M uch has been written about the revision to F-314 Instruction to Surveyors, the guidance document that addresses pressure ulcer management in long-term care.^1,2 Understanding exactly how a surveyor might view the pressure ulcer care provided in a facility in accordance with the Centers for Medicare and Medicaid Services (CMS) regulations may be helpful to long-term care providers. The following is an actual example of a survey conducted in a long-term care facility.

For clarity, the regulatory information below precedes the summary of deficiencies documented by the surveyor.

R eimbursement for telemedicine services is important to their provision.^1,2 The primer on telemedicine, available at http://www.amdtelemedicine.com/primer.cfm, sums up many of the issues surrounding telemedicine utilized in the following discussion of the reimbursement for home care and telemedicine.

The Balanced Budget Act of 1997 (BBA) required payment for telemedicine services that meet certain criteria. Under the BBA, Medicare required the presence of a Medicare-participating telepresenter to be eligible for Medicare

A n ostomy clinic provides patients long-term accessibility to a Certified Ostomy Care Nurse (COCN) or Certified Wound, Ostomy and Continence Nurse (CWOCN) specialist, essential for people requiring ostomies. Preoperative visits for education and stoma site marking, postsurgical visits for follow-up or problem resolution, and guidance and suggestions for patients who have lived with an ostomy for years help promote holistic care. Developing a relationship between the CWOCN/COCN and the patient is of utmost importance, has a positive influence on the patient’s quality of life with the ostomy,

  Healthcare policy makers, providers, and payors must find the optimal balance between providing high quality care and managing expenses. The estimated federal spending for Medicare and Medicaid beneficiaries in 2005 is $648 billion; for 2011, projected costs are more than $1 trillion.¹ On-going discussions about methods to reduce the growth of healthcare expenditures are tempered by considerable concern about the negative impact of any cost-cutting initiatives on the quality of care provided.