CMS sets a universal format for Physician Quality Measures

There is no doubt that physician quality measures are necessary to meet the growing need for data to support progress being made in patient outcomes and “quantified healthcare”. Physicians have been inundated with various types and formats of quality measurement metrics that are different for similar procedures and treatments.

This course is intended for use by individuals involved in the design and/or conducts human subject research and prepares investigators involved in the design and/or conduct of research involving human subjects to understand their obligations to protect the rights and welfare of subjects in research. The course material presents basic concepts, principles, and issues related to the protection of research participants. Private and public payers are using clinical data to determine contract and reimbursement rates. In fact, Medicare intends on using up to 90% of quality indicators as a basis for determining fee-for-service payment by the year 2018. This has created a serious need to come to a consensus on which quality indicators will be used to measure patient care.

The Centers for Medicare and Medicaid Services (CMS) and almost all major health insurance plans, in combination with various medical organizations, employer and consumer group

s have just announced the first set of “core measures” that will be used for value based payments.

Several health insurers including members of America's Health Insurance Plans (AHIP), as well as United Health Group and Aetna have just released a joint collaborative listing seven key core measure sets including metrics for the following specialties:

• Accountable care organizations
• Cardiology
• Gastroenterology
• HIV and hepatitis C
• Medical oncology
• Obstetrics and gynecology
• Orthopedics
• Patient-centered medical homes (PCMHs)
• Primary care

With time, this collaborative will continue to add and update the measurement metrics over time. CMS has already stated that it has already started to use these measures from each of the core sets. After ensuring the appropriate rules, CMS will put into practice new core measures across applicable Medicare quality programs. It hopes to eliminate all unnecessary and outdated measures that are not part of the core sets.  In addition, CMS will also oversee the Office of Personnel Management, Department of Defense, and the Department of Veterans Affairs to ensure that their quality measures align with these core sets.

Commercial health plans will start to apply these measure sets when hospital or healthcare contracts come up for renewal. So far it is not known if all AHIP member plans will implement the new core measures. CMS Acting Administrator Andy Slavitt reminded everyone that "In the U.S. healthcare system, where we are moving to measure and pay for quality, patients and care providers deserve a uniform approach to measure quality. This agreement today will reduce unnecessary burden for physicians and accelerate the country's movement to better quality."

The news release stated that the collaborative work "is informing CMS's implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)."

MACRA will establish at a later date on how physicians will be paid by Medicare starting in 2019. Meanwhile, quality data presently being reported to the Physician Quality Reporting System is being used as the basis for CMS' value-based modifier, which will affect all physicians' Medicare income, starting 2017.

Physicians have long been concerned about the high degree of complexity and burden of reporting on quality measures. There have been numerous complaints in the past from healthcare providers that this endeavor has been taking time and resource away from direct patient care. Hopefully, this new agreement on a set of core measures for primary care and PCMH will be a big step forward in standardizing performance measures, while simultaneously contributing to improving the quality of care.

Malignant Hyperthermia

      Malignant Hyperthermia (MH) or malignant hyperpyrexia is a rare life-threatening condition that is usually triggered by exposure to certain drugs used for general anesthesia — specifically the volatile anesthetic agents and succinylcholine a neuromuscular blocking agent.  Susceptible individuals can be induced by these drugs into a drastic and completely uncontrollable increase in oxidative metabolism within the skeletal muscle.  This means that there would be a sharp spike in cellular respiration in which cells convert biochemical energy from nutrients, into Adenosine Triphosphate (ATP).  If not immediately treated, MH can overwhelm the body's capacity to supply oxygen, remove carbon dioxide, and regulate body temperature.  This can ultimately result in respiratory collapse tragically leading to death.

ryanodine receptor 1

   
      Susceptibility to MH is an inherited disorder, more specifically an autosomal dominant disorder. MH susceptibility is phenotypically and genetically related to central core disease (CCD), an autosomal dominant disorder characterized both by MH signs and myopathy. MH is usually revealed upon or shortly after exposure to certain general anesthetic agents. There is no simple, straightforward test to diagnose the condition. Treatment with dantrolene and other drugs is usually initiated when MH is strongly suspected. Dantrolene and the avoidance of triggering agents in susceptible people have markedly reduced the mortality from this condition. 
      
