St. Francis Hospice: Medicare and health care reform

The St. Francis Hospice Program is symbolic of more than 100 years of Franciscan dedication to the people of Hawaii. Since Mother Marianne's arrival in November of 1883, the Sisters of the Third Franciscan Order Syracuse, New York have responded to the calling; "the charity of Christ impels us." It is through this calling that care and comfort for the terminally ill is a part of the mission of St. Francis Healthcare System. The magnificent spirit through which Hospice services have been made possible, is a reflection of God's great generosity to us throughout the years.     

Visions and revisions: viewpoints on nuclear medicine & health care reform. Part 1: Outcomes research

Although health care reform movements and the strategies that medical societies use to meet the challenges existed long before President Bill Clinton's September 1993 presentation of his reform bill, these strategies have since come into the foreground of medical reform discussions. Medical groups are carefully eying outcomes research as a method to both pinpoint their most effective procedures and to point up the effectiveness of their practice in overall patient care. Practice guidelines promise a way to sift out the optimal procedures and suggest them to all nuclear medicine physicians--to both unify the specialty and perhaps help protect practitioners in malpractice cases. Discussions of the specialty physician workforce question the need and practicality of any policy that substitutes generalists for specialists. And vigilance over the several pieces of legislation currently sifting through Congress alert members of specialty societies about political developments and how to influence congressmen. The question remains, are these strategies being employed in such a way as to best pull a specialty like nuclear medicine through the gantlet and optimize health care provision in the US? This four-part series will explore this question.     

Equity in health care: some conceptual and practical issues

17 beta-Hydroxysteroid dehydrogenase deficiency is an uncommon inherited disorder characterized by genital ambiguity and progressive pubertal virilization. We describe the clinical and biochemical features in a 13-year-old 46, XY individual who presented with progressive pubertal virilization.     

Older adults, reimbursement, and referrals: Implications for psychologists after Medicare reimbursement changes and before health care reform.

Psychologists' current provision of mental health services to older adults was investigated by a mail survey. One half of licensed psychologists in a metropolitan region in the Northeast were randomly sampled, with a return rate of 61% (n?=?37). 75% saw older adult clients (aged 65 and over), and 72% accepted Medicare payments. Older adults composed 8% of their practice. Solopracticing physicians were the chief referral link to and from the medical community. Barriers to providing mental health services included client's lack of social support network and low levels of reimbursement. The challenges of continuing psychologists' recent advances in serving the mental health needs of older adults in an era of health care reform and managed care are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The policy implications of using hospital and physician volumes as "indicators" of quality of care in a changing health care environment

There is growing interest in the quality of health care and in using quality measures to direct patients to hospitals and providers offering high quality, low cost health care. The dilemma is that, while there is an increasing need for quality indicators as a result of a changing health care environment, this changing environment has important implications for the use of some of these measures. Since the 1970s, a growing body of research in the U.S. has addressed the empirical relationship between the number of patients with a specific diagnosis of surgical procedure and their outcomes after treatment in a particular hospital or by a particular physician ("volume-outcome" studies). In this paper, we examine the policy implications of using hospital and physician volume information as an "indicator" of quality in a rapidly changing health care environment with new players and new incentives. We begin by describing the evolution of the use of volumes within both regulatory and market-oriented contexts in the U.S. We then discuss policy considerations and cautions in using volumes, along with suggestions for future research. Our purpose is to point out potential problems and clarify confusions about the use of volumes, so that policymakers and practitioners can be sensitive to the potential minefields they are traversing.     

The current state of health care in the former Soviet Union: implications for health care policy and reform

OBJECTIVE: To study planning of movement in Parkinson's disease. METHODS: The spatiotemporal pattern of movement related desynchronisation (MRD) preceding a self paced voluntary wrist flexion was compared between two groups of 10 untreated right and left hemiparkinsonian patients receiving no treatment and 10 control subjects. The MRD was computed in the 9 to 11 Hz frequency band from 11 source derivations covering the frontocentral, central, and parietocentral areas, during two successive left and right experimental conditions. RESULTS: In the two patient groups the desynchronisation appeared over the primary sensorimotor area contralateral to the affected side with a shorter latency (750 ms before movement onset for the right hemiparkinsonian group and 875 ms for the left hemiparkinsonian group) than in the control group (1750 ms), only when the movements were performed with the akinetic hand. For the non-affected hand, the same latency as in the control group was noted (1750 ms). CONCLUSION: The delay of appearance of MRD in Parkinson's disease confirmed that the programming of movement is affected, thus partially explaining akinesia.     

Providing mental health care to older adults: Unraveling the maze of Medicare and managed care.

