Physicians Eager but Unprepared to Meet Meaningful Use Requirements

April 27, 2012 By Leave a Comment

Most physicians were eligible for federal incentives in 2011, but few had EHR systems that met Meaningful-use criteria.

Meaningful use (MU), in a health information technology (HIT) context, defines the use of electronic health records (EHR) and related technology within a healthcare organization. Achieving meaningful use also helps determine whether an organization will receive payments from the federal government under either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program.

Although roughly half of physicians in a recent survey said they planned to apply to the Meaningful Use incentive program in 2011, few would have qualified for payments because their electronic health record systems would not have met enough of the Stage 1 core requirements, according to a study published this week in Health Affairs.

Of nearly 4,000 physicians responding to the survey, conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics, 51 percent said they intended to apply for the incentive payments. Only 11 percent, however, had an EHR system installed that would have met 10 out of 15 requirements for the Stage 1′s core objectives.

Such statistics should serve as a guide to current and future efforts by regional extension centers (RECs) designated to aid physicians in their push toward meeting Meaningful Use, according to the study’s authors. Physicians working with RECs toward Meaningful Use attestation have encountered multiple obstacles, according to analysis from earlier in the year by the ONC’s Health IT Policy Committee.

“The 2011 survey results portray widespread gaps in readiness,” the authors wrote. “Even in Wisconsin, the state with the highest percentage ready [to hit 10 of 15 core requirements], only 32 percent of all physicians reported this degree of readiness.”

Despite the results of the Health Affairs study, the number of eligible hospitals and professionals registered to participate in the EHR Incentive Programs continues to climb, according to recent statistics released by the Centers for Medicare & Medicaid Services. Additionally, according to CMS’s statistics, $4.5 billion in incentive payments have been made to eligible providers as of this past March.

View Health Affairs Abstract for more information – click here.
Original article content courtesy of FierceHealthIT.
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Success of Health Reform Hinges on Hiring 30,000 Primary Care Doctors by 2015

February 15, 2012 By Leave a Comment

On a chilly afternoon at a community clinic in Southeast Washington, three young doctors are busily laying the foundation for the health-care law’s success.

Jacob Edwards flips through a manual on skin conditions, diagnosing a rash that looks like chicken pox. Jessica O’Babatunde consults her supervisor on treating an adolescent’s obesity, which is literally off-the-charts. And Julie Krueger peppers 3-year-old Daphauni with questions at her physical: How do you spell your name? What did you eat for breakfast? What’s your favorite vegetable? (Cheese.)

Primary Care Physicians

They are primary-care residents at Children’s National Medical Center. A third of their class has more than $200,000 each in student loan debt. At the end of residency, they can stay in primary care and earn $29.58 an hour. Or they can specialize and make $74.45. Over a lifetime, a medical student who specializes can expect to earn $3.5 million more.

The Obama administration — and, arguably, the American health-care system — desperately needs them to choose primary care. [Read more...]

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Health Organizations Increasingly Hiring Chief Nursing Information Officers CNIOs

February 6, 2012 By Leave a Comment

Chief Nursing Information Officer (CNIO) is a fairly new title, but it is growing in popularity and more and more organizations are recruiting for the position, according to Linda Hodges, vice president and leader of information technology search practice at executive search firm Witt/Kieffer.

An increasing number of nurses are setting their sites specifically on attaining a CNIO position, Hodges told Healthcare IT News in an exclusive interview.

“This is something that has become a passion for many people who went into nursing but also love IT,” she said. “They can see how this role can impact care, especially with the evolving new role of accountable care organizations.”

“Nurses can see the need for an executive nurse focused on nursing needs and nursing practice, so that when health IT solutions are crafted for an organization, they will work for the nurses,” Hodges said.

If the CNIO title follows the course of the CMIO title, it might take some time to become accepted. According to Hodges, the title of chief medical information officer was ten years in the making. It wasn’t readily accepted at first.

Currently, academic institutions and large integrated health systems are the main organizations hiring such a position. A CNIO at a large system can expect to make from $200,000 to $250,000 in base pay annually, she said.

Nurses pursuing this position need a master’s degree in nursing informatics and in some cases a Phd, Hodges said. There are a number of good schools offering highly regarded programs, including the University of Maryland, Vanderbilt and Duke.

“The education programs that exist in nursing informatics need to evolve,” she said. “There is a lot of interest right now, and they are beginning to see traction in terms of more people.”