       The key to reducing the MH mortality rate, is how to identify if the patient is showing symptoms.  The top symptoms consist all signs of a hypercatabolic state (abnormal increase in metabolic rate)  this includes extremely high fever, increased heart rate, rapid breathing, increased carbon dioxide production, increased oxygen consumption, a sharp increase in the acidity of the patient's blood, Rhabdomyolysis, and rigid muscles.  These signs can be developed at any point during the administration of anesthesia.  The rate at which the susceptible body reacts to MH is alarmingly fast, but just as fast as the situation can grow, it can end.  The average case of a reaction is over after 7 minutes of the discontinuation of the triggering agent, however a great deal off damage can be dealt to the body due to the immense reaction that occurs.

       In the medical field, the use of anesthesia is immensely common and integrated.  With Malignant Hyperthermia being a potential threat looming over any and all first time anesthesia patients, it is imperative that staff of a medical facility are trained and informed about the dangers of MH.  If the proper precautions and measures are not taken, then the life of the patient is potentially at risk.  Ensure the safety, security, and livelihood of your patients, as well as your medical facility, and enforce the training of all staff on the proper response to the occurrence of an MH reaction.  Allow MedTrainer to assist you in your efforts to keep the medical field safe, and schedule a demo today! 
http://medtrainer.com/demo/

Zika Virus and Its impacts in Healthcare

              The Zika Virus is spread mostly by the bite of an infected Aedes species mosquito found mostly in tropical locations but has now been spread to the Aedes albopictus found in Mexico.  As of April 27, 2016, the CDC reports 426 travel-associated Zika Virus cases reported and 9 acquired cases in the US territories of Puerto Rico and the US Virgin Islands. There have not been any cases of infected mosquitoes in the US at this time. The first few cases of Zika virus were reported last year in Brazil and neighboring countries. Within a short time the virus is suspected to have infected millions of people in south and Central America; however, not all those who are infected become ill.  It is estimated that 80% of infections will not be diagnosed. 

The initial reports from Brazil revealed that Zika virus could cause birth defects when acquired by a pregnant female, but reports are inconclusive. The CDC reports that the Zika Virus although rare, can spread from a mother to her fetus during pregnancy and it may be linked to birth defects.  Other reports have indicated that the Zika virus could also cause a Guillain Barre like syndrome and partial paralysis. This has created a Level One Health Concern issued by the US Center for Disease Control (CDC) and the World Health Organization (WHO).  The CDC has not yet made a direct link between Guillain Barre and Zika. The CDC is working with Brazil to study the possibility of a link between Zika and GBS.

While it has always been believed that the Zika virus is transmitted by mosquitoes, the first case of Zika virus transmitted by sexual intercourse was recently reported.  The CDC recommends the use of condoms in areas of concerns and has issued travel advisories for pregnant women who are considering travel to areas that are affected in Mexico, Central and South America. Even though 3 people have been confirmed to have died in Chile due to a Zika virus, there is no report of prior medical conditions of these patients so the exact cause of death remains a mystery.  Additionally, there are no reports of infants getting Zika virus through breastfeeding.  Because of the benefits of breastfeeding, mothers are encouraged to breastfeed even in areas where Zika virus is found.

               The Zika virus is causing panic, so it is important to be clear about the facts.  The first thing to understand is that is not a contagious virus similar to the Ebola virus or the common cold.  The majority of people infected with Zika never develops symptoms. The Zika virus is not transmitted via aerosol droplets, so there is currently no need for personalized protection equipment or isolation rooms. The few patients who develop symptoms may present with fatigue, headache, joint pain, malaise and a cough. The only way to confirm the diagnosis in the US is for testing to be completed by the CDC through your healthcare provider.

               The media has caused such an uproar that healthcare professionals may believe that they need to started to investing in testing for the Zika virus and develop protocols on how to treat and manage infected patients.  We need to be prepared, but have to be careful not to overreact.  According to the CDC, “approximately 1 in 5 people infected with Zika virus become symptomatic. Characteristic clinical findings are acute onset of fever with maculopapular rash, arthralgia, or conjunctivitis. Other commonly reported symptoms include myalgia and headache. Clinical illness is usually mild with symptoms lasting for several days to a week. Severe disease requiring hospitalization is uncommon and case fatality is low”. 

