Taiyesha Baker’s Twitter Issue
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Posts tagged ‘julianne haydel’
Nov 29
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Nov 20
Veteran’s Day
When I looked up Veteran’s Day on the internet earlier in the week, the first links that appeared were related to office closures such as banks and public offices. There was nothing about actual men and women who served in the Military. But, there is a lot going on with the Veteran’s Health Administration and I learned some shocking facts about Veterans when researching this post. First, approximately 8 percent of our prisoners are veterans. The good news is that the number is falling and while there are probably a few veterans who simply committed crimes unrelated to their service to our country, many of them have PTSD.
Prison is the extreme but there are many more veterans who are suffering from PTSD. I never thought of it as a condition that affected the elderly but Dementia and PTSD have a relationship. Additionally, the traditional treatment of long term use of benzodiazepines to manage anxiety with PTSD is now suspected of contributing to Alzheimer’s Disease and other Dementias. Medication recommendations have changed and are successful, but Dementia and PTSD are still closely correlated. These are our patients – Medicare beneficiaries who fought in wars that ended long ago continuing to suffer from PTSD and losing the cognitive ability to cope.
Although younger men and women in the military are taught how to recognize PTSD and get help when needed, the older generation lived in an age when they were supposed to ‘suck it up’. They viewed mental illness as weakness. They had a preconceived notion that men were supposed to be ‘strong’ and boys didn’t cry. Some of them have lived miserable lives. But as they are approaching the end of their lives, you can help them by learning to assess for PTSD and assist your patient in getting the help they need.
The Veterans Health Administration has a seemingly unlimited amount of information available for Veterans and Healthcare Providers. There are continuing education courses online at no cost for nurses that grant credit. There are teaching guides that can be downloaded that will help you teach your patients about PTSD. They are yours by clicking the blue box.
When I worked in critical I took care of a patient shot six times by her retired husband. According to her family, they were the perfect couple but a flashback to a combat zone ultimately caused the death of my patient. A few years later, in the cath lab, a patient with Alzheimer’s Dementia became very angry when a physician of Asian decent walked into his room prompting the patient to scream something about killing those Japs. The physician was a kind man and didn’t take offense but imagine how very frightened my patient was thinking that the ‘enemy’ had found him.
Jails are now designating areas for Veterans. The Hospice Benefit has a program to recognize veterans. Home Health nurses won’t wait for a program to formally assist Veterans. Let’s get started by learning about PTSD and getting our Veterans Treatment.
They were willing to die for us. We can lighten the pain of their ongoing suffering.
Guess What Happened!
Image of the Flu virus courtesy of the CDC.
Guess what happened this past weekend? The flu season officially started. Although most people don’t like the flu season, the advent of flu season is better news than the LSU homecoming game score. Someone should invent a vaccine for the malaise that oozes out of Tiger Stadium and infects the entire state of Louisiana when LSU loses a game deliberately stacked in their favor. Where is Les Miles when you need him? I’m not even sure where Troy is.
Back to the flu. Last year’s flu season certainly wasn’t the worst we’ve seen but an estimated 71,000 flu related hospitalizations were prevented because people received the flu shot. Is your hospitalization rate high? Lower it with the flu vaccine. A full 2.5 Million MD visits were prevented because people received the flu shot. That’s about equal to the population of the state of Oregon.
We know that Medicare doesn’t give away stuff for free so have you asked why there is no charge for the vaccine? The total number of hospitalizations for the flu each year runs about 200,000.
And yet, in home health and hospice, our hands may be tied depending state specific pharmacy laws. In Louisiana, you have to figure that if LSU can’t beat Troy at our homecoming game, we are likely worthless against a deadly virus that kills between 3,000 and 50,000 people each year depending on the severity of the flu season. Because most states do not allow nurses to carry medications that are not labeled for individual patients, multi-use vials are not allowed to be carried by nurses just in case a patient is in the mood for a flu shot. While getting an order is not difficult, many nurses are not comfortable with injecting someone with the vaccine without having an emergency kit available for a possible reaction and it is impractical and wasteful to carry around a patient specific emergency kit for every flu vaccination given since it won’t be used.
According to the World Health Organization, for every 500,000 vaccinations given, someone will go into anaphylaxis (a condition causing the inability to breathe kind of like the way Louisiana residents gasped for air after Troy beat LSU on Saturday Night).
There is also a small but significant risk of coming down with Guillain-Barre’ after the flu vaccine. Although this is one of the more undesirable effects of the vaccine, many people don’t realize that the flu causes more cases of Guillain-Barre’ than the vaccine. So, roll the dice. Get no vaccine and hope you don’t get the flu or get the vaccine and have a tiny chance of contracting Guillain-Barre’. Of course, if you or your patients opt to forego the flu vaccine from your fall schedule this year and wind up sick with the flu, your chances of coming down with a pesky paralytic illness will be greater than those who didn’t get a flu shot and those that did get a flu shot combined.