Hodges will be co-presenting a session titled “The Emerging Role of the Chief Nursing Information Officer: What is the Current State” at the Nursing Informatics Symposium at HIMSS12 on Feb. 20 in Las Vegas.

 

Article origination by Diana Manos at HealthcareIT News

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Mandatory Overtime Caps for Nurses Having Effect

January 31, 2012 By Leave a Comment

State-mandated caps on nurses’ mandatory overtime hours have been effective in reducing overtime hours for new RNs, according to a study.

The study is part of the RN Work Project, a 10-year longitudinal study of newly licensed RNs (NLRNs) that began in 2006 and is funded by the Robert Wood Johnson Foundation. The overtime study drew on data from nurses in 34 states, covering 51 metropolitan areas and nine rural areas.

Past research has demonstrated that fatigue caused by long hours without sufficient rest between shifts can lead to mistakes that imperil both patients and nurses.

“The purpose of capping mandatory overtime is to make hospitals safer for patients and nurses,” study investigator Carol Brewer, RN, PhD, FAAN, professor at the University of Buffalo School of Nursing, said in a news release. “Nurses routinely work long shifts, often as long as 12 hours straight. These laws were intended to prevent hospitals from piling mandatory overtime on top of such shifts, a practice that research shows can increase the likelihood of mistakes. The laws seem to be accomplishing their objective.”

According to the study, in 2010, 16 states had rules restricting mandatory overtime hours for nurses: Arkansas, California, Connecticut, Illinois, Maryland, Minnesota, Missouri, New Jersey, New Hampshire, New York, Oregon, Pennsylvania, Rhode Island, Texas, Washington and West Virginia. At issue in the study was the extent to which those laws or regulations had actually affected the workplace. Researchers examined NLRNs’ self-reported mandatory and voluntary overtime hours, as well as their total work hours.

They found that in the states with rules governing mandatory overtime, NLRNs were 59% less likely to work mandatory overtime than their colleagues in unregulated states. (Not all states with overtime rules prohibit mandatory overtime, with some simply limiting total work hours.) Overall, 11.6% of nurses said they worked mandatory overtime in a typical work week, averaging 6.1 hours.

In the states regulating overtime, NLRNs worked an average of 50 fewer minutes per week than their colleagues in states without overtime regulations.

Researchers anticipated that caps on mandatory overtime might lead to increased voluntary overtime, thus defeating the purpose of the restrictions to some degree. But the data demonstrated no relationship between mandatory and voluntary overtime hours. Nevertheless, more than 50% of NLRNs reported working voluntary overtime in a typical workweek.

“While safety is the principal objective of caps on mandatory overtime, the laws probably also have a positive effect on nurse retention,” said study investigator Christine Koyner, RN, PhD, FAAN, professor at the New York University College of Nursing. “Nurses have lives and families outside the workplace just like everybody else, and they probably prefer to have a schedule they can rely on. One way to make their jobs and lives more manageable is to avoid mandatory overtime, which should lead to nurses staying in their jobs, and indeed in the profession longer.”

“The states developed caps on mandatory overtime with safety issues in mind, reasoning that fewer mandatory overtime hours would translate into fewer hours,” said study investigator Sung-Heui Bae, RN, PhD, MPH, assistant professor at the University of Buffalo School of Nursing. “What we learned in this study is that it’s working. The tool is effective. Other states with similar objectives can follow suit and expect similar results.”

RN Work Project

According to RWJF, the RN Work Project (www.rnworkproject.org) is the only multi-state, longitudinal study of new nurses’ turnover rates, intentions and attitudes — including intent, satisfaction, organizational commitment and preferences about work. To date, researchers have learned that more RNs work in hospitals than any other settings early in their careers, with 88.3% working in hospitals six to 18 months after licensure and 78.8% working in hospitals 31 to 54 months after receiving their license.

The study has also revealed that 18.1% of new nurses leave their first employer within a year of starting a job, and 26.2% leave within two years. Nine in 10 of those who leave remain in nursing.

Subsequent studies will determine why nurses stay in or leave their jobs, what influences their first job choice, how the job settings they work in vary over time and whether they move in and out of nursing.

The study appears in an online edition of Nursing Outlook and is available as a PDF at http://www.rnworkproject.org.

Original Article by Nurses.com News .

