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HHS OIG — Nursing Facilities’ Compliance with Federal Regulations for Reporting Allegations of Abuse or Neglect

August 19, 2014 Comments off

Nursing Facilities’ Compliance with Federal Regulations for Reporting Allegations of Abuse or Neglect
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
To protect the well-being of residents, nursing facilities must comply with Federal regulations to develop and implement written policies related to reporting allegations of abuse, neglect, mistreatment, injuries of unknown source, and misappropriation of resident property (allegations of abuse or neglect). Further, allegations of abuse or neglect must be reported to the facility administrator or designee and the State survey agency within 24 hours. Results of investigations of these allegations must be reported to the same authorities within 5 working days. Nursing facilities must also notify owners, operators, employees, managers, agents, or contractors of nursing facilities (covered individuals) annually of their obligation to report reasonable suspicions of crimes.

HOW WE DID THIS STUDY
This study included a: (1) review of sampled nursing facilities’ policies related to reporting allegations of abuse or neglect, (2) review of sampled nursing facilities’ policies related to reasonable suspicions of crimes, and (3) survey of administrators from those sampled facilities. It also included an examination of a random sample of allegations of abuse or neglect identified from the sampled nursing facilities, and a review of documentation related to those sampled allegations of abuse or neglect.

WHAT WE FOUND
It is both required and expected that nursing facilities will report any and all allegations of abuse or neglect to ensure resident safety. We found that 85 percent of nursing facilities reported at least one allegation of abuse or neglect to OIG in 2012. Additionally, 76 percent of nursing facilities maintained policies that address Federal regulations for reporting both allegations of abuse or neglect and investigation results. Further, 61 percent of nursing facilities had documentation supporting the facilities’ compliance with both Federal regulations under Section 1150B of the Social Security Act. Lastly, 53 percent of allegations of abuse or neglect and the subsequent investigation results were reported, as Federally required.

WHAT WE RECOMMEND
We recommend that CMS ensure that nursing facilities: (1) maintain policies related to reporting allegations of abuse or neglect; (2) notify covered individuals of their obligation to report reasonable suspicions of crimes; and (3) report allegations of abuse or neglect and investigation results in a timely manner and to the appropriate individuals, as required. CMS concurred with all three of our recommendations.

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Graduate Medical Education That Meets the Nation’s Health Needs

August 19, 2014 Comments off

Graduate Medical Education That Meets the Nation’s Health Needs
Source: Institute of Medicine

Since the creation of the Medicare and Medicaid programs in 1965, the public has provided tens of billions of dollars to fund graduate medical education (GME), the period of residency and fellowship that is provided to physicians after they receive a medical degree. Although the scale of govern­ment support for physician training far exceeds that for any other profession, there is a striking absence of transparency and accountability in the GME financing system for producing the types of physicians that the nation needs.

The IOM formed an expert committee to conduct an independent review of the governance and financing of the GME system. The 21-member IOM committee concludes that there is an unquestionable imperative to assess and optimize the effectiveness of the public’s investment in GME. In its report, Graduate Medical Education That Meets the Nation’s Health Needs, the committee recommends significant changes to GME financ­ing and governance to address current deficiencies and better shape the phy­sician workforce for the future. The IOM report provides an initial road­map for reforming the Medicare GME payment system and building an infrastructure that can drive more strategic investment in the nation’s physician workforce.

When Doctors Don’t Listen: Sample Worksheet Towards Your Diagnosis Before You Go to the Doctor

July 25, 2014 Comments off

Sample Worksheet Towards Your Diagnosis Before You Go to the Doctor (PDF)
Source: When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests (book, by Dr. Leana Wen and Dr. Josh Kosowsky)

General Tips

  • Use your own words, as if you are speaking to a family member
  • Being your own advocate will save your life.
  • Speak up! Interrupt if you do not feel like you are not being heard.