So, here’s what you do.
- First go to the CDC Flu page. There you will find all kinds of teaching materials for both patients and staff in multiple languages designed for various education levels.
- Check on your state’s regulations about the flu vaccine. If permitted to do so, get said permission in writing.
- If you can’t carry flu unlabeled flu vaccine (much like LSU can’t carry a football), use this nifty widget to find out where your patients can receive a vaccine. You can even put it on your website if you want.
- Coordinate with your patients and physicians to get orders for patients who are truly bedbound or live in rural areas so distant that a simple trip to the drug store is out of the question.
- Encourage everyone in the household to get vaccinated. Leave one of those cute flyers from the CDC website taped to the refrigerator along with the list of nearby flu shot providers to reach the maximum number of family members.
- You can also vaccinate other Medicare beneficiaries in the household if you get orders from their physicians. (Technically, Medicare doesn’t require an order but I highly recommend that you give nobody any medication without one; especially someone you haven’t fully assessed and are unaware of their history and physical).
- If your agency is going to vaccinate a lot of people, consider billing for the flu shot. I have no earthly idea of how this is done but Medicare has graciously published a little info sheet for people who know what they are doing. Note that you can only bill for patients with Part B.
The truth is that no matter what you do, the fact that Troy beat LSU cannot be changed. But imagine if you or your patients get the flu and are too sick to do anything that takes your mind off the greatest LSU humiliation in recent history. A situation like that could be the end zone for countless Louisiana residents.
And if you see Les Miles, tell him to come back.
PEPPER Reports
What if I could tell you how likely you are to find your agency under intense scrutiny by Medicare? Would you want to know? What if I could tell you what Medicare expects you to do to address any risk areas? Would you do it?
Chances are the answer is a resounding, ‘No!’
You can have all this information within 15 minutes. All you need is your provider number and a patient ID number for a claim that has been paid prior to July 17, 2016. Both of these numbers are available on any 485.
Using these two numbers, any Medicare certified home health care agency can access the PEPPER portal. There you will find your agency specific reports that show where an agency falls compared to other agencies in areas that Medicare has identified as those being closely associated with Medicare fraud and abuse. Of all certified home health agencies, only 20 percent nationwide have bothered to look at their data.
One nurse asked me if maybe it was better not to download reports. Her rationale was that if Medicare would come down harder if they believed the agency was aware of any high risk areas as opposed to being unaware. To be clear, Medicare is not going to cut you a break if you didn’t know that your agency was meeting the threshold for any of the target groups reported.
Here’s what the PEPPER reports show:
Average Case Mix
Agencies with an average rate of 1.6 or higher may find themselves looked at for possible up-coding.
Average Number of Episodes
Nationwide, agencies in the 80th percentile provide an average of 2.78 episodes. Medicare believes there is a high chance of improper payments if you meet or exceed an average of 2.78 episodes per patient.
5 or 6 Visits
In order to get paid the full amount for an episode, an agency must provide at least five visits. Any nursing care over and above five visits adds to the cost of the episode but not to the payment. If your agency has more than 7.2 percent of their episodes with five or six visits, Medicare believes there is a chance that you are maximizing income without regard to patient care.
Non-Lupa Payments
Medicare expects that agencies will have LUPA payments. When the number of LUPA payments is very low, Medicare suspects that an agency is avoiding LUPA costs by providing unnecessary visits to qualify for full payment.
High Therapy
Although some patients require 20 or more therapy visits per episode, the assumption is that agencies in which 2.9 percent or more of patients required 20 or more visits may be adding unnecessary visits to capitalize on the enhanced payment associated with high therapy.
Outliers
The target for outliers is 7.6 of total payment. Note that this is less than 7.6 of total episodes. Anything over 10 percent will be adjusted quarterly.
These indicators of possible improper payments are only data. It is possible to hit the target in one more areas without doing anything improper. However, a prudent agency will be well aware of where they fall and document accordingly. Should questions arise, the agency should be able to provide an explanation as to the aberrancy. If you cannot arrive at a suitable answer, take a long and hard look at your charts.
The PEPPER reports that have been shared with us do not approach any level of concern. (Fraudulent agencies often eschew our services which focus on compliance.) My guess is that PEPPER Reports are effective at identifying improper payments. Agencies that routinely provide three episodes per patient and all the episodes have exactly 6 visits may not be assessing the patient and meeting their individual needs. If you are employed by an agency that has hit multiple targets and seems disinterested in addressing them, you may want to reconsider your current employment status.
If you decide to download your PEPPER reports, please let us know. If you feel like sharing them, we’d love to see them and promise to keep them confidential.
