Month: June 2016

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survey report says that health care in the United States costs about $ 2000000000000 a year, or more than $ 6,600 for every man, woman and child in the country. With respect optimizing health with the elimination of medical errors, increasing labor costs and general expenses caused by the massive use of paper could benefit up to $ 300 billion each year, according to the national coordinator for health information technology under George W. Bush’s former president.

The essence of consensus is the implementation of electronic health record (EHR) the extent to change the paper based system of paperless save the economy on a massive scale. The true implementation of electronic medical records would distribute vast network; connect all offices hospitals, clinics and doctors. This would help in the exchange of patient data with a few clicks anywhere anytime.

Initially, few provide got suspicious of approved electronic medical records based on what prevents good time between patient and physician. They did not stick with the added chore of learning a new computer system, no matter what virtues does it offer. However, the user Ehrs restored inspection doctors gradually doubled the rate of EHR over the past two years, according to a notice from the Health and Human Services (HHS) Secretary Kathleen Sebelius. The current rate of use of EHR increased from 16% in 2009 to 35% in 2011.

EHR implementation benefits are not confined solely to patient care and easy access of data, but it also helps in quick disease diagnosis, improved monitoring, quality comparisons, benefit society on a larger scale. One of the big barriers to EHR adoption, the high cost charged by each vendor. This needs to be taken care of on a larger scale to improve its implementation. Now many manufacturers offer very user friendly and cost effective EHR software for doctors.

As the US government policy, it has become mandatory for all, to adopt EHR for 2014; after it was punishment in annual revenue when measured by the government. Approved EHR not only rely on the providers, it is heavy duty on sellers offering a very economical and user-friendly product which itself could appeal to the physicians. Implementation is a major concern not only benefit the individual and the country’s economy as well on a larger scale.

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Source by Asima Sadiia

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In the past 10-15 years, reimbursement and patient access related issues for large drugs have been addressed at great depth, especially where they belong to animal biologics. The same can not be said for the diagnosis and medical devices. The rules of the game, such as market access model and type of FDA requirements, can be very different for bringing medical devices on the market, vis-a-vis BIOLOGICS. In this article, we are addressing the medical device access issues.

To deal with some of the above differences, Congress has set a number of laws that affect Medicare reimbursement and coverage of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). In 2003, Medicare prescription drugs, Improvement and Modernization Act (MMA) mandated a temporary freeze in annual increases in payments for durable medical equipment (2004 through 2008), and established a new condition for payment and quality standards based on a competitive bidding process: Medicare pays only those suppliers selected through regional competitive bidding process. Current auctions program effective 1 January 2011 in nine regions and reimbursement to contract suppliers averages 32% of the Medicare DMEPOS tariff for nine product categories currently in the program. Plans are to expand the categories in the near future.

More recently, the Patient Protection and Affordable Care Act (ACA) signed into law March 23, 2010, is designed to increase access to affordable health insurance , control health care costs and improve health care quality. Several provisions of the ACA deal especially medical industry. For example, ACA eliminates full inflation update on DMEPOS tariff for the years 2011 through 2014. In particular, the ACA reduces inflation update DMEPOS in 2011 by “productivity adjustment” factor based on a 10-year moving average of annual changes in the overall economy private nonfarm business productivity gains in the provision of health care. For 2011, productivity adjustment is calculated by taking 1.1% inflation and reduce the productivity gains of 1.2%, resulting in a 0.1% decrease in DMEPOS tariff levels.

In addition, beginning in 2016, the ACA requires the Secretary of HHS use auctions payment information set DMEPOS payments in areas outside the areas competitive bids. ACA also proposes a new annual federal excise tax on certain medical device manufacturers and importers. Especially for sale on January 1, 2013 or later, manufacturers, producers and importers of taxable medical devices must pay excise tax of 2.3% on the price of the appliances are sold.

