Last month, the Centers for Medicare & Medicaid Services announced the start of a new program designed to give up to 10,000 Medicare patients with chronic conditions the ability to receive most of their primary care at home.

The idea behind the program is to bring back the old practice of house calls but with a modern day approach using today’s technology and team-based approach, said CMS Acting Administrator Marilyn Tavenner, RN, BSN, MHA. The new program, Independence at Home, significantly expands the scope of in-home services Medicare beneficiaries can receive.

The program not only helps the patient but it will also bring new avenues to care for medical practices nationwide. CMS will join with medical practices to test the effectiveness of delivering primary care services in a home setting to see if it improves care for Medicare beneficiaries with multiple chronic conditions. The program will also test whether home-based care can reduce the need for hospitalization, improve patient and caregiver satisfaction and lead to better health and lower costs to Medicare.

“In my days as a practicing nurse, I saw many patients whose health improved when they were happier with their living conditions,” Tavenner said. “When a critically ill patient can remain in familiar surroundings, the benefits are many: The person retains greater control over their daily lives, families and caregivers report greater satisfaction with the care and unnecessary hospitalizations are avoided.”

Home-based primary care generally allows health care providers to spend more time with their patients, perform assessments in a patient’s home environment and assume greater accountability for all aspects of the patient’s care. Independence at Home will build on these existing benefits by providing chronically ill patients a complete range of primary care services in the home setting.

Have you had experience in Home-Based Care? Medical practices wishing to participate must have in their employment physicians or nurse practitioners with experience in delivering home-based primary care. As many as 50 practices will be selected and each must serve at least 200 Medicare fee-for-service beneficiaries with multiple chronic conditions and functional limitations. Practices chosen to participate will be responsible for coordinating patient care with other health and social service professionals.

Medical practices chosen for the program that show a reduction in Medicare expenditures and succeed in providing high-quality care will receive an incentive payment. CMS will use quality measures to ensure that beneficiaries receive high quality care. Practices interested in joining the Independence at Home program can get more information by clicking here. Applications and letters of intent are due Feb. 6.

The health sector got a little healthier last week thanks to Cardinal Health Foundation’s pledge to offer more than $1 million in grants to help hospitals, health systems and other non-profit healthcare institutions across the country through their E3 Grant Program. Grants are handed out to improve the efficiency and quality of patient care.

“These grants are saving lives and that is what we are all about – making healthcare the very best it can be,” said Dianne Radigan, director of community relations for Cardinal Health. “The hospitals involved are reporting reduced readmissions and lengths of stays, improved anticoagulant compliance and outcomes, more efficient use of their operating rooms, better communication among their team. All-in-all, really improving care for patients as well as saving precious healthcare dollars.”

Cardinal Health began the grant program in 2008 and has awarded 147 grants worth more than $4.25 million. Hospitals and other healthcare systems interested in applying for the grants should submit funding requests for projects that will improve medication safety, specifically in relation to patients moving from the hospital to home or continued care settings; or for projects that will improve operating room safety through the use of World Health Organization Surgical Safety checklists.

In addition to the grants, successful applicants working on surgical errors get access to coaching support from members of the Association of periOperative Registered Nurses. Applicants awarded grants to work on medication safety projects get access to coaching and support from hospital pharmacy experts from the Cardinal Health Pharmacy Solutions team.

“We appreciate how challenging and complicated the world of patient care is, and we see these grants as a catalyst to help hospitals, clinics and ambulatory settings prioritize time and expertise to focus on the implementation of best practices,” Radigan said.  “We are so encouraged by the outcomes achieved by the organizations that have participated in this grant program over the past three years and are pleased to once again provide funding support to help an expanding network of hospitals and health clinics work together to improve the effectiveness, excellence and efficiency of patient care.”

Cardinal health is hosting two webinars to review program criteria and provide interested applicants an opportunity to ask questions. The webinars will take place today at 2:30 p.m. EDT. If you wish to participate dial 1-877-336-4425 using the access code 7577481 to hear the audio portion or visit https://www.connectmeeting.att.com and enter meeting code 877-336-4425 and use access code 7577481 to access the visual presentation of the webcast.

Applications will be accepted through Dec. 2, 2011 and can be submitted through Cardinal’s website.

