...Medicare Audits Affecting Healthcare Ecosystem Medicare is the most prominent health insurance program in the world; accounting for two percent of gross domestic production, seventeen percent of the U.S. health expenditures, and one-eighth of the government’s national budget. The major impact that this government payer program has in the healthcare ecosystem is the massive coverage it provides to the elderly and disabled. Costing about $260 billion annually, Medicare inaugurated the Recovery Audit Contractor (RAC) program to make claims more cost effective with the detection of over and under payments. The recovery audit was first drafted through Section 306 of the Medicare Modernization Act (MMA) of 2003 which directed the Department of Health and Human Services (DHHS) to constitute a demonstration of the program. The required program began in 2005 and utilized RACs to isolate and correct inappropriate payments in the Medicare Fee-For-Service (FFS) program. According to the Centers for Medicare and Medicaid Services (CMS) (2014), the demonstration ended in 2008 resulting over $900 million in overpayments and nearly $38 million in underpayments. The success of the audit trial gave CMS a “valuable new tool for preventing future inappropriate payments” (American Health Information Management Association (AHIMA), 2009). This succession brought the recovery audit into legislation under Section 302 of the Tax Relief and Healthcare Act of 2006 which mandated a permanent...
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...Quality Improvement Project: Address barriers and leveraging strengths to achieve improvement in your organization. The numbers of medical error that occur in hospital settings are usually under estimated. Improving these events has come a long way since 2005. The Patient Safety and Quality Improvement Act has contributed to the healthcare industry by allowing employees to report without fear of liability to agencies who then identify, analyze, and reduce risks and hazards that often occur when administering care to a patient (Youngberg, 2011). This is a great tool in advancing the training process of the health care team and increasing patient safety. In addition to employees having what I would call free speech to the Patient Safety Organizations, provider’s organizations can have the same privilege so long as they establish a relationship with the PSO who has participated in the peer review process. Any healthcare organization that wants to improve the quality of care their patient receives would encourage their employees to participate. Having a manager with strong leadership skills within the organization can also be a driving force for positive change. Strong leaders are creative, experienced and can motivate employees. They will be able to detect where and how a problem was initiated and can create a plan focused on preventing the problem. They can be an advantage to achieve quality improvements by analyzing data, composing a safety plan for all clients in and out...
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...In the 1999 research studies began to review the problem of medical errors and how they occurred. Studies and reports, such as the Institute of Medicine IOM report in 1999, strongly suggest that most medical errors are related to systems and processes and not individual negligence or misconduct. The IOM report recommended that the key to addressing medical errors is to focus on improving the processes used to deliver healthcare and not placing blame on the individuals involved. Approximately 1.3 million people are injured annually in the United States following "medication errors". The FDA defines a medication error as “any preventable event that may cause or lead to inappropriate medication use or harm to a patient”. The U.S. Food and Drug Administration (FDA) currently review medication error reports that come from drug manufacturers and through Med Watch, the agency's safety information and adverse event reporting program. The agency also receives reports about medication errors from the Institute for Safe Medication Practices (ISMP) and the U.S. Pharmacopeia. Some things the FDA has put into place to prevent medication errors: * Drug Name Review: To minimize drug name confusion, FDA reviews about 400 drug names a year that companies submit as proposed brand names. The agency rejects about one-third of the names that drug companies propose. * Drug Labels: FDA regulations require all over-the-counter (OTC) drug products (more than 100,000) to have a standardized...
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...In 1999 the Institute of Medicine (IOM) published a report titled “To Err Is Human: Building A Safer Health System” that leveled the healthcare community. They reported that according to two studies “perhaps as many as 98,000 people die in hospitals each year as a result of medical errors that could have been prevented”. IOM (1999) Then the Office of Inspector General for Health and Human Services followed up with a report in 2010 that stated “bad hospital care contributed to the deaths of 180,000 patients in Medicare alone in a given year”. Allen (2013) And finally in 2013, the numbers were once again raised. Per a report from the Journal of Patient Safety that approximately “440,000 PAEs (preventable/potential adverse events) that contribute to the death of patients each year from care in hospitals. This is roughly one-sixth of all deaths that occur in the United States each year”. They are now the U.S.’s third leading cause of death, behind only heart disease and cancer. All of the numbers mentioned in the first paragraph are medical errors that were “preventable”. Mistakes by the people you put your trust in killed you, not the reason why you were admitted to the hospital. Now understand they didn’t do it on purpose. But it happens. Define the problem Granted, a death by even one medical error is one too many, but why do the reports have such drastically different numbers? How in the world can “official” reports be off by approximately 400,000 deaths…per year? Who...
