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“Patient safety act” introduced
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"Operation Restore Trust" 9 A year-old antifraud campaign will be expanded from a five-state pilot project to a nationwide campaign. According to the Secretary of Health and Human Services (HHS) Donna Shalala, the program has saved $10 for every dollar spent. The pilot project focused on three "high-growth" Medicare and Medicaid areas: nursing homes, home health agencies, and medical equipment suppliers. The pilot program resulted in savings of $42.3 million. HHS has worked with the Health Care Financing Administration's data staff, auditors from the office of the Inspector General for HHS, and nurses from state agencies to conduct comprehensive reviews of rehabilitation and skilled nursing facilities with unusually high Medicare reimbursement rates.
Medicaid Managed Care Update 9 Plans that engage in Medicaid managed care must be able to provide case management and member outreach services. One third of the nation's 36 million Medicaid recipients are enrolled in managed care, but the market is not yet saturated. All states have at least one Medicaid waiver. Section 1115 waivers are u s u a l l y statewide demonstration/research projects. The 1915(b) waivers are usually freedom of choice waivers, such as the primary care case management waiver, which is a physician fee-for-
GERIATRIC NURSING Volume 17, Number 5
service managed care model. Thirty-eight states now have 1915(b) waivers. Home- and community-based care waivers typically provide services that include registered nurse case management, transportation, and home-delivered meals. State nurses associations are encouraged to be an active part of the waiver process. The most important concern is that advanced practice nurses (nurse practitioners, clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists) be named as primary and specialty providers by including statements in the nursing scope of practice that advanced practice nurses are independent primary and specialty providers. Medicaid managed care waivers are changing care from an acute intervention model to a prevention, health promotion, early diagnosis, and treatment model. The Health Care Financing Administration requires that Medicaid managed care plans report specific data so that the plans can be evaluated on the basis of patient outcomes and the cost of providing care.
Nurse Practitioners Included as Gatekeepers in Pennsylvania 9 In 1995 the Pennsylvania State Department of Health changed its health maintenance organization (HMO) regulations to include nurse practitioners in the definition of "primary care gatekeepers." The
shift resulted from a coalition of nurse practitioners and their allies, including the Pennsylvania nurses Association, and the willingness of the state to change. Two independent nursing centers located in public housing communities in Philadelphia operate under a parent corporation, a nonprofit human service organization. The centers are governed by a partnership agreement betwen the organization and the two community tenant councils. The centers depend on the collection of fees from medical assistance and other insurers and are required by the federal government to maximize fee collection with an ultimate goal of decreasing dependence on federal monies. In Philadelphia, Medicaid managed care plans are replacing the fee-for-service program as a method of providing health care to Medicaid recipients. Pennsylvania has received a waiver from the federal government to completely abandon the fee-for-service program in six counties surrounding and including Philadelphia in favor of HMOs. (Source: Nurse Practitioner World News, May/June 1996; 1:1,20)
"Patient Safety Act" Introduced 9 The Patient Safety Act of 1996, a bill drafted by the American Nurses Association, was introduced in the U.S. House of Representatives by Maurice Hinchey (D-NY). The act focuses on major safety, quality, and workforce issues for
Newsview
199
nurses employed by health care institutions and the patients who receive care in such institutions. The legislation is part of the "Every Patient Deserves a Nurse" campaign, designed to call attention to the current trend by hospitals to reduce costs by substituting minimally trained, unlicensed assistive personnel for educated, licensed professional registered nurses.
tive bargaining purposes and to engage in other concerted activities. ANA president Virginia Trotter Betts, RN, MSN, JD, stated, "This decision is a victory for nurses, who deserve the protection of federal labor law, and for their patients, who can feel confident that a nurse's professional obligation to advocate in their best interest is not undermined due to fear of firing."
ANA Urges Release of Proposed TB Standard
Flu Prevention Begins
9 The American Nurses Association is urging the Occupational Safety and Health Administration to publish the proposed Tuberculosis (TB) Standard as soon as possible. OSHA has been developing the standard for the past 2 years. The new date for publication of the standard is late September. The proposed standard would apply to 12 occupational settings including hospitals, clinics, prehospital emergency treatment, home health, and prisons. Application of the standards will be based on "encounters" to suspected or confirmed infectious TB.