There are no known cures or vaccines for Zika virus.  The CDC recommended treatment is getting plenty of rest, fluids, and use of analgesics and antipyretics. Because of similar geographic distribution and symptoms, patients with suspected Zika virus infections also should be evaluated and managed for possible dengue or chikungunya virus infection. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided until dengue can be ruled out to reduce the risk of hemorrhage. People infected with Zika, chikungunya, or dengue virus should be protected from further mosquito exposure during the first few days of illness to prevent other mosquitoes from becoming infected and reduce the risk of local transmission. 

EPA approved mosquito repellent can be used to help prevent mosquito bites as well as keeping infants covered when outdoors.  Lastly, to prevent any type of mosquitoes from calling your space their home, make sure to remove standing water where mosquitoes like to breed, as well as making sure that screens are in good repair and doors are kept closed.

Medicare Fraud, Waste, and Abuse

      Every year, millions of dollars are improperly spent because of fraud waste, and abuse.  This can be halted and prevented if the process of detect, correct, and prevent, is followed.  This process is required by The Social Security Act, as well as CMS regulations.  It is stated that those whom of which supply medicare and medicaid services, are required to have an effective compliance program of which includes measures to prevent, detect, and correct Medicare non-compliance.  There must also be implemented measures to prevent, detect, and correct fraud, waste, and abuse.  These steps and measures must be provided via effective training for employees, managers, and directors, as well as their first tier, downstream, and related entities.  (42 C.F.R. 422.503 and 42 C.F.R  423.504)
      An effective compliance program can be implemented via in-class settings, online courses, and "one on one" training.  If created correctly, an effective program would consist of steps as to how to detect, correct, and prevent.  It must also contain the 7 core compliance program requirements.
      The first step in stopping fraud waste and abuse, is prevention.  Being the most crucial step in halting fraud, is to go to the most vulnerable portion of information and ensure it's safety.  The most common types of fraud an abuse in the medicaid program include medical identity and theft, unnecessary billing, upcoding, unbundling, and beneficiary fraud.
      Medical identity theft, being the most common, involves the misuse of a person’s medical identity to wrongfully obtain health care goods, services, or funds. More specifically, medical identity theft has been defined as “the appropriation or misuse of a patient’s or [provider’s] unique medical identifying information to obtain or bill public or private payers for fraudulent medical goods or services.” Unique medical identifying information for physicians includes the National Provider Identifier, Tax Identification Number, U.S. Drug Enforcement Administration number, and State medical license number. Physician medical identifiers are used for such things as identifying the physician of record on claims and for tracking purposes. Stolen physician identifiers may be used to fill fraudulent prescriptions, refer patients for unnecessary additional services or supplies, or bill for services that were never provided.
      An excellent example of Medical Identity was seen when the ringleader of a criminal group in the Bronx stole prescription pads from doctors and hospitals in the New York City area. Between 2009 and 2011 she used the pads to forge more than 250 prescriptions for painkillers. By using stolen Medicaid cards, she was able to bill the prescriptions to the Medicaid program for a total of more than $200,000. She received two consecutive 4 to 8 year sentences in prison.  Thus, one tip for prevention is that health care professionals should keep their prescription pads in a secure location.
      The second most abused form of fraud is the billing for products or services that are not covered or medically needed.  The Federal Medicaid statute authorizes payment for items and services that are included in each State’s approved plan.  The included items and services vary from State to State. Only those items and services included in the relevant State’s plan are authorized. Even if an item or service is authorized, it is still not covered under Medicaid unless it is also medically necessary.  This can be easily prevented by constant review and analysis of your Medicaid approved plan, this will stop you and your organization from purchase of non-covered goods and or services.  If excessive purchases are made using medicaid that are not covered by the approved plan, the purchasing party can receive an extreme amount of jail time, as well as fines.  This was exemplified when an ambulance service owner in Texas was sentenced to 15 years for billing Medicare and Medicaid for transporting patients by ambulance to dialysis appointments even though the medical condition of the patients did not qualify for that level of transportation.
      Although it may sound like a complex network of underlying danger, Medicare fraud, waste, and abuse can be easily avoided as well as prevented.  If the measures for safety are taken, then it may be brought to a complete and utter stop.  All of the information presented here can be found in a more in-depth toolkit presented by Centers for medicare and medicaid services otherwise known as CMS.  MedTrainer offers extensive and captivating courses on the precautionary steps to take as to how to stop Medicare, Fraud, Waste, and Abuse.  Join us today in creating a more beneficial and productive medical field, free of theft and fraud.  Visit http://medtrainer.com/demo/ to learn more, as well as schedule your free demo.