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...to cite a single number to define the extent of the medication error problem due to differences in institutions, study methodologies, error definitions, and other variables. On the high end of estimates, one study that compiled data from 36 institutions reported 19% (~1 in 5) of the medication doses studied over a 4-day period involved medication errors (Barker et al., 2002). These errors included wrong time (43%), omission (30%), wrong dose (17%), and unauthorized drug (4%). The number of these errors deemed potentially harmful adverse drug events (ADEs) was 7%. A comprehensive review of medication error studies cited in the Institute of Medicine (IOM) 2000 report on errors in the U.S. healthcare system suggests that preventable ADEs, i.e., harmful medication errors, occur in ~1% to 10% of hospital admissions. The IOM report further estimated that 770,000 patients are injured and ~7,000 die each year due to medication errors. An estimated 28% to 95% of ADEs can be prevented (AHCPR, 2004) The added costs associated with treating medication errors can be very high (Classen et al., 1997;...
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...“Nursing’s Role in Promoting Quality and Patient Safety Assignment” Nurses inherently are concerned with patient safety. They are best positioned to prevent medical errors at the bedside. There is a moral and legal imperative to implement safe practices at all times. Nurses and the profession are negatively impacted when medical errors occur. Until recently the Centers for Medicare & Medicaid Services (CMS) mandated that all patient medications be administered 30 minutes before or after a scheduled time (Department of Health & Human Services [DHHS] & Centers for Medicare & Medicaid Services [CMS], 2011, December 22). Given the expanding role of nurses, the CMS mandate is now unrealistic and counter-productive. The Institute for Safe Medication Practices (ISMP) addressed this issue by creating an Acute Care Guideline for the timely administration of schedule medications. Institute for Safe Medical Practice The ISMP is dedicated to preventing medical errors by promoting safe medication administration procedures (ISMP, 2013a). The ISMP reviews all facets of safe medication administration. Medication errors frequently result in debilitating injuries or death. The ISMP posits that the most frequent medical error is medication administration. Medication error affects over 1.5 million people annually (ISMP, 2007b, p. 1). The ISMP has committed staff and resources to reduce medication errors. It has developed training and educational programs for health care staff and consumers...
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...and Administration The importance of safe medication preparation and administration in healthcare settings is being increasingly recognized. There have been numerous publications describing the transmission of bloodborne pathogens, viruses, and bacteria related to unsafe injection practices. The current field of nursing requires concerned parties to exercise a critical appraisal of research findings, and, establish a synthesis of contextual and empirical evidence that is relevant. However, practitioners have not established better alternatives regarding their practice. In addition, the essential evidence-based methods and critical skills in thinking are still lacking; yet they are ideal for the maximization of the cost-effectiveness and quality of health care (Camiletti, & Huffman, 1998). The Center for Disease Control reported that between 1998 and 2008 a total of 33 outbreaks of patient to patient transmission of HBV or HCV due to breaches of infection control by health care personal (http://www.cdc.gov/injectionsafety/CDCsRole.html1). More than 60,000 patients were at risk and 448 patients acquired with HBV or HCV. The disease transmission was primarily from lapses in aseptic technique, the reuse of syringes and contamination of medications that were multi-dose vials. In 2001(Luby, 2001) The World Health Organization reported the single largest outbreak that resulted in 133 patients infected with HBV or HCV due to the reuse of needles and multi-dose vials on multiple patients...
