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Adverse drug events (ADE) are defined by the IOM as, “injuries resulting from a medical intervention related to a drug.” Multiple studies reveal that ADEs are common in the nursing home setting, with an estimated 135 ADEs per year for the average size nursing facility. ADEs occur most often at the ordering and monitoring stages.[4] Some categories of drugs pose greater risks than others. Much of the risk associated with medication errors and adverse drug events in long-term care environments can be mitigated through diligent attention to several high-risk situations that create fertile ground for such errors. In this issue: The 2016 Leaders of Tomorrow Awards, managing disruptive visitors, grannycam policies and more. Some are familiar, such as cutting payments to providers, scaling back dental benefits and restricting access to brand-name prescription drugs.
From the most common to the innovative, here are five approaches states are trying, along with assessments of their prospects for success. In 2008, Medicaid fee-for-service provider payments averaged only 66 percent of Medicare rates (which in turn are lower than commercial reimbursement rates).
Providers have long alleged that cutting their payment rates doesn’t actually save money. Providers have also argued that cutting reimbursement rates makes it more difficult for Medicaid beneficiaries to find providers. In short, cutting provider reimbursements can save money (though states must comply with broad federal standards).
Last fall, Peter Orszag, President Obama’s first Office of Management and Budget director, penned a column for The New York Times in which he identified several regrets about the course of health-care reform. However, attempts to cap jury awards in medical malpractice cases remain intensely controversial in states with powerful plaintiffs’ bars.
Five percent of Medicaid beneficiaries account for up to 50 percent of total Medicaid spending. The second type of pay-for-performance plan takes place within the context of managed care. One area of coordination on which virtually every health-care expert agrees is promising care for the dual eligible -- people who are eligible for both Medicare and Medicaid. A new federal rule designed to ensure care is more visitor-friendly and home-like than nursing homes could make it difficult for facilities to qualify for federal money. La estimacon del costo asociado a errores en Estados Unidos de durante el ano 2008 fue de 19.500 millones dolares. 10 facts on patient safety Hecho 7: Al rededor de 100 millones de personas en el mundo requieren cada ano de una intervencion quirurgica.
This article explores the weighty problem of adverse events in long-term care and suggests strategies to mitigate medication-related adverse events in long-term care settings.
Department of Health and Human Services.[2] Of those residents, almost half received nine or more medications per day. Residents who receive antipsychotic agents, anticoagulants, diuretics and anti-epileptics are more likely to suffer from an ADE. The American Recovery and Reinvestment Act (ARRA) had boosted the federal share of total Medicaid costs by 6.2 percent, easing the pressure on states struggling to pay for Medicaid programs swollen by the Great Recession. However, the state has reduced payments, froze rates and curtailedbenefits in the past three years, according to the Idaho Department of Health & Welfare.
In its report to Congress earlier this year, MedPAC, the advisory federal panel for Medicare, took a look at the issue. By adding 10 new staff positions to its Medicaid Fraud Control Unit, Ohio increased its recoveries from $65 million in 2008 to $91 million in 2009.
In 2005, the Centers for Medicare and Medicaid Services (CMS) created the Medicaid Integrity Program and gave it a very specific charge: Provide state Medicaid programs with the technical assistance, such as sophisticated data mining, to identify overpayments. After reports of massive fraud surfaced in 2005, the state created the nation’s first Medicaid inspector general (IG). That’s a much smaller percentage reduction than an earlier generation of studies predicted. More than 80 percent of these high-cost beneficiaries have three or more chronic conditions, and up to 60 percent have five or more. More than half the states are currently attempting to align incentives with a patient-centered medical home -- a form of care that replaces episodic treatment based on individual illnesses with a long-term coordinated approach.
By the end of this year, 85 percent of state Medicaid programs will have instituted some kind of pay-for-performance program. More than 70 percent of Medicaid beneficiaries are already enrolled in some form of Medicaid managed care plans, and states as diverse as Kentucky, Florida and New York are pushing ahead with plans to expand these programs even further. There are 9 million people who fall into this category -- 15 percent of total Medicaid enrollees. In April, CMS selected 15 states with whom it would work to design care-coordination initiatives.


