We’re Equipped to Meet Your Needs!

ProMed is proud to be a one-stop shop for all of your equipment needs. We recently launched the Spring 2013 edition of our popular Equipment and Furniture Solutions catalog, which is available from your ProMed territory manager and can also be downloaded here. It immediately connects you with the products you need to provide both a great living environment and top-notch care.

The catalog includes products in the following categories:

• Mobility and Lifting
•  Beds and Accessories
• Mattresses
• Shower Chairs and Hydration Carts
• Clinical & Diagnostic
• Respiratory
• Fall Prevention & Safety

It also highlights our value-added services, including our Loan-to-Own (LTO) Program and complimentary interior design services.

Additionally, we’re in the process of revamping the Equipment Solutions section of our website to put all of these great products – and more – at your fingertips! 

When you’re ready to start discussing your equipment needs, contact your ProMed territory manager or give us a call at (800) 648-5190. 

Does Your Facility Have Sun Safety Guidelines?

Here in New Lenox, Illinois, we're experiencing our first warm, sunny day of the season! While it's tempting to just get outside and enjoy the sunshine, make sure you stop and ensure that your facility has a guideline for sun safety to protect residents from the harmful rays.

We recommend taking the following steps:

1. Ask the residents' families to purchase sunscreen, sunglasses, water bottles and hats for their loved ones to use during the warmer months. Ensure that the residents' names are written on the items. 
2. Encourage residents to wear lightweight pants and long-sleeved shirts to protect them from the sun's rays. 
3. Medications and some medical treatments can make residents more susceptible to sunburns. The nursing department should make a list of all sun-sensitive residents. 
4. Residents should be encouraged to come indoors periodically to cool off and prevent sunburn. 

Once all of that is handled - get outside and enjoy this beautiful day! 

HHS Revises CLAS to Reflect Changing Demographic Trends

The Department of Health and Human Services, or HHS, has made updates to the Culturally and Liguistically Appropriate Services (CLAS) standards. The standards, which were introduced in 2000, seek to reduce healthcare disparities among different groups of people defined by characteristics such as race, disability status, native language and sexual orientation.

The updated standards address changing demographic trends. The changes come in response to studies showing that some caregivers are struggling with some of these trends, such as a rise in black, Hispanic and Asian residents.

HHS hopes that the new standards will help providers avoid malpractice litigation by helping to cut down on miscommunication and help providers adhere to new laws and regulations.

Changes to the standards include:

• A broader definition of "culture" 
• Revised terminology (for example, "patients and consumers" has been replaced by "individuals and groups" 
• An introductory Statement of Intent 

To learn more, click here.

Additional Services Can Be a Great Source of Revenue

When we meet with our customers, discussions often turn to how they're tackling budget concerns in light of slashed reimbursement and rising costs. We've heard that they’ve strategized with financial and operational cost drivers, including banks and GPOs, to drive down expenses wherever possible. They've also worked to stabilize staff and labor costs.

Some of our customers have started to examine additional ways to increase their revenue and make themselves more attractive to the referral community. One way to do this is to add to your suite of services. This could include programs for:

• Dementia
• Assisted living
• Therapy
• Rehabilitation
• Hospice
• Home care
• Cardiac care

While all of these services can generate revenue, they can also be quite expensive to implement. If you are looking to offer additional services, we encourage you to reach out to us in the early planning stages to discuss the equipment you will need and the costs associated of these items. With careful strategizing and budgeting, specialized services can yield much-needed revenue.

To get started, contact your ProMed territory manager or give us a call at (800) 648-5190. 

Revised Survey Guidelines Give ROs More Discretion In Handling IJs

According to revised guidelines from CMS, regional authorities will now have the authority to decide whether to conduct full surveys of deemed providers that are cited for Immediate Jeopardy. Deemed status is available to certain long-term care providers, including hospices, home health agencies and rehabilitation agencies.

The revised guidelines, which were released on April 19, state that providers are subject to full surveys if a complaint investigation finds that they are exhibiting condition-level noncompliance (that is, care that poses a serious health or safety risk to residents, including Immediate Jeopardy citations). However, full surveys might not be necessary for all instances of condition-level noncompliance. Instead, CMS Regional Offices (ROs) will be tasked with deciding whether a full survey is needed on a case-by-case basis. CMS notes that this policy should improve efficiency and effectiveness. 

ROs will take the following into consideration when deciding whether a full survey is warranted (this list is not all-inclusive):

• The manner and degree of noncompliance (determined by the complaint investigation) 
• The provider's/supplier's complaint history
• Recent changes to ownership or management
• Whether the resources required to conduct a full survey are available in the timeframe needed
• The length of time since the provider's/supplier's last accreditation survey

If the RO determines a full survey is not needed, the provider/supplier will be placed on a 23- or 90-day termination track from the Medicare and Medicaid programs. Facilities that receive an IJ citation that isn't remedied while the surveyor is on-site will be placed on the 23-day track, but the RO will have the the option to conduct a revisit instead of a full survey prior to the 23-day deadline. 

