Archive
When Patients Don’t Take Their Medicine: What Role Do Doctors Play in Promoting Prescription Adherence?
When Patients Don’t Take Their Medicine: What Role Do Doctors Play in Promoting Prescription Adherence?
Source: RAND Corporation
Analyses indicated that although physicians uniformly felt responsible for assessing and promoting adherence to prescriptions, only a minority of them asked detailed questions about adherence.
Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population
Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population
Source: Archives of Internal Medicine
Background
Despite extensive data about physician burnout, to our knowledge, no national study has evaluated rates of burnout among US physicians, explored differences by specialty, or compared physicians with US workers in other fields.Methods
We conducted a national study of burnout in a large sample of US physicians from all specialty disciplines using the American Medical Association Physician Masterfile and surveyed a probability-based sample of the general US population for comparison. Burnout was measured using validated instruments. Satisfaction with work-life balance was explored.Results
Of 27 276 physicians who received an invitation to participate, 7288 (26.7%) completed surveys. When assessed using the Maslach Burnout Inventory, 45.8% of physicians reported at least 1 symptom of burnout. Substantial differences in burnout were observed by specialty, with the highest rates among physicians at the front line of care access (family medicine, general internal medicine, and emergency medicine). Compared with a probability-based sample of 3442 working US adults, physicians were more likely to have symptoms of burnout (37.9% vs 27.8%) and to be dissatisfied with work-life balance (40.2% vs 23.2%) (P < .001 for both). Highest level of education completed also related to burnout in a pooled multivariate analysis adjusted for age, sex, relationship status, and hours worked per week. Compared with high school graduates, individuals with an MD or DO degree were at increased risk for burnout (odds ratio [OR], 1.36; P < .001), whereas individuals with a bachelor's degree (OR, 0.80; P = .048), master's degree (OR, 0.71; P = .01), or professional or doctoral degree other than an MD or DO degree (OR, 0.64; P = .04) were at lower risk for burnout.Conclusions
Burnout is more common among physicians than among other US workers. Physicians in specialties at the front line of care access seem to be at greatest risk.
Questionable Billing by Community Mental Health Centers
Questionable Billing by Community Mental Health Centers (PDF)
Source: U.S. Department of Health and Human Services, Office of Inspector General
WHY WE DID THIS STUDY
During 2010, 206 community mental health centers (CMHC) received an estimated $218.6 million for providing partial hospitalization program (PHP) services to approximately 25,000 Medicare beneficiaries with mental disorders. Past OIG studies have found vulnerabilities in Medicare payments to CMHCs for PHPs. Additionally, in 2011, four CMHC owners and managers in Miami-Dade County, Florida, were convicted of fraudulently billing Medicare approximately $200 million for medically unnecessary PHP services from 2002 to 2010.
HOW WE DID THIS STUDY
We developed nine questionable billing characteristics based on past OIG work and input from CMS staff. We used 2009 and 2010 Medicare claims from CMS’s National Claims History File to identify CMHCs that had unusually high billing for at least one of nine OIG questionable billing characteristics in 2010 and the metropolitan areas where these CMHCs were located. We also determined whether the percentage of CMHCs with questionable billing varied according to whether States had licensure or certification requirements.
WHAT WE FOUND
In 2010, approximately half of CMHCs met or exceeded thresholds that indicated unusually high billing for at least one of nine questionable billing characteristics. Approximately one-third of these CMHCs had at least two of the characteristics. Additionally, approximately two-thirds of CMHCs with questionable billing were located in eight metropolitan areas. Finally, 90 percent of CMHCs with questionable billing were located in States that do not require CMHCs to be licensed or certified.
WHAT WE RECOMMEND
We recommend that CMS:
(1) Increase its monitoring of CMHCs’ Medicare billing and fraud prevention controls,
(2) Enforce the requirement that certifying physicians be listed on the PHP claims submitted by CMHCs,
(3) Finalize and implement the proposed conditions of participation for CMHCs, and
(4) Review and take appropriate action against CMHCs with questionable billing that we identified. CMS concurred with all four recommendations.
