Wednesday, September 13, 2017
Consent is a tricky issue in healthcare. Every procedure performed by a healthcare professional requires consent. It can be obtained in three ways:
Informed Consent – the procedure is explained to the patient (in language they can comprehend), including any options and possible outcomes. The patient agrees or refuses. A signed form is sometimes obtained.
Implied Consent – the procedure is explained to the patient and they indicate with their body language that they consent (e.g., rolling up a sleeve for a blood draw or sticking out a tongue for a strep culture).
Assumed/Presumed Consent – the patient is unconscious, but it is assumed that they would want life-saving measures taken as needed. Once the patient becomes conscience, informed consent is obtained.
The distinction between these consent lines is sometimes blurred, but for liability purposes, healthcare professionals should obtain informed consent on any invasive procedure. Using language the patient understand is crucial – we don’t want patient’s agreeing to something simply because we suggest it – that is considered paternalism and prevents the ability of a patient to make an informed choice. A culture of patient autonomy depends on providing as much information to the patient as possible and allowing them to make an educated choice.
Enter the situation in Salt Lake City. A nurse was recently arrested for refusing to draw blood from an unconscious patient. The patient could not give informed consent, was not under arrest (which causes an individual to lose certain rights), and the blood draw was not for medical purposes. The police officer forcibly removed the nurse from the hospital in handcuffs. She was later released and not charged. The police officer was put on administrative leave and the incident gained national attention. As a result, the hospital created a new policy – all police officers must stay out of clinical areas and must go through a liaison versed in health law and ethics. There is also an ongoing federal investigation.
What can we learn from this incident?
1. Healthcare administrators need to make sure that healthcare professionals understand patient rights, including consent.
2. Hospitals and HCO’s need to have clear policy for outside authority – including police, firefighters, federal agents, etc.
3. A clear chain of command needs to be in place to avoid situations from escalating to violence in a healthcare setting.
Obviously, it is easy to look at this situation and list all the problems. It would be better to use this issue as a teachable moment. Here we have a healthcare professional ready to defend patient rights to the end. That is an amazing culture for a HCO to have developed. Follow up is needed to ensure the support for that healthcare professional exists beyond just her own integrity.
The story: https://www.theguardian.com/us-news/2017/sep/01/utah-nurse-arrested-for-refusing-to-draw-blood-from-unconscious-patient
Valerie Connor, MA CCC-SLP; MS CHES
Thursday, August 31, 2017
The Master of Health Administration Program at Saint Joseph’s College has adopted a modified version of the Healthcare Leadership Alliance Competency Model as the basis for the program. Students completing the program are expected to have achieved at least intermediate mastery of each competence noted below.
Communication & Relationship Management
Utilize effective Interpersonal Communication
Exhibit Effective Writing Skills
Demonstrate Effective Presentation Skills
Effectively Lead and Manage Others
Manage Change Effectively
Able to Honestly Assess Self
Demonstrate Systems Thinking
Effectively Solve Problems and Make Decisions
Exhibit Personal and Professional Ethics
Contribute Profession and in Community
Work Effectively in Teams
Knowledge of the Healthcare Environment
Explain Health Care Issues and Trends
Analyze Population Health and Status Assessments
Explain Health Policy
Apply Health Care Legal Principles
Business and Analytical Skills
Manage Healthcare Finance
Effectively Manage Human Resources
Explain Organizational Dynamics and Governance
Apply Strategic Planning
Utilize Effective Marketing Principles
Understand and Effectively Manage Information and Use Technical Skills
Employ Quality Improvement/Performance Improvement Strategies
Demonstrate Quantitative Skills
Planning and Manage Projects
Analyze and Apply Economic Principles
Adopted July 2017
Tuesday, August 15, 2017
Throughout all our lives, there comes a defining moment where we must decide what our calling in life is. Those in the healthcare industry generally aim to serve those in need. Why is this? I like to think every one of us desires to serve some greater good. From an anthropological standpoint, humans have had somewhat of a natural inclination to help those in need. Regardless of our ethical and moral views, we as humans take care of someone in our lives. This can be our parents, children, friends, or from a healthcare setting, patients.
While taking the Leadership in Healthcare Administration course, we were required to listen to a podcast for one of our assignments. The title of the podcast was, "Erie Chapman - Bettering Healthcare with a Servants Heart." As I began to listen to the podcast, I was struck with somewhat of an epiphany. All of us in healthcare are servants. No matter what job title you obtain, you are a leader and servant to someone in need.
Knowing we are leaders and servants is a humbling, but exciting thing. As a future leader in healthcare administration, I always want to have the reason for my hope held tight to me. Our calling in life is ultimately serve daily for the betterment of others in need. THIS is why we work in a healthcare industry. If it is not, then maybe we should have some self reflection.
How is servant leadership effective? This question strikes and provokes my mind very often. Servant leadership reminds us daily of why we are involved in healthcare. It reminds the nurse every day of why she cares for the sick and dying. It reminds the surgeon of why he saves a dying child's life. It reminds the hospital manager of why he makes sure patients and caregivers are taken care of, and lastly, it reminds me of why I chose Saint Joseph's for graduate school.
