Archive

Archive for the ‘health care providers’ Category

Understanding the acceptability of e-mental health – attitudes and expectations towards computerised self-help treatments for mental health problems

April 18, 2014 Comments off

Understanding the acceptability of e-mental health – attitudes and expectations towards computerised self-help treatments for mental health problems
Source: BMC Psychiatry

Background
E-mental health and m-mental health include the use of technology in the prevention, treatment and aftercare of mental health problems. With the economical pressure on mental health services increasing, e-mental health and m-mental health could bridge treatment gaps, reduce waiting times for patients and deliver interventions at lower costs. However, despite the existence of numerous effective interventions, the transition of computerised interventions into care is slow. The aim of the present study was to investigate the acceptability of e-mental health and m-mental health in the general population.

Methods
An advisory group of service users identified dimensions that potentially influence an individual’s decision to engage with a particular treatment for mental health problems. A large sample (N = 490) recruited through email, flyers and social media was asked to rate the acceptability of different treatment options for mental health problems on these domains. Results were analysed using repeated measures MANOVA.

Results
Participants rated the perceived helpfulness of an intervention, the ability to motivate users, intervention credibility, and immediate access without waiting time as most important dimensions with regard to engaging with a treatment for mental health problems. Participants expected face-to-face therapy to meet their needs on most of these dimensions. Computerised treatments and smartphone applications for mental health were reported to not meet participants’ expectations on most domains. However, these interventions scored higher than face-to-face treatments on domains associated with the convenience of access. Overall, participants reported a very low likelihood of using computerised treatments for mental health in the future.

Conclusions
Individuals in this study expressed negative views about computerised self-help intervention and low likelihood of use in the future. To improve the implementation and uptake, policy makers need to improve the public perception of such interventions.

About these ads

Mental Health Professionals’ Attitudes and Expectations About Adoption and Adopted Children

April 16, 2014 Comments off

Mental Health Professionals’ Attitudes and Expectations About Adoption and Adopted Children
Source: National Council for Adoption

Many researchers have documented heavy use of clinical services by adoptees, but little is known about how much training mental health professionals actually receive about adoption, or their beliefs about adoption and adopted people. It is important to understand mental health professionals’ expectations for their adopted clients.

Previous research has shown that teachers treat students differently if they have high expectations for those students. In other studies, some adoptive parents have told us it was necessary to educate their child’s counselor about issues related to adoption. We have therefore investigated adoption-related expectations and training on adoption issues among mental health professionals. In this article, we will review some of the most current published information about the adjustment of adopted children, and present our own findings regarding clinicians’ beliefs and expectations for their adopted clients.

HHS OIG — Limited Compliance With Medicare’s Home Health Face to Face Documentation Requirements

April 15, 2014 Comments off

Limited Compliance With Medicare’s Home Health Face to Face Documentation Requirements
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
The Patient Protection and Affordable Care Act (ACA) requires that physicians (or certain practitioners working with them) who certify beneficiaries as eligible for Medicare home health services document-as a condition of payment for home health services-that face-to-face encounters with those beneficiaries occurred. This study (1) determined the extent to which physicians who certified home health care documented the face-to-face encounters, (2) described the nature of face-to-face documentation, and (3) assessed CMS’s oversight of the face-to-face requirement.

HOW WE DID THIS STUDY
We reviewed 644 face-to-face encounter documents to analyze the extent to which the documents confirmed encounters and contained the required elements. We interviewed the four Home Health and Hospice Medicare Administrative Contractors (HH MACs) to describe how they ensure that home health agencies met the face-to-face encounter requirements. We also reviewed guidance documents and policies from CMS or the HH MACs about monitoring the face-to-face requirement.

WHAT WE FOUND
For 32 percent of home health claims that required face-to-face encounters, the documentation did not meet Medicare requirements, resulting in $2 billion in payments that should not have been made. Furthermore, physicians inconsistently completed the narrative portion of the face to face documentation. Some face-to-face documents provide information that, although not required by Medicare, could be useful, such as a printed name for the physician and a list of the home health services needed. CMS oversight of the face-to-face requirement is minimal.

