Some rank-and-file Senate Democrats are voicing concerns about sweeping health legislation being crafted by Senate Finance Committee Chairman Max Baucus, citing what they describe as excessive burdens placed on some families and concerns over financing for the $880 billion package. Baucus has worked for months to craft a bill capable of attracting bipartisan support. His legislation would expand coverage to tens of millions of Americans but leave out a public health-insurance option supported by liberals.
Walk-in medical clinics run by retailers provide care for routine illnesses that is as good as, and costs less than, similar care offered in doctors' offices, hospital emergency rooms, and urgent care centers, according to a Rand Corp. study. The cost savings over emergency rooms, in particular, was quite dramatic, the study found.
Atlanta-based Grady Memorial Hospital is offering to relocate about 60 outpatient dialysis patients to other states or send them back to their home countries as the hospital prepares to close its dialysis unit. Hospital officials say they are willing to spend thousands of dollars to help relocate each patient and their family, including plane tickets, moving expenses, and rent security fees. But some patients say they cannot move to another state or back to their home country. And many are poor, uninsured, and undocumented immigrants.
Health and Human Services Secretary Kathleen Sebelius said upwards of 50 million doses of a new vaccine for the H1N1 virus will be available in mid-October, with millions more doses quickly following. The initial vaccines will go to what Sebelius calls priority populations: including caregivers, young people ages 6 to 24, hospital workers, pregnant women, and some seniors. They add up to about 160 million people, or nearly half the U.S. population.
States with high levels of poverty and unemployment have been struggling with growing Medicaid budgets during the recession, and some governors worry their financial burdens could get worse as Congress works on a comprehensive healthcare bill. These governors are especially worried about possible expansion of Medicaid, according to the Associated Press.
Although The media continues to highlight the UK's National Health Service in the healthcare reform debate, Australia may have elements of healthcare provision that some Americans are worried will be lost with reform, including patient choice and provider autonomy in service provision, says Sg2 analyst Rebecca Miller. Australia may offer a good example of a funding and delivery system that provides universal access to healthcare and allows choice for individuals through a substantial private sector involvement in delivery and financing, Miller says.
Hartford Hospital and an emergency room physician are being sued by the estate of Marcia Maglisco, who in 2007 hanged herself days after her 2-year-old grandson drowned in a bathtub while she was caring for him. The lawsuit claims Carl Washburn, MD, and the hospital erred by not keeping the woman overnight for treatment. She had been brought to the hospital for evaluation that day by West Hartford police, who were concerned about her mental state after they charged her with risk of injury in the death of her grandson.
With the state's budget in disarray, Illinois is more than six months behind in sending payments to doctors and hospitals that are due money from a state-funded health insurance plan. Left without payment for so long, some providers have grown anxious and employed debt collectors to apply some pressure. According to the state, more than 120,000 state employees, state government retirees, or dependents who are covered by Illinois' Quality Care Health Plan. The plan owes providers more than $300 million in claims that have been delayed because of the budget gap, state officials said.
The Joint Commission is seeking public comment on candidate measures for assessing and treating tobacco, alcohol, and other drug use and dependence for all hospitalized patients, according to the Joint Commission's official Web site.
The results will be used to help determine which of the measures will go forward to pilot testing. The Partnership for Prevention and The Substance Abuse and Mental Health Services Administration and their Center for Substance Abuse Treatment in the Department of Health and Human Services have supplied The Joint Commission with funds to develop these measures.
"These are very important and timely measures being proposed by the Joint Commission as they will help hospital organizations gather data that will better inform leadership in targeting interventions for tobacco, alcohol, and drug dependence," says Sharon Chaput RN, C, CSHA, director of Standards and Quality Management at the Brattleboro Retreat.
Chaput also states that according to the Center for Disease Control and Prevention, tobacco use alone is the single greatest cause of disease in the United States and accounts for more than 435,000 deaths each year. The CDC also reports that tobacco use accounts for an estimated $96 billion per year in direct medical expenses and $97 billion in lost productivity.
"It is critical at this time when our healthcare system is being looked at by Congress and our President for overhaul that we have the data to inform our decision making," says Chaput.
These candidate measures, known as the Tobacco Alcohol & Drug Dependence (TADD), currently address eight specific aspects of care:
TADD-1: Tobacco Use Assessment
TADD-2: Tobacco Use Treatment
TADD-3: Tobacco Use Treatment at Discharge
TADD-4: Tobacco Use Follow-up
TADD-5: Alcohol and Other Drug Use Screening
TADD-6: Alcohol and Other Drug Use and Dependence—Brief Intervention or Treatment
TADD-7: Alcohol and Other Drug Use and Dependence—Treatment Management at Discharge
TADD-8: Alcohol and Other Drug Use and Dependence—Follow-Up for Unhealthy Use and/or Discharge.
The TADD measures will be standardized as quantitative tools to help determine an organization's performance with a specified process and will help assist the healthcare organization in areas for improvement with tobacco, alcohol, and other drugs.
When was the last time your facility looked at tracers in the dietetic and food service areas?
"There have been a number of updates published in recent months on the topic, so it's a good time to take a look at best practices on the topic," says Elizabeth Di Giacomo-Geffers, RN, MPH, CSHA, a healthcare consultant in Trabuco Canyon, CA, and former Joint Commission surveyor.
In terms of Joint Commission standards, the following chapters have the most bearing on dietetic services:
Emergency Management
Environment of Care
Human Resources
Infection Control
Patient Care, Treatment, and Services
Record of Care, Treatment, and Services
Specific EPs to review include: PC.02.02.03, HR.01.04.01, and HR. 01.05.03.
Now let's take a look at CMS' Conditions of Participation (CoP). The CoPs require that a hospital have organized dietary services directed and staffed by adequate personnel. (Note: If your facility has a contract with an outside food management company, keep Joint Commission leadership standards in mind as well.)
What policies are required? Your facility should have and follow a minimum of the following policies and procedures, according to the CMS CoPs:
Availability of a diet manual and therapeutic diet menus to meet patients' nutritional needs
Frequency of meals served
A system for diet ordering and patient trays delivery
Accommodation of non-routine occurrences—e.g., parenteral nutrition (tube feeding), total parenteral nutrition, peripheral parenteral nutrition, change in diet orders, early/late trays, nutritional supplements, etc.
Integration of the food and dietetic service into the hospital-wide Quality Assessment and Performance Improvement and Infection Control programs
Guidelines for acceptable hygiene practices of food service personnel
Guidelines for kitchen sanitation
All of these policies apply whether the food services are provided by the hospital alone or through a contracted vendor.