Written by Cameron Davis, Graduate student at Saint Joseph's College
Monday, July 24, 2017
Healthcare is a highly regulated and in some cases, a highly competitive environment. Healthcare delivery is changing at a rapid pace. Healthcare leaders are learning how to adapt and lead their hospitals into the future. The center for Medicare services over the last few years adapted the Hospital Consumer Assessment of Healthcare Providers and Systems; better known as HCAPHS patient satisfaction scores to tie patient satisfaction in the calculation of reimbursement for patient stays (CMS, 2015).
Hospitals in competitive environments focus on how to deliver care and stand out from the competition. Additionally, social media has changed how patients share their healthcare experiences. Patients can praise or complain about their hospital experiences on Facebook, Twitter, Instagram and the like.
Leaders are in a great position to help staff understand the importance of patient experience to an organization, whether it be to improve overall scores or patient perception. Quality care is increasingly linked to efficiency, cost reduction and optimal utilization of resources. Healthcare quality care programs and metrics are increasingly influenced by financial incentives and measured by state of the art scientific tools and sophisticated methodologies. (Belasen, Eisenberg & Huppertz, 2016 p 144)
Patients and families view their experience of care in its entirety: The clinical treatment, the interactions with staff, and the physical and ambient environment all tie together as one, overall impression and journey. Leaders and caregivers who commit to observing and learning in detail about this journey quickly identify what needs to improve to create a better experience. (IHI, 2011)
How can you as a leader showcase the importance of patient experience in your workplace? Interpersonal relationships can go a long way to helping organizations improve scores. Effective leaders practice with conviction, and demonstrate the importance of the caregiver/patient relationship.
An important leadership quality is social intelligence. “Socially intelligent leaders have strong conversation and listening skills, a keen understanding of social roles and rules, confidence in interacting with different types of people and a fine-tuned ability to understand other’s thoughts and feelings.” (Sowick et al, 2015) One of my favorite quotes is from Maya Angelou “I have learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” This statement holds true not only to the patient’s we serve but also how we as leaders serve our teams.
Leaders of today must use both transactional leadership skills and transformational leadership skills to be an effective leader in today’s workplace. Being the vison setter to bring new ideas forward, to have the courage to lead by example and advocate for employees and patients will go a long way toward improving not only the patient but staff experience.
Balik, B. (2011, July). Institute for Healthcare improvement, Patient Safety Reprinted from ACHE.org
Belasen, A. T., Eisenberg, B, Huppertz, J. W., (2016). Mastering Leadership: A Vital Resource for Health Care Organizations, pgs.
Sowick, M, Andenoro, A, McNutt, M, Murphy, S.E (2015) Leadership 2050: Critical Challenges, Key Contexts, and Emerging Trends; Emerald Group
Provided by Robyn McDevitt, Graduate Student, Saint Joseph's College
Tuesday, July 18, 2017
Lately, I pondered the question of “….how would the retiring Boomer Long-Term Post-Acute Care (LTPAC) leaders be replaced….?" With the average age of administrator’s being in their 50’s, this is a real challenge for licensure boards, employers and educators. Public policy makers will need to find some solutions to this complex problem.
I had the opportunity to work with a number of students who are majoring in healthcare administration and are going out on a one-year practicum. I found them to be a delight to teach, but also to learn from. They are bright, focused, passionate about the LTPAC sector and were excited to learn about the profession.
It was enlightening and heartening to interact with this group, as they progressed in their studies. They asked great questions, researched many of the challenges facing our sector, and suggested innovative methods to approach some of the difficult issues facing the LTPAC sector.
What has been encouraging to me was that the students were from the millennial generation and very interested in an aging services career! There have been some articles and suggestions about the characteristics of this coming generation that were considered to be negative, when compared to Boomers. I did not find the “generalities” about millennials that have been suggested to be true nor accurate. They were serious with their studies, willing to learn, and excited about working in the sector.
It gave me considerable comfort that these students will make great leaders in the LTPAC sector. Now the question is how do we find more of the millennials that will be willing to prepare to learn and enter this profession?
Submitted by Steven Chies, Faculty at Saint Joseph's College
Friday, July 07, 2017
The Medicare Outpatient Observation Notice (MOON) came out earlier this year and this is something that always comes up as a question and not many know where to find the answers.
Medicare put out a MLN article in February for Critical Access Hospitals (CAHs) that provide observation services to Medicare Beneficiaries. The main point of this article was to identify and drive home a clear and concise message covering how providers in CAH facilities should utilize the MOON to educate Medicare beneficiaries. CAH providers should use the MOON to inform any Medicare beneficiary who is an outpatient in their facility that happens to be receiving observation services and are not an inpatient in the CAH or hospital.
