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Centers for Medicare and Medicaid Services, U.S. , Casas de Saúde , Admissão e Escalonamento de Pessoal , Recursos Humanos , Humanos , Centers for Medicare and Medicaid Services, U.S./legislação & jurisprudência , Centers for Medicare and Medicaid Services, U.S./normas , Casas de Saúde/normas , Casas de Saúde/legislação & jurisprudência , Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Admissão e Escalonamento de Pessoal/normas , Estados Unidos , Recursos Humanos/legislação & jurisprudência , Recursos Humanos/normasAssuntos
Centers for Medicare and Medicaid Services, U.S. , Inovação Organizacional , Melhoria de Qualidade , Centers for Medicare and Medicaid Services, U.S./organização & administração , Centers for Medicare and Medicaid Services, U.S./normas , Medicaid/normas , Medicare/normas , Melhoria de Qualidade/organização & administração , Melhoria de Qualidade/normas , Estados UnidosRESUMO
OBJECTIVE: To identify how features of the community in which a hospital serves differentially relate to its patients' experiences based on the quality of that hospital. DESIGN: A Finite Mixture Model (FMM) is used to uncover a mix of two latent groups of hospitals that differ in quality. In the FMM, a multinomial logistic equation relates hospital-level factors to the odds of being in either group. And a multiple linear regression relates the characteristics of communities served by hospitals to the patients' expected ratings of their experiences at hospitals in each group. Thus, this association potentially varies with hospital quality. The analysis was conducted via Stata. SETTING: Hospital Ratings are measured by Hospital Compare using the HCAHPS survey, a patient satisfaction survey required by the Centers for Medicare and Medicaid Services (CMS) for hospitals in the United States. Participants: 2,816 Medicare-certified acute care hospitals across all US states.
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COVID-19/epidemiologia , Centers for Medicare and Medicaid Services, U.S./normas , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Fatores Etários , Feminino , Humanos , Modelos Lineares , Masculino , Satisfação do Paciente/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , SARS-CoV-2 , Fatores Sexuais , Estados Unidos/epidemiologiaRESUMO
Editor's note: This article is by 22 nursing gerontology experts who are all advocates of nursing home reform. They are listed at the end of this article.
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COVID-19 , Centers for Medicare and Medicaid Services, U.S./normas , Política de Saúde , Enfermeiras e Enfermeiros/normas , Recursos Humanos de Enfermagem/tendências , Recursos Humanos/organização & administração , COVID-19/epidemiologia , COVID-19/transmissão , Humanos , Casas de Saúde , Recursos Humanos de Enfermagem/provisão & distribuição , Estados UnidosRESUMO
As currently written, national regulatory guidance on procedural sedation has elements that are contradictory, confusing, and out of date. As a result, hospital procedural sedation policies are often widely inconsistent between institutions despite similar settings and resources, putting emergency department (ED) patients at risk by denying them uniform access to safe, effective, and appropriate procedural sedation care. Many hospitals have chosen to take overly conservative stances with respect to regulatory compliance to minimize their perceived risk. Herein, we review and critique standards and policies from the Centers for Medicare & Medicaid Services, The Joint Commission, state nursing boards, the Food and Drug Administration, and others with respect to their effect on ED procedural sedation. Where appropriate, we recommend modifications of and enhancements to their guidance that would improve the access of ED patients to modern, safe, and effective procedural sedation care.
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Sedação Consciente , Serviço Hospitalar de Emergência , Regulamentação Governamental , Centers for Medicare and Medicaid Services, U.S./normas , Sedação Consciente/métodos , Serviço Hospitalar de Emergência/legislação & jurisprudência , Humanos , Estados Unidos , United States Food and Drug Administration/normasRESUMO
ABSTRACT: In the United States, hospitals must meet eligibility criteria to receive federal funding. Regulatory bodies, such as the Joint Commission, are approved by the government to give, or withhold, accreditation to hospitals. This accreditation is a requisite to continue receiving funding. Hospitals are frequently cited for items such as inadequate wearing of boot covers or covering of facial hair in the operating rooms. There are very little, if any, data to support an improvement in patient safety when these items are complied with. There is, however, a large amount of data showing the negative consequences for patient safety when providers are burned out. We therefore propose that regulatory agencies such as the Joint Commission require that hospital systems measure burnout and reduce concerning levels of burnout in their employees to continue receiving certification. We briefly review evidence-based methods that hospital systems might consider to accomplish this goal.