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...From Medscape Nurses Medication Error Prevention for Healthcare Providers Faculty and Disclosures CE Information There are between 44,000 and 98,000 individuals who die every year in hospitals due to preventable medical errors.[1] It has also been reported that this is only part of the problem, as thousands of other patients are adversely affected by medical errors or barely avoid injuries that are nonfatal.[2] These medical errors not only cost the loss of lives, but carry a financial burden that is estimated to be in a range of $17 billion to $29 billion annually. Additionally, there is physical and psychological pain and suffering related to these errors.[1] Another consequence is that medical errors diminish trust and satisfaction in the healthcare system and in healthcare professionals.[1] Ginette A. Pepper, PhD, RN, FAAN, a Professor and Helen Lowe Bamberger Colby Presidential Endowed Chair and Associate Dean for Research, University of Utah College of Nursing, Salt Lake City, spoke on medication safety for the geriatric nurse practitioner (GNP).[3] Dr. Pepper was trained as a pharmacologist with a nursing focus. She was one of the first NPs to add "geriatric" to her title as well as one of the first NPs to have prescriptive authority. Safety Principles and the Medication Use Process Dr. Pepper noted that safety issues are of the utmost importance for all healthcare providers.[3] Nursing as a profession has a long history of regarding patient safety as a primary...
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...Medication Errors Stephanie Stephens January 9, 2016 NU1426 ITT TECH Nurses must always follow the six rights of medication administration thoroughly to ensure patient safety. These rights include right medication, right route, right time, right client, right dosage, and right documentation. When one of these rights is not followed a medication error has occurred and must be reported immediately. Medication error prevention is vital in the role of the nurse. There were many contributing factors leading to this medication error and there are many ways to avoid medications errors. Looking at the reasons why medications occur helps the nurse understand what areas to be most vigilant. The main areas of medication errors are distractions/ interruptions, medication education, interpretation of an order and poor calculations. Patients during their time in the hospital will receive medications. Distractions will occur throughout a nurses shift, losing concentration at the task at hand can lead to serious and harmful mistakes. It is important for the nurse to let her surrounding nurses know when she/he is pulling medications so that there isn't any distractions. Also, a quiet environment when taking telephone orders so that the order can be heard clearly and dictation from the provider is understood. Another medication administration error prevention for the nurse is to allow for delegation and to not take on to much. When a nurse is in the process of administering medication...
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...Medication Administration Errors A medication error is commonly defined as a deviation from the physician’s medication order in the patient record or an error occurring in the medication-use process. (Choo, Hutchinson, & Bucknall, 2010, p. 854) The review of literature in the article “Nurses’ Role in Medication Safety” attempts to identify the challenges of medication safe delivery in the clinical practice by reviewing multiple studies. The article authors define two different approaches to viewing human errors in medication errors. The “person” approach focuses on the individual nurse making the error and focuses on the unsafe behavior related to inattention, forgetfulness, carelessness, negligence or recklessness. With this approach, errors are reduced by modifying human behavior. The system approach focuses on the working conditions and looks at errors as results of systems problems within the clinical setting, such as staff shortage, increased workload, interruptions etc. (Choo, Hutchinson, & Bucknall, 2010, p. 855) The system approach is more conducive to changing processes which contribute to errors instead of blaming the individual. Work environments are reported as being a major influence in medication errors. The authors cite a study by Sanghera et al. (2007) which states lighting, nurse interruptions, and poor communication amongst team members contribute to medication errors. Another study is cited as reporting increased workload for nurses as another cause of medication...
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...Annually, millions of Americans receive high-quality health care that restores their health to the best it can be and allows them to carry on functioning in society at their optimum best. Unfortunately this story does not resonate with some Americans who are far from happy about the level of care they received while sick. Quality problems are present in wide variation across board when talking delivery of health care services, in some instance, the issue could be with underutilization of a particular service, and other instances may include misuse of service which is generally preceded at onset by prior unacceptable level of errors. The purpose of this paper is to highlight medication errors as a health care safety issue. One solution involving automation would be explored since it has long been recognized as an important factor in reducing human errors in work processes. It is crucial to showcase this because numerous studies have substantiated the positive effects of health IT on quality and safety improvements, Slovenky & Menachemi (2011). A safety Initiative With new tools provided by the Affordable Care Act, hospitals can now aggressively implement programs with sole aim of assisting in the reduction of preventable errors. The act provides hospitals with incentives to improve the quality of health care, and provide real assistance to medical professionals, to support their efforts to reduce harm, McKinney & Zigmond (2011). The government predicted that this could save...