Finally, a medical device may also be affected by changes in state health care legislation and regulatory policies that are expected to approve the state budget due to contraction. Examples are planned reduction in provider and supplier compensation levels under state Medicaid programs. Also proposed federal fiscal year 2012 budget Obama – the 14 February 2011 proposes to reduce federal reimbursement to states for their Medicaid DME spending (proposal calls for reimbursement equivalent to what the government would have paid under Medicare DMEPOS competitive bidding program). The proposal requires congressional approval, but if the set is expected to reduce Medicaid reimbursement for DME of $ 2.35 billion over five years.

Although the potential impact ACA health reform provisions are still uncertain, it is possible that the legislation will have a significant negative impact on the medical devices business.

All of the above suggests that the states continue to face significant financial pressures, the medical device company will likely be reduced, resulting in reduced profitability for years to come.

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Source by Nick Poulios

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Shorter hospital stays related to cost containment with managed care, make another area important. That is patient education.

In hospitals who set the highest standards and have the budgetary ability for its support, there is a patient education department or at least the ability to provide to patient educational material. In most hospitals the nursing standards includes the provision of education to patients and families along with the appropriate literature related to their illness and incorporates this into nursing care.

Budget cutting that excludes the process of patient education falls short in meeting the needs of patients and fails miserably in our health care system.

What does this mean to a patient? It means from the time you enter a hospital until and including their discharge, there should be ongoing information provided.

It begins with instruction on the use of your call bell, with essential confirmation that you understand by feedback to your nurse. All the questions you are asked provide healthcare staff of important information, such as any allergies you may have. A wrist band should include your name and allergies.

Every procedure that is done to you as a patient should be preceded by an explanation as to what it is evaluating and how it is done.

Everytime a medication is administered to you, its name and action should be explained along with the provision of printed educational material.

When there is a change in your condition requiring a new plan of care you and your family should have input into it.

If you or your family member needs additional support not available through the hospital such as your community or religious support, they can be notified. Patient confidentiality prevents the hospital from making your stay there public.

Do not fear the hospital environment, but be alert to anything unusual, if your medication looks different or if you are suddenly being whisked off for a test you have not been advised of, notify your nurse. Make sure the hospital staff uses your last name in your care with frequent checks of your ID band.

When your injury or illness causes you pain. It is best to request medication before it becomes too severe as it will take time for the nurse to visit you and then obtain it for you. They should be using a pain scale to assess your pain and to be sure your pain relief is adequate.

Remember your nurse and your doctor should also be your teachers.

It is critical that any sudden pain or distress, such as chest pain or shortness of breath, be addressed promptly and it is most appropriate to call out for help if there is a delay in answering your call bell.

At the time of your discharge from the hospital, which can be overnight or a day or two.You should be given in writing discharge instructions with a verbal review for you and your family It should include new medications how they are to be taken and matching literature for reinforcement. It should advise diet and activity level, as well as return visit with doctor. There should be phone numbers and instructions for contact in the event of any complications.

In this harried time in health care try to understand the hospital has to triage in the emergency room, that means that the most critically ill patient must be seen first and often that means you must wait your turn. For non emergency type health problems it is best to use the office visit.

Ask questions freely, the harried staff will appreciate this and will give you clarifications rather then having things come undone through misunderstandings.

We are all part of this system as it is today, those who care for you also get ill and experience the same frustrations as everyone else. But, with all its imperfections, we have made great advances in healthcare and most of us will have a better quality of life because of it.

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Source by Ruth Bredbenner

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Hospice care is for terminally ill patients, who have less than 6 months to survive. The care ensures that the patients are comfortable in the last days of their life. The care does not try to prolong a terminally ill patient's life, and it does not try to hasten the end. Instead the care tries to offer comfort and relief from the symptoms and pain. While hospice care is often preferred for terminally ill, it has its advantages.

In a hospital setting even if the patient has a terminal illness, the doctors will continue treating the patient with the hopes of prolonging their life until the patient's body beats the disease or until the doctors can figure out a cure. On the other hand, this care stops all forms of treatment and finding a cure is not a priority. The medications that the patient is given are meant for easing discomfort and pain brought on by the disease. While hospice care tries to make the patient as comfortable as possible in the last days of the life, it does not attempt to treat the patient with medications to restore the person's health.