NLRB Ruling Applauded 9 The National Labor Relation Board (NLRB) ruled 3-1 that registered nurses are not statutory supervisors and therefore are protected by federal labor law. The ruling was made with regard to charge nurses at Providence Hospital in Anchorage, Alaska. The decision recognizes that the judgment exercised by registered nurses in monitoring and assessing patients is part of their professional role, rather than part of any statutory supervision as defined by the National Labor Relations Act. The implications are that registered nurses who work as professional, nonsupervisory employees have the right to organize for collec-
200 Newsview
9 The Centers for Disease Control and Prevention (CDC) states that influenza vaccination is essential for people at increased risk of complications from influenza. This group includes primarily people older than 65 years and those with chronic health problems. During the past two decades, influenza-related deaths have averaged 20,000 per year; more than 90% occurred in those 65 years of age or older. Studies Show that the flu vaccine can be 50% to 60% effective in preventing hospitalization and pneumonia and 80% effective in preventing death in nursing home populations. This year's flu vaccine includes three influenza strains: A/Johannesburg/33/94-!ike (H3N2), A/Texas! 36/91-1ike (H1N1), and B/Beijing! 184!93-1ike (represented in the U.S. vaccine by B/Harbin/07!94). The CDC suggests use of an antiviral drug for unvaccinated or recently vaccinated people in certain groups when influenza A activity begins in a community. People with flulike symptoms should see a physician as soon as possible, preferably within 48 hours.
MDS-2 and Skin Ulcer Assessment 9 The Minimum Data Set (MDS) is a comprehensive assessment tool required by all long-term care facilities that provide care to Medicare patients. The tool was created to
improve the quality of care. With regard to pressure ulcers, the MDS form is intended to "ensure that a resident who enters the facility without a pressure sore does not develop a pressure sore unless the individual's clinical condition demonstrates that (it was) unavoidable." In January the original MDS was replaced by a revised MDS (MDS-2) that provides for more extensive assessment of several functional areas including skin conditions. The definition of pressure ulcer provided in the MDS-2 provides for more extensive assessment of several functional areas including skin condition. However, it does not consider all factors in skin ulcer development and lacks the specificity to differentiate pressure ulcer injury from other types of injury. It also fails to provide a sufficient description of the defining characteristics of a pressure ulcer to permit accurate differentiation from other types of injuries, such as diabetic insensate foot ulcers. For more information, contact the National Pressure Ulcer Advisory Panel, SUNY at Buffalo, Beck Hall, 3435 Main St., Buffalo, NY 14214. (Source: NPUAP Report April 1996;4:1)
Call for Abstracts 9 The National Pressure Ulcer Advisory Panel Fifth National Conference on pressure ulcers will be held February 7 and 8, 1997, in Alexandria, Virginia. Abstracts and posters relating to the topic will also be submitted during the conference. Scientific abstracts for poster and oral presentations relating to monitoring pressure ulcer healing are being sought. Abstracts must be received no later than 5 pm on October 31, 1996. For more information, contact the National Pressure Ulcer Advisory Panel, (716) 881-3558; fax (716) 8813207.
September/October 1996 GERIATRIC NURSING
"Operation Restore Trust" 9 A year-old antifraud campaign will be expanded from a five-state pilot project to a nationwide campaign. According to the Secretary of Health and Human Services (HHS) Donna Shalala, the program has saved $10 for every dollar spent. The pilot project focused on three "high-growth" Medicare and Medicaid areas: nursing homes, home health agencies, and medical equipment suppliers. The pilot program resulted in savings of $42.3 million. HHS has worked with the Health Care Financing Administration's data staff, auditors from the office of the Inspector General for HHS, and nurses from state agencies to conduct comprehensive reviews of rehabilitation and skilled nursing facilities with unusually high Medicare reimbursement rates.
Medicaid Managed Care Update 9 Plans that engage in Medicaid managed care must be able to provide case management and member outreach services. One third of the nation's 36 million Medicaid recipients are enrolled in managed care, but the market is not yet saturated. All states have at least one Medicaid waiver. Section 1115 waivers are u s u a l l y statewide demonstration/research projects. The 1915(b) waivers are usually freedom of choice waivers, such as the primary care case management waiver, which is a physician fee-for-
GERIATRIC NURSING Volume 17, Number 5
service managed care model. Thirty-eight states now have 1915(b) waivers. Home- and community-based care waivers typically provide services that include registered nurse case management, transportation, and home-delivered meals. State nurses associations are encouraged to be an active part of the waiver process. The most important concern is that advanced practice nurses (nurse practitioners, clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists) be named as primary and specialty providers by including statements in the nursing scope of practice that advanced practice nurses are independent primary and specialty providers. Medicaid managed care waivers are changing care from an acute intervention model to a prevention, health promotion, early diagnosis, and treatment model. The Health Care Financing Administration requires that Medicaid managed care plans report specific data so that the plans can be evaluated on the basis of patient outcomes and the cost of providing care.