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...Medication Administration Errors A medication error is commonly defined as a deviation from the physician’s medication order in the patient record or an error occurring in the medication-use process. (Choo, Hutchinson, & Bucknall, 2010, p. 854) The review of literature in the article “Nurses’ Role in Medication Safety” attempts to identify the challenges of medication safe delivery in the clinical practice by reviewing multiple studies. The article authors define two different approaches to viewing human errors in medication errors. The “person” approach focuses on the individual nurse making the error and focuses on the unsafe behavior related to inattention, forgetfulness, carelessness, negligence or recklessness. With this approach, errors are reduced by modifying human behavior. The system approach focuses on the working conditions and looks at errors as results of systems problems within the clinical setting, such as staff shortage, increased workload, interruptions etc. (Choo, Hutchinson, & Bucknall, 2010, p. 855) The system approach is more conducive to changing processes which contribute to errors instead of blaming the individual. Work environments are reported as being a major influence in medication errors. The authors cite a study by Sanghera et al. (2007) which states lighting, nurse interruptions, and poor communication amongst team members contribute to medication errors. Another study is cited as reporting increased workload for nurses as another cause of medication...
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...1 Final Project N311 Dr.Peggy Shipley Shannon McKnight 6/14/2014 2. Introduction According to the Institute of Medicine there are more than a million injuries and almost 100,000 deaths associated with medication administration errors every year in the healthcare profession. Administration of medication is a large part of every day nursing care. As the patient’s primary advocates, it is the nurse’s responsibility to make certain these medication errors do not occur and to uphold the patient’s safety. Hebda & Czar (2013) state, “The desire to reduce or eliminate medication errors focuses attention on computerized physician order entry (CPOE), Bar Code Medication Administration (BCMA), and e-prescribing”. With the growing amount of medication errors, many institutions are introducing the Bar Code Medication Administration System. This is a system that will aid in assuring the right patient is getting the right medication and reduce the risk for medication errors. Although BCMA will not be a remedy for medication errors, it can provide a safeguard that is not possible with manual method. The implementation of the Bar Code Medication Administration system has been highly proven reduce the number of medication errors, improve patient safety, and increase the nurse’s job satisfaction. 3. Barrier to the Implementation Understanding the barriers to change...
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...Risk and Quality Management Strategies 4 Executive Summary VOLUME 2 July 2009 Key Recommendations Assess current activities in risk management and quality improvement to evaluate their effectiveness in addressing overlap. Establish a structure to ensure that patient care activities are addressed in a coordinated manner involving risk management and quality improvement functions. Seek legal counsel to ensure that the structure for risk management and quality improvement activities maximizes legal protections granted by state and federal statutes while allowing for the flow of information. Align risk management and quality improvement plans with the strategic goals of the organization. Educate stakeholders on the role of risk management and quality improvement functions. Design systems to coordinate and streamline data collection, analysis, monitoring, and evaluation. Risk Management, Quality Improvement, and Patient Safety In the past, the risk management and quality improvement functions often operated separately in healthcare organizations and individuals responsible for each function had different lines of reporting—an organizational structure that further divided risk management and quality improvement. Today, risk management and quality improvement efforts in healthcare organizations are rallying behind patient safety and finding ways to work together more effectively and efficiently to ensure that their organizations deliver safe and high-quality patient...
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...Sample Leadership Roles and Responsibilities for Quality Improvement: VTE Prevention This is a multifunctional document that leaders can use to negotiate and coordinate their individual responsibilities and make sure that all of the essential activities are covered. It can be used by the BOD, CEO, CMO, chief quality officer (CQO), C-Suite champion (CSC), and physician champion (PC) as a starting point for discussion. It is provided in a native file format (MS Word) so that it can also serve as a template for the final, approved version of leadership accountabilities. Board of Directors (BOD, or Board)—can include whole Board or just its Quality Committee • Approves a blood-clot prevention initiative as a high priority • Sets performance standards and benchmarks for blood-clot prevention • Approves the format, frequency, and level of detail expected for the quality reports the Board receives • Appropriates specific funds for clinic\al quality improvement activities • Formally reviews and discusses venous thromboembolism (VTE, or blood clots) performance data and seeks explanations for rates that fail to meet standards and benchmarks • Establishes and revises priorities for improving patient safety and clinical quality of care • Assures structure is clearly delineated for: a) obtaining stakeholder input; and b) approving materials for improving clinical quality and patient safety (e.g., policies, protocols, standing/pre-printed order sets, patient education/staff...
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