Hospice care can be emotionally tiring for family members. Family members do realize that their loved one is doing to die sooner or later. However, the helpless that they experience that they can not do anything to prevent the dying can be emotionally exhausting. In addition, the stress of caring for the patient is also exhausting. The family has to stop doing everything else and spend their time taking care of their loved which is a 24-hour job. So when a patient finally succumbs to the illness, the family may actually feel a sense of relief which can make them feel guilty.

Hospice care can be provided at home or in a hospice. Today, more and more patients are opting for home hospice care. As a result family members have to bear the responsibility of providing 24-hour care for their loved one. If a family has financial means, it can hire a professional nurse. However, most families do not have the means and end up taking care of their loved one which is extremely exhausting and tiring. Feeding, giving medications, bathing, toilet needs, changing linen and constantly checking on the patient is a full time job where the primary caregiver gets no rest or respite. This care giving continues until the patient finally dies.

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Source by Kum Martin

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Nurses have always played a vital role in the health care industry. They spend their lives caring for people who are afflicted with illnesses and injuries. Two types of nurses that are highly respected members of the medical community are Registered Nurses (RN) and Nurse Practitioners (NP). There are a number of differences between a Registered Nurse and Nurse Practitioner.

Registered Nurse (RN)

A Registered Nurse is a licensed medical professional who has completed a four-year nursing degree from a reputable nursing school. These nurses provide all types of nursing care to their patients and act as health advocates for the patient. As well, they evaluate, plan, and implement nursing care treatment for the sick and injured in conjunction with physicians and other health care providers. Registered nurses carry out a number of medical tasks such as: explaining and educating patients about their medical conditions, dispensing treatments such as medications and fluids, performing selected medical procedures, monitoring a patient's vital signs, advising and supporting patients, maintaining patient health records, and keeping families advised on a patient's health status and progress. A registered nurse can work in most areas of the health care field. With advanced training and experience, registered nurses can specialize in a specific medical area such as surgical procedures.

Nurse Practitioner (NP)

A Nurse Practitioner (NP) is a registered nurse who has normally completed either a master's degree or doctoral degree and undergone training in the diagnosis and management of common medical conditions. The Nurse Practitioner degree program is explicit in its educational goals that include physical assessment and screening, diagnosis, diagnostics, therapeutic treatment, pharmacology and drug interactions, assisting with patient emotional support and counseling, patient intake, referral and discharge procedures, and case management practices .

In the US, Nurse Practitioners are licensed by the state where they practice. They have national board certification which is normally done through the American Nurses Credentialing Center or American Academy of Nurse Practitioners. The specialized training and educations allows a nurse practitioner to perform many medical tasks usually performed by a doctor. Such tasks include diagnosing and treating illnesses and injuries. A few states permit nurse practitioners to write prescriptions. The nurse practitioner has advanced comprehension and clinical proficiency in assessment, diagnosis, treatment, and patient care practices. Nurse practitioners treat health conditions within their range of practice through the utilization of physical exams, physical therapy, ordering tests, and implementing therapies for patients,

Nurses are the first medical professionals people see when faced with a health problem. They can be found working in the community in such places as health clinics, schools, doctors' offices, home care, family planning clinics, rehabilitation centers, and hospices. In a hospital, nurses can be found working in emergency, intensive care, operating room, maternity, cardiovascular (heart), oncology (cancer), psychiatry, pediatrics, palliative, and geriatrics.

They provide important and essential support to doctors and other healthcare providers, patients, and families. A career as either a Registered Nurse or Nurse Practitioner is satisfying, lucrative, and meaningful.

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Source by Amy Nutt

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Nurses are respected and valued members of the medical community. They play a critical role in the health care field. Although the medical field is made up of many types of nurses, they are all exciting and rewarding careers. The following list outlines many types of nursing careers:

– Registered Nurse (RN): Registered Nurses work in almost all areas of the health care profession. They perform many tasks that include: administering treatments such as medications, performing certain medical procedures, monitoring vital signs, advising and supporting patients, educating patients about medical conditions, and keep families up-to-date on a patient's status. Registered Nurses can specialize in certain medical areas

– Certified Nurse Assistant (CNA): Certified Nurse Assistants are also known as nurses' aides, patient care technicians, home health aides, and home health assistants. CNAs are employed in a number of health care fields. They work in hospitals, nursing homes, private homes, and adult living homes. CNAs perform a number of duties that include: monitoring health such as recording a patients temperature, pulse, and respiration, helping patients eat, bathe, and dress, helping patients walk, keeping patients rooms in order, providing nutritious meals, answering patients' call bells, and making beds. They may also help patients to exam rooms and even assist with simple procedures. CNAs report to a Registered Nurse.