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CMS Selects Nurses to be “Innovation Advisers”

January 25, 2012 By Leave a Comment
A New York hospital is testing a new approach to fight obesity. A Boston hospital wants to try a new nursing model. A Montgomery County primary-care clinic plans to expand its pharmacy program that gives one-on-one medication counseling to patients with chronic illnesses.The people who created these programs are among the first 73 “innovation advisers” chosen by federal health officials this month to experiment with ways to provide better health care and reduce costs. Funded with $6 million from the health-care overhaul act, the initiative is one of the first programs of the new Innovation Center at the federal Centers for Medicare and Medicaid Services, known as CMS.
The advisers are meeting in Baltimore starting Monday for initial training and orientation as part of a year-long commitment, officials said. The health professionals include doctors, nurses, hospital executives and public health and policy experts from institutions in 27 states and the District. The home organizations receive stipends of up to $20,000 to cover some of the costs, such as travel.In the Washington region, the professionals include Rosemary Botchway of the Primary Care Coalition of Montgomery County; Stephanie Bruce, a geriatrician at Washington Hospital Center; and Len Nichols, a health economist at George Mason University.The overall goal of the CMS Innovation Center is to find new ways to improve health and lower costs, said Joe McCannon, a senior adviser. “That’s the North Star for every program we’re introducing,” he said.Some Republicans have questioned the value of investing in experimentation to produce results at a time of limited resources.Under the program, the advisers work on projects in their respective institutions. The goal is for them to become change agents at their home organizations, while also providing CMS officials with new ideas and approaches. CMS will work with them through the year to refine the projects and help “get some traction,” McCannon said. If the projects are successful, the ideas could then be applied more broadly, such as to Medicare and Medicaid.

Officials intend to select a second group of advisers in the spring, for a total of about 200 professionals. [Read more...]

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When Nurses Catch Compassion Fatigue, Patients Suffer

January 3, 2012 By Leave a Comment

As a nurse in the cancer center at Barnes-Jewish Hospital in St. Louis, Wilhelmina Roney, 26, sometimes feels overwhelmed by demands from patients, even though she tries her best to care for them. During a rough week, patients may die in such quick succession that she barely has time to cope.

Wilhelmina Roney prepares a treatment for patient Frank Ratino at Barnes-Jewish Hospital in St. Louis, which offers a program to help nurses fight compassion fatigue. Photo by Tim Mudrovic

With the help of an innovative program offered by the hospital, Ms. Roney says she’s learned how to handle an occupational hazard she wasn’t prepared for: compassion fatigue.

The Barnes-Jewish program is one of a growing number of efforts by hospitals and nursing groups to help combat the constant assault on nurse’s psyches. In addition to meditation and stress-reduction workshops, such programs include discussions about difficult patient situations, support groups, and staff retreats focused on the emotional aspects of care giving.

Compassion fatigue is a combination of secondary traumatic stress from witnessing the suffering of others and burnout. It can lead nurses to feel sadness and despair that impair their health and well-being. Hospitals are tackling the problem amid a worsening shortage of nurses and concerns that patients may suffer. Compassion fatigue can reduce nurses’ empathy and lead them to dread or even avoid certain patients, raising the risk of substandard care.

Nurses who avoid patients “don’t form the relationship necessary to truly understand the patient, identify their problems early, and adapt therapies to their needs,” says Patricia Potter, a nurse researcher and director of research for patient-care services at Barnes-Jewish. Nurses can also become rude and cynical, which can discourage patients from asking them for help, she says, adding less observant nurses may be more error-prone.

Compassion fatigue has been linked to decreased productivity, more sick days and higher turnover among cancer-care providers. A 2008 study led by the University of Nevada, Reno’s nursing school found that about 12% of registered nurses in the U.S. weren’t working. Of those, more than 27% cited burnout or stressful work environments. High turnover and the subsequent increased workload on remaining nurses can result in higher death rates and reduced patient safety, studies show.

“Recognizing, managing and relieving these issues are critical for nurses and their employers,” as well as for patients, says Holly Carpenter, a senior staff specialist at the Center for Occupational and Environmental Health of the American Nurses Association in Silver Spring, Md.

Compassion fatigue was identified as a special problem for nurses in the early 1990s. The ANA’s Healthy Nurse program sponsored its first workshop on the issue at its annual conference last year, with another planned for this year, and it offers special resources on its website. The New York State Nurses Association conducted its first compassion-fatigue workshop at a hospital last year and is urging hospitals and nursing schools in the state to offer such programs.

Concerned about turnover in the oncology unit and evidence of stress among nurses, three Barnes-Jewish nurse managers approached Dr. Potter and the head of the hospital’s patient and family counseling program, Theresa Deshields, for help in 2009. The problem was especially acute for those caring daily for very ill patients whose survival was in doubt. The nurses seemed susceptible to emotional and physical stress and as a result, sometimes disengaged from their patients.