Design and dementia: A case of garments designed to prevent undressing
Design and dementia: A case of garments designed to prevent undressing
Source: Dementia
This article focuses on garments used in care environments. We investigate a patient overall, developed for the care of people with severe memory problems, severe learning difficulties and brain injuries. The aim of the use of a patient overall is to prevent undressing in socially inappropriate situations and/or to stop the user from removing an incontinence pad. This article is based on interviews of designers of medical textiles and patients and family carers in Finland. Both designers and patients found patient overalls to be infantilizing and stigmatizing for the user but accepted the basic functions of the product. We report results of a design project aimed at designing a new type of garment that takes into account the technical requirements but provides a more dignified look and opportunities for activity. We discuss the ethical issues concerning the use of this kind of product in the care of people with dementia.
CBO — Medicare’s Payments to Physicians: The Budgetary Impact of Alternative Policies Relative to CBO’s March 2012 Baseline
Medicare’s Payments to Physicians: The Budgetary Impact of Alternative Policies Relative to CBO’s March 2012 Baseline
Source: Congressional Budget Office
Medicare’s payment rates for physicians’ services are scheduled to be reduced by 27 percent in 2013, CBO estimates, under the provisions of law known as Medicare’s Sustainable Growth Rate (SGR) mechanism. The SGR mechanism consists of expenditure targets, which are established by applying a growth rate (calculated by formula) to spending for physicians’ services and certain related services in a base period, and annual adjustments to the payment rates, which are designed to bring spending in line with the expenditure targets over time. (For further discussion of the SGR, see the appendix of Changes in Payments to Physicians.) In each of the past several years, legislation has been enacted to override the SGR and to either maintain or increase those payment rates when they were otherwise scheduled to decrease.
The attached tables show CBO’s estimates of the budgetary impact over the 2013–2022 period of various alternative policies for modifying the payment rates that are scheduled to take effect under the SGR mechanism. The options in the tables are listed in three categories: “cliff” options, “clawback” options, and others. (See the descriptions of those terms in the attached document; both “cliff” and “clawback” approaches have been adopted since the Congress began overriding scheduled reductions in physician payment updates in 2003.)
The estimates in the tables are relative to CBO’s March 2012 baseline, which is used for Congressional scorekeeping purposes. Both the scorekeeping baseline and the estimates of the impact of the policy options are likely to change when the final rule setting the physician fee schedule for 2013 is issued by the Administration in early November.
Inappropriate and Questionable Billing by Medicare Home Health Agencies
Inappropriate and Questionable Billing by Medicare Home Health Agencies (PDF)
Source: U.S. Office of Health and Human Services, Office of Inspector General
WHY WE DID THIS STUDY
In 2010, Medicare paid $19.5 billion to 11,203 home health agencies (HHA) for services provided to 3.4 million beneficiaries. Recent investigations and prior Office of Inspector General studies have found that home health services are vulnerable to fraud, waste, and abuse.HOW WE DID THIS STUDY
We analyzed data from home health, inpatient hospital, and skilled nursing facility claims from 2010 to identify inappropriate home health payments. In addition, we identified HHAs that billed unusually high amounts according to at least one of our six measures of questionable billing. Although these six measures indicate potential fraud, there may be legitimate reasons for an HHA to exceed the threshold for unusually high billing on any of the six measures. We also determined the geographic locations of HHAs that had questionable billing.
WHAT WE FOUND
In 2010, Medicare inappropriately paid $5 million for home health claims with three specific errors: overlapping with claims for inpatient hospital stays, overlapping with claims for skilled nursing facility stays, or billing for services on dates after beneficiaries’ deaths. Further, we found that approximately one in every four HHAs exceeded the threshold that indicated unusually high billing for at least one of our six measures of questionable billing. Overall, HHAs with questionable billing were located mostly in Texas, Florida, California, and Michigan.
WHAT WE RECOMMEND
We recommend that CMS:
(1) Implement claims processing edits or improve existing edits to prevent inappropriate payments for the three specific errors we reviewed,
(2) Increase monitoring of billing for home health services,
(3) Enforce and consider lowering the 10‑percent cap on the total outlier payments an HHA may receive annually,
(4) Consider imposing a temporary moratorium on new HHA enrollments in Florida and Texas, and
(5) Take appropriate action regarding the inappropriate payments we identified and HHAs with questionable billing.