WHAT WE RECOMMEND
We recommend that CMS (1) consider requiring a standardized form to ensure that physicians include all elements required for the face-to-face documentation, (2) develop a specific strategy to communicate directly with physicians about the face-to-face requirement, and (3) develop other oversight mechanisms for the face-to-face requirement. CMS concurred with all of our recommendations.

.

Reducing Firearm-Related Injuries and Deaths in the United States: Executive Summary of a Policy Position Paper From the American College of Physicians

April 10, 2014 Comments off

Reducing Firearm-Related Injuries and Deaths in the United States: Executive Summary of a Policy Position Paper From the American College of Physicians
Source: Annals of Internal Medicine

Firearm violence is not only a criminal justice issue but also a public health threat. A comprehensive, multifaceted approach is necessary to reduce the burden of firearm-related injuries and deaths on individuals, families, communities, and society in general. Strategies to reduce firearm violence will need to address culture, substance use and mental health, firearm safety, and reasonable regulation, consistent with the Second Amendment, to keep firearms out of the hands of persons who intend to use them to harm themselves and others, as well as measures to reduce mass casualties associated with certain types of firearms.

As an organization representing physicians who have first-hand experience with the devastating impact firearm-related injuries and deaths have on the health of their patients, the ACP has a responsibility to participate in efforts to mitigate these needless tragedies. Because patients trust their physicians to advise them on issues that affect their health, physicians can help to educate the public on the risks of firearms and the need for firearm safety through their encounters with their patients. This Executive Summary provides a synopsis of the full position paper, which is available in Appendix 1.

Participation Rises in Medicare Physician Quality Reporting System and Electronic Prescribing Incentive Program

April 9, 2014 Comments off

Participation Rises in Medicare Physician Quality Reporting System and Electronic Prescribing Incentive Program
Source: U.S. Department of Health and Human Services (Centers for Medicare & Medicaid Services)

The Centers for Medicare & Medicaid Services (CMS) today released the 2012 Physician Quality Reporting System and Electronic Prescribing (eRx) Experience Report, showing a significant increase in participation in two key programs that allow eligible professionals to earn incentive payments through voluntary participation.

“Our physician and other clinician quality programs reached new records this year with over 430,000 professionals participating in the Physician Quality Reporting System and over 340,000 e-prescribing,” said Patrick Conway, M.D. deputy Administrator for innovation and quality and chief medical officer at CMS. “Clinicians are actively measuring and reporting on quality, and CMS is in the beginning stages of adding this information to the Physician Compare website, which can be viewed by patients. Measuring, transparently sharing, and improving quality performance is key to a better health system.”

The full report can be found at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2012-PQRS-and-eRx-Experience-Report.zip

The Physician Quality Reporting System (PQRS) has been using incentive payments, and will begin to use payment adjustments in 2015, to encourage eligible health care professionals to report on designated quality measures. The Electronic Prescribing (eRx) Incentive Program used a combination of incentive payments and payment adjustments to encourage electronic prescribing by eligible professionals.

HHS OIG — Questionable Billing for Medicare Electrodiagnostic Tests

April 8, 2014 Comments off

Questionable Billing for Medicare Electrodiagnostic Tests
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
In 2011, Medicare paid approximately $486 million to 21,700 physicians who billed for electrodiagnostic tests for 877,000 beneficiaries. Electrodiagnostic tests are used to evaluate patients who may have nerve damage. Recent investigations have found that electrodiagnostic testing is an area vulnerable to fraud, waste, and abuse. For example, in 2011, following work by the Medicare Fraud Strike Force, a group of physicians was charged with fraudulently billing Medicare $113 million for false claims, including claims for electrodiagnostic tests. CMS issues comparative billing reports to providers for a variety of services, including electrodiagnostic testing. Such reports are intended to proactively educate providers and to help them identify and correct errors in their billing.

