Best Practices

Next Generation ACO post discharge home visit waiver: Who should be on the team? Print E-mail
Written by   
Thursday, 21 December 2017 11:00

As CMS focuses on keeping patients healthy at home, Next Generation ACO primary care physicians are being encouraged to conduct more regular follow-up visits. While the next generation ACO home visit waiver encourages that, the question remains as to who should visit the home and when.

Next generation accountable care organizations like ours are coming up with innovations that can deliver quality care without overextending staff. While an experienced registered nurse is a must for the first visit to a discharged patient, follow-up care can be handled by others.

A paramedic can make sure that in-home equipment is working, that patients have been taking their vitals, and that they're comfortable with their plan of care. If at any point that level of care needs to be elevated, a registered nurse can step in. By matching the medical qualifications to individual needs, patients remain as independent and safe as possible within their home environment while office staff are put to best use.
Paramedics make sense not as a substitute for a registered nurse, but as a complement to that individual’s care. If a patient were to be in distress and called 911, paramedics would respond. They are trained to assess acuity and to contact the primary care physician to determine whether the patient is stable enough to stay at home or must go to the emergency room. In this and similar situations, paramedics are performing the roles for which they are trained while the physician maintains full control over the patient’s care.

For example, a patient who has  congestive heart failure experiences weight gain. Equipment that the paramedic installed in the home notifies the doctor’s cellphone, who then communicates with the patient, advising the person to take a water pill and the paramedic to conduct  a re-evaluation. If the patient is stable, the physician instructs the patient to schedule a follow up office visit the next day.

Does every physician’s  office require  a paramedic? No. Some physicians like to have their own teams during office hours. Others outsource the service. The ultimate benefit is better quality care and better use of people’s training and skills.

Accountable Care Options ( is one of a select group of physician directed organizations organizations accepted into the Medicare Shared Savings Program to improve patient access, medical quality and care coordination in South Florida.

Last Updated on Thursday, 21 December 2017 11:04
Next Generation ACO post-discharge home visit Medicare waiver Print E-mail
Written by   
Thursday, 14 December 2017 08:37

To lower readmission rates, the number of incident to billable visits will jump next year to nine in the first 90 from the current two in the first 30 days.
The new rules eliminate the time intervals between visits. If a patient requires more upfront attention, a post-discharge team can evaluate her or him three times in the first two weeks, and therefore reduce costs by preventing an avoidable readmission. 
Not all nine home visits may be needed and the first in-home assessment is the most critical. The doctor should send an experienced registered nurse, someone who has done either case management or social services and thus knows how to assess the patient physically, functionally and socially.
That professional will find out how much the patient can do on her or his own, whether a caretaker or family is there to assist, and whether certain measures are in place such as power of attorney and notification of next of kin. The nurse will also assess the patient’s condition, which will then dictate the next visits and follow-up office appointment.
Again, much depends on the initial assessment: What types of care would help the patient stay in the home? How much assistance does the individual need? How would the doctor be alerted to send a care team so the patient doesn’t need to call 911?
The answers can help the patient stay healthier and more independent, and could bring down the national 18 percent Medicare readmission rate.

Last Updated on Thursday, 14 December 2017 08:40
JAMA study: Double booking surgeries leads to negative outcomes Print E-mail
Written by FHI News   
Tuesday, 05 December 2017 18:51

Overlapping surgery, also known as double-booking, refers to a controversial practice in which a single attending surgeon supervises 2 or more operations, in different operating rooms, at the same time. Entitled Association of Overlapping Surgery With Increased Risk for Complications Following Hip Surgery, A Population-Based, Matched Cohort Study and published online December 4, 2017 by JAMA Intern Med., the authors found that for "patients undergoing overlapping procedures, there was an approximately 90% increase in the risk for surgical complications at 1 year."

When Social Media and Patient Privacy Collide Print E-mail
Written by Vitale Health Law   
Tuesday, 28 November 2017 19:01

Earlier this month, three employees of an assisted living facility in Glendale, Arizona were let go after allegedly videotaping patients and posting them to Snapchat. The video shows employees making fun of elderly residents in their care and, instead of taking care of one woman asking for help, the employee continues to film and make fun of her. To its credit, management said it was investigating the matter and that it also had been reported to the State Board of Nursing as well as the Arizona Department of Health Services for review. The matter came to management's attention thanks to a whistleblower (a nurse) who saw the video on Snapchat and reported it.

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Last Updated on Friday, 05 January 2018 19:20
Gastric Cancer Risk Doubled With Long-term PPI Use Print E-mail
Written by Megan Brooks | Medscape   
Wednesday, 01 November 2017 00:00
Use of a proton-pump inhibitor (PPI) after Helicobacter pylori eradication more than doubles the risk for gastric cancer, according to a population-based study from Hong Kong. The "clear dose-response and time-response" trend in PPI use and gastric cancer risk observed suggests the need for "caution when prescribing long-term PPIs to these patients even after successful eradication of H. pylori," write Wai Keung Leung, MBChB, MD, from Queen Mary Hospital, Hong Kong, and colleagues. The study was published online October 31 in Gut.
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