– Licensed Practical Nurse (LPN): Although Licensed Practical Nurses have less training than Registered Nurses, they are employed in all areas of health care. They work in hospitals, nursing homes, and medical clinics. LPNs perform such duties as monitoring a patient's overall condition, giving injections, recording vital signs, and applying dressings. They will also assist patients with personal hygiene and report any treatment reactions

– Critical Care Nurse: A Critical Care Nurse works with seriously injured and ill patients in the hospital. This type of nurse works in the ICU (intensive care unit) or CCU (critical care unit). Their job is to care for patients who are being treated for serious and life-threatening illnesses.

– Travel Nurse: A Travel Nurse is a nurse that travels to different areas and provides short term support when there is a nurse shortage. They will fill in when a full time nurse goes on maternity leave, during peak work times, if a nurse has a long term illness, or if a nurse is on an extended vacation. There assignments are short term but they are highly paid. An assignment usually runs for about 13 weeks. Travel Nurses often work in hospitals and medical clinics. Employers will provide many benefits such as free housing and health insurance.

– Licensed Vocational Nurses (LVN): Theses nurses perform the same job function as licensed practical nurses. LVNs provide certain medical services such as giving enemas, treating bedsores, bandaging wounds, and recording vitals. They also assist patients with bathing and dressing.

– Public Health Nurse (PHN): These nurses are registered nurses who have specialized in community health. They often go to community centers, homes, and schools where they assist individuals and families with health concerns. They work with community organizers regarding health related issues. They also perform the same duties as registered nurses.

– Nurse Practitioner: A Nurse Practitioner is a registered nurse who has specialized training and education which allows them to carry out many tasks normally performed by a doctor. Such tasks include diagnosing and treating illnesses and injuries. Some states allow practical nurses to write prescriptions.

These are just a few of the more popular areas of nursing. Nurses are on the front lines of health care and are usually the first people patients meet when faced with a health issue. Nurses provide valuable support for patients and their families making them an indispensable part of the health care community.

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Source by Amy Nutt

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Since the prognosis for SCID is very poor if a compatible bone marrow donor is not available, nursing care is directed at supporting the family in caring for a fatally ill-child. Genetic counseling is essential because of the modes of transmission in either form of the disorder. Nursing goals are directed at helping parents prevent sources of infection in the child, such as cautious isolation from crowded facilities and individuals with active infection, meticulous skin and mouth care, good general nutrition, and careful supervision during periods of activity to prevent skin trauma. However, even with exacting environmental control, these children are prone to opportunistic infection. Chronic fungal infections of the mouth and nails with Candida albicans are frequent problems despite vigorous efforts at prevention or treatment.

A hoarse voice may result from repeated esophageal and vocal cord erosions from the fungus, It is important to stress to parents that such conditions are not a result of laxity on their part in preventing them but are the result of the severe immunologic disorder. Parents should be encouraged to immediately notify a physician regarding any evidence of a worsening infection.

Children who receive frequent injections of immune serum globulin (ISG, or IG) need support during the procedure because the injections are painful. Infants are best comforted by their parents, but toddlers and preschoolers may benefit from needle play. Immune globulin is injected deeply into a large muscle mass, usually the vastus lateralis. To prevent tissue damage and provide maximum absorption, the total amount may be divided into two injections and given in two different sites, A record is kept of the sites to ensure a rotating schedule for future injections. An intravenous preparation of ISG (intravenous modified ISG [MISG]) is available that reportedly is more effective and causes less distress.