High Interest GAO Report — GAO-14-705T, Patient Protection and Affordable Care Act: Preliminary Results of Undercover Testing of Enrollment Controls for Health Care Coverage and Consumer Subsidies Provided Under the Act, July 23, 2014

July 23, 2014 Comments off

GAO-14-705T, Patient Protection and Affordable Care Act: Preliminary Results of Undercover Testing of Enrollment Controls for Health Care Coverage and Consumer Subsidies Provided Under the Act, July 23, 2014
Source: Government Accountability Office

Centers for Medicare & Medicaid Services (CMS) officials told us they have internal controls for health care coverage eligibility determinations. GAO’s undercover testing addressed processes for identity- and income-verification, with preliminary results revealing questions as follows:

  • For 12 applicant scenarios, GAO tested “front-end” controls for verifying an applicant’s identity or citizenship/immigration status. Marketplace applications require attestations that information provided is neither false nor untrue. In its applications, GAO also stated income at a level to qualify for income-based subsidies to offset premium costs and reduce cost sharing. For 11 of these 12 applications, which were made by phone and online using fictitious identities, GAO obtained subsidized coverage. For one application, the marketplace denied coverage because GAO’s fictitious applicant did not provide a Social Security number as part of the test.
  • The Patient Protection and Affordable Care Act (PPACA) requires the marketplace to provide eligibility while identified inconsistencies between information provided by the applicant and by government sources are being resolved through submission of supplementary documentation from the applicant. For its 11 approved applications, GAO was directed to submit supporting documents, such as proof of income or citizenship; but, GAO found the document submission and review process to be inconsistent among these applications. As of July 2014, GAO had received notification that portions of the fake documentation sent for two enrollees had been verified. According to CMS, its document processing contractor is not required to authenticate documentation; the contractor told us it does not seek to detect fraud and accepts documents as authentic unless there are obvious alterations. As of July 2014, GAO continues to receive subsidized coverage for the 11 applications, including 3 applications where GAO did not provide any requested supporting documents.
  • For 6 applicant scenarios, GAO sought to test the extent to which, if any, in-person assisters would encourage applicants to misstate income in order to qualify for income-based subsidies. However, GAO was unable to obtain in-person assistance in 5 of the 6 initial undercover attempts. For example, one in-person assister initially said that he provides assistance only after people already have an application in progress. The in-person assister was not able to assist us because HealthCare.gov website was down and did not respond to follow-up phone calls. One in-person assister correctly advised the GAO undercover investigator that the stated income would not qualify for subsidy.

A key factor in analyzing enrollment is to identify approved applicants who put their policies in force by paying premiums. However, CMS officials stated that they do not yet have the electronic capability to identify such enrollees. As a result, CMS must rely on health insurance issuers to self-report enrollment data used to determine how much CMS owes the issuers for the income-based subsidies. Work is underway to implement such a system, according to CMS, but the agency does not have a timeline for completing and deploying it. GAO is continuing to look at these issues and will consider recommendations to address them.

Psychology — Gifted Children and Adults—Neglected Areas of Practice

July 2, 2014 Comments off

Gifted Children and Adults—Neglected Areas of Practice
Source: National Register of Health System Psychologists

Working with gifted and talented children and their families and with gifted adults is a neglected area of practice for psychologists. Two widespread myths among educators, pediatricians, and psychologists, is that gifted children and adults are quite rare, and that bright minds have few issues and seldom need special help. In fact, gifted children and adults are defined as those in the upper three to ten percent of the population in any of several intellectual domains (NAGC, 2010). Clinical and educational practice usually focuses on disadvantaged persons and obvious psychopathology. Many are unaware that talented and gifted children are at risk for underachievement, peer relationship issues, power struggles, perfectionism, existential depression, and other problems, and that bright adults often have job difficulties, problems with peers, spouses or children, and existential depression that stem from giftedness. In addition, few psychologists understand that special issues can arise when a child or adult is twice-exceptional—that is, gifted as well as having diagnosable condition such as a learning disability, vision difficulties, auditory issues, ADHD, etc. As a result, many gifted children and adults are being overlooked, misdiagnosed, and receiving treatment that may be inappropriate.