A survey of 150 staffers found that compassion-fatigue symptoms were high enough to warrant intervention.

[Read more...]

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Nurses Say Restrictions to ICU Visitation Should be Reduced

December 22, 2011 By Leave a Comment

The American Association of Critical-Care Nurses (AACN) has issued an alert touting the importance of expanding the presence and participation in ICU settings of patients’ family members and friends.

The AACN Practice Alert describes family members, friends and other supporters as “partners in care” and outlines administrative and practical considerations for nurses to implement less-restrictive access to the bedside in the ICU.

Although official hospital policies often limit visiting hours in ICUs, most nurses in adult critical care units generally permit unrestricted family visitation, according to the AACN. “This inconsistency contributes to conflict among staff and confuses families,” according to an AACN news release.

Hospitals may limit visiting hours under the assumption that family visitation causes stress for the patient, interferes with the provision of care, is mentally exhausting to patients and families or contributes to increased infections.

“These assumptions are not substantiated by evidence,” according to the AACN. “Instead, evidence suggests that unrestricted presence and participation of a support person … improves communication, facilitates a better understanding of the patient, advances patient- and family-centered care and improves staff satisfaction.”

The AACN Practice Alert calls for nurses to remain accountable for ensuring the safety and well-being of the patient, noting they may choose to limit visitation when doing so is in the patient’s best interest.

The AACN advocates the following guidelines for healthcare facilities relating to visitation rights:

  • Establish policies and procedures that support unrestricted visitation in ICUs — ones that allow for the patient’s unrestricted contact with a desired support person while protecting the privacy of other patients and the safety of patients and staff. Policies should support a patient’s right to identify individuals the patient views as “family” and chooses to be partners in care, without discrimination.
  • Provide leadership and support for senior administrators to change restrictive visiting policies and practices, including updating materials to communicate more flexible policies to patients, families and communities and educate them about the policies’ benefits.
  • Welcome a patient’s “partners in care” 24 hours a day, based on patient preference.
  • Allow children to visit when supervised by an adult family member.

According to the AACN and based on available evidence, the goals of policies relating to family visitation within the adult ICU are to:

  • Facilitate unrestricted access of hospitalized patients to a chosen support person such as a family member, friend or a trusted individual who is integral to the provision of emotional and social support 24 hours a day according to patient preference, unless the support person infringes on the rights of others, affects safety and/or is medically or therapeutically contraindicated.
  • Ensure that the facility and/or unit has an approved practice document — a policy procedure or standard of care — for allowing the patient’s designated support person, who may or may not be the patient’s surrogate decision-maker or legally authorized representative, to be at the bedside during the course of the patient’s stay in accordance with the patient’s wishes.
  • Evaluate policies to ensure that they prohibit discrimination based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation and/or gender identity or expression.
  • Confirm there is an approved written practice document for limiting visitors whose presence infringes on the rights of others, affects safety and/or is medically or therapeutically contraindicated to support staff in negotiating visiting privileges.

 

Article courtesy of News at Nurses.com

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House Rejects Senate Tax Measure – Physician Pay Cut Looms

December 21, 2011 By Leave a Comment

The threat of a 27.4% cut to Medicare physician payments Jan. 1 became more real Tuesday after the House of Representatives voted 229-193 on a motion to disagree with a Senate-amended version of a House payroll tax cut bill that would have placed a two-month freeze on payments to the nation’s doctors.

In that same vote, the lower chamber requested a conference, which would allow the House and Senate to resolve their differences in the two bills. On Saturday, the Senate approved an amended version of a House payroll tax cut bill that the House passed Dec. 13. Both pieces of legislation would avert the scheduled reduction in Medicare physician payments and extend certain healthcare provisions that are set to expire by year’s end. But while the House version calls for a two-year fix to the sustainable growth-rate formula and provides a 1% update for doctors in 2012 and 2013, the Senate’s amended legislation would place a two-month freeze on physician payments until Feb. 29.

House Speaker John Boehner (R-Ohio) and Majority Leader Eric Cantor (R-Va.) have said a two-month extension of the payroll tax holiday is inadequate, and continue to push for a full-year extension. But Senate Majority Leader Harry Reid (D-Nev.) said Monday that before negotiations are re-opened on a yearlong extension of the payroll tax cut, the House must first pass the compromise that had been negotiated with Republicans.