A rare complication of long-term ISG administration is mercury toxicity (acrodynia, or pink disease) caused by a mercury-containing bacteriostatic agent in the commercial preparation. Nurses working with these patients should be aware of signs of this unusual reaction, including pink, scaling pruritic palms and soles, photophobia, sweating, irritability, and insomnia.

Care of a patient undergoing bone marrow transplantation is mainly directed at preventing infection. Due to the fact it takes 7 to 20 days before evidence of bone marrow functioning becomes obvious, hospitalization is long. It is not the purpose of this discussion to detail the care of the patient with a bone marrow transplant because of the specialized care involved, except to emphasize that the psychological needs of the parents and child are tremendous. For the parents, it represents the last hope for successful therapy and survival. For the child it means sensory deprivation because of isolation, numerous blood tests, and the possibility of more pain and suffering if a graft-vs-host reaction occurs. To meet these needs, a sensitive, consistent team of nurses who function effectively as members of the total health team is essential.

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Source by Funom Makama

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INTRODUCTION

Patient rights are under siege, as evidenced in a recent survey conducted by the National Institute for Patient Rights (NIPR). NIPR staff compiled the results based on responses from one-thousand randomly selected, former hospital patients who took part in the study. The results of the survey show that, despite billions spent on advances in medical technology, patients daily experience an erosion of their rights "at the hospital bedside." Ironically, it may be a consequence of the success of science in medicine.

Among those responding to essay questions, the following was a typical scenario. A hospital admits a loved one with "complications" (a medical euphemism for "we really do not know all that's going on here, but there are several organs involved"). While the loved one rests stable in bed, a line of doctors and nurses seems to form at the door. One after another, doctors enter the room, make a few comments, then turn around and exit. Primary care physicians refer patients to specialists who rely on subspecialists. It seems like each separate organ has its own special doctor.

In the health care industry, this is commonly referred to as "component management," which results from a focus on the treatment of individual organ systems in isolation from others. It suffers from two shortcomings: (1) specialists and subspecialists tend to segregate organ systems at the expense of the whole patient; and (2) it is inefficient, because it inevitably leads to "episodic intervention" where if something happens, you see one specialist for a particular organ system; if something else happens, then you see another specialist or subspecialist, and so on.

Episodic intervention leads unavoidably to uncoordinated care that lacks continuity for the patient and for the patient's family. Many individual decisions in patient treatment by numerous specialists and subspecialists entail a fragmented delivery system. According to the findings of the NIPR study, this leads to the number one problem in contemporary healthcare delivery: a failure to communicate.

PIECING TOGETHER BITS OF INFORMATION

The study suggests health care suffers from a decided lack of coordination and cooperation among diverse healthcare professionals. Participants in the survey invariably stated that, with no one to treat the entire patient and coordinate care, patients and their families are left largely on their own to integrate their own care. According to one respondent, "We had to somehow piece together bits of information from different doctors to try to get a complete picture of our mom's progress."

This can be very difficult to do in a hospital setting and extremely frustrating. Participants in the study frequently stated that no one seemed willing to tell them exactly what was going on with the whole patient. Doctors were more than willing to share information about their specialty, about precisely what was happening with their particular organ system, but no one seemed especially willing to say anything about how the entire patient was doing.

THE TOP TEN MOST VIOLATED PATIENT RIGHTS

This failure to communicate is responsible for the # 1 spot on the top ten list of most violated patient rights. A full 63% of participants felt that healthcare providers most often violated their right to informed consent. When prompted to explain, many complained about the inadequacy of multiple diagnoses coming from multiple providers. Without a single, complete diagnosis, respondents felt unable to make an informed choice about appropriate treatment options.

The # 2 violation on the list is related to the same problem. Participants often complained about the way in which doctors presented them with treatment options. The following is a representative statement, "I felt as if I was in automobile show room and the salesman was presenting me with a list of options for a new car."

The # 2 most violated of patient rights was a lack of respect for personal, spiritual, and religious values ​​and beliefs. Participants observed that many doctors do not seem to care about personal preferences. Consequently, they often failed to acknowledge the unique nature of personal lifestyles in their presentation of treatment options. To quote one respondent, "I would have liked my doctor to have recommended a treatment option tailored to my love of the outdoors. He never even asked."