Assuntos
Esgotamento Psicológico/epidemiologia , Centers for Medicare and Medicaid Services, U.S./normas , Humanos , Pacientes , Estados UnidosAssuntos
Especialidades Cirúrgicas/tendências , Telemedicina/tendências , Centers for Medicare and Medicaid Services, U.S./economia , Centers for Medicare and Medicaid Services, U.S./normas , Humanos , Preferência do Paciente , Segurança do Paciente , Mecanismo de Reembolso/normas , Especialidades Cirúrgicas/economia , Especialidades Cirúrgicas/métodos , Especialidades Cirúrgicas/organização & administração , Telemedicina/economia , Telemedicina/organização & administração , Estados UnidosRESUMO
National and international nephrology organizations have identified substantial unmet supportive care needs of patients with kidney disease and issued recommendations. In the United States, the most recent comprehensive effort to change kidney care, the Advancing American Kidney Health Initiative, does not explicitly address supportive care needs, although it attempts to implement more patient-centered care. This Perspective from the leaders of the Coalition for Supportive Care of Kidney Patients advocates for urgent policy changes to improve patient-centered care and the quality of life of seriously ill patients with kidney disease. It argues for the provision of supportive care by an interdisciplinary team led by nephrology clinicians to improve shared decision-making, advance care planning, pain and symptom management, the explicit offering of active medical management without dialysis as an option for patients who may not benefit from dialysis, and the removal by the Centers for Medicare & Medicaid Services and all other payors of financial and regulatory disincentives to quality supportive care, including hospice, for patients with or approaching kidney failure. It also emphasizes that all educational and accreditation programs for nephrology clinicians include kidney supportive care and its essential role in the care of patients with kidney disease.
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Centers for Medicare and Medicaid Services, U.S./normas , Nefropatias/terapia , Cuidados Paliativos/normas , Assistência Centrada no Paciente/normas , Política Pública , Índice de Gravidade de Doença , Tomada de Decisão Compartilhada , Humanos , Nefropatias/epidemiologia , Cuidados Paliativos/métodos , Assistência Centrada no Paciente/métodos , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Patients in inpatient psychiatry settings are uniquely vulnerable to harm. As sources of harm, research and policy efforts have specifically focused on minimizing and eliminating restraint and seclusion. The Centers for Medicare and Medicaid's Inpatient Psychiatric Facility Quality Reporting (IPFQR) program attempts to systematically measure and reduce restraint and seclusion. We evaluated facilities' response to the IPFQR program and differences by ownership, hypothesizing that facilities reporting these measures for the first time will show a greater reduction and that ownership will moderate this effect. METHODS: Using a difference-in-differences design and exploiting variation among facilities that previously reported on these measures to The Joint Commission, we examined the effect of the IPFQR public reporting program on the use and duration of restraint and seclusion from the end of 2012 through 2017. RESULTS: There were a total of 9705 observations of facilities among 1841 unique facilities. Results suggest the IPFQR program reduced duration of restraint by 48.96% [95% confidence interval (95% CI), 16.69%-68.73%] and seclusion by 53.54% (95% CI, 19.71%-73.12%). There was no change in odds of zero restraint and, among for-profits only, a decrease of 36.89% (95% CI, 9.32%-56.07%) in the odds of zero seclusion. CONCLUSIONS: This is the first examination of the effect of the IPFQR program on restraint and seclusion, suggesting the program was successful in reducing their use. We did not find support for ownership moderating this effect. Additional research is needed to understand mechanisms of response and the impact of the program on nontargeted aspects of quality.
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Centers for Medicare and Medicaid Services, U.S./normas , Transtornos Mentais , Isolamento de Pacientes/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Restrição Física/estatística & dados numéricos , Humanos , Pacientes Internados , Propriedade , Registros Públicos de Dados de Cuidados de Saúde , Fatores de Tempo , Estados UnidosRESUMO
OBJECTIVE: The objective of this study was to examine variation in hospital responses to the Centers for Medicare and Medicaid's expansion of allowable secondary diagnoses in January 2011 and its association with financial penalties under the Hospital Readmission Reduction Program (HRRP). DATA SOURCES/STUDY SETTING: Medicare administrative claims for discharges between July 2008 and June 2011 (N=3102 hospitals). RESEARCH DESIGN: We examined hospital variation in response to the expansion of secondary diagnoses by describing changes in comorbidity coding before and after the policy change. We used random forest machine learning regression to examine hospital characteristics associated with coded severity. We then used a 2-part model to assess whether variation in coded severity was associated with readmission penalties. RESULTS: Changes in severity coding varied considerably across hospitals. Random forest models indicated that greater baseline levels of condition categories, case-mix index, and hospital size were associated with larger changes in condition categories. Hospital coding of an additional condition category was associated with a nonsignificant 3.8 percentage point increase in the probability for penalties under the HRRP (SE=2.2) and a nonsignificant 0.016 percentage point increase in penalty amount (SE=0.016). CONCLUSION: Changes in patient coded severity did not affect readmission penalties.
