Year's End Notables

Gwen B. Turnbull, RN, BS, CETN

Index: Ostomy Wound Manage 2001;47(12):10,51

Terrorist Attack Highlights Nursing Shortage
  Representatives and Senators recently joined nurses who treated World Trade Center victims for a press conference to highlight the importance of passing the Nurse Reinvestment Act (HR 1436 and S 06). This legislation is designed to help address the nursing shortage and ensure that our health system has enough nurses to be prepared for any future crisis. The Nurse Reinvestment Act establishes a National Nurse Service Corps to provide educational scholarships to nurses that commit to serving where a critical nursing shortage exists. It also would make grants available to any level of the nursing profession (from nursing aides to nurse practitioners) to obtain more education. In addition, the bill is designed to provide funding for public service announcements and nursing recruitment grants for educational facilities.

  An interesting sideline is the bill’s expansion of Medicare and Medicaid funding for clinical nursing education as well as reimbursement to some home health agencies, hospices, and nursing homes for nurse training. Hopefully, action will be taken to move this legislation forward by the end of the year.

CMS Establishes Penalties for Certain Acts of Noncompliance
  The Centers for Medicare and Medicaid (CMS) issued a final rule with a comment period, updating some of the civil monetary penalty regulations under the Balanced Budget Act of 1997 (BBA 97). Two items under this revised rule may potentially affect home health agencies (HHA). Under BBA97, HHAs are required to provide an itemized statement for Medicare items and services within 30 days of a request from a Medicare beneficiary. Any provider who knowingly or willingly fails to do so is subject to a penalty of $100 for each incident. However, the penalty is not inflicted if the provider merely neglects to meet the deadline, as punishment is based upon deliberate intent. Additionally, if a person or entity willfully bills for outpatient therapy other than on an assignment-related basis, CMS, the Department of Health and Human Services Office of Inspector General, is authorized to impose a penalty of not more than $10,000 for each violation. The revised rule can be viewed in the September 28, 2001 edition of the Federal Register on page 49544; regulations are effective October 29, 2002 with the comment period open until November 27, 2001.

Kennedy Terminal Ulcer Website Announced
  Karen L. Kennedy, RN, CS, FNP, the developer of the concept of a terminal pressure ulcer, has announced the debut of her website devoted to ongoing investigation and information about what have been termed Kennedy Terminal Ulcers. More than 20 years ago, Karen, a family practice nurse practitioner, began noticing similarities in the appearance of certain pressure ulcers in a particular population of patients in her clinical practice at Byron Health Center, a 500-bed long-term-care facility in Fort Wayne, Indiana. Perplexed by the fact that development of pressure ulcers of a certain appearance often resulted in the death of patients, Karen began to record her observations and clinical findings. After several years of data collection and patient analysis, a definitive pattern became clearly evident. The development of a pear-, butterfly- or irregularly-shaped pressure ulcer with certain color characteristics, which presents superficially but progresses rapidly on certain areas on the body, seemed to be an indicator that death was imminent – usually within 2 weeks. Karen presented the results of her research to the physicians at the facility who, in turn, named this ulcer after her, in recognition of her work in observing and quantifying the sequela.

  Karen’s new website offers valuable resources on the subject, clinical photographs of the ulcers, information about their course and prognosis, and input from family members who have been touched by the “end of life ulcer.” Visit www.KennedyTerminalUlcer.com.

National Task Force Recommends OASIS Streamlines
  In response to CMS’s invitation to submit recommendations on ways to reduce paperwork and streamline patient assessment requirements, a task force called the OASIS Provider Task Force has been established. It consists of representatives from national associations, home health agencies, and consumer advocates. The goal of this task force is to develop ways to consolidate the OASIS document and its related regulatory mandates. Many home health providers believe that the increased paperwork required by OASIS has negatively impacted their ability to recruit and retain nurses in an already understaffed environment. Because of the costs associated with implementing and maintaining OASIS regulatory compliance, many providers often cite OASIS as the number one reason nurses leave home healthcare. They also believe that the cost of OASIS exceeds payment, as they are not compensated for the cost of professional staff time or the technology necessary for OASIS data collection and submission and prospective payment systems implementation.

  The task force has submitted a letter to CMS with their recommendation of items that could be eliminated from the OASIS data set and as well as other numerous changes to regulatory requirements. The OASIS Provider Task Force is awaiting response to its request for an opportunity to discuss its recommendations with CMS officials.

GAO Looks at Medical Supplies in Home Health
  Currently, Medicare makes a single payment to HHAs for each 60-day episode of care. This payment covers most services and supplies (including nonroutine supplies but excluding durable medical equipment) without regard for volume or types of services and supplies actually provided during the episode. Additionally, HHAs are responsible for submitting all Part B claims for services or supplies, whether they have furnished them directly or under an arrangement with an outside supplier (called consolidated billing).

  Nonroutine supplies include, but are not limited to: dressings and other wound care items, IV supplies, ostomy supplies, catheters, and catheter supplies. If certain supplies covered under PPS are too costly relative to the episodic payment, HHAs might be inclined to “pinch” on needed supplies, or even avoid admitting patients who, during preadmission, could be identified as needing them. On the other hand, excluding too many supplies could also undermine the cost control potential of PPS. The Government Accounting Office (GAO) has been asked to review the process used to include nonroutine medical supply costs in the PPS and provide recommendations as to whether certain supplies should be excluded from the per episode payment; thus, allowing them to be billed separately. - OWM

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