Hospitals and CAHs must provide the MOON to beneficiaries who receive observation services in a CAH or hospital for more than 24 hours. This form must be provided to the Medicare beneficiary no later than 36 hours after observation services begin in the outpatient setting. Now, this is not only for the traditional Medicare Part A and Part B patient, but those beneficiaries that do not have Part B coverage, as this is optional, and when a patient is admitted prior to the required delivery of the MOON.
Now, one may think, let’s give these to all of our Medicare patients receiving outpatient services. This will not work as the MOON should not go to all beneficiaries receiving outpatient services. It is intended only for patients that exceed 24 hours of observation services. But here is a good twist, the CAH or hospital can deliver the MOON to Medicare beneficiaries that are receiving observation services in a CAH or hospital, but have not exceeded the 24 hour rule. As long as they are receiving observation services the CAH or hospital can deliver the MOON to the patient, but no later than 36 hours after observation services have started.
Some other points:
- The MOON must remain two pages
- Additional information may be attached, per individual state regulations
- Hospitals and CAHs can put their logo on the top of the MOON
- In completing the MOON, hospitals or CAHs must type or write (clearly) the patient name, patient number, and reason for outpatient in the blanks of the MOON.
- CAHs and hospitals must provide, not only the written MOON, but an oral notification as well. This must consist of an explanation of the standard written MOON.
- To show proof of delivery, the patient or representative must sign and date the MOON to show delivery and understanding of the information contained in the form.
- An electronic form of the MOON is permitted with an electronic signature capture pad.
- With an electronic form of the MOON, the patient must receive a paper copy as well.
Submitted by Kevin Harrington, MS, RHIA, CHP, Faculty, Saint Joseph's College
Wednesday, June 07, 2017
Alternative Payment Models (APMs) is an approach that was developed in partnership with the clinician community and it provides added incentives for clinicians to provide high-quality and cost-effective care. The APM can apply to a specific condition or a specific episode of care, or a population. APMs can offer significant opportunities to eligible clinicians who are not ready to take on the additional risk and requirements of Advanced APMs.
Advanced Alternative Payment Models (Advanced APMs) enable clinicians and practices to earn greater rewards for taking on some risk related to the patients that they serve and their associated outcomes. It is important to mention that the Quality Payment Program does not change the design of any particular APM, however, it can create extra incentives for an ample degree of participation in Advanced APMs. There are six models for APMs and they are Comprehensive End Stage Renal Disease Care Model, Comprehensive Primary Care Plus (CPC+), Shared Savings Program Track 2, Shared Savings Program Track 3, Next Generation ACO Model, and the Oncology Care Model. The listing of Advanced APMs are posted on the CMS website at QPP.CMS.GOV and will be updated as needed.
To help identify future opportunities, MACRA established the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to review and assess Physician-Focused Payment Models based on proposals submitted by stakeholders to the committee. In future performance years, we anticipate that the following models will be Advanced APMs such as Comprehensive Care Joint Replacement Payment Model, Advancing Care Coordination through Episode Payment Models Track 1, ACO Track 1+, New Voluntary Bundled Payment Model, and the Vermont Medicare ACO Initiative.
Submitted by Kevin Harrington, MHSA, RHIA, CHIP, Full-Time Faculty Member at Saint Joseph's College
Thursday, May 18, 2017
When the Affordable Care Act was passed in 2010, it was met with two completely different reactions. Some viewed it as a mandate, while others viewed it as a right. In a sense, the law mandated that all United States citizens carry health insurance while also propagating that all United States citizens have a right to affordable access to health care. Not everyone agrees with either of these proponents, which has made for interesting conversations over the past year. One of those conversations focuses on patient rights – specifically how much we deserve.
If you have not read the Immortal Life of Henrietta Lacks, I highly suggest that you do so. Or, if you prefer to watch TV, you can watch the TV version that was just released. Either way, it is a very interesting story. Henrietta passed away from cancer, but before she died, a sample of her cancer cells were used to create the HeLa chain – a chain of cells that proved to be very helpful to scientists. These scientists eventually benefitted financially from their research (involving Henrietta’s cells), but neither Henrietta nor her living relatives received any compensation for the cells or research finds.
Is this unusual? Not really. Henrietta’s cells were unusual, yes, and very helpful to scientists, but we do not usually benefit from body parts that are donated in our country. The law states that once a blood or tissue sample taken from a patient leaves the room that the patient occupies, it becomes property of the healthcare facility. The healthcare facility is then free to use it for purposes beyond the tests that have been ordered. In Henrietta’s case, the cells were found to be very helpful to scientists. But, without the scientist’s expertise, the cells would have simply sat in a petri dish or been discarded.
Some may argue that Henrietta did not consent for her cells to be used for research. The law is also clear on that issue – patients have the right to consent to or refuse research. However, the research was conducted after Henrietta’s cells were removed from her presence. It’s actually quite remarkable that her family members learned about the research – most of us never know what happens to that blood or tissue sample after we rececive our test results.