A failure to communicate was also the cause of the # 3 violation of patient rights, a lack of respect for advance directives. Participants complained vociferously about the way in which advance directives are handled by most hospitals. Stated one respondent, "The only time any one every mentioned my living will was at admissions. No one ever asked me again about my personal wishes."

Miscommunication was the cause of violation # 4. Despite HIPAA, many participants observed that providers often showed no regard for the privacy and confidentiality of their personal health information. Cell phones were often cited as the main culprit. Said one respondent, "A nurse bent over me to straighten out a line with a cell phone in her other hand, blurting out sensitive information about a patient in the next room. It was embarrassing!"

CONFLICTS ABOUND

Conflict between "team" and patient / advocate was the cause of # 5 on The List. Patients and their advocates have a right to know of realistic care alternatives when hospital care is no longer appropriate. Some participants observed that no one ever approached them about realistic care alternatives in the event that hospital care was no longer appropriate.

Not only was there no discussion of alternative care options, but many respondents complained about how they were made to feel when they disagreed with providers about the continued appropriateness of hospital care. One respondent noted, "They made us feel like we were immoral when we questioned their treatment recommendations!"

Conflict was also the cause of violations # 6 and # 7, violations of a right to know hospital rules on charges and payment methods, and a right to review the hospital bill, have information explained, and get a copy of the bill. Said one respondent, "It was like pulling teeth to try to get an explanation of certain charges. I still do not know why I was charged for things I know we did not use."

Under violation # 8, some participants complained about their inability to identify hospital personnel who could help in resolving discrepancies over billing issues or in disagreement over treatment between "team" and patient / advocate. Patients and their advocates have a right to know of hospital resources, such as patient complaints and grievance processes, patient representatives or ethics committees. It was common in the survey results that respondents express the desire to have known about the hospital ethics committees and their members in the event of conflict over treatment options.

MEDICAL MISTAKES AND RECORD KEEPING

Although listed at # 9, the violation of a patient / advocate's right to know the identity and professional status of those who care for the patient contained some of the most poignant responses in our survey results. Some of the narrative statements were truly heartbreaking.

Many participants claimed to have suffered some harm as a result of medical error. Some even noted if they had had ready access to information about the identity and professional status of their providers, they would have had second thoughts about consenting to treatment. Said one respondent, "I am permanently disabled because of what a doctor did to me. I found out only much later and through my lawyer the hospital knew the doctor caused similar problems in the past with other patients. Why did not they just tell me ?! "

Coming in at a close # 10 was the violation of a right to review medical records and receive an accounting of disclosures regarding health information. Participants observed that they have moved frequently during their life times. Consequently, they have received medical care from various providers over time. Each provider keeps his or her records detailing visits and treatments. The same is true for hospitals, clinics, laboratories, pharmacies, and so on. One participant noted, "Like most people, I've moved around quite a bit. Over time, it's easy to forget when you were treated, by whom and even for what!"

Respondents noted such problems as the wide variation among providers in the amount of time they retained records, paper records were misfiled or even destroyed, electronic records were lost, stolen, damaged or vulnerable to unauthorized access, and physicians sold their practices. Stated a respondent, "I was made to feel intimated in asking one of my doctors for a copy of my medical records. He acted like my medical record was his property and his only."

CONCLUSION

Despite billions spent on advanced medical technologies such as drugs and devices, patients daily experience an erosion of their most fundamental rights. The rights of patient self-determination and informed consent suffer the most.

Ironically, the widespread violation of patient rights in hospital-based care may be a direct consequence of the success of medicine, specifically of the application of science to medicine. The scientific method lends itself to reductionism with researchers analyzing smaller and smaller parts. Likewise in medicine, doctors become specialist who confine their focus to individual organs; subspecialist focus even more narrowly on the parts of organs.

Component management leads to episodic intervention and the fragmentation of care. The lack of coordination causes anger and frustration among patients and their families by the breakdown in communications. A failure to communicate may not just cause anger and frustration but also unnecessary conflict. Conflict is costly! Miscommunications can also cause significant harm when patients suffer underuse, overuse or misuse as a result of medical error.

