The Rural Diabetes Clinic (RDC) is in a rural community in Oklahoma and serves a population primarily of American Indian descent. The RDC currently does not meet the benchmark goals of the Clinical Quality Measures (CQM) – improvement activities for Hemoglobin A1c (HbA1c) levels in the diabetic patients, ages 18 to 75. The Need for Policy and Guideline Change The federal benchmark goals for diabetic patients of the ages 18-75 is for HbA1c levels less than 9% are 0%. This means the patients for a healthcare organization must all have HbA1c levels less than 9% to be eligible for the maximum adjustment of Medicare part B reimbursement through the Merit-Based Incentive Payment System (MIPS) for health services (Centers for Medicare and Medicaid …show more content…
The regulatory considerations and the MIPS criteria for receiving reimbursement for health services will influence the financial abilities of the RDC to provide resources such as adequate staffing and health services (Santilli & Vogenberg, 2015). For instance, if the MIPS criteria are not met for HbA1c then the reimbursement for health services decreases, which affects the RDC’s ability to retain staff and provide quality health services. Hence, the policy and guidelines/strategies for the RDC must be realistic, streamlined, and adaptable to the environmental factors to improve the health of the patients and the community. Policy and Guidelines The proposed change policy to improve performance benchmarks for HbA1c is: • To provide high-quality care for the RDC diabetic patient is through an interprofessional team approach for delivering, monitoring, managing, and evaluating patient care to improve HbA1c levels and adherence to diabetic disease management treatment plans through culturally inclusive patient engagement (USHHS, 2018). The guidelines/strategies for the change policy to improve benchmarks for the HbA1c for the RDC patients are: • Develop a diverse interprofessional team that represents the diversity of the community’s population and provide culturally competent education for the team members (Akiyode & Davis, 2015; Gucciardi et al.,
With clinicians and CEHRT, the ONC plans to improve healthcare quality through interoperability (Office of the National Coordinator for Health Information Technology, n.d.) The ONC will promote more appropriate healthcare decisions in real-time, patient-centered care, and prevention of medical errors (Office of the National Coordinator for Health Information Technology, n.d.). The ONC’s goal is to reduce healthcare costs by addressing inefficiencies (Office of the National Coordinator for Health Information Technology,
With the passage of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) has initiated reimbursement based off of patient satisfaction scores (Murphy, 2014). In fact, “CMS plans to base 30% of hospitals ' scores under the value-based purchasing initiative on patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems survey, or HCAHPS, which measures patient satisfaction” (Daly, 2011, p. 30). Consequently, a hospital’s HCAHPS score could influence 1% of a Medicare’s hospital reimbursement, which could cost between $500,000 and $850,000, depending on the organization (Murphy, 2014).
Diabetes Mellitus (Type 2 diabetes/adult onset diabetes) is an epidemic in American Indian and Alaska Natives communities.7 AI/AN have the highest morbidity and mortality rates in the United States.7 American Indian/Alaska Native adults are 2.3 more times likely to be diagnosed with Diabetes Mellitus than non-Hispanic Whites.7 More importantly, AI/AN adolescent ages 10-14 are 9 times likely to be diagnosed with Diabetes Mellitus than non-Hispanic Whites.7 Type 2 diabetes is high blood glucose levels due to lack of insulin and/or inability to use it efficiently.8 Type 2 diabetes usually affects older adults; 8 however, the incident rate is rising quicker amongst AI/AN youth than non-Hispanic Whites.7 This is foreshadowing of earlier serious complications that will be effecting the AI/AN communitie...
Accordingto Diabetes UK (2012) “There are currently 3.8 million people in the UK with diabetes, including an estimated 850,000 people who have Type 2 diabetes but do not know it.” Helping to shape their services and work, Diabetes UK makes sure to involve people affected by and at risk of diabetes no matter what ethnic background they come from. From support and care to preventing, campaigning, fundraising and researching, they work to take on the fastest growing epidemic in the UK.
Type 1: Is an Autoimmune disorder in which no insulin is being produced affecting only 5-10% of people with diabetes and is more common in Caucasians with a typical onset before the age of 30. There aren’t many risk factors for Type 1 Diabetes, but some known ones include, Family History, Genetics, and Geography. Other possible ones are Viral exposure or viral infections, early drinking of Vitamin D (cow’s milk), and other dietary factors such as drinking water with nitrates may also increase the risk.
