1) what are the factors (eg, timely and appropriate clinical services) that determine whether patients at risk for pressure ulcers receive proper skin care?
2) what does administration need to do to ensure that the hospital is not submitting claims for services for which payment is not available under applicable rules? take into account the role of individuals who may want to become a whistleblower, or qui tam relator , under the False Claims Act.
3) legally, how did CMS go about deciding that it would reduce reimbursement for hospital-acquired pressure ulcers and other conditions? does this policy make sense to you? why? does the policy raise any ethical issues?
4) in what ways might an administrator alter systems to avoid the adverse conditions impacting payment, as described in this scenario? in particular, what, if anything, might a hospital administrator do regarding the skilled nursing facility from which this and other patients come?
References
Peter McNair 2009, Medicare’s policy not to pay for treating hospital-acquired conditions: the impact.
Rosenthal Meredith, 2007, nonpayment for performance? Medicare’s new reimbursement rule.
Robert Wachter, Nancy Foster, R.adams Dudley 2008 Medicare’s decision to withhold payment for hospital errors: the devil lis in the details.

 

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http://au.medline.com/media/ukmedline/mkt/research/research%20library/pressure-ulcer-prevention/understanding-risk-factors-pressure-uncer-development.pdf

http://nursingcenter.com/JournalArticle?Article_ID=767830

http://hospitals.jefferson.edu/about-us/financial-statements-and-corporate-compliance/policy-122-11/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881841/

http://www.nbch.org/nbch/files/ccLibraryFiles/Filename/000000001630/HAC%20Payment%20Policy%20Toolkit%20(final%20version)%20081109.pdf

1) what are the factors that determine whether patients at risk for pressure ulcers receive proper skin care?

The factors that determine if patients at risk for pressure ulcers when receiving skin care include whether the patient received proper circulation, whether or not nurses used the method of dragging or sliding the patient when moving the patient; whether the nurses were able to reduce mechanical stress to the skin, if nurses kept the wound temperature constant were vigilant and alert regarding temperature changes, whether or not the nurses kept the moisture balance stable and didn’t allow the skin get too wet or too dry, and whether bacterial invasion of the skin was effectively prevented with the appropriate medicine and sanitation on all parts of the body.

2) what administration needs to do to ensure that the hospital is not submitting claims for services for which payment is not available under applicable rules? take into account the role of individuals who may want to become a whistleblower, or qui tam relator , under the False Claims Act.

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