CMS concurred with all five recommendations; however, it disagreed with our estimate of the inappropriate payments for home health claims overlapping with claims for inpatient hospital stays and skilled nursing facility stays.
Nurse Practitioners and Sexual and Reproductive Health Services: An Analysis of Supply and Demand
Nurse Practitioners and Sexual and Reproductive Health Services: An Analysis of Supply and Demand
Source: RAND Corporation
Use of Sexual and Reproductive Health (SRH) services is projected to grow between 10 and 20 percent from 2006 to 2020. This growth is driven largely by changes in the racial/ethnic make-up of the population of women of reproductive age and an increase in the number of people with insurance coverage because of new health care legislation.
Trends in supply and demand for SRH services, particularly for low-income individuals, suggest demand will outstrip supply in the next decade. Nurse Practitioners (NPs) with a women’s health focus are key providers of SRH care in Title X-funded clinics, which deliver a significant proportion of U.S. family planning and SRH services to low-income populations. This report looks at why numbers of women’s health NPs (WHNPs) have been declining, and are projected to continue to decline, despite significant growth in total numbers of NPs. Barriers to increasing the supply of NPs competent in SRH care — such as reduced funding for WHNP training, increased funding for primary care and geriatric NP training, and a shrinking proportion of WHNPs choosing to work in public health, clinics, and family planning — are identified.
From the standpoint that the evolution of the health care delivery system may serve as an opportunity to optimize the delivery of SRH services in the United States, a comprehensive set of options spanning education, federal and state regulations, and emerging models of care delivery are explored to reverse this trend of too few WHNPs, particularly for servicing Title X facilities and their patients.
Medicare Could Be Paying Twice for Prescription Drugs for Beneficiaries in Hospice
Medicare Could Be Paying Twice for Prescription Drugs for Beneficiaries in Hospice
Source: U.S. Department of Health and Human Services, Office of Inspector General
During calendar year 2009, Medicare Part D paid for prescription analgesic, antinausea, laxative, and antianxiety drugs, as well as prescription drugs used to treat chronic obstructive pulmonary disease and amyotrophic lateral sclerosis, that likely should have been covered under the per diem payments made to hospice organizations. As a result, the Medicare program could be paying twice for prescription drugs for hospice beneficiaries: once under the Medicare Part A hospice per diem payments and again under Medicare Part D.
To be eligible for Medicare hospice care, a beneficiary must be entitled to Part A of Medicare and be certified as terminally ill (i.e., having a medical prognosis that life expectancy is 6 months or less if the disease runs its normal course). Under the Medicare Part D program, individuals entitled to benefits under Medicare Part A may obtain voluntary coverage for prescription drugs.
We recommended that CMS (1) educate sponsors, hospices, and pharmacies that it is inappropriate for Medicare Part D to pay for drugs related to hospice beneficiaries’ terminal illnesses; (2) perform oversight to ensure that Part D is not paying for drugs that Medicare has already covered under the per diem payments made to hospice organizations; and (3) require sponsors to develop controls that prevent Medicare Part D from paying for drugs that are already covered under the per diem payments. CMS concurred with our first and third recommendations but did not concur with our second recommendation.
Federally Qualified Health Centers and Private Practice Performance on Ambulatory Care Measures
Federally Qualified Health Centers and Private Practice Performance on Ambulatory Care Measures (PDF)
Source: American Journal of Preventive Medicine
Background:
The 2010 Affordable Care Act relies on Federally Qualifıed Health Centers (FQHCs) and FQHC look-alikes (look-alikes) to provide care for newly insured patients, but ties increased funding to demonstrated quality and effıciency.
Purpose:
To compare FQHC and look-alike physician performance with private practice primary care physicians (PCPs) on ambulatory care quality measures.
Methods:
The study was a cross-sectional analysis of visits in the 2006 –2008 National Ambulatory Medical Care Survey. Performance of FQHCs and look-alikes on 18 quality measures was compared with private practice PCPs. Data analysis was completed in 2011.