It really boils down to “what do we deserve”? Should Henrietta’s family be compensated for the use of her cells? Or should the compensation stay with the scientists who used their knowledge to further research surrounding cancer and cancer treatments? A lawsuit will be looking at that issue later this year. If the courts rule in favor of Henrietta’s family, we might be looking at another dynamic change in our country.
For more information:
Submitted by Valerie Connor, M.A., CCC-SLP, Adjunct Faculty at Saint Joseph's College.
Friday, April 28, 2017
When June became aware her growing impatience with her staff was a result from trying to solve a problem that was not a problem to solve but a polarity to leverage, her capacity to be an effective leader increased.
Healthcare leaders are master problem solvers. There are many situations and issues that daily require problem solving skills and decision making. For example, do we need a policy for xyz? Who should we have complete the survey? And, Should Mary be promoted to nurse manager? Problems to solve have end points. They are not ongoing. They have mutually exclusive opposites. Problems to solve require Or thinking.
Polarities require Both/And thinking. Both sides of the polarity are important. There is a natural tension in polarities and the oscillation between both sides is ongoing. Other realities about polarities include:
· Polarities are inherently unsolvable in that you cannot choose one pole of the pair as a “solution” to the neglect of the other pole and be successful over time.
· If you treat a polarity as if it were a problem to solve, the natural tension between the poles becomes a negative, self-re-enforcing loop or “vicious cycle” leading to unnecessary dysfunction, pain and suffering.
· If you can see a polarity within an issue, you can leverage the natural tension between the poles so it becomes a positive, self-re-enforcing loop or “virtuous cycle” lifting you and your organization to goals unattainable with OR thinking alone.
· The natural tension within all polarities is often experienced as resistance. Polarity thinking helps us leverage the wisdom within this resistance. It helps us convert resistance to change into a resource for stability AND change.
· Polarity thinking helps us see ourselves and our world more completely thus increasing our capacity to love.
Dr. Barry Johnson www.polaritypartnerships.com
In addition to Task AND Relationship, other common leadership polarities include: Stability AND Change, Candor AND Diplomacy, Directive AND Participative, Collaborate AND Compete, and Conditional Respect AND Unconditional Respect.
What can we do when we experience the tensions and dilemmas of polarities? Dr. Barry Johnson created the Polarity Map™ and his team at Polarity Partnerships created the 5 Step S.M.A.L.L process to help leaders leverage polarities.
Seeing – Identify the tension and the two interdependent poles that when leveraged well will create a virtuous cycle toward a greater purpose.
Mapping – Determine the upsides (values) and downsides (fears) of both poles.
Assessing – Gather data to determine how well or how poorly we are leveraging the polarity.
Learning – Understand what we learn from the assessment.
Leveraging – Create action steps and early warning signs that provide us a path to navigate the energy of the polarity.
June’s map helped her organize the energy she was experiencing while feeling impatient with her staff and acknowledge the oscillation of energy needed in the polarity of Task AND Relationship to help her reach her greater purpose of being an effective and inspiring leader.
Polarity Thinking – Dr. Barry Johnson www.polaritypartnerships.com
Blog post submitted by: Danine Casper, MHA, St. Joseph’s Adjunct Faculty Member HA 511 Leadership in Health Administration. Danine is also a Leadership Coach and Consultant. www.aponicoaching.com and is completing the Polarity Mastery Program to be a licensed polarity consultant.
Tuesday, April 18, 2017
Healthcare leaders work in complex and continuously changing environments. The challenges in this environment require new levels of leadership effectiveness. Leaders who capitalize on complexity have the capacity to supplement Either/Or problem solving skills with Both/And thinking.
June’s story illustrates developing leadership effectiveness using a polarity lens.
Feeling the pressure to meet performance improvement goals, June noticed herself becoming increasingly impatient with her staff. She asked for help to ensure her staff implemented her well-developed strategy and completed their tasks. Before discussing this, June agreed to explore her experience of being impatient and the impact it was having on her and the team.
During our conversation, June became aware that her impatience was connected to her need to control the outcome of the project in order to be recognized for the achievement and avoid the embarrassment of failure. This awareness shifted June’s perspective from wanting to control the outcome to ensuring she was being an effective leader. We discussed this dilemma and tension using the lens of Polarity Thinking.
Polarities are “An interdependent pair of values or alternative points of view that appear different and unrelated, competitive, or even opposite, but in reality need each other over time to reach outcomes neither can reach alone.” (Wesorick, 2016 p.6) Polarity Thinking supplements Either/Or problem solving with Both/And thinking.
June was experiencing a common leadership polarity: Task AND Relationship. Task and relationship each have a pole in the polarity and each have important values and benefits. However, when one pole of a polarity is overemphasized to the neglect of the other pole, over time, the result will be to experience a negative, defeating energy; a vicious energy system leading toward a deeper fear. June realized her impatience was due to her overemphasis on task to the neglect of relationships driven by her fear of failure and letting her team down.