HOW WE DID THIS STUDY
We developed seven measures of questionable billing on the basis of past OIG work and input from CMS staff. We analyzed Medicare 2011 electrodiagnostic test claims to identify physicians who had unusually high billing for at least one of these measures. We also determined whether physicians with questionable billing for electrodiagnostic tests received comparative billing reports in 2011 for such tests. Finally, we identified the geographical areas with the highest amounts of questionable billing.

WHAT WE FOUND
In 2011, 4,901 physicians had questionable billing for Medicare electrodiagnostic tests totaling $139 million. Additionally, we found that approximately 20 percent of these physicians received comparative billing reports in 2011 on the basis of their 2010 billing for electrodiagnostic tests. Finally, physicians in the New York, Los Angeles, and Houston areas had the highest total questionable billing for Medicare electrodiagnostic tests in 2011.

WHAT WE RECOMMEND
We recommend that CMS (1) increase its monitoring of billing for electrodiagnostic tests, (2) provide additional guidance and education to physicians regarding electrodiagnostic tests, and (3) take appropriate action regarding physicians whom we identified as having inappropriate or questionable billing. CMS partially concurred with two of our recommendations and concurred with the third recommendation.

Risk stratification using data from electronic medical records better predicts suicide risks than clinician assessments

April 1, 2014 Comments off

Risk stratification using data from electronic medical records better predicts suicide risks than clinician assessments
Source: BMC Psychiatry

Background
To date, our ability to accurately identify patients at high risk from suicidal behaviour, and thus to target interventions, has been fairly limited. This study examined a large pool of factors that are potentially associated with suicide risk from the comprehensive electronic medical record (EMR) and to derive a predictive model for 1–6 month risk.

Methods
7,399 patients undergoing suicide risk assessment were followed up for 180 days. The dataset was divided into a derivation and validation cohorts of 4,911 and 2,488 respectively. Clinicians used an 18-point checklist of known risk factors to divide patients into low, medium, or high risk. Their predictive ability was compared with a risk stratification model derived from the EMR data. The model was based on the continuation-ratio ordinal regression method coupled with lasso (which stands for least absolute shrinkage and selection operator).

Results
In the year prior to suicide assessment, 66.8% of patients attended the emergency department (ED) and 41.8% had at least one hospital admission. Administrative and demographic data, along with information on prior self-harm episodes, as well as mental and physical health diagnoses were predictive of high-risk suicidal behaviour. Clinicians using the 18-point checklist were relatively poor in predicting patients at high-risk in 3 months (AUC 0.58, 95% CIs: 0.50 – 0.66). The model derived EMR was superior (AUC 0.79, 95% CIs: 0.72 – 0.84). At specificity of 0.72 (95% CIs: 0.70-0.73) the EMR model had sensitivity of 0.70 (95% CIs: 0.56-0.83).

Conclusion
Predictive models applied to data from the EMR could improve risk stratification of patients presenting with potential suicidal behaviour. The predictive factors include known risks for suicide, but also other information relating to general health and health service utilisation.

UK — Review Body on Doctors’ and Dentists’ Remuneration 42nd report: 2014

March 26, 2014 Comments off

Review Body on Doctors’ and Dentists’ Remuneration 42nd report: 2014
Source: Review Body on Doctors’ and Dentists’ Remuneration, Department of Health and Office of Manpower Economics

This report sets out the DDRB analysis of evidence given by relevant organisations and makes proposals on doctors and dentists’ pay from April 2014.