Healthcare reforms continue to make headlines, and those of you in the nursing field have an opportunity to ensure that your voice is heard in the ongoing debate. The Scholar in Residence Program at the Institute of Medicine (IOM) of the National Academies provides a yearlong leadership opportunity in health policy. The application deadline is August 8, 2011.

The program is designed as an immersion experience to facilitate nurse leaders engaging in a prominent role in health policy development at the national level and to increase their interaction with other health fellows and scholars. Prior attendees report many doors opening to new opportunities and since the program offers a chance to step outside the hospital, nurses see new and different perspectives.

Among the criteria required to be considered for the scholarship program, applicants need to be a current member of the American Academy of Nursing (AAN) and be in agreement with the health care policies of the IOM and AAN. The IOM was established in 1970 as the health arm of the National Academy of Science and provides information to decision makers, who can then change regulation or policy, and to other groups who are able to change behavior. The AAN serves the public and the nursing profession by advancing health policy and practice through the generation, synthesis, and dissemination of nursing knowledge.

Those accepted as scholars will direct a self-initiated study with policy consequences that builds on a current IOM initiative. An annual stipend of $75,000 is included and scholars will be provided with an office at IOM. An intensive two-month orientation in federal health policy formation will be included as part of the program.

To be successful in the program, applicants should have an understanding of the importance of networking within the health policy community, including identifying opportunities for nurse-leader engagement and communication of those interactions and opportunities to sponsors.  As a scholar you will have direct interaction with staff who work for the AAN and the American Nurses Association and the American Nurses Foundation – all who support the IOM on this program.

During the program, applicants can expect to be involved in a number of projects including writing policy-oriented papers in a chosen area of study to be submitted for refereed publication within six months of completion of the scholarship program. Other areas of involvement include providing testimony, participating in IOM workshops and engaging with other nurses on policy-related websites. A report to the AAN, ANA and ANF Boards of activities and accomplishments must be filed within 60 days of completing the program.

For additional information on this unique opportunity to take your leadership skills to the next level click here.

Earlier this year we looked at the Patient-Centered Medical Home. Now a similar movement is on the rise known as Accountable Care Organizations, or ACOs. An ACO is a group of providers that collectively takes on the responsibility of delivering health care for a defined population of patients while managing both the quality and cost of that care. For physicians and healthcare administrators, navigating the definitions, requirements, regulations and payment models of these healthcare models will be an ongoing challenge, but one that must be tackled to keep your competitive edge in the healthcare field.

ACOs have already been successfully executed as evidenced by Kaiser Permanente and HealthCare Partners Medical Group. But with the passage of the Patient Protection and Affordable Care Act (ACA), requirements for ACOs have been officially outlined by the federal government. And the Centers for Medicare and Medicaid Services (CMS) is currently drafting regulations for the Medicare Shared Savings program part of which will allow ACOs to contract with Medicare by January 2012.

Several ACO pilot programs are currently underway across the country with commercial insurers and state Medicaid programs (New Jersey, Vermont, Colorado, etc) in advance of the Medicare Shared Savings Program. As you attempt to understand the ins and outs of the ACO, know that there are resources to help you ford these sometimes murky waters.

To stay on top of the progress of ACOs, engage your peers in an ongoing discussion on the topic at meetings, informal gatherings and online. You might also consider assigning a member of your staff to make it his/her job to track ACO-related news and make a monthly report at staff meetings.

And of course, you’ll want to look for workshops, seminars or conferences within your professional membership organizations. For example, the American Association of Family Practitioners (AAFP) will hold a free webinar on ACOs June 22 from 1:00-2:00 pm. Items on the agenda include:

• Definitions of an ACO
• How the PCMH fits in the ACO
• How an ACO can affect your practice
• Why an ACO is more than just Medicare

“With all the buzz about ACOs, there’s still a lot of mystery and a lot of uncertainty about what this model means to physician practices,” said AAFP’s Medical Director of Quality Improvement Bruce Bagley, M.D., one of the moderators of the webinar. He went on to say that the AAFP webinar will “bring that conversation down to an easy-to-understand level.”

Additionally, the CMS is offering a free class called the Accelerated Development Learning Program to help physicians develop an action plan for improving health care delivery and providing more coordinated patient care in the ACO model. The class will be offered four times this year, the first of which takes place June 20-22 in Minneapolis. The class will also be webcast. CMS is also looking for input on various components of its work on ACOs.