Fire Safety and Necessity

      OSHA has over seventy regulatory standards set into place for fire safety.  As a result, only about three percent of workplace fatalities are caused by a fire or explosion.  This is in direct correlation, to all the precautionary steps taken by employers to prepare their workers for potential danger.  Although three percent may seem low, the actual amount of fatalities should be zero.  It is understandable to be conflicted when keeping up with fire safety.  However, it is unacceptable to do so, for in order to keep your employees safe, as well as your facility, and business, you must understand the responsibilities that are required to be upheld.
      The first and foremost way to begin your path to compliance, is through the creation of a fire prevention plan.  This must be an updated and written form containing of all potential fire hazards, proper handling procedures for hazardous materials, the control of potential ignition sources, and the necessary equipment to control each major hazard.  This form must be written and stored in an area of which can be obtained by each and every employee.  If your facility has more than ten employees, an oral presentation of the fire prevention plan must be given.
      Alternate exit-routes are another crucial step in securing employee safety.  In the case of a fire, your typical facility exit may be blocked or inaccessible.  As a result, other ways to leave the building are required to ensure a safe escape without harm being caused to you or your employees.  These alternate exits should be included in you emergency action plan.  Aside from an evacuation process, the emergency action plan should contain procedures for reporting a fire or other emergency, procedures for rescue or medical duties, and procedures to account for all employees after an evacuation.  Included outside of the emergency action plan, training should be given to a selection of employees whom of which will assist in a safe and orderly evacuation of all other employees.
      Within a facility may reside potentially hazardous materials of which can cause a spontaneous combustion, explosion, fire, and meltdown.  These materials are required to be documented, each with their own proper disposal process, how to control the material in an emergency situation, and the proper equipment to take said control.  Under the category of hazardous materials falls: compressed gases, acetylene, hydrogen, oxygen, flammable liquids, spray finishing, explosives and blast agents, storing of gases, storing of anhydrous ammonia, safety management of highly hazardous chemicals, and lastly the hazardous waste operations and emergency response.
      Fire safety wouldn't be complete without an overview on fire protection.  Within the scope of fire protection, falls an entire list of application and definitions of which are applicable to items such as fire detection systems, extinguishers, and much more.  Plans must be physically available for all employees in a facility ranging in genre of proper extinguisher use all the way to fire brigades.  Although extinguishers are required, ones containing carbon tetra-chloride, or chlorobromomethane, are not permitted by OSHA.  It is also necessary to inspect and maintain fire extinguishers in a fully charged and operable condition, of which are easily located and accessible.
      With all forms of fire safety taken into full account, your facility and employees can confidently work with assurance that you are prepared for a fire.  The process of creating a fire safety plan, can be long, grueling, overwhelming, and tedious, all the while entirely necessary.  However, with the help of MedTrainer, fire safety planning has never been easier.  With many templates already created, MedTrainer can increase your facility's preparedness for an unexpected fire.  Schedule your free demo today at: http://medtrainer.com/demo/