“Regardless of whether Congress will retroactively make up this devastating loss of practice income next year, federal lawmakers’ failure to act will cause grave disruption in physician practices,” Dr. Glenn Stream, president of the American Academy of Family Physicians, said in a statement. “Nearly one in four patients seen by family physicians is a Medicare beneficiary. For some family physicians, Medicare patients comprise as much as eight in 10 of their patients. No business can sustain such immediate and draconian cuts to their revenue.”

Related content from 12/17: Senate OKs two-month freeze on doc pay
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Defense Department Needs to Coordinate Revamp of Physician Credentialing: GAO

December 19, 2011 By Leave a Comment

The U.S. Defense Department needs to establish a process coordinating all current and future efforts to revise credentialing and privileging requirements for physicians at military treatment facilities as well as establishing an oversight process to review credential samples to identify and address areas of noncompliance, according to a U.S. Government Accountability Office report.

The report was requested by Congress after Major Dr. Nidal Malik Hasan, a U.S. Army psychiatrist, was accused of killing 13 people in a Nov. 5, 2009 shooting spree at Fort Hood, Texas. His trial is set to begin March 5, 2012.

According to the GAO report, the competence review and credentialing requirements of the DOD, Army, Navy and Air Force “are in some cases inconsistent with DOD’s requirements and each other’s.” As an example, the report cited how the DOD calls for verification of all state licenses physicians have held throughout their careers while the Navy only requires verification for the previous 10 years.

For the report, the GAO said it reviewed credentials for 150 Army physicians and interviewed staff at five Army medical facilities.

In 34 cases, it found that complete career verification of state licenses had not been documented before privileges were granted and, in seven of these cases, there was no documentation of the doctor’s current license, according to the report.

It was also noted that the facilities did not consistently document clinical competence with any peer recommendations or performance assessments. In some cases, performance assessments lacked required data to back up the assessment. The Army also requires a search of malpractice history, but “files often lacked information needed to determine if the MTF (military treatment facility) had documented a complete practice history, as required.”

“Weaknesses in Army requirements contributed to noncompliance and incomplete documentation,” the report concluded. “For example, MTFs did not consistently document follow-up on peer recommendations, in part because existing requirements do not clearly delineate responsibilities for documenting follow-up.”

 

Article by Andis Robeznieks at ModernHealthcare.com

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Nurses Again Rank First in Gallup Ethics 2011 Survey

December 14, 2011 By Leave a Comment

Nurses maintained their dominance atop Gallup’s annual poll on trustworthy professions, topping the list for the 12th time in the 13 years they have been included as an option.

The survey was conducted Nov. 28 to Dec. 1 among a random sample of 1,012 adults representing all 50 states and Washington, D.C. When asked to rate the honesty and ethical standards of nurses, 84% responded with “very high” or “high,” while 15% responded “average” and only 1% responded “low” or “very low.”

The 84% positive response is tied for the highest rating nurses have achieved; they received the same rating in 2001, 2006 and 2008. The only year nurses did not finish first in the survey since their inclusion was 2001, when firefighters took the top spot in the wake of the Sept. 11 terrorist attacks.

Medical professions abounded at the top of the list of 21 professions, with pharmacists (73% positive response) and medical doctors (70%) rounding out the top three. The lowest-rated professions, with a 7% positive response, were car salespeople, lobbyists and members of Congress.

“Americans are as positive as they have ever been about those in medical professions, though the public has always held doctors, nurses and pharmacists in high esteem,” Gallup noted in a news release.

“The public’s continued trust in nurses is well-placed, and reflects an appreciation for the many ways nurses provide expert care and advocacy,” American Nurses Association President Karen A. Daley, RN, PhD, MPH, FAAN, said in a news release. “Major national policy initiatives also show trust in nurses. The Affordable Care Act and the Future of Nursing recommendations call on nurses to take more leadership roles and collaborate fully with other professionals in providing essential healthcare to a growing number of people who will have greater access to services.”

ANA noted a recent high-profile legal case that underscored the commitment nurses demonstrate to patient safety and quality. In 2009, two Texas nurses reported a physician at their hospital for unsafe practices. The nurses withstood intimidation and criminal charges, and held firm to their principles (http://bit.ly/tMRplh).

When the legal battles concluded in November, four individuals involved with bringing charges against the nurses were either convicted or pled guilty to misuse of official information and retaliation.

To read the full results of the Gallup poll, visit http://bit.ly/rPpNGF.

Article source  Nurse.com

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