Medicare Finalizes A New Rule For Telemedicine Services To Keep Beneficiaries In Rural

Main Category: Medicare / Medicaid / SCHIP
Also Included In: IT / Internet / E-mail
Article Date: 02 May 2011 – 10:00 PDT

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The Centers for Medicare Medicaid Services (CMS) today announced that it has finalized a rule for telemedicine services to ensure that patients in rural or remote areas will continue to receive the most cutting-edge medical care from many of their local hospitals.

The final rule changes the process that hospitals and critical access hospitals (CAH) can use for credentialing and granting privileges to physicians and practitioners who deliver care through telemedicine. Specifically, the rule simplifies how hospitals and CAHs partner with hospitals and non-hospital telemedicine entities (such as teleradiology facilities) to deliver care to their patients. The streamlined process will be particularly beneficial to patients of small hospitals and CAHs in rural or remote areas that may lack staff or resources to deliver specialized clinical expertise to their patient populations.

“Today’s final rule is the result of close collaboration with hospital and telemedicine care experts,” said CMS Administrator Donald M. Berwick, MD. “We at CMS want to be sure that as we develop rules to protect the safety and quality of care at America ‘s hospitals and CAHs, we also devise policies that reflect the most innovative practices in delivering care to all patients, especially patients in rural or remote parts of the country through telemedicine practices.”

Before today’s final rule, CMS regulations required hospitals and CAHs to grant practice privileges to remote-site doctors and other practitioners already credentialed in distant-site facilities, after their own individualized consideration of the practitioner’s qualifications, on a practitioner-by-practitioner basis. This meant that these practitioners could not provide care via telemedicine unless they were granted practice privileges both by their home hospital as well as by the remote hospital or CAH to which the telemedicine services were being delivered.

Privileging decisions are currently made based upon the recommendations of a hospital’s staff after the staff has thoroughly examined and verified the credentials of the practitioners and also used specific criteria to determine whether privileges should be granted.

As part of credentialing, hospitals research the qualifications of licensed healthcare professionals and assure that these qualifications are appropriate and legitimate. Privileging considers a practitioner’s credentials, including a license or ability to legally practice in a state, the practitioner’s training and experience, any special certifications the individual may hold from a medical specialty board, as well as the individual’s clinical skills and abilities.

The final rule aims to reduce the burden of the traditional credentialing and privileging process for Medicare-participating hospitals and CAHs, both those that provide telemedicine services and those that use such services. In particular, the rule extends the option of a streamlined credentialing and privileging process to those small hospitals and CAHs that use the telemedicine services of practitioners from distant-site telemedicine entities, both Medicare- and non-Medicare-participating, in order to improve access to specialty services for patients while further reducing the regulatory burden imposed on hospitals and CAHs.


A hospital or CAH that furnishes telemedicine services to its patients via an agreement with a “distant” hospital or telemedicine entity may now rely upon information furnished by the distant hospital (often a larger medical center) or telemedicine entity when making credentialing and privileging decisions for the physicians and practitioners at the distant site that will furnish the services.

Telemedicine is the use of electronic information and telecommunications technologies to provide professional health care services. Telemedicine is often used to connect practitioners and clinical experts in large hospitals or academic medical centers with patients in smaller hospitals or CAHs, which are typically located in more remote locations. Telemedicine can assure that these remotely located patients enjoy the same access to potentially life-saving technologies and expertise that are available to patients in more populated parts of the country.

The final rule was developed in response to concerns about the urgent need to preserve access to telemedicine for patients.

Today’s final rule updates the conditions of participation for hospitals and CAHs. Conditions of participation are rules that apply to health care organizations that seek to begin and continue participating in the Medicare and Medicaid programs. The conditions are the baseline health and safety standards and are the foundation for improving quality and protecting the health and safety of beneficiaries. CMS implements these standards through state departments of health and accrediting organizations recognized by CMS (through a process called “deeming”), which review provider practices to assure they meet or exceed Medicare’s condition standards.

Source:

Centers for Medicare Medicaid Services



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Early Warning Signs Of Joint Replacement Failure With New Test

Main Category: Medical Devices / Diagnostics
Also Included In: Arthritis / Rheumatology;  Bones / Orthopedics
Article Date: 27 Apr 2011 – 8:00 PDT

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5 (2 votes)

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4.5 (2 votes)

A new test shows promise for detecting the early stages of a major cause of failure in joint replacement implants, so that patients can be treated and perhaps avoid additional surgery. More than 1.5 million total joint replacement operations are performed worldwide each year. While the success rate is 90 per cent, almost 10 per cent of implants fail and require additional surgery, report appears in the ACS journal Molecular Pharmaceutics.