Integrating Primary Care Practices and Community-based Resources to Manage Obesity: A Bridge-building Toolkit for Rural Primary Care Practices

July 1, 2014 Comments off

Integrating Primary Care Practices and Community-based Resources to Manage Obesity: A Bridge-building Toolkit for Rural Primary Care Practices
Source: Agency for Healthcare Research and Quality

Managing and treating obesity is particularly challenging for primary care practices. Although evidence suggests the potential for improving eating and physical activity behaviors by effectively linking primary care practices and community resources, establishing such linkages may be especially challenging in rural areas, where limited availability of and access to services may compound standard barriers.

In 2010 the Oregon Rural Practice-based Research Network (ORPRN) received funding from the Agency for Health Care Research and Quality for research into “Integrated Primary Care Practices and Community-based Programs to Manage Obesity.” Over a 2-year period we worked with eight primary care practices and community-based health coalitions in four rural Oregon communities to:

  1. Evaluate local clinic and community factors necessary to develop sustainable linkages between primary care and community resources for obesity management.
  2. Design, implement, and evaluate a participatory process using practice facilitation and community-health development principles to achieve these linkages.

We used the findings from this 2-year process to develop this toolkit to help other primary care clinics that want to improve linkages with community-based resources for obesity management. This process highlights strategies to build on the ties that often already exist in rural areas. Although our process is tailored to rural settings, we anticipate that many of the strategies will be beneficial for urban practices and communities to consider. This toolkit offers key steps in our process, providing tools and recommended steps that we encourage you to adapt to fit your local setting.

HHS OIG — Special Fraud Alert: Laboratory Payments to Referring Physicians

June 26, 2014 Comments off

Special Fraud Alert: Laboratory Payments to Referring Physicians (PDF)
Source: U.S. Department of Health and Human Services, Office of Inspector General

This Special Fraud Alert addresses compensation paid by laboratories to referring physicians and physician group practices (collectively, physicians) for blood specimen collection, processing, and packaging, and for submitting patient data to a registry or database. OIG has issued a number of guidance documents and advisory opinions addressing the general subject of remuneration offered and paid by laboratories to referring physicians, including the 1994 Special Fraud Alert on Arrangements for the Provision of Clinical Laboratory Services, the OIG Compliance Program Guidance for Clinical Laboratories, and Advisory Opinion 05-08. In these and other documents, we have repeatedly emphasized that providing free or below-market goods or services to a physician who is a source of referrals, or paying such a physician more than fair market value for his or her services, could constitute illegal remuneration under the anti-kickback statute. This Special Fraud Alert supplements these prior guidance documents and advisory opinions and describes two specific trends OIG has identified involving transfers of value from laboratories to physicians that we believe present a substantial risk of fraud and abuse under the anti-kickback statute.

School mental health services: signpost for out-of-school service utilization in adolescents with mental disorders? A nationally representative United States cohort

June 25, 2014 Comments off

School mental health services: signpost for out-of-school service utilization in adolescents with mental disorders? A nationally representative United States cohort
Source: PLoS ONE

Background
School mental health services are important contact points for children and adolescents with mental disorders, but their ability to provide comprehensive treatment is limited. The main objective was to estimate in mentally disordered adolescents of a nationally representative United States cohort the role of school mental health services as guide to mental health care in different out-of-school service sectors.

Methods
Analyses are based on weighted data (N = 6483) from the United States National Comorbidity Survey Replication Adolescent Supplement (participants’ age: 13–18 years). Lifetime DSM-IV mental disorders were assessed using the fully structured WHO CIDI interview, complemented by parent report. Adolescents and parents provided information on mental health service use across multiple sectors, based on the Service Assessment for Children and Adolescents.