For many in the health field, addressing the problems most commonly associated with our health-care system means changing the system itself, moving away from uncoordinated fee-for-service payment systems that reward volume toward capitated arrangements that reward value. Participating doctors and hospitals enter into five-year global budget contracts with Blue Cross Blue Shield (BCBS) of Massachusetts whereby they are paid a lump sum to cover all of their patients’ health-care needs -- inpatient and outpatient care, rehabilitation and prescription drugs. While states such as Massachusetts have tried to work through the private sector by pressuring insurers or through public levers by using the power of Medicaid and state purchasing to affect the health-care system, Vermont is focused more on providers. Ariel Alejandro Palacios Jefe de Seguridad del Paciente Hospital Universitario Austral Docente Facultad. De ello, alrededor del 87% fue generado por el aumento de los costos de la prestacion medica de hospitalizacion, consulta externa y servicios de medicamentos recetados a personas que se vieron afectados por errores medicos Ademas los costos indirectos fueron aproximadamente 1.400 millones dolares en relacion con las tasas de aumento de la mortalidad entre las personas que sufren errores medicos y aproximadamente $ 1100 millones relacionados con la perdida de productividad debido a las reclamaciones relacionadas con la discapacidad a corto plazo. Los problemas asociados a la seguridad quirurgica representan la mitad de los eventos adversos evitables que concluyen en muerte o discapacidad.
Y, ya se sabia Era cuestion de tiempo Y, si ponen gente sin capacitacion… Aqui debe haber un responsable!! Polypharmacy and multiple chronic medical conditions combine to make frail and elderly residents especially susceptible to medication errors.
Thus, emphasis should be placed on categories of drugs which pose a greater likelihood of serious harm as well as on the ordering and monitoring stages. Another -- beefing up anti-fraud efforts -- is fast emerging as one of the highest return-on-investment initiatives states can undertake. According to this argument, doctors and hospitals pass cost increases along to private health insurers. According to a 2008 Health Systems Change survey, only 53 percent of physicians were accepting new Medicaid patients.
It found that most hospitals reacted to reimbursement pressure by operating more efficiently.
Researchers recently looked at the result of Oregon’s decision to eliminate Medicaid dental benefits back in 2003. In recent years, Texas has beefed up its Medicaid integrity effort, creating a separate civil fraud division in fiscal 2008-2009. Earlier this summer, CMS began using predictive modeling to target Medicare fraud in south Florida. Andrew Cuomo a rare rebuke by rejecting his efforts to cap awards in New York, a step that New York hospitals (pointing to a 2004 study commissioned by malpractice insurers) claimed would have allowed them to reduce their premiums by a quarter. However, given overall national health expenditures of $2.6 trillion, it would still translate into big savings. The state, which has the nation’s only all-payer rate setting system, decided to pay hospitals that did a better-than-average job of reducing such incidences a bit more. Yet the majority of these patients receive fragmented and uncoordinated care, often leading to unnecessary and costly hospitalizations and institutionalizations. One approach Bella intends to explore would encourage the CMS, states and health plans to enter into a three-way contract. Christine Gregoire, the head of the National Governors Association, told Kaiser Health News.
Providers who exceed their budgets pay the cost overruns; providers who come in under budget share in the savings.
John Kitzhaber, a physician serving his third term as governor, and the Legislature passed the Oregon Health Transformation Act, which will move half a million Oregonians away from managed care and into coordinated care organizations (CCO).
Lawmakers there are betting that the greater efficiency of a single-payer system will generate big savings.
By 2015, at current rates of growth, he says that every Vermonter will have to spend an additional $2,500 every year on health care -- even though they will be earning the same money they earned 10 years ago. Informes, estudios e investigacion 2008.Revision Bibliografica sobre Trabajos de Costes de la No Seguridad del Paciente.
Decreased renal function, impaired hearing and vision, and cognitive or functional limitations place older residents at an even greater risk for medication errors and adverse drug events. While federal spending on Medicaid is projected to decline by 13 percent over the course of the current fiscal year, state spending on Medicaid is expected to rise 18.6 percent. The provision prohibits states, with limited exceptions, from changing eligibility standards to reduce the number of Medicaid beneficiaries. Insurers pass them on to employers, who respond by increasing premiums for employees and holding down wage increases. They found people who lost benefits responded by seeking care in more expensive emergency room settings.