When we find ourselves in the energy of the downside of the pole we have overemphasized, we have a natural tendency to course correct. June acknowledged when she notices herself becoming impatient it is a warning sign for her to evaluate how she is leveraging Task AND Relationships and adjust her energy accordingly.
As June recognized the impact her overemphasis on task was having on her team, she described what she and her team were missing out on by not leveraging the value of relationships. When they trust and support one another, they know their achievement far exceeds what any one of them could accomplish alone. When both Task and Relationship are leveraged a virtuous energy system is created that leads to the teams greater purpose of creating a thriving workplace.
At the end of our conversation June shared she was grateful for her new awareness that being an effective leader required her to have the knowledge and skills for the tasks to be accomplished AND self-awareness to recognize when there is a problem to solve or a polarity to leverage.
Part 2 of this blog will explore problems to solve and polarities to leverage along with a Polarity Map® and Five-Step S.M.A.L.L process for individuals and teams to leverage polarities.
Wesorick, B. (2016) Polarity Thinking in Healthcare: The Missing Logic to Achieve Transformation, Amherst, MA: HRD Press Inc.
Polarity Thinking – Dr. Barry Johnson www.polaritypartnerships.com
Blog post submitted by: Danine Casper, MHA, St. Joseph’s Adjunct Faculty Member HA 511 Leadership in Health Administration. Danine is also a Leadership Coach and Consultant. www.aponicoaching.com
Thursday, April 13, 2017
For several decades, our society has known that Baby Boomers would re-define what it means to age. Some aspects of “conventional wisdom” are now being challenged. I’ve recently challenged some of my students in a gerontology class to think about their own retirement. Assuming they will retire at the age of 65, and their life expectancy will give them quite a few healthy years beyond that, what would they want to do? Asking this question of people in their 20’s and 30’s can yield interesting results.
In Long Term Care, we’re developing an appreciation that quality of life is just as important as quality of care. What makes life meaningful and purposeful? Upon admission, we ask residents about their past hobbies and interests in order to support those areas. Often, though, I’ve heard people mention an area of interest that they haven’t pursued. “I’ve always wanted to take up painting, photography, music, reading for pleasure, etc., but between work and raising a family, I’ve haven’t had time.” The so-called golden years may be a time to take up a new hobby, too. We’re dispelling the idea that seniors can’t learn new things.
Elderhostel is a well-known program of designing classes for seniors. Teaching methods may differ somewhat from classes designed for “typical” college students, and the topics may not be commonly taught on college campuses.
Gerontological research is now showing that the abilities to think, learn, create, and innovate do not necessarily diminish with aging. People are often required to use these skills during their careers and child-rearing years. Upon retirement, the demand to use such skills may diminish, but the cognitive ability does not. Certain disease processes, such as dementia, may impact these skills, but aging itself does not. How can a senior use and sharpen such abilities?
First, the effort must be intentional. Pursue a new area of interest. Take classes through your adult education program or online (such as a course from Saint Joseph’s College!). Persist in learning a new skill, even if you aren’t proficient at first. The repetition of learning something new and practicing that skill can help to develop new neural pathways in the brain.
Secondly, hone your problem-solving skills. Mathematical puzzles such as Sudoku, and language puzzles such as crosswords, can train new neural pathways while also accessing previously known knowledge. I enjoy trying to figure out a mystery “whodunit.”
Third, view your personal history as an asset. By participating in classes with students from other generations, for example, you can lend your voice of expertise while also learning the new perspectives of others. I always enjoy teaching a multi-generational class where a variety of ideas can be shared. I’ve taken classes with students who were much older than myself, and I’ve admired them and the experiences they have shared. This may be the time to write your memoirs, make a quilt related to your family, or record stories about your family’s history, which will serve to benefit future generations.
Fourth, view your history in new ways. Gerontologist Harvey Lehman conducted a study of creativity in aging. He found that many of the most renowned sculptures in the art world were crafted by older artists. They used their life experience artistically in their work. If you create art, dance, music, etc., does the art you create at an older age take on a different, more mature meaning than it did at a younger age? The question may, or may not, be your skill level, but more importantly, the perspective presented by a more mature artist. Reclaim a long-forgotten hobby and compare your work of today with your work from decades ago.
Fifth, consider spending time in charitable work. Many seniors are taking time for short-term mission trips where they can use their skills for the benefit of others. Other cultures need your expertise in medical care, teaching, agriculture, and developing businesses, for example. Even if you can’t afford to travel to exotic locations, there are areas in the United States that need you, and there are growing opportunities for using these skills online. Many people express that they intended to bless others through their charitable work, but they received blessings as well.
Sixth, even if your senior years are compromised by health issues, find a way to give to others. In my work as a nursing home administrator, I found that depression and discouragement can be improved by focusing on the needs of others, not ourselves. Can you write letters to soldiers, knit mittens for underprivileged children, tutor children in reading, send care packages to college students, or record your own books for the blind? One of our most fun annual events was Bowl for Kids’ Sake, a bowling tournament to raise money for the Big Brothers/Big Sisters organization. While the organization’s bowling tournament occurred at a bowling alley on a Saturday, our event was held on Friday on Wii. The organization brought our residents t-shirts, snacks, and prizes. One year the top fundraiser for the entire community was a nursing home resident! An important part of having purpose is the ability to give to others, to be a provider and not just a recipient.
