Reimbursement

Part 3 in a series examining the reduction of facility costs and the continuation of quality care

For Part 1, Click Here
For Part 2, Click Here

By Sue Hull MSN, RN, CWOCN

After recognizing that wound care is expensive, North Mississippi Medical Center (NMMC) assessed the situation to discover possible reasons for why advanced wound care was costing so much. Then they standardized processes, education and products. So, the question is, what happened? Did they reduce costs? If so, did patient care suffer?

Part 2 in a series examining the reduction of facility costs and the continuation of quality care

For Part 1, Click Here

By Sue Hull MSN, RN, CWOCN

After North Mississippi Medical Center (NMMC) identified advanced wound care as a costly service, observed that multiple wound care products were being used to perform the same clinical functions, and realized that evidence-based practice would be difficult to implement without standardization, they developed a strategy for change.

By Glenda Motta RN, MPH

Anyone interested in keeping abreast of Medicare basics as well as payment policy should add the Medicare Payment Advisory Commission (MedPAC) to your list of resources. MedPAC, an independent congressional agency, advises the U.S. Congress on issues affecting the Medicare program. The Commission’s 17 members have diverse expertise in the financing and delivery of health care services.

Part 1 in a series examining the reduction of facility costs and the continuation of quality care

By Sue Hull MSN, RN, CWOCN

Remember W. Edwards Deming? We all learned about him in business management, right? He taught and demonstrated that systematic approaches were necessary to improve quality and control costs. Maybe I’m the only one, but I couldn’t really grasp how that principle could be applied to wound care.

By Glenda Motta RN, MPH

Say what you will about Obamacare, but the President has made eliminating fraud, waste, and abuse in healthcare a top priority. The Attorney General and Health and Human Services (HHS) Secretary recently released a report on health care fraud prevention and enforcement efforts in Fiscal Year (FY) 2011.¹ Nearly $4.1 billion was recovered, the highest ever reported. The Health Care Fraud Prevention & Enforcement Action Team (HEAT) works to prevent fraud, waste, and abuse in the Medicare and Medicaid programs. Their efforts and other approaches are being expanded using tools authorized by the Affordable Care Act.

By Michael Miller DO, FACOS, FAPWCA

RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 8

“…(7) Go to, let us go down, and there confound their language, that they may not understand one another's speech.(8) So the Lord scattered them abroad from thence upon the face of all the earth: and they left off to build the city. (9)Therefore is the name of it called Babel..." (Genesis, Chap. 11).

By Glenda Motta RN, MPH

In 1978, I was hired to develop a comprehensive discharge planning program at an inner city hospital in Washington, D.C. Way before DRGs and any reimbursement limits were placed on hospitals, this facility knew it had a problem. 40 patients had a length of stay that exceeded 60 days! Can you imagine that scenario today?

By Michael Miller DO, FACOS, FAPWCA

RAMBLINGS OF AN ITINERANT WOUND CARE GUY PT. 4

I willingly confess that I enjoy being a maverick. Of course, at age 52 with two cats, a wonderful wife of 27 years, and two daughters (this order in no way implies favoritism), that term seems to be a bit of a stretch. As a wound care clinician and scientist, I am always on the lookout to find that new innovative dressing, technique, or technology that will help my patients just a little bit more than the next guy. I believe the trade term for my type of psychosis is called “Early Adopter.” I prefer to think of myself in terms of the little kid we all knew who had to have the newest toy first.

By Glenda Motta RN, MPH

Medicare is now beginning round two of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. Congress mandated this through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). This applies to a number of items used by beneficiaries on an outpatient basis. The intent is to reduce beneficiary out-of-pocket expenses and save the Medicare program money, but still ensure beneficiary access to quality items and services.

By Glenda Motta RN, MPH

Centers for Medicare and Medicaid Services (CMS) just released regulations for acute and long-term care hospitals that include a new set of quality measures that will determine payment starting in the fiscal year 2015. The initial set of 10 quality measures was put in place in 2004 as mandated by the Medicare Prescription Drug, Improvement and Modernization Act (MMA).