Whether you are already functioning within an established PCMH or ACO model or are researching the options currently before you, it is important to be aware of the continuing changes and how they will affect your practice. And if you participate in the implementation of either or both, chart your progress and include your work on your resume, in your bio, and in your online profiles in places like LinkedIn.

The medical field (and technology in general) seem to be changing almost daily and as a healthcare provider you know staying on top of the most current trends, treatments and technology is a must in your profession. But a new partnership using a smart phone application may take a little more pressure off of you as it allows the patient to take charge of their own urgent healthcare needs.

Healthagen, developer of the leading mobile consumer healthcare application iTriage, has partnered with Practice Velocity, a leading manufacturer in medical software solutions for the urgent care industry. This partnership allows patients using iTriage to make appointments and pre-register for urgent care visits through Practice Velocity’s ZipPass function, which is a software management system.

Patients can use the technology to register and “get in line” for an urgent care visit all by using their mobile phone device such as an iPhone or an Android. This streamlines the wait time and registration process allowing you to deliver health care much sooner. The American Academy of Urgent Care Medicine feels so strongly about the technology the group has also partnered with iTriage to allow the thousands of physicians that hold a membership with AAUCM to promote their services to smart phone wielding patients looking for the nearest urgent care center.

There are approximately 9,000 urgent care centers in the United States, a number that is growing. Urgent care facilities are widely used for small and minor injuries, which leave the ER open for more critical care. Practice Velocity’s ZipPass function allows patients to wait at home instead of in the clinic. Their partnership with iTriage will expand their ZipPass technology to mobile phone users.

“Physician appointment setting and pre-registration are emerging trends in the health care industry. iTriage is leading this trend by empowering the patient with convenient access through mobile devices,” said David Stern, CEO, Practice Velocity.

Physicians with memberships in AAUCM can use iTriage to list critical details about their urgent care center, and patients using the application can identify if their specific need will be addressed or if they would be better off at another care facility.

“By staying at the forefront of emerging technologies like iTriage, AAUCM can enhance doctor/patient communications and Urgent Care Center visibility,” said Peter Hudson, M.D., CEO, Healthagen. “This partnership highlights how two leading organizations can create an alliance to improve healthcare delivery for those with minor acute care needs.”

One more good reason to retire in Florida!

It seems one non-profit has figured out a highly effective way to care for uninsured or underinsured Americans over the age of 50. Senior Friendship Centers of Southwest Florida has been providing healthcare for older adults since 1973 and has even become a national model for developing innovative and cost-effective approaches to address the health and wellness needs of those 50 years and older.

Volunteers serve in nearly every aspect of the Senior Friendship Centers, which has a network of health service facilities called Centers for Healthy Aging. Volunteer physicians, dentists, pharmacists and other medical personnel provide care through an umbrella of programs including health and wellness and supportive aging services.

The program also enables those retiring from the medical field to stay current and active in their profession for the reason they started in the first place – to help other people.

By volunteering their time and expertise they uphold the organization’s motto of “People Helping People” and help offset skyrocketing healthcare costs. Estimated numbers from when the organization was founded in 1973 through May 2010 show volunteers have contributed time valued at nearly $25 million. And last year alone, 1,500 volunteers contributed more than 132,000 hours of service with an in-kind value of nearly $2.5 million.

Recently, the volunteers for the Senior Friendship Center in Collier County were honored as part of the Diamond Volunteer Program, which was founded by a local real estate agent to honor hard-working volunteers. Friendship’s Collier County site was recognized for amassing more than 7,000 hours of volunteer service each year.

There are more than 70 retired physicians, representing 15 specialties, who volunteer in Friendship’s Centers for Healthy Aging clinics. Additionally, there are more than 30 dentists, 8 dental hygienists, 3 pharmacists, 25 nurses and 15 clinic aides. Despite all this, there is still a waiting list that forces some patients to wait up to three months for care so more volunteers are always welcome.

Medical personnel living in Southwest Florida interested in giving their time and knowledge in the healthcare field can click here to learn more about what is needed in their area. Senior Friendship Centers also serve Sarasota, Manatee, Charlotte, DeSoto and Lee counties. Help is especially needed in the summer and fall months when many current volunteers return north.

We at Hospital Dream Jobs applaud this great healthcare organization and look forward to its continuing influence on other organizations around the country endeavoring to provide care to uninsured and underinsured seniors. And we encourage all of you healthcare professionals to get out there and volunteer your time to a worthy organization in your neck of the woods!