Don’t let your assumptions define how you’ll spend your senior years. After all, this isn’t your grandmother’s retirement!
Submitted by Philip C. DuBois, CNHA, FACHCA, Program Manager, Long Term Care Administration, Saint Joseph's College
Thursday, March 30, 2017
I picked up a copy of Haider Warraich’s book Modern Death as soon as I saw it advertised. This is a topic that I find fascinating and Mr. Warraich’s book was billed as the “follow-up” to Atul Gawande’s Being Mortal, so I didn’t think twice about the impulse purchase. While reading the first few chapters, I was a little disappointed. Mr. Warraich wasn’t presenting anything that I hadn’t already read or taught about as a professor of health law and ethics. I didn’t make my first earmark until page 91, but shortly after had to be careful not to earmark every other page. I quickly decided that Mr. Warraich had written a text that should be read by everyone – not just people fascinated with the legal and ethical issues surrounding end of life.
Modern Death begins with an overview of issues surrounding death, including the legal definition of “death” and methods of sustaining life. Landmark cases are explained and a detailed history of the development of CPR is included. After building a firm foundation, Mr. Warraich delves into the issues he sees most often as a physician. That first earmark on page 91? It was for this quote: “The reason people increasingly don’t want CPR is not that they are afraid it will fail but that they are afraid it will only partially work. Patients are afraid that if CPR makes their heart start beating again their brain will have to pay a huge cost.” In a society that values independence and self-reliance, this is so very true. Most people would rather not continuing living if they have to live in a vegetative or severally impaired condition. What is life in today’s world if you cannot continue to do the daily activities that you love?
After an excellent ethical analysis of death and resuscitation efforts, Mr. Warraich considers deeply the role of religion in the dying process. He states: “Physicians very frequently find themselves in difficult situations with patients who have a strong faith, but rarely do they talk about religion and spirituality.” One study estimates that only 10% of physicians broach this difficult but important subject. This number is extremely low considering a study of cancer patients showing that patients provided with “spiritual care had a better quality of life prior to their deaths, were more likely to pass in hospice, and were less likely to receive aggressive and unnecessary care close to death” when compared to patients not provided spiritual intervention.
Modern Death also examines the role of physicians assisting care-givers and surrogate decision makers. He proffers that physicians are usually at the center of the decision-making process and they are often required to buffer the various opinions of family members and caregivers. In addition, he states that the burden placed on surrogate decision makers (aka health care proxies) is seriously overlooked.
The topics of euthanasia and physician assisted suicide are also touched on in Modern Death. Mr. Warraich offers his own personal perspective and thoughts regarding this controversial topic. He provides a unique perspective regarding the shift in opinion over centuries, not just decades.
I have added this book to my list of texts that every healthcare professional should consider reading. Additionally, I will be giving it to my parents. Per Mr. Warraich’s suggestion, I will instigate the talk that everyone avoids, but everyone should have before it is too late and we simply have to guess.
Submitted by Valerie J Connor, MA CCC-SLP; MS CHES
Thursday, March 23, 2017
Merit-based Incentive Payment System (MIPS) rewards exceptional performers by giving them a positive adjustment in their payment from Medicare. If the practice is a low performer then they will receive a lower payment, or a penalty. For exceptional performance a practice can receive additional payments from 4% in 2019 to 9% in 2022 and forward. For a poor performing practice they can be penalized anywhere from 4% in 2019 to 9% in 2022 and forward. Each practice can choose how much they wish to participate. They can go from a “Test Pace” where they submit some data after January 1, 2017 and receive a neutral adjustment to a small pay adjustment. They can choose a “Partial Year” option where they can report for a 90 day period after January 1, 2017 and before October 2, 2017 and they can receive a small positive payment adjustment.
Keep in mind that whenever a practice chooses to start, they will need to send in their performance data by March 31, 2018. Lastly, they can choose a “Full Year” option where they can fully participate starting January 1, 2017 and receive a modest positive payment adjustment. The best way for a practice to realize the positive impact from the Full Participation option is to submit data on all the MIPS performance categories.
Now to avoid any downward payment adjustment a practice can submit a minimum amount of data in 2017 to Medicare that can be one quality measure or one improvement activity, and they can avoid any downward payment adjustment. A key factor for positive adjustments is that these are based on the performance data on the performance information submitted, and not the total amount of information submitted or the length of time that the practice is reporting on during the year.
The Bonus Payments and Reporting Periods are as follows. To receive the MIPS payment adjustment it will be based on the data submitted.