Identifying Abuse/Neglect in Children and Elders

      The improper usage or treatment of an entity, otherwise known as abuse is sadly all to common in day to day human interaction.  It takes hundreds of shapes and forms, such as physical, verbal, maltreatment, injury, assault, violation, rape, and of course unjust practices.  although abuse can occur in many different ways, it is most commonly found in elders, as well as children due to their inability to defend or protect themselves.  This may be a horrible topic to cover, however, it is enormously crucial to understand the importance behind identification, prevention, and taking action in order to stop abuse.
      The first step that all of us are responsible for, is identifying when abuse occurs, what form it may be, and whom of which caused it.  Let's start with identification, specifically physical abuse.  Physical abuse is the most used of all, and as a result is the simplest to identify.  Common signs of physical abuse consist of bruises, sprains, difficulty in walking, bruises on neck that resemble fingerprints, and spiral fractures usually occurring in the wrists, arms, and legs.  Spiral fractures are common in both children and elders, due to their bone composition being more fragile and weak than that of a typical adult.  The most regular of which appears on the wrist which can simply be caused by a fast grabbing and rotating motion.  This is normally caused when the abuser attempts to gain immediate control of the victim with excessive force.
      Abuse prevention is above all, the most important step in this process, for if prevention is successful, then there is no need for the other two portions.  There are many different ways to prevent abuse, such as training, information awareness, and anger management courses.  quite possibly the most crucial portion of prevention, is learning the facts and understanding the risks.  This means that we must be entirely aware of the situation of potential victims, and have factual information that can prove potential abuse.
      It is up to us to report abuse, as it is reported that on average, only 1 out of 10 victims will report it themselves.  This is due to the fact that the victims fear what will occur if their abusers are exposed.  About 33% of abusers are family members, while 59% are people whom of which are judged by the family as trustworthy.  It can be difficult to identify the abuser, as there are little to no characteristics that "set them apart."  They look and act just like us and sometimes go out of their way to appear trustworthy.  Because of this, you will more than likely have to confront the potential victim directly.  This process can be dreadful and typically painful for the victim, as they likely fear what their abuser will do if they are exposed.  To start, ensure that you have a factual basis to form your reason for confronting the victim.  This can consist of but is not limited to: abrasions, flinching when being addressed, a look of fear when spoken to by a caretaker/guardian, and complaint of pain and difficulty walking.  Always have a valid reason for addressing the potential victim, and ensure them that everything they say to you is confidential and will not reach their abuser.  If the victim confesses to whom their abuser is, and the actions he or she has done, it becomes your responsibility to contact authorities, or a legal entity that can grant the victim permanent safety.
      With all of these steps followed correctly, and the actions taken properly, then we may one day live in a world with no abuse.  However, we currently live in a world riddled with abuse of which must be brought to an immediate end.  It is up to all of us to identify, prevent, and take action against all forms of abuse.  Take the first step, and make an impact in your healthcare facility with MedTrainer, offering multiple courses on everything discussed in this post.  Contact us today for your free demo, and begin the process in bringing abuse to a halt.
http://medtrainer.com/demo/

Informed Consent

      Informed consent is only given when the receiver-to-be has a clear appreciation and understanding of the facts, potential outcomes, as well as potential consequences.  Although this concept appears simple, it contains an entire list of potential prevention factors.  Certain impairments such as mental illness, Alzheimer's disease, intoxication, and even basic intellectual immaturity can restrict a person from granting permission to healthcare providers.  In certain cases where the individual of concern is incapable of giving his or her own consent, another person is generally authorized to give consent for said individual.  This can be seen with guardians of children, as well as conservators for the mentally ill whom of which may be rendered incapable of providing conscientious and informed consent.

      In the medical world, millions of people receive care for injuries and sickness.  All of which give consent so that medical professionals can do their job.  The process in which permission is gained before healthcare intervention on a person is granted, is called Informed Consent.  It is granted via patient permission and follows guidelines from the fields of medical ethics as well as research ethics.
      There are multiple different forms and sheets of which a person is required to sign so that the informed consent has physical and legal documentation that is created by legal standards.  Templates of these consent forms can be easily accessed on the World Health organization Website for common and practical use.  Not only are these forms required, but they are extremely useful when it comes to assessment of consent.  Assessment of consent is the process in which the determination between comprehension and confusion of the agreement is made.  This can be complex to evaluate due to the fact that neither expressions of consent, nor expressions of understanding of implications, mean that full consent was given, nor that full comprehension was successfully digested.  With the assistance of informed consent documents, the assumption that the individual comprehends the matter, is implied due to their signature of agreement.  However, without documentation, it can be stated that a person may verbally agree to something from fear, perceived social pressure, and or psychological difficulty in asserting true feelings.  The occurrence of incomprehension may also happen if the person fails to understand the potential consequences.
      Alternate circumstances may change the necessity of informed consent.  Multiple situations can consist of emergencies where the individual is incapacitated or otherwise unable to give consent.  In this instant, it is necessary to give medical treatment to the injured or otherwise incapacitated individual in order to sustain their life, therefor informed consent is not needed.  However, if the individual is not in need of medical treatment, and instead desires treatment, then consent must be implemented.
      The use of Informed consent forms is a widely spread practice to ensure the comfort of both the healthcare provider as well as the patient.  Although at times it may seem rather excessive, it is another necessary precaution of which me must uphold in the medical field.  Enforce this requirement, and make sure that your healthcare facility is practicing safely, soundly, and of course with compliance to local, state, and federal regulations.  Ensure this and much more with the help of MedTrainer.  Contact us today and reserve an appointment for your free online demo at: http://medtrainer.com/