According to Hodge, the new office, which has funding for 41 employees and a yearly budget of about $6 million, returned $96.5 million to state and federal taxpayers in fiscal 2010.
Medicaid databases are far more complicated, but several states have shown how powerful they can be in finding fraud and recovering funds.


More than two dozen now have laws designed to limit or cap jury awards in medical malpractice cases. However, in a recent National Bureau of Economic Research paper, Lakdawalla found that reducing malpractice awards further would have only a modest impact on total health-care expenditures.
In 2009, West Virginia estimated that a medical home initiative involving 1,800 physicians would produce annual savings of $57 million for the state, as well as savings of $173 million for insurers and $171 million for policyholders.
Yet according to Melanie Bella, a former Indiana Medicaid director who now heads the Federal Coordinated Health Care Office at the U.S.
Participating plans would receive a blended payment in exchange for providing comprehensive, seamless coverage.
The Massachusetts model, with its subsidies for low-income residents and a health exchange for small businesses and individuals, became the model for the Affordable Care Act. Providers who meet quality-of-care standards specified by the insurer also become eligible for performance bonuses of up to 10 percent, a much larger sum than in most pay-for-performance arrangements. Four working groups appointed by the governor are working on guidelines that will establish how the CCOs will operate, who will pay for which procedure and how effectiveness will be measured. But if it doesn’t, the state has also authorized a more forceful command and control approach to cost reduction. Universidad Javeriana - Cali Florence Nightingale (1820-1910) Puede parecer extrano decir que el primer principio en un Hospital es no hacer dano a los enfermos. Faulty or sparse documentation of medication administration by the skilled nursing staff can add additional medical and legal risks.
As a result, states must do something to constrain health-care spending in general and Medicaid in particular. Oregon enacted legislation that will move more than 500,000 Oregonians into new coordinated care networks that will emphasize prevention and primary care. Some economists have suggested that such legislation has reduced state health-care expenditures by 3 to 4 percent. Precisely because some doctors practice defensive medicine, higher malpractice costs are likely to save lives, which more than justifies the impact on medical costs. One year in, the state has seen a 20 percent decline in hospital-acquired infections and $60 million in savings. But so far, efforts to evaluate these medical homes and other coordinated care initiatives have been distinctly tentative in their findings.
Perhaps the most notable example of this approach is North Carolina’s Community Care program, in which 14 networks serve more than 1 million Medicaid patients. Now the state is trying to reform health delivery so the costs of health care won’t swamp its system.
The committees will also take on the challenging question of designing a long-term care system. When the Vermont Legislature committed the state to implementing a single-payer system, it also created the Green Mountain Care Board, which will have the power to do everything from setting fee-for-service rates to developing new payment models to implementing a global budget for health-care spending.
Blue Cross Blue Shield of Massachusetts has responded to state demands to contain costs by creating a new global payment system, the alternative quality management contract. Not surprisingly, the National Association of State Budget Officers reports that some 20 states announced plans to ramp up Medicaid integrity activities this year.
Each network has a small cadre of caseworkers who help manage care for people with multiple, chronic syndromes. According to a year-one evaluation conducted by BCBS, participating providers saw measures of process improvements increase at three times the rate of non-participating physicians -- a rate of improvement in quality of care greater than any one-year change seen previously in the insurance provider network. Policymakers in Vermont are instituting a single-payer system -- the most radical change of all.
In addition, state Medicaid fraud units are teaming up to mount complex, multistate cases, many targeting pharmaceutical companies promoting unapproved, off-label prescription drug use, a strategy that in 2008 alone recovered $1.4 billion from 13 multistate civil suits. In fiscal 2008-2009, recoveries jumped to $304 million, while the state Medicaid Fraud Control Unit brought in another $227 million, bringing the total funds recovered by the state to more than $550 million. A New England Journal of Medicine assessment also found modest cost savings of 1.9 percent. The outcome, state officials say, has been better care and an 8 percent reduction in the rate of growth of Medicaid spending.
In contrast, CMS figures show that the average state recovers a mere 0.09 percent of state Medicaid spending. No wonder at least half a dozen states -- Florida, Georgia, Illinois, Kansas, Kentucky and New Mexico -- followed suit in creating inspectors general.



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