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Centers for Medicare and Medicaid Services, U.S./normas , Codificação Clínica/estatística & dados numéricos , Aprendizado de Máquina , Readmissão do Paciente/estatística & dados numéricos , Grupos Diagnósticos Relacionados , Número de Leitos em Hospital/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros , Medicare/estatística & dados numéricos , Readmissão do Paciente/economia , Políticas , Índice de Gravidade de Doença , Estados UnidosRESUMO
BACKGROUND: Centers for Medicare and Medicaid Services (CMS) has proposed a rule change to redefine the metric by which organ procurement organizations (OPOs) are evaluated. The metric relies on Centers for Disease Control and Prevention (CDC) data on inpatient deaths from causes consistent with donation among patients <75 years of age. Concerns have been raised that this metric does not account for rates of ventilation, and prevalence of cancer and severe sepsis, without objective data to substantiate or refute such concerns. METHODS: We estimated OPO-level donation rates using CDC data, and used Agency for Healthcare Research and Quality/Healthcare Cost and Utilization Project data from 43 State Inpatient Databases to calculate "adjusted" donation rates. RESULTS: The CMS metric and the ventilation-adjusted CMS metric were highly concordant in absolute terms (Spearman and Pearson correlation coefficients ≥0.95). In the Bland-Altman plot, 100% (48/48) of paired values (standard deviations [SDs] of the CMS and "ventilation adjusted" metrics) were within 1.96 SDs of the mean difference, with near-perfect correlation in Passing and Bablok regression (Lin's concordance correlation coefficient: 0.97). The CMS metric and the ventilation/cancer/sepsis-adjusted metric were highly concordant in absolute terms (Spearman and Pearson correlation coefficients ≥0.94). In the Bland-Altman plot, 97.9% (47/48) of paired values (SDs of the CMS and "ventilation/cancer/sepsis adjusted" metrics) were within 1.96 SDs of the mean difference, with near-perfect correlation in the Passing and Bablok regression (Lin's concordance correlation coefficient: 0.97). CONCLUSIONS: These conclusions should provide CMS, and the transplant community, with comfort that the proposed CMS metric using CDC inpatient death data as a tool to compare OPO is not compromised by its lack of inclusion of ventilation or other comorbidity data.
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Benchmarking/normas , Centers for Medicare and Medicaid Services, U.S./normas , Transplante de Rim/normas , Insuficiência Renal Crônica/terapia , Obtenção de Tecidos e Órgãos/organização & administração , Fatores Etários , Idoso , Benchmarking/métodos , Causas de Morte , Comorbidade , Mortalidade Hospitalar , Humanos , Neoplasias/epidemiologia , Neoplasias/terapia , Insuficiência Renal Crônica/mortalidade , Respiração Artificial/estatística & dados numéricos , Sepse/diagnóstico , Sepse/epidemiologia , Sepse/terapia , Índice de Gravidade de Doença , Obtenção de Tecidos e Órgãos/normas , Estados Unidos/epidemiologiaAssuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Cirurgia Plástica/organização & administração , Telemedicina/organização & administração , COVID-19 , Centers for Medicare and Medicaid Services, U.S./normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Procedimentos Cirúrgicos Eletivos/normas , Humanos , Colaboração Intersetorial , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Procedimentos de Cirurgia Plástica/normas , SARS-CoV-2 , Cirurgia Plástica/normas , Estados UnidosRESUMO
In the 2020 Final Rule, the Center for Medicare & Medicaid Services adopted a new coding structure and accepted the substantial increase in valuation for office/outpatient Evaluation and Management codes set to begin in 2021. Given budget neutrality requirements, the projected increase in reimbursement will require a reduction in the conversion factor to offset such increases. The aim is to inform neuroradiologists the impact of these proposed changes on reimbursement and the profession.