Until hospitals adjust to the success of science in medicine, patients and their families are likely to continue to experience one or more of the top ten violations of patient rights.

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Source by Mark Meaney

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Primary care specialties will receive the largest increase in payment by virtue of a new payment for managing a Medicare beneficiary's care when the beneficiary is discharged from an outpatient hospital observation, inpatient hospital, community mental health center, partial hospitalization services or from an SNF. While announcing its new policy, CMS acknowledged that the extensive non-face-to-face care coordination provided by physicians and nurses was not considered in the existing payment schedule for E / M (Evaluation & Management) services. The new directive will provide payments for physicians as well as other healthcare providers for coordinating care transitions of Medicare beneficiaries after they are discharged from hospitals / skilled nursing facilities to assisted living facilities or their own homes. The new rule is effective from January 1, 2013.

The New Codes: 99495 & 99496

CMS has a clear objective in introducing these new codes for Transitional Care Management (TCM) services. They are intended to prevent emergency department visits and re-hospitalizations during the first 30 days after discharge. Apart from primary care physicians who would be billing for most of these services, specialists who provide necessary services can also bill these new CPT codes.

TCM Code Requirements

• 99495, TCM: Communication (direct contact , telephone, electronic) with the patient and / or caregiver within two business days of discharge; Medical decision-making of at least moderate complexity during the service period; face-to-face visit within 14 calendar days of discharge.
• 99496, TCM: Communication (direct contact , telephone, electronic) with patient and / or caregiver within two business days of discharge; Medical decision-making of high complexity during the service period, face-to-face visit within seven calendar days of discharge.

It is to be noted that both these codes necessitate communication with the patient and / or care provider within two business days of discharge, plus a face-to-face visit with the patient within a fixed time period. Decision regarding medication and management must be made at least by the day of the face-to-face visit.

Non face-to-face care coordination services can be carried out by the provider and / or licensed clinical staff under his / her direction. However, the face-to-face visit is to be performed by the providers themselves with staff assistance.

Fee Schedule for the New TCM Codes

The values ​​assigned to the new TCM codes are 4.82 relative value units for Code 99495 and 6.79 relative value units for Code 99496. Provided the Congress prevents the impending 26.5% cut to payments for physicians and maintains the current conversion factor of $ 34.0066, the payments for these codes will be:

In non-facility (Physician office) settings:

• Code 99495: $ 163.91
• Code 99496: $ 230.90

In facility (Outpatient hospital) settings:

• Code 99495: $ 134.67
• Code 99496: $ 197.58

These codes can be billed only after at least 30 days post discharge, when the service period is completed. The primary care incentive payments will not be added to these amounts.

Points to Keep in Mind

• Make sure that you bill only for post-discharge patients who require moderate or high-complexity medical decision making.
• The initial face-to-face visit need not necessarily be in the office.
• The first face-to-face visit with the patient after discharge is part of the TCM service and can not be reported separately. E / M services provided additionally can be reported separately.
• Documentation guidelines for E / M are not applicable to these codes. Providers must therefore take into account how they would like to document the non face-to-face services that are required by codes. Complexity of the medical decision making, timing of the first communication after discharge, and date of the face-to-face visit will have to be documented.
• Providers can use these codes to bill for new as well as established patients.
• Discharge services and the face-to-face visit required under the TCM code can not be provided on the same day. However, the same practitioner who bills for discharge services can also bill for TCM services. Importantly, the same practitioner can not report TCM services provided during a post-surgery period for a service with a global period since it is understood that these services are already included in the payment for the underlying procedure.
• A very important point to remember is that only one practitioner can bill for TCM services during the 30 days post discharge of a patient. The first practitioner to bill for the service alone will receive reimbursement. Therefore, practitioners should necessarily communicate with the patient and / or caregiver, and the discharging physician to be clear about who will be managing the TCM services.
• Practitioners can bill for TCM only once in the 30 days after discharge even if the patient happens to be discharged 2 or more times within the 30-day period.
• Providers can not bill for other care coordination services (such as care plan oversight codes 99339, 99340, 99374 – 99380) provided during the TCM period.

