Medicare covers yoga for heart disease from CNN

CNN) -- Frank Korona lives near the West Virginia-Pennsylvania border with his wife Kathy, in a house that he built with his own hands, on the same property where he grew up.

He served in the Army Special Forces in Vietnam. The Koronas have a long, proud tradition of military service, but their family's greatest losses have been to heart disease.

"Our family has shrunk tremendously. We've lost so many people through death," Kathy says.

In 1992, Frank's brother Bob died in his arms, suffering a heart attack on their kitchen floor. Parents, siblings, aunts, uncles and cousins have all died from complications from heart disease, too. The Koronas point them out in a graveyard near their home.

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Patient Recruiters and the Anatomy of Healthcare Scam from Nurse Together

Healthcare scams are constantly evolving and costing tax payers billions of dollars, most of which will probably never be recovered. The U.S. Department of Health and Human Services’ strike force operations have obtained over 1,000 indictments for individuals who have fraudulently billed Medicare for more than $2.3 billion since March 2007.

A healthcare scam is the premeditated fraud carried out by a provider, hospital, clinic, employer group, member, or other group or individual for illegal financial gain. Fraud takes many forms, and can involve what are known as “cappers,” or patient recruiters who literally recruit patients to become part of a healthcare scam designed to bilk millions out of the Medicare program.

For the full article please go here.

Case Managers: How Can You Enrich Your Patient's Life? from Nurse Together

One of the key outcomes case managers strive to achieve is an improved quality of life for the patients they work with. Yet many of the services that can improve a patient’s quality of life may not be reimbursable by traditional payment systems. To get a feel for the impact of this statement, think about the things that you depend on for enjoyment. Things like the ability to dress independently, to drive a car, to gather with friends for a glass of wine, access to cable television, the means to go to a baseball game, movie or a take a vacation.

We all have things that enrich our lives and they are as individual as we are. Yet for the person who is disabled, access to many of these things may be a challenge and take creativity to achieve. Families who have a member who is disabled are the key advocates for their family members. Many are the voice of the person and work to ensure that their family member is included and that accommodations be made if necessary to allow them to participate. Families may also be able to pay for things that we all take for granted, but with expenses mounting for necessities, sometimes funds are limited and have to be put aside.

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Readmissions Reporting Methods Explained from Nurse Together

Targeting and reducing hospital readmission rates has become a top priority for the Medicare program, and beginning in October, the Patient Protection and Affordable Care Act will start slashing payments to hospitals with higher than average readmission rates under the new fee-for-service program.

The need for proven readmission strategies has never been more urgent with the regulation taking effect later this year. In fiscal year 2013, the payment decrease can be up to one percent of Medicare reimbursement, rising to two percent in 2014 and three percent in 2015.

A new working paper published in January by America’s Health Insurance Plans, the industry group that represents health insurance companies, says there are many ways to measure readmission rates, some of which may be suitable for certain purposes but not others.

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Scientists Repair Heart Attack Damage Using Patient's Own Stem Cells To Regrow Healthy Heart Muscle from Medical News Today

Details of a small clinical trial published in The Lancet on Tuesday reveal how scientists helped patients with hearts damaged by heart attack to re-grow healthy heart muscle and reduce scar tissue with an infusion of stem cells taken from the patients' own hearts.

Leading international cardiologist and heart researcher Dr Eduardo Marbán, who is director of the Cedars-Sinai Heart Institute in Los Angeles and Mark S. Siegel Family Professor, is senior author of the study. He told the press what they saw in the trial:

"... challenges the conventional wisdom that, once established, scar is permanent and that, once lost, healthy heart muscle cannot be restored."

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Are You Standing in the Way of High Performance? from H and HN

PHOENIX— It's possible, Michael Frisina postulated, that when your hospital developed its strategic plan for the coming year, it actually validated a policy that said a certain percentage of your patients will be harmed. If zero errors aren't the goal, Frisina said during a keynote yesterday at the 25th Annual Rural Health Care Leadership Conference, then you're acknowledging that patients will be harmed.

"We say that patient care comes first and the patient is at the center of our care delivery," said Frisina, head of a self-named consulting firm and senior research scholar at The Center for Influential Leadership. "When are we really going to do that?"

Much like Bridget Duffy's presentation the day before, Frisina made the case that all too often our own behaviors stand in the way of us — and our organizations — from achieving more. His most critical assessment was aimed at the C-suite: Leaders set the tone. Their behavior will determine whether an organization strives for high-performance and compassionate care.

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The New Health Reform Bill: Do You Know How It Will Affect You? from Nurse Together

Unprecedented evolution of the health system in our country is beginning with the institution of the new health care bill. Over one thousand pages of legal-ease have made it virtually impossible for anyone to understand the changes and far less a chance to predict the outcomes. Most hospitals and healthcare organizations have appointed entire legal teams to attempt to assess the effects of this new legislation on their organizations. There are also many potential effects on the nursing profession that in some cases may be an advantage. Some could also be problematic. To attempt to predict the effects of the bill on nursing, let us attempt to explore the bill in simple terms.