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Centers for Medicare and Medicaid Services, U.S./normas , Codificação Clínica/normas , Reembolso de Seguro de Saúde/normas , Medicare/normas , Humanos , Pacientes Ambulatoriais , Radiologistas , Estados UnidosAssuntos
Antibacterianos/uso terapêutico , Pacotes de Assistência ao Paciente/normas , Sepse/terapia , Antibacterianos/administração & dosagem , Gestão de Antimicrobianos/normas , Centers for Medicare and Medicaid Services, U.S./normas , Humanos , Guias de Prática Clínica como Assunto , Sepse/tratamento farmacológico , Choque Séptico/terapia , Fatores de Tempo , Tempo para o Tratamento , Estados UnidosRESUMO
Wound/ulcer management scientists, researchers, manufacturers, professionals, and providers cannot assume that clearance or approval by the Food and Drug Administration (FDA) will guarantee reimbursement for medical devices they develop or wish to use in their practices. Even if a relative code and a published payment rate for the code exist, if the payers do not provide coverage for the technology, the devices may not be able to be sold and used in all settings throughout the continuum of care. Unfortunately, reimbursement (particularly coverage) is often an after-thought once FDA clearance or approval is achieved. This article describes two new Medicare coverage processes that should encourage all stakeholders to educate payers early and often why important medical devices should be covered for their patients with wounds/ulcers.
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Centers for Medicare and Medicaid Services, U.S./economia , Aprovação de Equipamentos , Medicare/economia , United States Food and Drug Administration/economia , Centers for Medicare and Medicaid Services, U.S./normas , Humanos , Marketing de Serviços de Saúde , Medicare/normas , Sistema de Pagamento Prospectivo/normas , Mecanismo de Reembolso , Avaliação da Tecnologia Biomédica/economia , Estados UnidosAssuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Dermatologia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/normas , COVID-19 , Centers for Medicare and Medicaid Services, U.S./legislação & jurisprudência , Centers for Medicare and Medicaid Services, U.S./normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Dermatologia/economia , Dermatologia/legislação & jurisprudência , Dermatologia/tendências , Health Insurance Portability and Accountability Act/legislação & jurisprudência , Health Insurance Portability and Accountability Act/normas , Humanos , Cobertura do Seguro/legislação & jurisprudência , Cobertura do Seguro/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Privacidade , Mecanismo de Reembolso , SARS-CoV-2 , Telemedicina/economia , Telemedicina/legislação & jurisprudência , Telemedicina/tendências , Estados Unidos/epidemiologiaRESUMO
Background and Purpose- Timely access to endovascular thrombectomy (EVT) centers is vital for best acute ischemic stroke outcomes. Methods- US stroke-treating centers were mapped utilizing geo-mapping and stratified into non-EVT or EVT if they reported ≥1 acute ischemic stroke thrombectomy code in 2017 to Center for Medicare and Medicaid Services. Direct EVT-access, defined as the population with the closest facility being an EVT-center, was calculated from validated trauma-models adapted for stroke. Current 15- and 30-minute access were described nationwide and at state-level with emphasis on 4 states (TX, NY, CA, IL). Two optimization models were utilized. Model-A used a greedy algorithm to capture the largest population with direct access when flipping 10% and 20% non-EVT to EVT-centers to maximize access. Model-B used bypassing methodology to directly transport patients to the nearest EVT centers if the drive-time difference from the geo-centroid to hospital was within 15 minutes from the geo-centroid to the closest non-EVT center. Results- Of 1941 stroke-centers, 713 (37%) were EVT. Approximately 61 million (19.8%) Americans have direct EVT access within 15 minutes while 95 million (30.9%) within 30 minutes. There were 65 (43%) EVT centers in TX with 22% of the population currently within 15-minute access. Flipping 10% hospitals with top population density improved access to 30.8%, while bypassing resulted in 45.5% having direct access to EVT centers. Similar results were found in NY (current, 20.9%; flipping, 34.7%; bypassing, 50.4%), CA (current, 25.5%; flipping, 37.3%; bypassing, 53.9%), and IL (current, 15.3%; flipping, 21.9%; bypassing, 34.6%). Nationwide, the current direct access within 15 minutes of 19.8% increased by 7.5% by flipping the top 10% non-EVT to EVT-capable in all states. Bypassing non-EVT centers by 15 minutes resulted in a 16.7% gain in coverage. Conclusions- EVT-access within 15 minutes is limited to less than one-fifth of the US population. Optimization methodologies that increase EVT centers or bypass non-EVT to the closest EVT center both showed enhanced access. Results varied by states based on the population size and density. However, bypass showed more potential for maximizing direct EVT-access. National and state efforts should focus on identifying gaps and tailoring solutions to improve EVT-access.