Two great organizations have joined in the fight against childhood cancer. Compass to Care and Angel Flight Central (AFC) are joining teams to provide transportation for patients and their families to treatment centers that are often prohibitively far from patients’ homes.

Thankfully, childhood cancer is quite rare, affecting only one or two children a year for every 10,000 in the United States. But that number is little comfort to those one or two children and their families. All cancer, especially childhood cancer, requires aggressive treatment. And most kids require care at special pediatric oncology medical centers which are not located in every city. For a family that doesn’t live in close proximity to a cancer treatment center, long-distance travel is not only costly but just one more unwelcome burden for the family and the ill child.

Compass to Care is a non-profit organization which serves as a medical concierge for families with children stricken with cancer. To allow families to focus on their more pressing needs, Compass to Care steps in and handles the scheduling part of transportation including meals, lodging and ground transportation whether it’s bus, train or taxi. At times, these travel arrangements can require flying to specialized medical centers, a cost Compass to Care also provides assistance with.

Angel Flight Central is also a non-profit, staffed by volunteer pilots, which serves the Midwest portion of the United States. AFC provides free air transportation for families requiring access to specialized health care, among other services. Now working together, these two organizations can assist more families and relieve part of the burden that accompanies the high cost of care.

“We are so excited to have formed such a valuable relationship with Angel Flight Central,” said Michelle Ernsdorff, founder and CEO of Compass to Care. “This is a perfect partnership that truly provides travel relief at a time when these families need it most.”

Angel Flight Central has transported more than 15,000 passengers over seven million miles since 1995. 16 years ago, AFC founder James H. Stevens Jr. offered to fly an ailing but chipper 8 year old boy to another state for a life-saving emergency and was hooked.

Michelle Ernsdorff, who was diagnosed with a rare form of kidney cancer in 1974, founded Compass to Care in honor of her parents. Michelle’s family spent years traveling back and forth from home to specialists incurring unexpected and overwhelming financial costs before she was finally cured. 

Both organizations rely on donations and volunteers to serve their mission. Interested members of the community, especially pilots, who wish to support either group via donation or their time should visit www.angelflightcentral.org or www.compasstocare.org. If you live outside the midwest and have medical needs requiring long distance travel, there are similar organizations across the country who can provide aid both for adults and children. Simply go online and use search words like “angel flight” and “medical travel concierge.”

Jobs at Virginia Mason Medical Center are coveted positions. Why? Because the Leapfrog Group has announced that Virginia Mason (along with University of Maryland Medical Center) has been awarded a Top Hospital of the Decade award.

Leah Binder, Leapfrog CEO, says that the top notch performance of the hospital is a tribute not only to the employers but to the Boards of Trustees and the management and employee teams at the hospital.

Describing Virginia Mason efforts as “extraordinary in every sense of the word,” Leapfrog’s Board Chair David Knowlton agrees. “Hospitals like Virginia Mason…are blazing a trail and have committed themselves to change, accountability and transparency. They have done the work that others must now undertake.”

In awarding the honors, Leapfrog focused on three critical areas of patient safety and quality. These included how patients fare (including stats like mortality for common high-risk surgeries), resources used to care for patients measured by length of stay and readmission rates and management practices that promote safety and quality (including the adoption of a computerized physician order entry to reduce medication errors and properly staffing ICU’s with specially trained doctors and nurses).

Some specific examples of how Virginia Mason rated in the high-risk procedures include:

1. Heart Bypass Surgery- VM improved from second best quartile to top quartile for performance and in the top quartile for cost of care.
2. Weight Loss Surgery- VM remained in the top quartile for performance. They performed 292 surgeries and the Leapfrog standard is 125.

Some specifics examples regarding patient safety include:

1. Prevention of Medication Errors- VM remained in the top quartile for performance and evaluated high on the use and performance of a CPOE system.
2. Managing Serious Errors- Following the policy of Leapfrog to admit when mistakes are made, VM maintained this policy as well as other policies implemented to improve patient safety.
3. Steps to Avoid Harm- Following 17 safe/best practices determined by the National Quality Forum, VM reduced the amounts of catheter-related infections, ventilator-associated pneumonia, assessing and preventing blood clots and more.

Virginia Mason Board Chair, Carolyn Corvi says, “It’s hard to find the words to convey just how proud I am to serve this organization as a community advocate. The Top Hospital of the Decade honor is well-deserved and speaks to the dedication and commitment by all team members…this confirms, without question, that Virginia Mason’s patients are truly the focus of everything that our team members do.”