To learn more, click here. 

Gov't. Asks for Feedback On How Potential HIPAA Changes Could Impact Mental Health Reporting, Gun Purchases

The federal government is asking for feedback on  how updated HIPAA rules could impact reporting information about individuals' mental health conditions and whether they should be able to purchase guns.

The government is concerned that critical information is not being reported to the National Instant Criminal Background Check System out of fear of violating privacy concerns.

According to the advanced notice of proposed rulemaking (APRM): "Federal law does not require State agencies to report to the NICS the identities of individuals who are prohibited by Federal law from purchasing firearms, and not all states report complete information to the NICS. Therefore, the NICS Index does not include information about all individuals who are subject to one or more of the prohibited categories."

The APRM includes questions for providers regarding possible HIPAA changes. One of those questions is, "If the HIPAA Privacy Rule were to be amended to expressly permit disclosures of the identities of individuals covered by the mental health prohibitor to the NICS Index, would you still face any barriers to reporting?"

To learn more, click here.

Floods Underscore Need for Emergency Preparedness

The floods in the Midwest last week reinforce the need for all long-term care facilities to have emergency preparedness plans in place.

During the flooding, at least two facilities, including one in Lisle, Illinois, staged evacuations. The facility, Snow Valley Nursing and Rehabilitation Center, reported water that was mid-calf high in the facility. Residents and staff were ferried from the facilities in rescue boats and taken to other facilities throughout the Chicago suburbs. The facility's administrator confirmed that family members of every resident had been notified of their well-being and location.

The administrator, Stephen Brumer, also stated that, "The staff did a great job and these emergency guys were superb. I've been in this business a long time and I've never seen or had to do anything like this before. I think the dedication of our staff and community shines through more than ever in situations like this."

To learn more, click here.

CMS Group Releases Report on Criminal Employment at Nursing Homes

The Long-Term Care Criminal Convictions Work Group, which consists of CMS employees and volunteers from 11 state agencies, has released a report that urges providers and states to agree upon what a "direct access employee" is and whether a person with a criminal background should be allowed to work in a nursing home.

According to a March 2011 report from the Department of Health and Human Services, 92 percent of nursing homes employ at least one person with a criminal conviction.

To learn more, click here.

Abbott Recalls FreeStyle InsuLinx Blood Glucose Meters

On April 15, Abbott announced a voluntary recall of their FreeStyle InsuLinx blood glucose meters. The company has determined that at extremely high blood glucose levels of 1024 mg/dL and above, the meter will display and store in memory an incorrect test result that is 1024 mg/dL below the measured result. For example, at a blood glucose value of 1066 mg/dL, the meter will display and store a value of 42 mg/dL. No other Abbott blood glucose meters are affected by the issue. 

Customers who have purchased the meters can take one of the two following steps: 

1. Log on to www.freestyleinsulinx.com/swupdate to access a software update. 
2. Contact Abbott Diabetes Care Customer Service at 866-723-2697 to arrange for return and replacement of their meter at no charge. 

To learn more, click here. 

VA Revises Rules Regarding Nursing Home Care

Newly proposed rules from the Department of Veterans Affairs would provide more flexibility to veterans in terms of their healthcare benefits and prioritize government funding for state homes that provide care to veterans.

The first rule eliminates the regulation that allows refusal of VA medical care if a veteran misses two medical appointments without providing 24 hours' notice and a reasonable excuse. The second rule would change the way grant applications are considered by the VA for state homes that provide nursing care to veterans. Grants that go toward remedying life or safety deficiencies would receive priority. The rule also updates which VA member can issue citations for threats to life or safety in these homes.

To learn more, click here.

Spring Has Sprung! Is Your Facility Ready?

After a late start, it appears that spring has finally sprung and your residents are doubtlessly looking forward to being able to spend more time outdoors. Have you given your facility a good “spring cleaning” to ensure that both inside and outside are ready for longer, warmer days?

We’ve created this handy spring cleaning checklist to help you out!

• Contact a pest control company to make sure that your facility is protected against invaders such as flies, rodents, cockroaches and ants
• Bring your outdoor furniture out of storage and clean it thoroughly before placing it outside
• Scrub your grill and prepare it for outdoor barbeques
• Make sure that vegetation that could trip residents hasn't grown up over sidewalks and walkways
• Wash all of the windows, both inside and out
• Vacuum window screens
• Clean window coverings, including draperies, blinds and screens
• Shampoo and vacuum carpets
• Dust cobwebs out of the corners on the floor and ceiling
• Remove and clean lighting fixtures and lampshades
• Move all furniture and vacuum underneath it
• Clean the cupboards and oven in the kitchen

Finally, once your facility is in tip-top shape, get outside and enjoy the fresh air! 

Diabetics Develop Dementia Sooner than Non-Diabetics

Australian researchers have determined that people with diabetes are at risk of developing dementia earlier and dying sooner from its complications.