The best way to get the most out of the program is to participate for a full year. This type of participation gives the practice the most measures to pick from. CMS is encouraging clinicians to pick the option that best fits their practice needs and abilities. The categories are Quality, Cost, Improvement Activities, and Advancing Care Information. The default weights for each category are Quality (60%), Cost (0%), Improvement Activities (15%), and Advancing Information (25%). These default weights can be adjusted in certain circumstances. Quality has approximately 300 different quality measures and the practice needs only to select about 6. For Advancing Care Information there are 2 measure sets for EHR.
The nice thing here is that if a clinician faces a significant hardship and are unable to report on the Advancing Care Information measures, they can apply to have their performance category reduced to a weight of 0%. If this category is not applicable to the clinician, then the 25% weight will be added to a different category.
Submitted by Michael "Kevin" Harrington, MSHA, RHIA, CHP, Faculty, Saint Joseph's College
Wednesday, March 08, 2017
Many physicians and their staff ask what a Quality Payment Program is and who can or should participate. Currently the Centers for Medicare and Medicaid Services (CMS) is looking to move to a more beneficial Quality Payment Program (QPP), but knowing the past would be helpful. Way back physicians were reimbursed in a Fee-for-Service (FFS) model where it was volume, not quality that drove the payment. As this payment model was slowly getting out of hand, Congress passed temporary fixes called “doc fixes” to avoid cuts in reimbursement. If they did not do this it would have resulted in a 21% cut in Medicare payments to clinicians.
In comes a great idea, a Quality Payment Program (QPP) that can help to reform Medicare Part B payments for more than 600,000 clinicians across the country. This is a huge step in the direction of improving care and controlling costs across an entire healthcare delivery system. There are two tracks that a clinician can choose from which are Advanced Alternative Payment Models (APMs) that require the clinician to participate in an innovative payment model.
The second option is the Merit-based Incentive Payment System (MIPS) which works with clinicians that choose to remain in a more traditional Medicare payment model and possibly earn a performance-based payment adjustment.
Now the question is who can participate? The Quality Payment Program is available to all Medicare Part B clinicians billing more than $30,000 a year to Medicare and providing care for more than 100 Medicare patients per year. The clinicians include Physicians, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists.
Those clinicians who are excluded from the QPP are ones that enroll in Medicare for the first time during a performance period as they are exempt from reporting on any measures and activities for MIPS until the next performance year. Also, clinicians that are below the low-volume threshold of $30,000 per year in billing to Medicare or they see less than 100 Medicare patients per year. In addition, clinicians significantly participating in Advance Payment Models (APMs) are excluded.
Overall, this program is designed for small practices to be able to successfully participate in the Quality Payment Program by reducing the time and cost to participate, allowing the small practices to “Pick Your Pace,” increasing the opportunities to participate in an APM, including a practice-based option for participation in an Advanced APM as an alternative to total cost-based, and by conducting support and outreach to small practices through various programs such as Transforming Clinical Practice Initiative.
For the Rural and Health Professional Shortage Areas (HPSAs) they can have less than or equal to $30,000 in Medicare Part B allowed charges or less than or equal to 100 Medicare patients served. They only need to report on one high-weighted activity or two medium-weighted activities. These are all designed to have ease of access to the program, regardless of the size of the practice or the location that they serve Medicare patients.
Written by Michael "Kevin" Harrington, MSHA, RHIA, CHP Faculty, Saint Joseph's College
Monday, February 27, 2017
Race, Ethnicity & Culture: Health Disparities and Outcome
As is widely recognized, today's older adult population is highly diverse, with one's ethnic minority status being an important source of this diversity. According to recent U.S. Census Bureau reports (2015), members of minority groups currently represent over one-third of the American population. Looking into the future, we can expect faster growth among elder ethnic minorities than among Caucasians. By 2042, the U.S. is poised to become a minority-majority nation.
Recent research findings by cultural anthropologists are enhancing our understanding of health and morbidity-related data among various groups (Lehman, 2011). While great variability is recognized, several common, recurring themes are noteworthy as follows:
- · For most elders of color, their resources and social status reflect discriminatory social, economic, and educational practices that were experienced in early life. They are often among those who have a history of being marginalized and under-served. e.g. elder immigrants with cultural and language barriers.
- · In general, most share the following socio-demographic characteristics: poverty, malnutrition, sub-standard housing, and poor health.
Exception: Japanese Americans & Chinese Americans, who have longer life expectancies.
- There are higher rates of mortality from the following diseases: diabetes, heart diseases, and cancer, as well as higher rates of functional disabilities.
In efforts to interpret the impact of these findings upon health disparities, researchers underscore the inter-relatedness of race, ethnicity, and culture (Hooyman & Kiyak, 2011). Historically, one's socio-economic status is directly linked to health and longevity. Accordingly, poor people of all ages and cultural origins are at greater risk of health problems and related disabilities.
Among the oldest-old (those age 85+), there is increased likelihood of multiple chronic health conditions occurring simultaneously. However, research indicates that the origins of long-term illness often begin in early childhood. Risk continues to be heightened throughout the life course by factors such as financial instability and educational disparities. In other words, economic and health conditions experienced early in life appear to have long-term adverse consequences for adult health (World Health Organization, 2014).