Results:
Compared to private practice PCPs, FQHCs and look-alikes performed better on six measures (p 0.05); worse on diet counseling in at-risk adolescents (26% vs 36%, p 0.05); and no differently on 11 measures. Higher performance occurred in ACE inhibitors use for congestive heart failure (51% vs 37%, p 0.004); aspirin use in coronary artery disease (CAD) (57% vs 44%, p 0.004); -blocker use for CAD (59% vs 47%, p 0.01); no use of benzodiazepines in depression (91% vs 84%, p 0.008); blood pressure screening (90% vs 86%, p 0.001); and screening electrocardiogram (EKG) avoidance in low-risk patients (99% vs 93%, p 0.001). Adjusting for patient characteristics yielded similar results, except that private practice PCPs no longer performed better on any measures.
Conclusions:
FQHCs and look-alikes demonstrated equal or better performance than private practice PCPs on select quality measures despite serving patients who have more chronic disease and socioeconomic complexity. These fındings can provide policymakers with some reassurance as to the quality of chronic disease and preventive care at Federally Qualifıed Health Centers and look-alikes, as they plan to use these health centers to serve 20 million newly insured individuals.
See: When Public Beats Private: Community Clinics That Keep Costs Down and Do a Better Job, Too (The Atlantic)
Updated CDC Recommendations for the Management of Hepatitis B Virus–Infected Health-Care Providers and Students
Updated CDC Recommendations for the Management of Hepatitis B Virus–Infected Health-Care Providers and Students
Source: Morbidity and Mortality Weekly Report (CDC)
This report updates the 1991 CDC recommendations for the management of hepatitis B virus (HBV)–infected health-care providers and students to reduce risk for transmitting HBV to patients during the conduct of exposure-prone invasive procedures (CDC. Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR 1991;40[No. RR-8]). This update reflects changes in the epidemiology of HBV infection in the United States and advances in the medical management of chronic HBV infection and policy directives issued by health authorities since 1991.
The primary goal of this report is to promote patient safety while providing risk management and practice guidance to HBV-infected health-care providers and students, particularly those performing exposure-prone procedures such as certain types of surgery. Because percutaneous injuries sustained by health-care personnel during certain surgical, obstetrical, and dental procedures provide a potential route of HBV transmission to patients as well as providers, this report emphasizes prevention of operator injuries and blood exposures during exposure-prone surgical, obstetrical, and dental procedures.
These updated recommendations reaffirm the 1991 CDC recommendation that HBV infection alone should not disqualify infected persons from the practice or study of surgery, dentistry, medicine, or allied health fields. The previous recommendations have been updated to include the following changes: no prenotification of patients of a health-care provider’s or student’s HBV status; use of HBV DNA serum levels rather than hepatitis B e-antigen status to monitor infectivity; and, for those health-care professionals requiring oversight, specific suggestions for composition of expert review panels and threshold value of serum HBV DNA considered “safe” for practice (<1,000 IU/ml). These recommendations also explicitly address the issue of medical and dental students who are discovered to have chronic HBV infection. For most chronically HBV-infected providers and students who conform to current standards for infection control, HBV infection status alone does not require any curtailing of their practices or supervised learning experiences. These updated recommendations outline the criteria for safe clinical practice of HBV-infected providers and students that can be used by the appropriate occupational or student health authorities to develop their own institutional policies. These recommendations also can be used by an institutional expert panel that monitors providers who perform exposure-prone procedures.
Foreign-Born Health Care Workers in the United States
Foreign-Born Health Care Workers in the United States
Source: Migration Policy Institute
Employment in health care occupations increased despite the recession and is projected to outpace almost every major occupational group in terms of job growth between 2010 and 2020, according to the US Bureau of Labor Statistics. Amid this growth, the number of foreign-born health care workers has also been on the rise, increasing from 1.5 million to 1.8 million between 2006 and 2010.
Today, immigrants make up a sizeable proportion of the US health care workforce. In 2010, the foreign born accounted for 16 percent of all civilians employed in health care occupations in the United States. In some health care professions, this share was larger. More than one-quarter of physicians and surgeons (27 percent) were foreign born, as were more than one out of every five (22 percent) persons working in health care support jobs as nursing, psychiatric, and home health aides.
Although the characteristics of health care workers varied across occupational categories, as a group foreign-born health care workers were more likely than their native-born counterparts to have obtained a college degree and more likely than employed immigrants overall to speak English fluently or be naturalized US citizens.