National Survey of Substance Abuse Treatment Services (N-SSATS): 2012 Data on Substance Abuse Treatment Facilities

March 21, 2014 Comments off

National Survey of Substance Abuse Treatment Services (N-SSATS): 2012 Data on Substance Abuse Treatment Facilities (PDF)
Source: Substance Abuse and Mental Health Services Administration

This report presents results from the 2012 National Survey of Substance Abuse Treatment Services (N-SSATS), an annual census of facilities providing substance abuse treatment. Conthe Substance Abuse and Mental Health Services Administration (SAMHSA), N-SSATS is designed to collect data on the location, characteristics, and use of alcohol and drug abuse treatment facilities and services throughout the 50 states, the District of Columbia, and other U.S. jurisdictions. It is important to note that values in charts, narrative lists, and percentage distributions are calculated using actual raw numbers and rounded for presentation in this report; calculations using rounded values may produce different results.

CRS — Federal Health Centers

March 11, 2014 Comments off

Federal Health Centers”>Federal Health Centers (PDF)
Source: Congressional Research Service (via University of North Texas Digital Library)

The federal health center program is authorized in Section 330 of the Public Health Service Act (42 U.S.C. §§201 et. seq.) and administered by the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services. It awards grants to support outpatient primary care facilities that provide care to primarily low-income individuals or individuals located in areas with few health care providers. Federal health centers are required to provide health care to all individuals regardless of their ability to pay and are required to be located in geographic areas with few health care providers. These requirements make health centers part of the health safety net—providers that serve the uninsured, the underserved, or those enrolled in Medicaid. Data compiled by HRSA demonstrate that health centers serve the intended safety net population, as the majority of patients are uninsured or enrolled in Medicaid. Some research also suggests that health centers are a cost-effective way of meeting this population’s health needs because researchers have found that patients seen at health centers have lower health care costs than those served in other settings. In general, research has found that health centers, among other outcomes, improve health, reduce costs, and provide access to health care for populations that may otherwise not obtain health care.

Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries

March 4, 2014 Comments off

Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
From 2008-2012, we conducted a series of studies about hospital adverse events, defined as harm resulting from medical care. This work included a Congressionally mandated study to determine a national incidence rate for adverse events in hospitals. As part of this work, we developed methods to identify adverse events, determine the extent to which events are preventable, and measure the cost of events to the Medicare program. This study continues that work by evaluating post-acute care provided in skilled nursing facilities (SNF). SNF post-acute care is intended to help beneficiaries improve health and functioning following a hospitalization and is second only to hospital care among inpatient costs to Medicare. Although various health care stakeholders have in recent years paid substantial attention to patient safety in hospitals, less is known about resident safety in SNFs.

HOW WE DID THIS STUDY
This study estimates the national incidence rate, preventability, and cost of adverse events in SNFs by using a two-stage medical record review to identify events for a sample of 653 Medicare beneficiaries discharged from hospitals to SNFs for post-acute care. Sample beneficiaries had SNF stays of 35 days or less.

WHAT WE FOUND
An estimated 22 percent of Medicare beneficiaries experienced adverse events during their SNF stays. An additional 11 percent of Medicare beneficiaries experienced temporary harm events during their SNF stays. Physician reviewers determined that 59 percent of these adverse events and temporary harm events were clearly or likely preventable. They attributed much of the preventable harm to substandard treatment, inadequate resident monitoring, and failure or delay of necessary care. Over half of the residents who experienced harm returned to a hospital for treatment, with an estimated cost to Medicare of $208 million in August 2011. This equates to $2.8 billion spent on hospital treatment for harm caused in SNFs in FY 2011.

WHAT WE RECOMMEND
Because many of the events that we identified were preventable, our study confirms the need and opportunity for SNFs to significantly reduce the incidence of resident harm events. Therefore, we recommend that AHRQ and CMS raise awareness of nursing home safety and seek to reduce resident harm through methods used to promote hospital safety efforts. This would include collaborating to create and promote a list of potential nursing home events-including events we found that are not commonly associated with SNF care-to help nursing home staff better recognize harm. CMS should also instruct State agency surveyors to review nursing home practices for identifying and reducing adverse events. AHRQ and CMS concurred with our recommendations.