> View all job opportunities at Virginia Mason
> Learn more about Virginia Mason

If you’ve been in healthcare long enough, you would probably agree that the old “deer in headlights” look could easily be changed to “family member in headlights”. Like the somewhat vacant, slightly panicked, definitely confused look of a son picking up his father after an emergency or major surgery. Certainly the patient can’t be expected to remember all of your discharge instructions, so that’s why you give it to the family member. You care deeply about your patient’s health and well-being and want to ensure his recovery.

But put yourself in the shoes of that son. You gave him detailed instructions for his father’s post-op care. I’m sure he was nodding and even giving you verbal affirmations but in reality, he may not have heard a thing you said. So it should come to no surprise when you see that patient back in the hospital sometime within the next month.

If you’re working in hospital medicine it’s likely this scenario has played out more times than you care to admit. In fact, it’s such a common occurrence a study was recently featured in the New England Journal of Medicine that showed 20 percent of Medicare patients were back in the hospital within 30 days. And, it’s been reported that 75 percent of those readmitted could have been prevented by proper post-discharge care.

No, you’re definitely not a bad healthcare provider. The example above is what many healthcare providers face when handing off their patient to family members, nursing facilities or even hospice care. Ideally, your work as doctor, nurse or other provider would not end when your patient leaves the hospital. But hand them off you must, and then you cross your fingers!

The problem of patient’s returning to the hospital in such a short time period is being faced head on by the Society of Hospital Medicine. SHM is a leader in providing quality improvement programs and was officially recognized this year as a Patient Safety Organization by the Agency for Healthcare Research and Quality (AHRQ), the lead federal agency for improving the quality, safety, efficiency and effectiveness of healthcare. SHM is one of the first professional medical societies with a division listed as a Patient Safety Organization.

SHM is especially proud of their Project BOOST, a discharge-transition program. This past week, the Washington Post profiled one hospital that began the program a few years ago and proactively targeted patients considered to be at high risk for readmission. Results showed a 30-day readmission rate for patients under 70 years old dropped from 13 percent to under 4 percent, and patients 70 and older dropped from 16 percent to 11 percent.

More than 250 hospital sites have taken advantage of SHM programs to reduce readmissions as well as improve patient care in other areas. If you want to learn first-hand how to help reduce that “deer in headlights” look and effectively manage your hospital medicine program, look into SHM’s Leadership Academy March 21-24 in Las Vegas.

Last week, the National Private Duty Association (NPDA) announced that its Annual Leadership Conference will take place in Las Vegas, March 2-4, 2011. Although the NPDA represents a wide range of home care providers including companions and housekeepers, healthcare providers figure largely in their network of more than 1,100 home care agencies. If you are a healthcare provider involved in private duty home care, especially in a position of leadership (for example, an RN supervising a home care team), this is an event you don’t want to miss! If you are a leader in another segment of healthcare you may find the NPDA’s Leadership Conference agenda and guest speakers of interest as you pursue better standards and practices in your own business.

This particular period of history is important for the home care industry both because of changes taking place in our nation’s health care system and because of the ever-expanding numbers of seniors in need of home care. Keynote speakers include human resources expert Mel Kleiman who will share his proven strategies for building world-class teams by recruiting, hiring and retaining the best employees. Also on hand will be Dr. Tom Barrett, author of bestselling books like Dare to Dream and Work to Win and Success Happens. He is known world-wide as an expert in leadership training and will address the little things home care agency leaders can do to make a big impact. In addition to these informative and inspiring guests, a few firsts will take place at the conference. The first-ever Caregiver of the Year will be named, and an All-Star Panel of experts will address key issues impacting private duty home care businesses including health care reform.

Sheila Mackin, President of NPDA, expects “this to be the largest event in the history of the private duty home care industry. NPDA’s intent is to provide an opportunity for home care agency professionals to learn the latest trends from industry leaders and the best business practices from thought leaders outside our industry.”

The conference is open to all private duty home care agencies and will include networking opportunities, discussion sessions, education programs and an industry trade show. Session topics will include hiring practices, caregiver training, client support, business marketing strategies, legal issues and technology. The NPDA is a non-profit organization dedicated to the advocacy and education of private pay home care providers. It also serves to help the public find quality home care.