Under-Utilization of Health & Social Services
In general, ethnic minority members under-utilize health and social services. Among the primary contributing factors are: cultural and language difficulties, physical isolation, financial impoverishment, culture-based values and expectations, distrust, and structural barriers to service accessibility (Hooyman & Kiyak, 2011).
While the above findings paint a bleak picture of health disparities and hardships, we also need to acknowledge and celebrate the considerable strengths and resilience of some elders of color. This is especially true among the oldest-old, a finding of The New England Centenarian Study, as well as several cultural anthropological studies (Sokowsky, 2012).
Definition of "Culture:"
Learned or shared knowledge, beliefs, traditions, customs, rules, arts, history, folklore, and institutions of a group of people. These are then used to interpret experiences and to generate social behavior. (Sokowsky, 2012).
Definition of "Cultural Competence:"
The ability of providers and organizations to effectively deliver healthcare services that meet the social, cultural, and linguistic needs of patients. (Campinha-Bacote, 2012).
As minority groups within the older adult population increase in numbers throughout the U.S., the importance of cultural competence is becoming more evident. The need for cultural awareness, knowledge, skills, and considerations is pronounced. Key concepts include:
- · Language & Effective Communication
- · Trans-Cultural Education
- · Understanding specific cultural values, beliefs, practices
- · Self-Awareness & Consideration of healthcare provider bias / prejudice
- · Demonstrating respect & Fostering trust
- · Recognizing "folk medicine" & non-traditional health care practices.
Cultural Beliefs & Practices: Impact upon Health
It is now generally recognized that cultural beliefs and practices often influence an individual's health and behavior. This includes choices, utilization, and compliance. (McBride, 2015). As healthcare leaders, cultural competence must be a high priority for quality patient-centered care. All health institutions must make it known that the care they provide will respect cultural differences and that they will adapt services in order to effectively address patients' cultural needs.
It is critical that healthcare providers be educated on population-specific health related cultural values, beliefs, and behaviors (McBride, 2015). If all facilities provide education and support the basic tenets of developing cultural competencies among all practitioners, elders can be provided with consistent quality care.
Campinha-Bacote, J. (2012, May). The Process of Cultural Competence in the delivery of Health Care Services. Retrieved on February 25, 2017 from http://www.transculturalcare.net/Cultural_Competence_Model.htm.
Hooyman, N., & Kiyak, H. (2011). Social Gerontology: A Multidisciplinary Perspective (9th ed.). Boston: Allyn and Bacon.
Lehman, D. (March/April 2011). 21st Century Caregivers: Diversity in Culture. Aging Well. 2(2), 26-29.
McBride, M. (2015). EthnoGeriatrics and Cultural Competence for Nursing Practice. Hartford Institute for Geriatric Nursing. Retrieved on May 6, 2016 from http://consultgerirn.org/topics/ethnogeriatrics_and_cultural_competence_for_nursing_practice/want_to_know_more
Sokolovsky, J. (2012). The Cultural Context of Old Age (3rd ed.). Santa Barbara: Greenwood Press.
U.S. Census Bureau. Statistical Abstract of the United States (2014). (132nd ed.). Washington, D.C. Retrieved on January 6, 2017 from http://www.census.gov/compendium/2015.
World Health Organization. (2014). Active Aging: A Policy Framework. Paper presented at the third United Nations World Assembly on Aging, Madrid, Spain.
Cultural Competencies in Senior Health Care
Training / Curricula Modules
· Campinha-Bacote, J. (2012, May). The Process of Cultural Competence in the delivery of Health Care Services. http://www.transculturalcare.net/the-process-of-cultural-competence-in-the-delivery-of-healthcare-services/
· Hartford Institute for Geriatric Nursing. EthnoGeriatrics and Cultural Competence for Nursing Practice. http://consultgerirn.org under “geriatric topics,” click onto “ethnogeriatrics and cultural competence.”
Office of Minority Health. Center for Linguistics & Cultural Competence in Health Care. https://minorityhealth.hhs.gov
· Office of Minority Health. Think Cultural Health. https://www.thinkculturalhealth.hhs.gov/education
· Stanford School of Medicine. EthnoGeriatrics. https://geriatrics.stanford.edu
· Sokolovsky, J. (2012). The Cultural Context of Old Age: Worldwide Perspectives. (3rd ed). Santa Barbara: Greenwood Press.
· Vaughn, L., & Cruz, D. (2017). EthnoGeriatrics: Health Care Needs of Diverse Populations. London: Springer Publishing.
Blog Author: Donnelle Eargle, PhD, MEd Contact: firstname.lastname@example.org
With a background in geriatric rehabilitation psychology, Dr. Eargle teaches gerontology-related courses at Saint Joseph’s College. Standish, Maine.
Posted by Twila Weiszbrod at 10:04 AM