More than One Third of Adults with Major Depressive Episode Did Not Talk to a Professional

February 26, 2014 Comments off

More than One Third of Adults with Major Depressive Episode Did Not Talk to a Professional (PDF)
Source: Substance Abuse and Mental Health Services Administration

Every year, about 15.2 million adults experience a major depressive episode (MDE). Combined data from the 2008 to 2012 National Surveys on Drug Use and Health (NSDUHs) show that more than one third of adults with past year MDE (38.3 percent) did not talk to a health or alternative service professional during the past 12 months. Of the adults with MDE, 48.0 percent talked to a health professional only, and 10.7 percent talked to both a health professional and an alternative service professional.

Credentialing: Understanding the Education, Training, Regulation, and Licensing of Complementary Health Practitioners

February 14, 2014 Comments off

Credentialing: Understanding the Education, Training, Regulation, and Licensing of Complementary Health Practitioners
Source: National Center for Complementary and Alternative Medicine

Health care providers’ credentials—the licenses, certificates, and diplomas on their office walls—tell us about their professional qualifications to advise and treat us. In the United States, local and state governments and professional organizations establish the credentials that complementary health practitioners need to treat patients. This fact sheet provides a general overview of the credentialing of practitioners and suggests sources for additional information.

World Trade Center Health Program: CDC Should Strengthen Efforts To Monitor and Evaluate Clinic Compliance With Contract Terms

February 2, 2014 Comments off

World Trade Center Health Program: CDC Should Strengthen Efforts To Monitor and Evaluate Clinic Compliance With Contract Terms
Source: U.S. Department of Health and Human Services, Office of Inspector General

The World Trade Center Health Program (WTCHP) was established in January 2011. Under the WTCHP, CDC’s Procurement and Grants Office (PGO) contracted with clinics to provide medical services and pharmacy benefits to eligible responders and survivors with health conditions related to the September 11, 2001, terrorist attacks on the World Trade Center.

We found that the PGO and the National Institute for Occupational Safety and Health (NIOSH) did not monitor and evaluate clinic compliance with contract terms and conditions as required by Federal regulations. Specifically, PGO contracting officers (COs) did not ensure that NIOSH contracting officer representatives (CORs) used the surveillance methodology established in the quality assurance surveillance plans (QASPs) developed to monitor clinic contract performance. In addition, neither the CORs nor the COs took timely or appropriate action when they learned of three instances of clinic contract noncompliance. Furthermore, the CORs’ and COs’ evaluations of contractor performance were not completed as required and were not always entered into the Contractor Performance Assessment Reporting System and the Past Performance Information Retrieval System.

These inadequacies occurred because the PGO and NIOSH did not (1) consider the QASP surveillance methodology to be mandatory or the QASP performance standards to be realistic or attainable for the clinics and (2) have standard operating procedures to ensure that required performance evaluations were conducted in a timely manner.

We recommended that CDC (1) monitor clinics’ performance in accordance with contract terms, (2) address clinics’ noncompliance with contract terms as required by Health and Human Services Acquisition Regulation subpart 342.70, and (3) follow Federal Acquisition Regulation section 42.1503 by developing and implementing standard operating procedures for evaluating contract performance. CDC concurred with our recommendations and described the actions that it has taken to address them.

Vital Signs: Communication Between Health Professionals and Their Patients About Alcohol Use — 44 States and the District of Columbia, 2011

January 22, 2014 Comments off

Vital Signs: Communication Between Health Professionals and Their Patients About Alcohol Use — 44 States and the District of Columbia, 2011
Source: Morbidity and Mortality Weekly Report (CDC)

Introduction:
Excessive alcohol use accounted for an estimated 88,000 deaths in the United States each year during 2006–2010, and $224 billion in economic costs in 2006. Since 2004, the U.S. Preventive Services Task Force (USPSTF) has recommended alcohol misuse screening and behavioral counseling (also known as alcohol screening and brief intervention [ASBI]) for adults to address excessive alcohol use; however, little is known about the prevalence of its implementation. ASBI will also be covered by many health insurance plans because of the Affordable Care Act.