Results
School mental health service use predicted subsequent out-of-school service utilization for mental disorders i) in the medical specialty sector, in adolescents with affective (hazard ratio (HR) = 3.01, confidence interval (CI) = 1.77–5.12), anxiety (HR = 3.87, CI = 1.97–7.64), behavior (HR = 2.49, CI = 1.62–3.82), substance use (HR = 4.12, CI = 1.87–9.04), and eating (HR = 10.72, CI = 2.31–49.70) disorders, and any mental disorder (HR = 2.97, CI = 1.94–4.54), and ii) in other service sectors, in adolescents with anxiety (HR = 3.15, CI = 2.17–4.56), behavior (HR = 1.99, CI = 1.29–3.06), and substance use (HR = 2.48, CI = 1.57–3.94) disorders, and any mental disorder (HR = 2.33, CI = 1.54–3.53), but iii) not in the mental health specialty sector.

Conclusions
Our findings indicate that in the United States, school mental health services may serve as guide to out-of-school service utilization for mental disorders especially in the medical specialty sector across various mental disorders, thereby highlighting the relevance of school mental health services in the trajectory of mental care. In light of the missing link between school mental health services and mental health specialty services, the promotion of a stronger collaboration between these sectors should be considered regarding the potential to improve and guarantee adequate mental care at early life stages.

We’re helping long-term care facilities protect older Americans from financial exploitation

June 20, 2014 Comments off

We’re helping long-term care facilities protect older Americans from financial exploitation
Source: Consumer Financial Protection Bureau

We’ve heard a lot of stories about vulnerable adults falling prey to con artists, family members, fiduciaries, and professional advisers who steal their nest eggs and threaten their financial security.

A son steals $315,000 from his elderly mother’s retirement accounts and frequents casinos. When he doesn’t pay his mother’s rent, she’s evicted from her assisted living facility.

The pastor of a 77-year-old man with Alzheimer’s and Parkinson’s diseases makes 130 withdrawals from the man’s bank account but fails to make nursing home payments on his behalf for nine months. The man was nearly discharged from his nursing home.

These stories are all too common. We’d like to equip assisted living and nursing facility staff with the know-how to prevent and spot the warning signs of abuse, so we’re releasing a guide to protecting residents from financial exploitation.

Our action-oriented guide gives staff the tools to:

  • Prevent financial exploitation and scams by educating staff, residents, and family members about warning signs and precautions
  • Recognize, record, and report financial abuse as early as possible using a model protocol and a team approach
  • Get help from first responders in the community

Cohort Turnover and Productivity: The July Phenomenon in Teaching Hospitals

June 11, 2014 Comments off

Cohort Turnover and Productivity: The July Phenomenon in Teaching Hospitals
Source: Harvard Business School Working Papers

We consider the impact of cohort turnover-the planned simultaneous exit of a large number of experienced employees and a similarly sized entry of new workers-on productivity in the context of teaching hospitals. Specifically, we examine the impact of the annual July turnover of residents in American teaching hospitals on levels of resource utilization and quality relative to a control group of non-teaching hospitals. We find that, despite the anticipated nature of the cohort turnover and the supervisory structures that exist in teaching hospitals, this annual cohort turnover results in increased resource utilization (i.e., longer length of hospital stay) for both minor and major teaching hospitals and decreased quality (i.e., higher mortality rates) for major teaching hospitals. Particularly in major teaching hospitals, we find evidence of a gradual trend of decreasing performance that begins several months before the actual cohort turnover and may result from a transition of responsibilities at major teaching hospitals in anticipation of the cohort turnover.

Department of Veterans Affairs Access Audit– System-Wide Review of Access: Results of Access Audit Conducted May 12, 2014, through June 3, 2014

June 9, 2014 Comments off

Department of Veterans Affairs Access Audit– System-Wide Review of Access: Results of Access Audit Conducted May 12, 2014, through June 3, 2014 (PDF)
Source: U.S. Department of Veterans Affairs

1. Efforts to meet needs of Veterans (and clinicians) led to an overly complicated scheduling process that resulted in high potential to create confusion among scheduling clerks and front-line supervisors.