This Spotlight provides a demographic and socioeconomic profile of foreign-born health care workers residing in the United States. The data come primarily from the US Census Bureau’s 2010 American Community Survey (ACS) and the US Bureau of Labor Statistics. All data refer to employed civilians age 16 and older unless otherwise noted.
Physician Payment Sunshine Act
Physician Payment Sunshine Act
Source: Deloitte
Calls for more transparency and disclosure of payments made by the life sciences industry to health care professionals are creating challenges and opportunities for all parties involved in the delivery of health care. These new rules, such as the Physician Payment Sunshine Act (PPSA) in the U.S., were not intended to eliminate financial interactions between life sciences companies and individual health care providers, but rather to empower patients by providing visibility to those interactions. The hope was that by providing such visibility, patients could question whether the financial interactions might negatively affect their course of treatment.
To better understand how all parties are addressing these requirements and this new era of transparency, Deloitte, in collaboration with Forbes Insights, surveyed 110 U.S. based physicians and 223 global life sciences executives about transparency and these new requirements. The survey, Physician Payment Sunshine Act: Physicians and life sciences companies coming to terms with transparency? indicates that both parties appear to be coming to terms with the concept of transparency, and health care providers and life sciences companies expect to continue collaborating to develop new and more effective treatments for patients. Physicians do have concerns over how the data will be interpreted by the public (e.g., the context), as well as their own understanding of the requirements of the new regulatory environment.
Life sciences company executives, on the other hand, at this time are less focused on the public’s interpretation of the data than the logistics of aggregating and reporting it. As a result, most are still investigating how best to leverage the data for competitive advantage once it becomes publicly available.
Oversight of Quality of Care in Medicaid Home and Community Based Services Waiver Programs
Oversight of Quality of Care in Medicaid Home and Community Based Services Waiver Programs
Source: U.S. Department of Health and Human Services, Office of Inspector General
WHY WE DID THIS STUDY
In recent years, States have altered their approach to providing Medicaid-funded long-term care services. Rather than providing the majority of that care in institutions-such as nursing homes-States are now providing more care in homes and other community-based settings. States most often provide this care through 1915(c) home and community-based services (HCBS) waiver programs, and the individuals served by these programs are most commonly disabled and/or over age 65. In fiscal year 2010, Medicaid expenditures for HCBS waiver programs serving this population totaled an estimated $8.9 billion. Strong oversight of waiver programs is critical to ensuring the quality of care provided to HCBS beneficiaries. The beneficiaries who rely on HCBS waiver programs are among Medicaid’s most vulnerable, and the nature of these programs puts beneficiaries at particular risk of receiving inadequate care.
HOW WE DID THIS STUDY
States must operate their HCBS waiver programs in accordance with certain "assurances," including three assurances related to quality of care. To meet these assurances, States must demonstrate that they have systems to effectively monitor the adequacy of service plans, the qualifications of providers, and the health and welfare of beneficiaries. We based this study on a review of documents from CMS’s most recent quality review of waiver programs from 25 States, as well as information gathered from structured interviews with staff from the 10 CMS regional offices.
WHAT WE FOUND
Seven of the twenty-five States that we reviewed did not have adequate systems to ensure the quality of care provided to beneficiaries. Although CMS renewed the waiver programs in all seven of these States, three did not adequately correct identified problems. Not only did these States fail to correct these problems before renewal of their programs, they also had still not adequately addressed the problems long after renewal. In addition, CMS did not consistently use the few tools it has to ensure that States correct problems related to quality of care.
WHAT WE RECOMMEND
We recommend that CMS: (1) provide additional guidance to States to help ensure that they meet the assurances, (2) require States that do not meet one or more assurances to develop corrective action plans, (3) require at least one onsite visit before a waiver program is renewed and develop detailed protocols for such visits, (4) develop a broader array of approaches to ensure compliance with each of the assurances, and (5) make information about State compliance with the assurances available to the public. CMS concurred with four of the recommendations and partially concurred with our recommendation to require onsite visits.