Methods:
CDC analyzed Behavioral Risk Factor Surveillance System (BRFSS) data from a question added to surveys in 44 states and the District of Columbia (DC) from August 1 to December 31, 2011, about patient-reported communication with a health professional about alcohol. Elements of ASBI are traditionally delivered via conversation. Weighted state-level prevalence estimates of this communication were generated for 166,753 U.S. adults aged ≥18 years by selected demographic characteristics and drinking behaviors.

Results:
The prevalence of ever discussing alcohol use with a health professional was 15.7% among U.S. adults overall, 17.4% among current drinkers, and 25.4% among binge drinkers. It was most prevalent among those aged 18–24 years (27.9%). However, only 13.4% of binge drinkers reported discussing alcohol use with a health professional in the past year, and only 34.9% of those who reported binge drinking ≥10 times in the past month had ever discussed alcohol with a health professional. State-level estimates of communication about alcohol ranged from 8.7% in Kansas to 25.5% in DC.

Conclusions:
Only one of six U.S. adults, including binge drinkers, reported ever discussing alcohol consumption with a health professional, despite public health efforts to increase ASBI implementation.

Implications for Public Health Practice:
Increased implementation of ASBI, including systems-level changes such as integration into electronic health records processes, might reduce excessive alcohol consumption and the harms related to it. Routine surveillance of ASBI by states and communities might support monitoring and increasing its implementation.

Reviews of Clinicians Associated With High Cumulative Payments Could Improve Medicare Program Integrity Efforts

December 22, 2013 Comments off

Reviews of Clinicians Associated With High Cumulative Payments Could Improve Medicare Program Integrity Efforts
Source: U.S. Department of Health and Human Services, Office of Inspector General

Clinicians generating high Part B payments represent a greater risk to Medicare if they bill incorrectly or commit fraud. Of the 303 clinicians who each furnished more than $3 million of Part B services during 2009, Medicare administrative contactors (MACs) and Zone Program Integrity Contractors (ZPICs) identified 104 (34 percent) for improper payment reviews. As of December 31, 2011, the MACs and ZPICs had completed reviews of 80 of the 104 clinicians and identified $34 million in overpayments. In addition, three of the clinicians had their medical licenses suspended and two were indicted. The results of these reviews demonstrate that identifying clinicians who are responsible for high cumulative payments could be a useful means of identifying possible improper payments. Although existing procedures may identify some of these clinicians for review, the procedures were not designed specifically to identify all clinicians whose payments exceed an established threshold. In addition, existing procedures may not always identify clinicians responsible for high cumulative payments in a timely manner.

We recommended that CMS (1) establish a cumulative payment threshold-taking into consideration costs and potential program integrity benefits-above which a clinician’s claims would be selected for review and (2) implement a procedure for timely identification and review of clinicians’ claims that exceed the cumulative payment threshold. CMS partially concurred with both of our recommendations.

New From the GAO

December 20, 2013 Comments off

New GAO Reports
Source: Government Accountability Office

1. Children’s Health Insurance: Information on Coverage of Services, Costs to Consumers, and Access to Care in CHIP and Other Sources of Insurance. GAO-14-40, November 21.
http://www.gao.gov/products/GAO-14-40
Highlights – http://www.gao.gov/assets/660/659181.pdf
Podcast: http://www.gao.gov/multimedia/podcasts/659175

2. Workforce Investment Act: DOL Should Do More to Improve the Quality of Participant Data. GAO-14-4, December 2.
http://www.gao.gov/products/GAO-14-4
Highlights – http://www.gao.gov/assets/660/659336.pdf

3. VA Nursing Homes: Reporting More Complete Data on Workload and Expenditures Could Enhance Oversight. GAO-14-89, December 20.
http://www.gao.gov/products/GAO-14-89
Highlights – http://www.gao.gov/assets/660/659881.pdf