There are three main problems with the current health system that this bill will attempt to address. These include rising costs secondary to insurance premiums and aging population, holes in coverage for most people with preexisting conditions, lifetime limits on benefits and rising costs to employers who are reducing coverage and individuals without access to healthcare at all. The bill will be phased in over time beginning now. The following will be the highlights of each phase.

For the full article please go here.

Employing Docs Without a Strategy? Think Again from H and HN

Click here to view and excellent video on doctor hiring strategies.

Reducing Hospital Readmissions from H and HN

The Centers for Medicare & Medicaid Services have been focusing on reducing acute care readmissions within 30 days of discharge through its Hospital Readmissions Reduction Program. Hospitals with higher than expected 30-day readmission rates will incur penalties against their total Medicare payments beginning in federal fiscal 2013.

Commercial payers likely will follow suit, as organizations such as the Joint Commission, Partnership for Patients and the National Quality Forum support this program.

To meet the challenge, hospitals need to take a structured approach to reducing readmissions — an assessment of the organization's risk and a comprehensive strategy that transitions the patient from the hospital to post-hospital care.

For the full article please go here.

In Focus: Rural Health from H and HN

Last month, regular H&HN Daily contributor Ian Morrison wrote a compelling column (aren't they all?) on reinventing rural health. In it he discussed the multitude of challenges facing rural providers — staff shortages, payer mix, capital and IT gaps, and more. The column also spends a fair amount of time discussing the hurdles rural providers will face as we move to a value-based, accountable care system.

In a bit of an understatement, he wrote: "Rural health is tough to manage, from both a policy and practical point of view." But he's then quick to note: "As we redesign the overall health care delivery system from volume to value, we raise the question of what happens to rural health care. While the challenges described here are real, in my travels I detect a growing openness to reinvention of rural health among community leaders and hospital CEOs across the country."
I couldn't agree more. I'm always amazed by the can-do attitude exhibited by rural health care leaders. They approach the hurdles in front of them head on, knowing that in so many cases they are the lifelines of their communities. That's part of the reason that I'm eager to board a plane Saturday afternoon and head to Phoenix for the 25th Annual Rural Health Care Leadership Conference. Year in, year out, it is one of my favorite meetings (and I'm not just saying that because it's our meeting).

For the full article please go here.

States Under Pressure As Health Law Deadlines Approach from Kaiser Health News

The health law's biggest changes don't take effect until 2014, when states and insurers must be ready to begin signing up an estimated 32 million people in Medicaid and private insurance. But a successful rollout in two years hinges on critical decisions that states must make – and take quick action on – this year.

It will be difficult for many states to meet fast-approaching deadlines, and some may not make it, says Brett Graham, a managing director at Leavitt Partners, a consulting firm working with states on implementation of the law.

Time is short, and states are missing key pieces of how-to guidance from the federal government about everything from what various insurance exchange options will look like to which benefits must be included in health plans, he says. To make matters worse, states are competing for a limited pool of information technology vendors to help them get started.

"It's a pressure cooker," said Graham. States are "in a position where they have to act with imperfect information."

One of the most pressing tasks for states this year has to do with the creation of exchanges, through which individuals and small businesses can buy insurance starting in 2014.

For the full article please go here.

Riding Herd on the Silver Stampede from H and HN

Are you ready for the "Silver Stampede?" That's the question contributing editor Geri Aston asked hospital leaders in her December Hospitals & Health Networks article on the onslaught of older patients, which will have — indeed, already is having — an enormous impact on our health care system. Like most of the stories we run in H&HN, the focus of Geri's article was on real-world solutions — positive, practical ways health care organizations are confronting a difficult issue, in this case senior care, so that other hospital leaders can decide whether those strategies might be worth adapting in their own organizations.

I write frequently in this space about generational issues in health care, and after Geri's article ran, I heard from a number of readers wanting to let me know that they and their colleagues also are taking creative steps to confront this issue. Here are four you might find interesting and useful:

For the full article please go here.

Medication Errors In Hospitals Reduced By e-Prescribing from Medical News Today

A study published in this week's PLoS Medicine shows that commercial electronic prescribing systems (commonly known as e-prescribing, in which prescribers use a computer to order medications for their patients through a system with the help of prompts, aids, and alerts) could substantially reduce prescribing error rates in hospital in-patients.

In the study, led by Professor Johanna Westbrook from the University of New South Wales in Sydney, Australia, the authors studied the introduction of the Cerner Millennium e-prescribing system into one ward in one hospital (Hospital A), and used three other wards as controls. At another hospital, the authors compared the error rates on two wards before and after the introduction of the e-prescribing system iSoft MedChart.

For the full article please go here.