2. Meeting a 14-day wait-time performance target for new appointments was simply not attainable given the ongoing challenge of finding sufficient provider slots to accommodate a growing demand for services. Imposing this expectation on the field before ascertaining the resources required and its ensuing broad promulgation represent an organizational leadership failure.

3. The concept of “desired date” is a scheduling practice unique to VA, and difficult to reconcile against more accepted practices such as negotiating a specific appointment date based on provider availability, or using a “return to clinic” interval requested by providers.

4. Overall, 13 percent of scheduling staff interviewed indicated they received instruction (from supervisors or others) to enter in the “desired date” field a date different from the date the Veteran had requested. At least one instance of such practices was identified in 76 percent of VA facilities. In certain instances this may be appropriate (e.g., a provider-directed date can, under VA policy, override a date specified by a patient), but the survey did not distinguish this, nor did it determine whether this was done through lack of understanding or malintent unless it was clearly apparent.

5. Eight percent of scheduling staff indicated they used alternatives to the Electronic Wait List (EWL) or Veterans Health Information Systems and Technology Architecture (VistA) package. At least one of such instance was identified in 70 percent of facilities. As with desired date practices, we did not probe the extent to which some of these alternatives might have been justified under VA policy. The questionnaire employed did not isolate appropriate uses of external lists.

6. Findings indicate that in some cases, pressures were placed on schedulers to utilize inappropriate practices in order to make waiting times (based on desired date, and the waiting lists), appear more favorable. Such practices are sufficiently pervasive to require VA re-examine its entire performance management system and, in particular, whether current measures and targets for access are realistic or sufficient.

7. Staffing challenges were identified in small CBOCs, especially where there were small counts of providers or administrative support.

See also: VA Access Audit (all reports)

Crisis Services: Effectiveness, Cost-Effectiveness, and Funding Strategies

June 8, 2014 Comments off

Crisis Services: Effectiveness, Cost-Effectiveness, and Funding Strategies
Source: Substance Abuse and Mental Health Services Administration

Summarizes the evidence base on the clinical and cost effectiveness of different types of crisis services, and presents cases studies of different approaches states are using to coordinate, consolidate, and blend funding sources to provide robust crisis services.

Outbreaks of Infections Associated With Drug Diversion by US Health Care Personnel

June 5, 2014 Comments off

Outbreaks of Infections Associated With Drug Diversion by US Health Care Personnel (PDF)
Source: Mayo Clinic Proceedings

Objective
To summarize available information about outbreaks of infections stemming from drug diversion in US health care settings and describe recommended protocols and public health actions.

Patients and Methods
We reviewed records at the Centers for Disease Control and Prevention related to outbreaks of infections from drug diversion by health care personnel in US health care settings from January 1, 2000, through December 31, 2013. Searches of the medical literature published during the same period were also conducted using PubMed. Information compiled included health care setting(s), infection type(s), specialty of the implicated health care professional, implicated medication(s), mechanism(s) of diversion, number of infected patients, number of patients with potential exposure to blood-borne pathogens, and resolution of the investigation.

Results
We identified 6 outbreaks over a 10-year period beginning in 2004; all occurred in hospital settings. Implicated health care professionals included 3 technicians and 3 nurses, one of whom was a nurse anesthetist. The mechanism by which infections were spread was tampering with injectable controlled substances. Two outbreaks involved tampering with opioids administered via patient-controlled analgesia pumps and resulted in gram-negative bacteremia in 34 patients. The remaining 4 outbreaks involved tampering with syringes or vials containing fentanyl; hepatitis C virus infection was transmitted to 84 patients. In each of these outbreaks, the implicated health care professional was infected with hepatitis C virus and served as the source; nearly 30,000 patients were potentially exposed to blood-borne pathogens and targeted for notification advising testing.