Nurse Practitioners Included as Gatekeepers in Pennsylvania 9 In 1995 the Pennsylvania State Department of Health changed its health maintenance organization (HMO) regulations to include nurse practitioners in the definition of "primary care gatekeepers." The
shift resulted from a coalition of nurse practitioners and their allies, including the Pennsylvania nurses Association, and the willingness of the state to change. Two independent nursing centers located in public housing communities in Philadelphia operate under a parent corporation, a nonprofit human service organization. The centers are governed by a partnership agreement betwen the organization and the two community tenant councils. The centers depend on the collection of fees from medical assistance and other insurers and are required by the federal government to maximize fee collection with an ultimate goal of decreasing dependence on federal monies. In Philadelphia, Medicaid managed care plans are replacing the fee-for-service program as a method of providing health care to Medicaid recipients. Pennsylvania has received a waiver from the federal government to completely abandon the fee-for-service program in six counties surrounding and including Philadelphia in favor of HMOs. (Source: Nurse Practitioner World News, May/June 1996; 1:1,20)
"Patient Safety Act" Introduced 9 The Patient Safety Act of 1996, a bill drafted by the American Nurses Association, was introduced in the U.S. House of Representatives by Maurice Hinchey (D-NY). The act focuses on major safety, quality, and workforce issues for
Newsview
199
nurses employed by health care institutions and the patients who receive care in such institutions. The legislation is part of the "Every Patient Deserves a Nurse" campaign, designed to call attention to the current trend by hospitals to reduce costs by substituting minimally trained, unlicensed assistive personnel for educated, licensed professional registered nurses.
tive bargaining purposes and to engage in other concerted activities. ANA president Virginia Trotter Betts, RN, MSN, JD, stated, "This decision is a victory for nurses, who deserve the protection of federal labor law, and for their patients, who can feel confident that a nurse's professional obligation to advocate in their best interest is not undermined due to fear of firing."
ANA Urges Release of Proposed TB Standard
Flu Prevention Begins
9 The American Nurses Association is urging the Occupational Safety and Health Administration to publish the proposed Tuberculosis (TB) Standard as soon as possible. OSHA has been developing the standard for the past 2 years. The new date for publication of the standard is late September. The proposed standard would apply to 12 occupational settings including hospitals, clinics, prehospital emergency treatment, home health, and prisons. Application of the standards will be based on "encounters" to suspected or confirmed infectious TB.
NLRB Ruling Applauded 9 The National Labor Relation Board (NLRB) ruled 3-1 that registered nurses are not statutory supervisors and therefore are protected by federal labor law. The ruling was made with regard to charge nurses at Providence Hospital in Anchorage, Alaska. The decision recognizes that the judgment exercised by registered nurses in monitoring and assessing patients is part of their professional role, rather than part of any statutory supervision as defined by the National Labor Relations Act. The implications are that registered nurses who work as professional, nonsupervisory employees have the right to organize for collec-
200 Newsview
9 The Centers for Disease Control and Prevention (CDC) states that influenza vaccination is essential for people at increased risk of complications from influenza. This group includes primarily people older than 65 years and those with chronic health problems. During the past two decades, influenza-related deaths have averaged 20,000 per year; more than 90% occurred in those 65 years of age or older. Studies Show that the flu vaccine can be 50% to 60% effective in preventing hospitalization and pneumonia and 80% effective in preventing death in nursing home populations. This year's flu vaccine includes three influenza strains: A/Johannesburg/33/94-!ike (H3N2), A/Texas! 36/91-1ike (H1N1), and B/Beijing! 184!93-1ike (represented in the U.S. vaccine by B/Harbin/07!94). The CDC suggests use of an antiviral drug for unvaccinated or recently vaccinated people in certain groups when influenza A activity begins in a community. People with flulike symptoms should see a physician as soon as possible, preferably within 48 hours.
MDS-2 and Skin Ulcer Assessment 9 The Minimum Data Set (MDS) is a comprehensive assessment tool required by all long-term care facilities that provide care to Medicare patients. The tool was created to
improve the quality of care. With regard to pressure ulcers, the MDS form is intended to "ensure that a resident who enters the facility without a pressure sore does not develop a pressure sore unless the individual's clinical condition demonstrates that (it was) unavoidable." In January the original MDS was replaced by a revised MDS (MDS-2) that provides for more extensive assessment of several functional areas including skin conditions. The definition of pressure ulcer provided in the MDS-2 provides for more extensive assessment of several functional areas including skin condition. However, it does not consider all factors in skin ulcer development and lacks the specificity to differentiate pressure ulcer injury from other types of injury. It also fails to provide a sufficient description of the defining characteristics of a pressure ulcer to permit accurate differentiation from other types of injuries, such as diabetic insensate foot ulcers. For more information, contact the National Pressure Ulcer Advisory Panel, SUNY at Buffalo, Beck Hall, 3435 Main St., Buffalo, NY 14214. (Source: NPUAP Report April 1996;4:1)
Call for Abstracts 9 The National Pressure Ulcer Advisory Panel Fifth National Conference on pressure ulcers will be held February 7 and 8, 1997, in Alexandria, Virginia. Abstracts and posters relating to the topic will also be submitted during the conference. Scientific abstracts for poster and oral presentations relating to monitoring pressure ulcer healing are being sought. Abstracts must be received no later than 5 pm on October 31, 1996. For more information, contact the National Pressure Ulcer Advisory Panel, (716) 881-3558; fax (716) 8813207.
September/October 1996 GERIATRIC NURSING