Center to Advance Palliative Care
Dates of Support: 1999–2011Field of Work: Palliative and end-of-life careProblem Synopsis: Advances in public health, preventive medicine, and medical technology have led to dramatic increases in the number of Americans living longer. While many people over age 65 enjoy good health for some time, eventually most adults will have one or more chronic illnesses often characterized by pain and frailty. The nation’s health care system is not well suited to address the array of medical, social, emotional, and other needs of patients living for long periods with serious, but not immediately terminal, conditions.Synopsis of the Work: During 1999–2011, the Center to Advance Palliative Care (CAPC) at the Mount Sinai School of Medicine undertook a range of initiatives to increase the number of hospitals able to provide palliative care, make hospital-based palliative care standard practice, and develop standards for palliative care programs.To achieve these goals, CAPC selected and supported nine Palliative Care Leadership Centers (six funded by RWJF) based at hospitals across the country, led a consortium of organizations in developing consensus standards of palliative care, and demonstrated cost savings attributable to palliative care. In addition, CAPC provided ongoing in-person and online resources, and training via national seminars, audio grand rounds, and guidebooks.Key Results: CAPC developed a new understanding of palliative care that shaped the thinking of physicians, patients, and policy-makers. By distinguishing palliative care from end-of-life or hospice care, CAPC expanded its audience to include patients with serious, but not immediately life-threatening, conditions. Physicians and their patients could work simultaneously on providing care aimed at both curing the condition and ensuring that patients were comfortable and stable.
- By 2009, the number of hospitals providing palliative care increased by 138 percent, from 658 to 1,568.
- The Palliative Care Leadership Centers had trained 1,029 teams from hospitals across the country, 80 percent of which had established their own palliative care programs within two years.
- In 2006, the National Quality Forum endorsed a framework for preferred practices in palliative and hospice care. In 2011, the Joint Commission launched a Palliative Care Advanced Certification program.
Center to Advance Palliative Care
Dates of Support: 1999–2011Field of Work: Palliative and end-of-life careProblem Synopsis: Advances in public health, preventive medicine, and medical technology have led to dramatic increases in the number of Americans living longer. While many people over age 65 enjoy good health for some time, eventually most adults will have one or more chronic illnesses often characterized by pain and frailty. The nation’s health care system is not well suited to address the array of medical, social, emotional, and other needs of patients living for long periods with serious, but not immediately terminal, conditions.Synopsis of the Work: During 1999–2011, the Center to Advance Palliative Care (CAPC) at the Mount Sinai School of Medicine undertook a range of initiatives to increase the number of hospitals able to provide palliative care, make hospital-based palliative care standard practice, and develop standards for palliative care programs.To achieve these goals, CAPC selected and supported nine Palliative Care Leadership Centers (six funded by RWJF) based at hospitals across the country, led a consortium of organizations in developing consensus standards of palliative care, and demonstrated cost savings attributable to palliative care. In addition, CAPC provided ongoing in-person and online resources, and training via national seminars, audio grand rounds, and guidebooks.Key Results: CAPC developed a new understanding of palliative care that shaped the thinking of physicians, patients, and policy-makers. By distinguishing palliative care from end-of-life or hospice care, CAPC expanded its audience to include patients with serious, but not immediately life-threatening, conditions. Physicians and their patients could work simultaneously on providing care aimed at both curing the condition and ensuring that patients were comfortable and stable.
- By 2009, the number of hospitals providing palliative care increased by 138 percent, from 658 to 1,568.
- The Palliative Care Leadership Centers had trained 1,029 teams from hospitals across the country, 80 percent of which had established their own palliative care programs within two years.
- In 2006, the National Quality Forum endorsed a framework for preferred practices in palliative and hospice care. In 2011, the Joint Commission launched a Palliative Care Advanced Certification program.
Nature and Impact of Grief Over Patient Loss on Oncologists’ Personal and Professional Lives
Nature and Impact of Grief Over Patient Loss on Oncologists’ Personal and Professional Lives (PDF)
Source: Archives of Internal Medicine
Caring for critically ill and terminal patients can generate grief reactions in health care professionals (HCPs). While all HCPs can potentially experience grief over patient loss, oncologists face unique pressures because they are legally responsible for the patients’ care and may be blamed when patients die.5 Despite the evidence that grief over patient loss is an intrinsic part of clinical oncology, there are no qualitative studies examining the nature and extent of oncologists’ grief over patient loss nor the impact of this grief on oncologists’ lives. The objectives of our study were to explore and identify oncologists’ grief over patient loss and the ways in which this grief may affect their personal and professional lives.