Conclusion
These outbreaks revealed gaps in prevention, detection, and response to drug diversion in US health care facilities. Drug diversion is best prevented by health care facilities having strong narcotics security measures and active monitoring systems. Appropriate response includes assessment of harm to patients, consultation with public health officials when tampering with injectable medication is suspected, and prompt reporting to enforcement agencies.

See also press release: CDC Report: Patients Harmed After Health Care Providers Steal Patients’ Drugs

Do Unto Others: Doctors’ Personal End-of-Life Resuscitation Preferences and Their Attitudes toward Advance Directives

June 4, 2014 Comments off

Do Unto Others: Doctors’ Personal End-of-Life Resuscitation Preferences and Their Attitudes toward Advance Directives
Source: PLoS ONE

Objective
High-intensity interventions are provided to seriously-ill patients in the last months of life by medical sub-specialists. This study was undertaken to determine if doctors’ age, ethnicity, medical sub-specialty and personal resuscitation and organ donation preferences influenced their attitudes toward Advance Directives (AD) and to compare a cohort of 2013 doctors to a 1989 (one year before the Patient Self Determination Act in 1990) cohort to determine any changes in attitudes towards AD in the past 23 years.

Design
Doctors in two academic medical centers participated in an AD simulation and attitudes survey in 2013 and their responses were compared to a cohort of doctors in 1989.

Outcomes
Resuscitation and organ donation preferences (2013 cohort) and attitudes toward AD (1989 and 2013 cohorts).

Results
In 2013, 1081 (94.2%) doctors of the 1147 approached participated. Compared to 1989, 2013 cohort did not feel that widespread acceptance of AD would result in less aggressive treatment even of patients who do not have an AD (p<0.001, AUC = 0.77); had greater confidence in their treatment decisions if guided by an AD (p<.001, AUC = 0.58) and were less worried about legal consequences of limiting treatment when following an AD (p<.001, AUC = 0.57). The gender (p = 0.00172), ethnicity (χ2 14.68, DF = 3,p = .0021) and sub-specialty (χ2 28.92, p = .004, DF = 12) influenced their attitudes towards AD. 88.3% doctors chose do-not-resuscitate status and wanted to become organ donors. Those less supportive of AD were more likely to opt for “full code” even if terminally ill and were less supportive of organ donation.

Conclusions
Doctors' attitudes towards AD has not changed significantly in the past 23 years. Doctors' gender, ethnicity and sub-specialty influence their attitudes towards AD. Our study raises questions about why doctors continue to provide high-intensity care for terminally ill patients but personally forego such care for themselves at the end of life.

Narrow Provider Networks in New Health Plans: Balancing Affordability with Access to Quality Care

June 2, 2014 Comments off

Narrow Provider Networks in New Health Plans: Balancing Affordability with Access to Quality Care (PDF)
Source: Center on Health Insurance Reforms (Georgetown University)

Many health insurance plans offered in the individual market—both inside and outside the new marketplaces (also referred to as “Exchanges”)—have narrowed their provider networks relative to what they have offered in the past. Although it is not yet known how widespread this practice is, anecdotal reports of narrower networks have garnered notice from the media as well as federal and state policy-makers. As one state official put it, “I don’t know that many of us a year ago anticipated that qualified health plans inside the exchange were going to be changing their networks as dramatically as we experienced them.

New network configurations offer trade-offs for consumers. Many insurers were able to lower their overall costs by reducing the prices they pay participating providers, which in turn allowed them to lower their premiums to attract price-conscious shoppers. However, in many cases, consumers have been surprised to discover that their new plan offers a more limited choice of providers. Some others willing to pay more to purchase a plan with broader access to providers have found that only limited-network plans are available in their area.

