costs incurred if one or more of these happen to a patient while in the hospital. CMS was the first to implement such a pay-for-performance model—and major insurance companies have followed their lead.

In recently published NEJM study, 63% of the adverse events reported in the hospitals studied were deemed preventable. This study was disheartening because we recently passed the 10-year anniversary of the release of the Institute of Medicine’s Report, “To Err is Human,” (pdf) and now know that real progress to reduce harm to patients has been moving at a snail’s pace.

As I blogged here previously, there have been some pockets of significant improvement, such as the implementation of checklists. That said, we have a long way to go to reduce the occurrence of preventable harm to our patients. This statement from the article I began this post with, that “hospitals kill an estimated 180,000 people a year due to adverse events,” should get your attention. It certainly kept me reading.

I also hope it is a call to action for nurses, since we are often the last stop before a medication or treatment touches a patient. Read the rest of this entry ?

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Supporting Nurse Practitioners as ‘Priority Primary Care Practitioners’

July 29, 2010

By Susan McBride, PhD, RN, professor at Texas Tech University Health Science Center School of Nursing 

It’s important for nurses to understand the Medicare and Medicaid incentives to implement electronic health records (EMRs) and to move to their “meaningful use,” as well as the purpose of the Regional Extension Centers created to support nurse practitioners and other “priority primary care providers” in the implementation process.

Dr. Mari Tietze, John Delaney, and I are fortunate to be involved in two of the Regional Extension Centers in Texas. We believe that nursing professionals have many contributions to make in the evolving electronic highway in the U.S. We will blog later about our roles as nursing informaticists in the Regional Extension Center program.

What are ‘Regional Extension Centers’? Under the Office of the National Coordinator (ONC) Health Information Technology Initiative to support getting providers to meaningful use on electronic health records, the ONC has established Regional Extension Centers. There are 60 Regional Extension Centers that will furnish assistance to providers in specific geographic services areas covering virtually all of the U.S. A total of $643 million is devoted to these centers.

The purpose of the Regional Extension Centers is to support priority primary care practitioners in priority settings to implement and use EMRs according to the meaningful use requirements outlined in our previous post (below is a screenshot illustrating one example of how an EMR might align with meaningful use requirements; click image to enlarge). The goal of the program is to provide federally subsidized outreach and support services to over 100,000 priority primary care practitioners within the next two years. 

© 2010 e-MDs, Inc. All rights reserved. Product and company names are trademarks or trade names of their respective corporations.

Regional Extension Centers will provide the following support services to providers:

  • EHR implementation
  • education and training
  • project management
  • incentives
  • meaningful use

NPs as “priority primary care practitioners.” A priority primary care practitioner is defined by the ONC as a primary care provider  that is any doctor of medicine or osteopathy, any nurse practitioner, nurse midwife, or physician assistant with prescriptive privileges in the locality where she or he practices, who is actively practicing in one of the following specialties: family, internal, pediatric, or obstetrics and gynecology.

Priority settings. Many NPs work within priority settings identified by the ONC, including small group practices of 10 or fewer, public and critical access hospitals, federally qualified health care clinics, rural healthcare clinics, and other settings serving uninsured, underinsured, and medically underserved populations.

NPs are eligible for support services of the Regional Extension Centers. For more information on what services might be available to you, contact the Regional Extension Center within your geographic region. A table and map covering the 60 centers is available here.

Incentives program for EMR implementation. February 17, 2009, President Obama signed the American Recovery and Reinvestment Act (ARRA) and along with that Act $33 billion dedicated to Medicare and Medicaid incentives for providers and hospitals who adopt, implement, or upgrade an EMR system and meaningfully use that system. As we blogged previously, meaningful use of EMRs has many parameters that providers must meet—but with that comes financial incentives that eligible providers can receive.

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For Those Interested In Learning More, See Below….

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Dying in Agony in America’s Nursing Homes – Case Study Poses Ethical Quandaries for Nurses

June 1, 2009

KayserScreenshot3
“Oh, that hurts! You’re hurting me. Please, please, just leave me alone. Please stop.” These were the words of Louis Daly, a friendly, cognitively alert African American man in his late 80s, as nurses were changing the dressing on his stage IV pressure ulcer two days before he died. (This is a real patient; his name and other identifying details have been changed.)

So starts “Dying with a Stage IV Pressure Ulcer” in the January issue of AJN. Read the rest of this entry ?

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