4. Small Business Innovation Research: DOD’s Program Supports Weapon Systems, but Lacks Comprehensive Data on Technology Transition Outcomes. GAO-14-96, December 20.
http://www.gao.gov/products/GAO-14-96
Highlights – http://www.gao.gov/assets/660/659877.pdf

Spotlight On… Fighting Fraud at Community Mental Health Centers

December 19, 2013 Comments off

Spotlight On… Fighting Fraud at Community Mental Health Centers
Source: U.S. Department of Health and Human Services, Office of Inspector General

Lethal Weapon. Tootsie. Ghostbusters. Batman. You may think these are great movies—some might argue they’re classics—but do they qualify as psychotherapy? Patients at Diagnostic and Behavioral Health Clinic watched these films for entertainment and participated in other recreational activities, such as playing games and going on field trips, while the clinic billed Medicare for mental health services. Therapists also charged for 1-hour sessions when patients were in-and-out the door in 15 minutes. As a result, the clinic improperly billed Medicare over $4 million. OIG’s investigation of this case led to the 1999 convictions of the owner and another employee.

Over a decade later, OIG and our law enforcement partners found that employees at another facility—American Therapeutic Corporation External link—concocted a $205 million fraud scheme involving fictitious companies, fabricated patient files, patient recruiters, kickbacks, and elaborate cover-ups. They also illegally prescribed unnecessary psychotropic medications. Prosecutors for the case charged dozens, and the three owners/operators received a combined 120 years in prison (additional information below).

Besides committing fraud, the facilities in these two examples have something else in common: both are Community Mental Health Centers (CMHC), a type of facility that provides mental health services to individuals who reside in a defined geographic area. Fraud at CMHCs is not new, and OIG studies on CMHCs show that it isn’t isolated. For example, the report Questionable Billing by Community Health Centers found approximately half of CMHCs had unusually high billing for at least one of nine questionable billing characteristics. These characteristics include billing for patients with no mental health diagnoses, billing for patients who participated in CMHCs outside their own communities, or billing for patients who were not referred by health care facilities. While there are procedures in place for detecting and deterring fraud involving CMHCs, another OIG report – Vulnerabilities in CMS’s and Contractors’ Activities to Detect and Deter Fraud in Community Mental Health Centers – identified a number of shortcomings in oversight of CMHCs and found the extent to which Medicare contractors engaged in anti-fraud activities varied considerably.

Guide to Patient and Family Engagement in Hospital Quality and Safety

December 18, 2013 Comments off

Guide to Patient and Family Engagement in Hospital Quality and Safety
Source: Agency for Healthcare Research and Quality

The Guide to Patient and Family Engagement in Hospital Quality and Safety focuses on four primary strategies for promoting patient/family engagement in hospital safety and quality of care:

  • Encourage patients and family members to participate as advisors.
  • Promote better communication among patients, family members, and health care professionals from the point of admission.
  • Implement safe continuity of care by keeping the patient and family informed through nurse bedside change-of-shift reports.
  • Engage patients and families in discharge planning throughout the hospital stay.

Long-Term Care Services in the United States: 2013 Overview

December 16, 2013 Comments off

Long-Term Care Services in the United States: 2013 Overview (PDF)
Source: National Center for Health Statistics

Long-term care services include a broad range of services that meet the needs of frail older people and other adults with functional limitations. Long-Term care services provided by paid, regulated providers are a significant component of personal health care spending in the United States. This report presents descriptive results from the first wave of the National Study of Long-Term Care Providers (NSLTCP), which was conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). Data presented in this report are drawn from five sources: NCHS surveys of adult day services centers and residential care communities, and administrative records obtained from the Centers for Medicare & Medicaid Services on home health agencies, hospices, and nursing homes. This report provides information on the supply, organizational characteristics, staffing, and services offered by providers of long-term care services; and the demographic, health, and functional composition of users of these services. Service users include residents of nursing homes and residential care communities, patients of home health agencies and hospices, and participants of adult day services centers.

Follow

Get every new post delivered to your Inbox.

Join 777 other followers