Dong Wang and colleagues at University of Nebraska Medical Center and the Hospital for Special Surgery of New York explain that wear and tear in a joint replacement can create tiny bits of debris that cause local inflammation and lead to bone loss. When this happens, the implant can become loose and set the stage for failure. Treatment usually comes too late, they note, since it’s difficult to detect the problem in its early stages. “When pain or clear radiographic evidence is reported, unfortunately, considerable bone loss has already occurred, which cannot be easily restored,” the scientists note.

To provide an early diagnostic tool for implant failure, the researchers developed a polymer-based system for imaging the inflammation that is associated with the wear debris. Their tests of the imaging agent in mouse bone suggest that it can help them detect the early stages of bone loss that might cause a joint implant to become loose. They also found that they could tether a powerful anti-inflammatory drug to the polymeric system, offering a way to treat inflammation and bone loss in these early stages of wear. “Subsequent therapeutic interventions at this stage,” they write, “would permit prolongation of the lifetime of the implant with improved patient outcomes.”

The authors acknowledge funding from the National Institute of Arthritis, Musculoskeletal and Skin Diseases and the American College of Rheumatology Research and Education Foundation.

Source:
Michael Bernstein

American Chemical Society



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Patients With A Chronic Condition Benefit From Ongoing Relationship With Care Provider

Main Category: Primary Care / General Practice
Also Included In: Arthritis / Rheumatology;  Diabetes
Article Date: 01 May 2011 – 2:00 PDT

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People with a chronic condition such as diabetes or arthritis may find themselves taking on a more active role in maintaining or improving their own health if there is an ongoing relationship with a primary healthcare (PHC) provider, according to University of British Columbia research.

Appearing in the current issue of Medical Care, the study is the first in Canada to investigate the links between having a regular primary healthcare provider and patient activation, a growing direction in healthcare that aims to increase people’s skills, confidence and knowledge so they can better manage their own health.

Primary care refers to the first level of contact with healthcare for individuals. These include clinical services from doctors, nurses or nurse practitioners as well as health promotion activities.

“The idea is that we need to do the best we can with our current healthcare dollars to provide sustained quality care for individuals who in some cases are living with one or more chronic conditions,” says Assoc. Prof. Sabrina Wong, lead author and a researcher in the School of Nursing and Centre for Health Services and Policy Research.

“What we’re seeing across North America is a policy direction that links patient-reported outcome measures such as patient activation to the quality of services and care provided by primary healthcare, especially in chronic disease management,” says Wong.

Previous U.S.-based studies have shown that having a strong primary healthcare system in place pays dividends for patients, and ultimately the taxpayer. For example, individuals with one or more chronic conditions experience reduced risk, and reduced duration and effects, of acute and episodic conditions. As well, they report reduced risk and effects of continuing health conditions.

For their study, Wong and the research team looked at relationships between patient activation and multiple dimensions of primary healthcare in B.C. including access, utilization, responsiveness, interpersonal communication and satisfaction for patients, both with and without a chronic condition.

Taking part in the study were 504 B.C. residents with an average age of 46. Fourteen per cent of participants reported their health as being fair or poor, and 44 per cent reported having at least one chronic condition such as arthritis, high blood pressure or diabetes.

“The results suggest there is a strong relationship between patients’ ability to self-manage their health and having a positive relationship with at least one PHC provider,” says Wong.

With the typical primary care visit lasting between 10 and 12 minutes, one aspect of care especially important to those with a chronic condition was having enough time to talk with their family physician or nurse practitioner.

Other aspects of care such as communication, patient-centered decision-making and being treated as a whole person also appear especially important for those with a chronic condition.

Findings also show that for patients with a chronic condition, high quality PHC was more about a strong connection with the place of care than whether it was delivered through group practice, solo practice or a walk-in clinic.

What was most important, however, for physically healthy adults – who may visit doctors or clinics less frequently – was the quality of the interpersonal interaction.

Source:
Lorraine Chan
University of British Columbia


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Rewarding Hospitals For Quality Of Care Provided To Medicare Patients

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Main Category: Medicare / Medicaid / SCHIP
Also Included In: Public Health
Article Date: 01 May 2011 – 0:00 PDT

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A new initiative has been released by the HHS (Department of Health and Human Services) which rewards hospitals for quality of care given to Medicare beneficiaries, a move which should bring down health care costs, the HHS and CMS (Centers for Medicare and Medicaid Services) announced yesterday.

Through the Hospital Value-Based Purchasing program, 3,500 hospitals around the USA will receive payments for quality provided in inpatient acute care services, rather than quantity. The program was authorized by the Affordable Care Act.

