Older Americans are living longer than ever and enjoying better health and financial security, although there continue to be lingering disparities between racial and ethnic groups, according to a report. Edward Sondik, director of the National Center for Health Statistics, said in a statement that the report comes at "a critical time." Sondnik added that "as the baby boomers age and America's older population grows larger and more diverse, community leaders, policymakers and researchers have an even greater need for reliable data to understand where older Americans stand today and what they may face tomorrow."
Insurer Group Health Cooperative will change its policies and will pay for a Spokane, WA, man's life-saving liver transplant. The procedure had been initially denied on a technicality because the man was in the midst of a waiting period for organ-transplant coverage. The decision marks the first time a health-insurance company in Washington has officially revoked the controversial loophole. Critics have said the waiting period allows insurers to unfairly get out of expensive transplants for new members who had been covered under previous plans.
A bill that would make major changes in Minnesota healthcare has received preliminary approval in the state Senate, but there is a deep divide among politicians that could make for rough negotiations ahead. Under the measure, providers would make their fees public, and standard benefit sets would allow consumers to compare care and prices. If the bill is passed, the state would also monitor children's obesity levels, and chronic diseases could be managed through nurse phone calls as well as doctor visits.
Legislation working its way through the Georgia General Assembly is intended to make health insurance more affordable. But consumer groups are critical of the legislation because it would hand insurers $146 million in tax breaks over the next five years. That benefit, the consumer groups say, dwarfs the five-year tax savings to employers and individuals projected under the bill.
Healthways Inc., a Nashville-based disease management program administrator, said that more than 300 doctors, group practices and health systems have appealed to Congress to preserve a pilot program under which the company provides care support to chronically ill Medicare beneficiaries in Maryland and the District of Columbia. The Centers for Medicare and Medicaid Services said that the overall pilots weren't meeting requirements for improving clinical quality and customer satisfaction and weren't hitting savings targets.
The number and roles of nurse practitioners is expanding to include more who work in retail clinics or for care-support firms that offer guidance to the chronically ill over the telephone. As a result, doctors' groups are calling for updated rules that would give them more supervision over the nurse practitioners. In Tennessee, state health professionals are now weighing whether changes are needed. Under Tennessee rules, nurse practitioners are restricted to practicing in the same area of medicine as their supervising physician, and what they can do is determined by written guidelines developed with the supervising doctor.
India is fast becoming the destination of choice for patients seeking complicated high-end procedures they can't afford or can't manage to schedule with a doctor they trust in their home country. In 2007, India attracted 150,000 "medical tourists" from the United States, Britain, Africa and elsewhere in South Asia. The patients are attracted to the country for their highly trained English-speaking doctors, quick appointments and bargain-basement prices.
In an interview, Democratic Presidential candidate Hillary Rodham Clinton said that if elected, she would push for a universal healthcare plan that would limit what Americans pay for health insurance to no more than 10 percent of their income. Clinton said she would like to cap health insurance premiums at 5 percent to 10 percent of income. The average cost of a family policy bought by an individual in 2006 was 10 percent of the median family income of $58,526, according to America's Health Insurance Plans. Some policies cost up to 16 percent of median income.
National Patient Safety Goal No. 2 requires hospitals to improve staff communication, but it does not require them to do so with a form. Still, 77% of AHAP members have a form to facilitate handoffs, according to AHAP's 2008 handoff communications benchmarking survey. And only 27% make the forms part of patients' permanent records.
Hopefully, the 23% of survey respondents who said they do not have a form have an appropriate process in place, says Elizabeth Di Giacomo-Geffers, RN, MPH, CNAA, BC, a healthcare consultant in Trabuco Canyon, CA, former Joint Commission surveyor, and member of the AHAP advisory board.
"The 27% that do not make the form part of the permanent record does not match the 23% that do not have a form," she says. "They must use something else, like a 'ticket to ride.' "
It's not surprising that most organizations have a form, says Gayla J. Jackson, RN, BSN, nurse manager at Mount Auburn Hospital in Cambridge, MA, and also a member of the AHAP advisory board. "It seems like we are all experimenting with different types of forms to help the process."
Jackson isn't surprised, either, that few organizations are making handoffs part of the permanent record. "Nor do I think they should," she says.
Department-specific forms Thirty-seven percent of AHAP members who responded to the survey said they have one handoff form for the entire organization, while another 37% said they have many, department-specific forms.
"With many, department-specific forms, how is the process standardized?" asks Di Giacomo-Geffers.
"I have seen and heard of different forms used on specific units to facilitate change-of-shift reports," says Jackson.
"Every unit has its own specific type of change-of-shift report. And most organizations do not want to upset the 'unit thing.' We are trying to use the same form for handoffs between units and for tests," she says. "And that does make sense."
According to the survey, of the organizations that use many, department-specific handoff forms, 72% have a standardized component in each form.
Keeping one part of the form standardized is important, says Jackson. "That is the part that ensures we meet all the implementation expectations for this National Patient Safety Goal."
Creative tools Sixty-six percent of AHAP members responding to the survey reported that they use SBAR to help staff remember their handoff process. While 14% reported using another creative tool, 20% said they do not use a creative tool.
For those that do not using a creative tool, the assumption is that they already communicate effectively, says Di Giacomo-Geffers. "But most hospitals are struggling to come up with a tool that will work for all parts of the hospital," adds Jackson.
For the 80% that did report using a creative tool to help staff remember their handoff process, 49% reported that their tool is paper-based, 6% said their tool is electronic, and 45% said their tool is a combination of both.
"We use a combination-paper for the specific units and electronic for the transfers and procedures," says Jackson.
Regardless of the approach AHAP members are using to help staff remember the handoff process, it appears to be working--100% of those surveyed in the past year reported that The Joint Commission rated their handoff process as compliant.
"That 100% indicates they are doing something right," says Di Giacomo-Geffers, "or surveyors missed opportunities for improvement."
The handoff requirements are not too hard to comply with, add Jackson, "as long as your staff can speak to the required components as listed in the implementation expectations."
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