A Shot in the Arm for Adult Vaccination
Vaccine-preventable diseases take a heavy toll on U.S. adults despite the widespread availability of vaccines. Office-based providers can do more to promote adult vaccinations but need clearer guidance and a better business case to offer them.
A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists
Summary Points+ The American Psychiatric Association (APA) instituted a financial conflict of interest disclosure policy for the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).+ The new disclosure policy has not been accompanied by a reduction in the financial conflicts of interest of DSM panel members.+ Transparency alone cannot mitigate the potential for bias and is an insufficient solution for protecting the integrity of the revision process.+ Gaps in APA’s disclosure policy are identified and recommendations for more stringent safeguards are offered.
Gaps Continue to Exist in Nursing Home Emergency Preparedness and Response During Disasters: 2007-2010
WHY WE DID THIS STUDYFederal regulations require that Medicare- and Medicaid-certified nursing homes have written emergency plans and provide employees with emergency preparedness training. In a 2006 report about nursing homes that experienced hurricanes, we found that emergency plans lacked many provisions recommended by experts. In response, the Centers for Medicare & Medicaid Services (CMS) issued guidance checklists for emergency planning of health care facilities, long-term care (LTC) ombudsman programs, and State survey agencies (SA). We conducted this study to assess emergency preparedness and response of nursing homes that experienced more recent disasters.HOW WE DID THIS STUDYFor this study, we analyzed national survey data to determine compliance with Federal regulations. We also conducted site visits to 24 selected nursing homes that experienced floods, hurricanes, and wildfires in 2007–2010. We interviewed nursing home administrators and staff, local emergency managers, and representatives from State LTC ombudsman programs and SAs. We also compared the emergency plans of each selected nursing home to the CMS checklist for health care facilities.WHAT WE FOUNDMost nursing homes nationwide met Federal requirements for written emergency plans and preparedness training. However, we identified many of the same gaps in nursing home preparedness and response that we found in our 2006 report. Emergency plans lacked relevant information—including only about half of the tasks on the CMS checklist. Nursing homes faced challenges with unreliable transportation contracts, lack of collaboration with local emergency management, and residents who developed health problems. LTC ombudsmen were often unable to support nursing home residents during disasters; most had no contact with residents until after the disasters. SAs reported making some efforts to assist nursing homes during disasters, mostly related to nursing home compliance issues and ad hoc needs.WHAT WE RECOMMENDWe made three recommendations to CMS and one recommendation to the Administration on Aging (AoA). CMS agreed with our recommendations to revise Federal regulations to include specific requirements for emergency plans and training, update the State Operations Manual to provide detailed guidance for SAs on nursing home compliance with emergency plans and training, and promote use of the checklists. AoA agreed with our recommendation to develop model policies and procedures for LTC ombudsmen to protect residents during and after disasters. Finally, in a memorandum report, we outline guidance that CMS can consider when revising the checklist for health care facilities.
Navigating the ICD-10 Transition: Implementation imperative for hospitals and medical groups
Navigating the ICD-10 Transition: Implementation imperative for hospitals and medical groups
Source: Deloitte
On February 16, 2012, the Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced that “HHS will initiate a process to postpone the date” by which certain health care entities have to comply with ICD-10. While there is uncertainty on a new compliance date, the transition to the ICD-10 coding set presents opportunities, benefits, and challenges that providers should address whether the implementation date is set for 2013, 2014, or beyond.
As organizations review their implementation plans based on scenarios that could play out with an extension, leaders of hospitals and medical groups should keep in mind that regardless of the compliance date, the transition to ICD-10 requires extensive planning and coordination across the organization. Organizations that have completed their ICD-10 readiness assessments have discovered that the road forward presents enterprise-wide challenges that require both a strategic and tactical solution if they plan to leverage benefits from the transition.
This article explores strategic decisions and leading practices for ICD-10 implementation across four key areas: project governance, technology, finance, and operations.
+ Full Document (PDF)