This article reviews fundamental information about mental health benefits for older adults. Major systems, including Medicare, Medicaid, and managed care, are described. Regulations and policies that influence mental health care for older adults are distinct from those for the general population. In addition, Medicare has adopted managed-care options more recently than the private insurance industry. This relationship between Medicare and managed care is chronicled and future directions are postulated. Finally, we examine several empirical questions that have been raised due to the recent changes in the delivery of mental health care to older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Human immunodeficiency virus infection: knowledge of the disease and attitudes toward related issues and policies among health care workers in a low-incidence nonurban hospital

We compared the knowledge and attitudes regarding human immunodeficiency virus (HIV) infection among employees in a tertiary care teaching hospital in a nonurban southeastern city with a relatively low incidence of acquired immunodeficiency syndrome (AIDS). All 260 physicians and a random sample of 240 other employees were asked to complete a 59-item anonymous mail survey. All groups of respondents, including physicians, showed a lack of understanding of critical aspects of AIDS, particularly transmission. Negative attitudes such as victim blaming and not liking to care for persons with HIV infection were common, especially among house staff and respondents who do not give hands-on care. Misinformation, aversion, fear, and lack of compassion were evidenced by a substantial proportion of the respondents, particularly house staff. The attitudes expressed suggest that there is more focus on the rights of the caregiver than on the welfare of patients. These findings show that there is a need for medical education that focuses on both knowledge and affective issues of HIV infection.     

Assessing influenza immunization rates in Medicare managed care plans: a comparison of three methods

BACKGROUND: In an effort to improve care delivered to Medicare beneficiaries, the Health Care Financing Administration (HCFA) has encouraged competitive Medicare risk plans to collaborate on quality improvement projects. PRO-West, a private, nonprofit quality improvement organization, fostered a collaboration of all Medicare risk plans in Washington State in order to assess and improve influenza immunization rates among seniors enrolled in managed care. METHODOLOGY: After the 1994-1995 influenza immunization season, immunization rates were determined for each participating plan from administrative data and medical record review. In the 1995-1996 season, these methods were supplemented with a telephone survey. The survey was used to identify perceived barriers to immunization and to estimate immunization rates. RESULTS: Immunization rates, as estimated by administrative data and medical record review, were similar for both years. The average immunization rate using administrative data for the 1995-1996 flu season was 60.6% (range, 42.8% to 72.3%). The estimated rate increased to 77.8% (95% confidence interval, 75.3% to 80.3%) when the telephone survey data were added. Medical record review contributed little additional information. CONCLUSIONS: Influenza immunization rates for seniors enrolled in Medicare risk plans in Washington State exceed those reported for fee-for-service Medicare beneficiaries. Telephone surveys resulted in higher and probably more valid estimates of influenza immunization rates than did analysis of administrative data and medical records. Plans with lower rates can emulate "benchmark" plans that are explicit about the methods they use to achieve high coverage rates. Medicare risk health plans competing in the same markets can collaborate in quality assessment activities in an effective manner.     

Communication and records: Hippa issues when working in health care settings.

To refocus awareness on the original mandate of the Health Insurance Portability and Accountability Act (HIPPA) regulations, this article will review record keeping requirements and examine patient-doctor and interdisciplinary communication as a way to improve the health care consumer's trust in the privacy of their personal information while facilitating integrated and fluid health care delivery systems. The HIPPA rules especially important in medical settings are discussed with a special emphasis on issues confronting psychologists who practice outside of medical institutions and hospitals. The article also examines important implications for practice activities when psychologists attend patients who are hospitalized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The perinatal nurse's role in obstetric emergencies: legal issues and practice issues in the era of health care redesign

The perinatal nurse is charged with providing safe and effective care in both routine and emergency situations. This duty arises from the states' nurse practice acts and American Nurses Association's Code for Nurses, and it has been affirmed by a growing body of case law. Current changes in health care systems have created new challenges for the perinatal nurse. In some instances, the transformations occurring in health care may actually hinder the nurse's ability to provide care when faced with an obstetric emergency. These changes do not, however, alter the nurse's affirmative duty to take some positive action when complications arise. The article elaborates essential nursing actions required when an obstetric emergency occurs within the context of redesigned maternity settings.     

Educating families and caretakers of traumatically brain injured patients in the new health care environment: a three phase model and bibliography

Shorter inpatient stays for traumatically brain injured patients frequently allow less time for comprehensive education of families and caretakers. What is needed to compensate for the shortened duration of brain injury rehabilitation in many settings is a family educational programme that (1) satisfies the family's acute information needs as they arise, and (2) standardizes the delivery of information so that certain knowledge criteria are met. The following article proposes a three phase model of family and caretaker education with an accompanying bibliographical index.     

"Ruling in" and "ruling out": two approaches to the micro-rationing of health care

Seropositive gay and bisexual men who reveal their sexual orientation or HIV/AIDS status to their employer risk discriminatory reprisals. However, non-disclosure may limit potential social, emotional, and tangible support. Among our sample of 389 seropositive gay and bisexual men employed in the US, 52% were 'out' to their employer and 35% had disclosed their serostatus to him or her. Among gay men, employer awareness of their sexual orientation was related to their being European American (vs Latino or African American), being HIV-seropositive for more than 4 years, and having a gay or bisexual employer. Disclosure of HIV infection in the total sample was related to being European American, HIV-seropositive for more than 4 years, symptomatic (vs asymptomatic), 'out' at work, and having a gay or bisexual employer. Men who had informed their employers of their HIV status reported consequences that were substantially more positive than those anticipated by men who had not disclosed. Policy and research implications for improving the work environment for gay and bisexual men living with HIV are considered.