Geriatric Practice Management

Noncompliant use of Atypical Antipsychotics

The DHHS OIG staff just issued an analysis (http://oig.hhs.gov/oei/reports/oei-07-08-00150.asp) claiming frequent misuse of Atypical Antipsychotic drugs in the NF population. Based on a 2007 sample, their summary says:

For the period January 1 through June 30, 2007, we determined using medical record review that 51 percent of Medicare claims for atypical antipsychotic drugs were erroneous, amounting to $116 million.

A member of Congress requested that OIG evaluate the extent to which elderly nursing home residents receive atypical antipsychotic drugs and the associated cost to Medicare. Specifically, this member expressed concern with atypical antipsychotic drugs prescribed to elderly nursing home residents for off-label conditions (i.e., conditions other than schizophrenia and/or bipolar disorder) and/or in the presence of the condition specified in the Food and Drug Administration's (FDA) boxed warning (i.e., dementia). Medicare requires that drugs be prescribed for "medically accepted indications" for reimbursement. Further, CMS sets standards to ensure that nursing home residents' drug therapy regimens are free from unnecessary drugs.

DNR Orders Clarification

We have recently received several calls about the portable Do Not Resuscitate (DNR) order form, also known as the Goldenrod form. Several readers have told us that some physicians are under the impression that only a physician can sign a portable DNR order. This is incorrect. In 2004, the Office of Emergency Medical Services (OEMS) issued a memo in response to this same question and clarified that a physician’s assistant or nurse practitioner can also execute a portable DNR order, and the order is effective and “should be followed by all health care providers as if the orders were signed and issued by a physician.” The memo also stated that the official portable DNR form had been revised to reflect this interpretation.

Raise Pay for Chronic Care

Medpac (Medicare Payment Assessment Commission) is an independent entity that advises Congress on changes to the Health Care payment schemes. Their annual report to Congress usually sets Medicare payment strategies for the coming year (FY 2012) http://www.medpac.gov/documents/Jun11_EntireReport.pdf

This June’s report is making a more serious effort to restructure payments with an eye towards a more primary care focused scheme. To fit within the existing Medicare Part B budgeting guidelines, Medpac is urging Congress to cut physician payments for Imaging and many tests.

I want my neighbors records...NOW!

Let me give you a hypothetical situation. Resident A has no known family and very few visitors. A longtime neighbor visits the resident regularly, is very involved in her care, and attends care planning meetings. One day, she appears at the nurses’ station, visibly upset, and demands a copy of the resident’s medical records, pronto! What do you do?

Providers call us with this question on a regular basis. Part of the confusion centers on the whole “responsible person” concept that is embodied in federal law, but is never defined. Under federal law, a resident’s responsible person stands in the shoes of the resident and has his or her rights, if and when the resident is incompetent.

Report on questionable billing

The OIG performed a statistical review of SNF part A bills for 2006 and 2008. They noted a significant increase in the number of claims for the highest level of Rehab combined with the greatest level of ADL impairment.

Here is a link to a summary of the report - http://www.racmonitor.com/news/33-top-stories/489-questionable-skilled-nursing-billings-could-top-500-million.html
Here is the link to the report itself - http://www.oig.hhs.gov/oei/reports/oei-02-09-00202.pdf

It is worth scanning the report to see the significant difference in Therapy needs based on the ownership of the building.

Noncompliant use of Atypical Antipsychotics

DNR Orders Clarification

Raise Pay for Chronic Care

I want my neighbors records...NOW!

Report on questionable billing

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