It is not yet clear whether these new, narrower network plans can effectively deliver on the benefits promised under the plan. If policyholders opt to seek medically necessary care out-of-network, it could expose them to significant financial liabilities. If policyholders delay or forgo care because in-network providers can’t meet their needs, it could put their health at risk.

Consequently, state and federal policy-makers are taking another look at the Affordable Care Act (ACA) requirement that plans participating on the new health insurance marketplaces maintain an adequate provider network. In doing so, they must strike a delicate balance.

New From the GAO

June 2, 2014 Comments off

New GAO Reports
Source: Government Accountability Office

1. State Department: Pervasive Passport Fraud Not Identified, but Cases of Potentially Fraudulent and High-Risk Issuances Are under Review. GAO-14-222, May 1.
http://www.gao.gov/products/GAO-14-222
Highlights – http://www.gao.gov/assets/670/662920.pdf

2. Medicare Physical Therapy: Self-Referring Providers Generally Referred More Beneficiaries but Fewer Services per Beneficiary. GAO-14-270, April 30.
http://www.gao.gov/products/GAO-14-270
Highlights – http://www.gao.gov/assets/670/662859.pdf

HHS OIG — State Requirements for Conducting Background Checks on Home Health Agency Employees

June 2, 2014 Comments off

State Requirements for Conducting Background Checks on Home Health Agency Employees
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
In response to a congressional request, OIG initiated two related evaluations regarding home health agencies’ (HHAs) employment of individuals with criminal convictions. This memorandum report summarizes the first evaluation, which we conducted to (1) identify State background check requirements for HHAs and (2) identify the types of criminal convictions that, under State law or regulation, disqualify individuals for employment by HHAs. A second evaluation, entitled Home Health Agencies’ Employment of Individuals With Criminal Convictions (OEI-07-14-00130), will (1) determine the extent to which HHAs employed individuals with criminal convictions as of January 1, 2014, and identify criminal convictions of selected employees that potentially disqualify them for HHA employment, and (2) identify the procedures that HHAs use to perform background checks on prospective and/or current employees.

HOW WE DID THIS STUDY
We surveyed State officials to identify State requirements for conducting background checks for prospective HHA employees, including the job positions for which States require HHAs to conduct background checks, and the types of convictions that States consider to be disqualification for HHA employment.

WHAT WE CONCLUDED
Our survey found that, of the 50 States and the District of Columbia (hereinafter referred to as States), 41 States require HHAs to conduct background checks on prospective employees. Of the 10 States that have no background check requirement, 4 States reported that they have plans to implement background check requirements in the future. Thirty-five States specify convictions that disqualify individuals from employment, and 16 States allow an individual who has been disqualified from employment to submit an application to have his/her conviction(s) waived. CMS may wish to use the information from this report as it administers the Nationwide Background Check Program. The report may also be useful to States that are considering establishing or enhancing background-check requirements for HHA employees.

Trends in Electronic Health Record System Use Among Office-based Physicians: United States, 2007–2012

May 23, 2014 Comments off

Trends in Electronic Health Record System Use Among Office-based Physicians: United States, 2007–2012 (PDF)
Source: National Center for Health Statistics

Objectives—
This report presents trends in the adoption of electronic health records (EHRs) by office-based physicians during 2007–2012. Rates of adoption are compared by selected physician and practice characteristics.

Methods—
The National Ambulatory Medical Care Survey (NAMCS) is based on a national probability sample of nonfederal office-based physicians who see patients in an office setting. Prior to 2008, data on physician characteristics were collected through in-person interviews with physicians. To increase the sample for analyzing physician adoption of EHR systems, starting in 2008, NAMCS physician interview data were supplemented with data from an EHR mail survey. This report presents estimates from the 2007 in-person interviews, combined 2008–2010 data from both the in-person interviews and the EHR mail surveys, and 2011–2012 data from the EHR mail surveys. Sample data were weighted to produce national estimates of office-based physician characteristics and their practices.