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Source by Robert Kruse

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As a young man, my parents were always healthy and it never crossed my mind that I would eventually have to endure a complete role reversal with them. The child takes on the paternal role of caring, nurturing, and coordinating the activities of daily living, and the parent becomes increasingly helpless. This phenomena becomes increasingly apparent as you yourself reach middle age, and witness so many friends and families take on the roles of primary caregiver of a disabled child, sibling or parent.

In today's health care climate, it's often the only viable choice due to the prohibitive costs of quality home and medical care, and the special attention a quadriplegic patient requires. On the other hand, no one will take care of your loved ones the way you would, so doing it yourself has many advantages as well as providing peace of mind to the family. Of course with my background, this kind of personal care for a quadriplegic is easy. However, I have trained many live-in caregivers over the years to assist me, and none of them had any prior medical background. Each provided excellent care, and allowed my loved one to live years beyond anyones' expectations. I realize each case is different and this article is not meant to replace a hospice nurse or a visit from a medical doctor. It will however give you an idea of ​​what to expect if you considering providing care to a quadriplegic in your home.

Time: You have to first try to fathom the incredible amount of time it takes to care for a quadriplegic patient. The time spent can be divided up into two categories. The time you spend planning and providing care, and the time you spend being confined to the home because leaving them alone simply is not an option. It can be done if there is a "stay home adult" such as a spouse, to help out. Remember, some patients require attention almost all their waking hours most days of the week, and some require considerably less, depending on the level of function. How is this possible? Consider the following points.

• Feeding: at least 1/2 hour per meal, but if your patient is not a good eater, you may spend a few hours in food preparation, coaxing and spoon feeding and encouraging them to simply chew and swallow.
• Bathing: 1 bath a week burns up about 2 hours in bathing, grooming, dressing.
• Toileting: While a quadriplegic wears diapers, you may not elect to use stools softeners to the point where the patient poops in their diapers every other day. So toileting on a bedside commode is an option that can take about an hour or so per week.
• Laundry: Sheets, bibs, drool cloths, clothing, towels.
• Food Preparation: special diet? that takes time!
• Doctors visits: home visits by the doctor or nurse, or loading up the patient to take them to the clinic.
• Skin Maintenance: turn the patient every 30min to prevent bed sores. This is incredibly important
• Oral Maintenance: often overlooked, if you do not pay attention to this, the patient's healthy dentition will quickly decline
• Conservatorship
• Any other special medical needs
• Accounting and booking
• Other personal affairs

Money: It really helps if the patient has their own financial resources and insurance. I found that the initial expenses of setting up your home care is a little tough, but the monthly expenses are not as bad. Here are some of the items I recommend. Some may be covered by your insurance.

• Diapers: You get what you pay for and the cheaper they are, the more they leak. Try large diapers, even if your patient is tiny.
• Formula or other special diet
• Special Clothing and gowns
• Hospital bed
• Special mattress: Air filled, self turning
• Suction device
• Oral care equipment
• Bedside commode
• Bathing equipment
• Medications, ointments, stool softeners, etc
• Other incidentals
• Caregivers on call to give you a break (respite care)

Physical Ability: To handle the care of an adult quadriplegic, you really have to be in good shape yourself. There is a lot of lifting dead weight, and a back injuries to the caregiver is a very common occurrence. In addition, physical strength to simply turn the patient, pull them up in bed, change their clothing, transfer them from the wheelchair to the bed, or toileting, all takes a lot of physical stamina. With that in mind, consider this. Do you have the stomach to change soiled diapers, give sponge baths, do oral care in a mouth with rotten teeth, feed the patient through a tube, suction mucous, etc.? You do not want to put yourself and your loved one in a situation you both suffer from and can not get out of.

There are many resources to help you out with many of the above issues. If your loved one is not yet ready for hospice care but is still gravely disabled, most insurances will cover home nurse visits in what they call a palliative care program. These usually consist of RNs that will come by every now and then and check on the progress, do a medical assessment and help you in finding a solution taking care of your patient at home. So if you decide to go for it, know that you will be providing a service that no one else can. Love and care in a familiar family home and environment.

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Source by Rich D. Fan