This innovation is similar to practices used in clinical settings that are similar with the same result. At my place of work diabetes patients who are admitted for uncontrolled diabetes their HgA1C are checked at admission. Upon discharge these individuals are schedule a follow up appointments with their primary care providers to get repeated HgA1C and blood sugar levels. If the patients labs are not within normal limits the primary care provider will then keep following up on patients HgA1C and blood sugars until it is better control. This practices is similar to the innovation of the diabetes
Conditions of Participation was created to ensure all facilities participating in Medicare follow a set of regulations that protect the safety of Medicare recipients. In 1986 revisions were made to reinforce accreditation and certification procedures. Participating hospitals that are accredited by the Joint Commission on Accreditation of Healthcare Organizations or American Osteopathic Association have been deemed to meeting Conditions of Participation requirements on the wellbeing of Medicare Recipients. The Joint Commission on Accreditation of Healthcare Organizations also requires that the facilities are licensed by their state. (Lohr, 1990, p.
My former clinical instructor has DM1, and she taught us about carbohydrate counting, the importance of exercise, and what keeping up with insulin does. We did a carbohydrate counting project that we presented to the nurses and then to the patients. We made sure to an...
Diabetes is a metabolic disease defined by high blood glucose concentration, also known as hyperglycemia (Mertig, 2012). Hyperglycemia is the result of having a problem with insulin release and/or a problem with insulin action. In other words, a person living with diabetes produces little to no insulin (type 1 diabetes) or does not have the ability to utilize efficiently the insulin produced (type 2 diabetes) (Mertig, 2012). Diabetes is a growing epidemic in the United States. In an effort to better manage and reduce the incidence of diabetes, researchers dedicate an enormous amount of time each year trying to gain a stronger understanding of the disease (Philis-Tsimikas and Decker, 2011). After all, the long term complications of uncontrolled diabetes (i.e. blindness, renal failure, heart disease, amputations, etc) can be devastating and needs to be prevented and/or controlled (Mertig, 2012). Individuals living with diabetes need to incorporate nutritional management, physical activity, compliance with medications, proper monitoring of blood sugars, self education and most importantly actively participate in their own diabetes care. According to Inzucchi et al, a patient centered approach is best and means, “Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” An approach proven to be effective in managing diabetes is the diabetes self-management education (DSME) approach. DSME is a “patient centered” approach that actively involves the client in all aspects of their diabetes care and provides the necessary tools to encourage self-directed growth. A huge part of the DSME approach is the client’s diet,...
This system provides annual statics on Medicare payment amounts for institutional providers. A nurse leader can use HCRIS to find other similar institutions with whom to compare reimbursement rates and use this information to make necessary adjustments (“Healthcare Cost Report”, 2016). Lastly, nurse leaders can also use cost-to-charge ratios, volume-based measures, per diem rates, and balanced scorecards to gain better insight of unit reimbursement (Liberty University,
In 2015, the Centers for Medicaid and Medicare Services (CMS) released the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which implements the final rule which offers financial incentives for Medicare clinicians to deliver high-quality patient centered care.5 Essentially, taking the time to learn the patient’s goals and treatment preferences allows for the patient to walk away from the medical treatment or service feeling understood and cared for by the provider.4 Thus, resulting in a better, more comprehensive plan of care. Policy makers are hopeful that the new incentive-based payment system will accelerate improvement efforts.
For my cultural interview, I decided to interview an African American male of age 49, who is suffering from chronic diabetes mellitus. This disorder has caused a significant
Lee, W. K., Wong, V., & Judd, N. (2010, May). Promoting Diversity of the Health Care Workforce. Hawaii Medical Journal, 69(5), 130-131.
In the healthcare system, it is needed even more. Many healthcare facilities need to have their workforce diverse in order to reap benefits. In the 2000 U.S. Census, African Americans accounted for nearly 12.7 percent of the workforce, that number hasn’t increased exponentially today. Many minorities are underrepresented in the healthcare workforce, which can affect delivery of healthcare. Some benefits that many organizations see from a diverse work environment are: varied ideas, a larger talent pool, reduced discrimination, and more productivity. These benefits can impact the healthcare delivery system by improving quality of care and quality in the
Diversity and Inclusion are important to the University of Toledo’s campus because they don’t just serve to one ethnicity, they serve to many. Many different kinds of cultures come to UT to give themselves an education and to better themselves. Here at the University, they want everyone to get along with each other, since it’ll make coming to school more exciting