According to the HHS, this move will help acheive the aims of the Partnership for Patients, a partnership involving public and private bodies to improve the affordability, safety and efficacy of health care for all citizens. There is the potential to save up to $30 billion in health costs, as well as 60,000 lives within three years – and possibly a $50 billion savings over a decade.

HHS Secretary Kathleen Sebelius, said:

“Changing the way we pay hospitals will improve the quality of care for seniors and save money for all of us. Under this initiative, Medicare will reward hospitals that provide high-quality care and keep their patients healthy. It’s an important part of our work to improve the health of our nation and drive down costs. As hospitals work to improve their performance on these measures, all patients – not just Medicare patients – will benefit.”

Approximately $850 million will be assigned in 2013 to hospitals according to their overall performance. Performance will be measured according to a set of requirements that have proven to improve patient satisfaction and clinical processes.

The financing will come from money saved by Medicare on what it would have spent. The fund will gradually grow in size, with payments being granted according to performance.

HHS Secretary Kathleen Sebelius said:

“Medicare is in a unique position to reward hospitals for improving the quality of care they provide,” said HHS Secretary Kathleen Sebelius. “. Under this new initiative, we will reward hospitals for delivering high-quality care, treating their patients with respect and compassion, and ensuring they have the opportunity to participate in decisions about their treatment.”

Included among the measure are:

  • Whether heart attack patients get care within 90 minutes
  • Whether heart failure patients when being discharged receive instructions
  • Whether hospitals have a high level of hygiene and maintain their facilities well
  • Whether patients who underwent surgery received care within 24-hours to prevent blood clots

Quality

This will be determined on how closely hospitals adhere to best known clinical practices. Patients’ ratings of experiences of care will also be closely monitored. Following proven best practices improves patient outcomes and reduces their risk of complications, as well as significantly bringing down health care costs.

The higher quality measures a hospital receives, the more money it will get from Medicare. HHS and CMS say that the measures included in the Hospital Value-Based Purchasing program for 2013 have been endorsed by experts from around the country, including the National Quality Forum.

Written by Christian Nordqvist

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today



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What about medicaid? in that topic?

posted by Rachel on 30 Apr 2011 at 4:33 pm

I’m Deaf and I am single no job not married, I’m concern about medicaid’s future how can I afford pay Rx cost? and care in Hospital etc… etc…. I mean I’m struggling to save money some of it not cover Rx, dr visit etc.. etc… so also some hospital etc… refuse provide interpreter cuz I’m Deaf patient I’m mad about it not happy with ER Dept. for not providing it for interpreter so I wish someday make it better? and care of the health ya I’m saying?

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Racial Disparities In Cardiac Arrest Patients

Main Category: Cardiovascular / Cardiology
Also Included In: Public Health;  Medicare / Medicaid / SCHIP
Article Date: 01 May 2011 – 2:00 PDT

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Black cardiac arrest victims are more likely to die when they’re treated in hospitals that care for a large black population than when they’re brought to hospitals with a greater proportion of white patients, according to new research from the University of Pennsylvania School of Medicine. The study is published in the April issue of the American Heart Journal.

The Penn team found that, among 68,115 cardiac arrest admissions analyzed through Medicare records, only 31 percent of black patients treated in hospitals that care for a higher proportion of black patients survived to be discharged from the hospital, compared to 46 of those cared for in predominantly white hospitals. Results showed that even white patients were less likely to survive when treated at these hospitals which provide care for higher proportions of black patients.

“Our results also found that black patients were much more likely to be admitted to hospitals with low survival rates,” says lead author Raina M. Merchant, MD, MS, an assistant professor of Emergency Medicine. “Since cardiac arrest patients need help immediately and are brought to the nearest hospital, these findings appear to show geographic disparities in which minority patients have limited access to hospitals that have better arrest outcomes. For example, these hospitals may not utilize best practices in post-arrest care, such as therapeutic hypothermia and coronary artery stenting procedures. These findings have implications for patients of all races, since these same hospitals had poor survival rates across the board.”

Among factors that may influence the disparities, several include: differences in staff quality and training, patient/family preferences regarding end-of-life care and withdrawal of life support during the post-arrest period where prognosis is often uncertain, and variation in ancillary supports such as laboratory, cardiac testing or pharmacy services. Merchant and her colleagues suggest that further research into how the use of advanced postresuscitation therapies influence survival is necessary to improve outcomes for all patients, perhaps leading to the development of a regionalized care model for cardiac arrest, similar to the system that funnels trauma patients to hospitals that meet strict national standards.

Other authors of the study include Lance B. Becker, MD, Feifei Yang, MS, and Peter W. Groeneveld, MD, MS.

Source:
Holly Auer
University of Pennsylvania School of Medicine



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