Results—
In 2012, 71.8% of office-based physicians reported using any type of EHR system, up from 34.8% in 2007. In 2012, 39.6% of physicians had an EHR system with features meeting the criteria of a basic system, up from 11.8% in 2007; 23.5% of office-based physicians had an EHR system with features meeting the criteria of a fully functional system in 2012, up from 3.8% in 2007. In 2007, a wide gap existed in use of any type of EHR system between physicians in practices with 11 or more physicians (74.3%) compared with physicians in smaller practices (20.6% among solo practitioners); the gap, however, narrowed during 2007–2012. In 2007, no significant gap was observed in adoption of a fully functional system between primary care (4.7%) and nonprimary care physicians (2.8%); the gap, however, widened over time (27.9% compared with 19.4% in 2012). The difference in adoption of a fully functional system between physicians in practices with 11 or more physicians compared with solo practitioners was 10.4 percentage points in 2007; the gap widened to 30.6 percentage points in 2012.

Physicians, Medical Ethics, and Execution by Lethal Injection

May 21, 2014 Comments off

Physicians, Medical Ethics, and Execution by Lethal Injection
Source: Journal of the American Medical Association

In an opinion dissenting from a Supreme Court decision to deny review in a death penalty case, Supreme Court Justice Harry Blackmun famously wrote, “From this day forward, I no longer shall tinker with the machinery of death.” In the wake of the recent botched execution by lethal injection in Oklahoma, however, a group of eminent legal professionals known as the Death Penalty Committee of The Constitution Project has published a sweeping set of 39 recommendations that not only tinker with, but hope to fix, the multitude of problems that affect this method of capital punishment.

Many of the recommendations this committee makes with regard to legal and administrative reforms appear worthwhile and reasonable. Their final recommendation, however, concerns the role of the medical profession in performing lethal injection. It states: “Jurisdictions should ensure that qualified medical personnel are present at executions and responsible for all medically-related elements of executions.”

In particular, the recommendation specifies that “Execution team members…are licensed, practicing doctors, nurses or emergency medical technicians who are responsible for performing functions in their day-to-day practice that are similar to those they will perform at the execution.” Regardless of this committee’s recommendations, physician participation in capital punishment is an ethical dilemma that the profession of medicine must address.

Perceived competence and attitudes towards patients with suicidal behaviour: a survey of general practitioners, psychiatrists and internists

May 15, 2014 Comments off

Perceived competence and attitudes towards patients with suicidal behaviour: a survey of general practitioners, psychiatrists and internists
Source: BMC Health Services Research

Background
Competence and attitudes to suicidal behaviour among physicians are important to provide high-quality care for a large patient group. The aim was to study different physicians? attitudes towards suicidal behaviour and their perceived competence to care for suicidal patients.

Methods
A random selection (n?=?750) of all registered General Practitioners, Psychiatrists and Internists in Norway received a questionnaire. The response rate was 40%. The Understanding of Suicidal Patients Scale (USP; scores?<?23?=?positive attitude) and items about suicide in case of incurable illness from the Attitudes Towards Suicide Questionnaire were used. Five-point Likert scales were used to measure self-perceived competence, level of commitment, empathy and irritation felt towards patients with somatic and psychiatric diagnoses. Questions about training were included.

Results
The physicians held positive attitudes towards suicide attempters (USP?=?20.3, 95% CI: 19.6?20.9). Internists and males were significantly less positive. There were no significant differences in the physicians in their attitudes toward suicide in case of incurable illness according to specialty. The physicians were most irritated and less committed to substance misuse patients. Self perceived competence was relatively high. Forty-three percent had participated in courses about suicide assessment and treatment.

Conclusions
The physicians reported positive attitudes and relatively high competence. They were least committed to treat patients with substance misuse. None of the professional groups thought that patients with incurable illness should be given help to commit suicide.Further customized education with focus on substance misuse might be useful.

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