According to the researchers, diabetics develop dementia an average of 2.2 years earlier than non-diabetics. While diabetes is a risk factor for dementia, little is known about the association between the two conditions.

Individuals with diabetes and dementia died an average of 2.6 years earlier than non-diabetics, according to the study. People with a long history of diabetes who were diagnosed with dementia before turning 65 died almost twice as fast.

The study also noted that as people got older, the impacts of having both diabetes and dementia became less pronounced.

To learn more, click here.

AGS No Longer Recommending Aspirin Therapy for Elderly Diabetics

It's common for people to take aspirin to help prevent cardiovascular disease, but the American Geriatrics Society (AGS) is now saying that it's not a great idea for elderly people with type 2 diabetes to do so.

The recommendation is based on two large studies that found taking aspirin did not improve cardiovascular health outcomes for adults with type 2 diabetes. Combined with the risk of bleeding and other adverse side effects associated with taking aspirin, the AGS is no longer recommending it for geriatric diabetics as a way of preventing cardiovascular disease.

On the other hand, there is strong evidence that aspirin might be useful for elderly diabetics who have already had a heart attack or stroke. For this population, it can be an effective means of secondary prevention against cardiovascular disease.

To learn more, click here.

Walgreens Announces Its Take Care Clinics Will Now Offer Diagnosis and Treatment for Chronic Conditions

Walgreens has announced that it is expanding its healthcare services to include diagnosing and treating patients for chronic conditions such as asthma, diabetes and high cholesterol. This move would set the store apart from other retail store clinics that help customers manage chronic illnesses, but typically only after they have been diagnosed elsewhere.

To accommodate these new services, Walgreens will staff more than 300 of their Take Care clinics with nurse practitioners and physician assistants to do tests, make diagnoses, write prescriptions, refer patients for additional tests and help them manage their conditions.

To learn more, click here.

CMS Alters Survey Procedures In Light of Sequestration Cuts

In a memo released on Tuesday, CMS announced plans to alter some nursing home survey procedures related to life safety codes as a result of sequestration budget cuts. The CMS Survey & Certification budget has been reduced 5 percent from 2012.

The changes are as follows:

• Life Safety Code (LSC) Survey Focus: To help surveyors meet the August 13, 2013 deadline for all nursing homes to install automatic sprinklers, CMS has created a Short Form survey process. 
• Efficiency and Effectiveness: The agency hopes that the Short Form will help surveyors work more efficiently in light of the budget cuts. It should allow them to spend less time at facilities that have demonstrated compliance with codes in the past and more time at facilities with less-than-stellar records. 
• State Option: States will be given the option to implement a Short Form Fire Safety Survey for a limited number of specified facilities that have demonstrated superior compliance with life safety codes and are fully sprinklered. 
• Training: Surveyors in states using the Short Form must be trained during a special training event before utilizing the new process. 

Beginning in FY2013 and at the beginning of each year thereafter, CMS will send each state a list of facilities that qualify to use the Short Form survey process. 

To read the memo, click here.

PT/INR: The Case for Point-of-Care Testing

Every year, two million new people begin taking warfarin, an oral anticoagulant drug that helps to prevent blood clots, heart attacks and strokes. The drug's optimal dose can be tricky to set from person to person and depends on many risk factors, including age, diet and the use of other medications. Studies have shown that one-third of people receiving warfarin metabolize it differently than expected.¹

If too high a dose of warfarin is given, the resident is at risk of life-threatening bleeding. On the other hand, if too low a dose of the drug is administered, they are at risk of equally dangerous blood clots.¹ To monitor how well the drug is working, physicians and caregivers must perform prothrombin time, or PT, tests to evaluate the blood's ability to clot properly. The results of the PT test are then compared to the expected value in healthy people, known as the International Normalized Ratio, or INR.

Until fairly recently, caregivers had to send blood drawn for PT/INR testing to a lab for analysis, which takes precious time. However, with the introduction of units designed for point-of-care testing, healthcare personnel can now receive PT results quickly, allowing them to arrange for faster warfarin dosage adjustments and potentially avoid life-threatening complications.

Point-of-care PT/INR testing is possible because it has received CLIA-waived status, which is granted to tests that have low complexity, low risk for incorrect results and will not harm the resident if performed incorrectly. These tests are typically easy to perform and do not require special training or education.²

Professional Medical now offers the only point of care device that uses direct detection of clot formation to test rather than an electrochemical process. The portable Coag-Sense PT/INR system provides accurate results in less than a minute and requires a small blood sample size.

References
1 Food and Drug Administration. FDA Approves Updated Warfarin (Coumadin) Prescribing Information. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108967.htm. Accessed March 1, 2013.

2 Wagar EA, Yasin B, Yuan S. Point-of-Care Testing: Twenty Years’ Experience. LabMedicine. 2008;39(9):560-563. 

Study: Kidney Disease Tied to Increase Risk of C. Diff Death

Researchers at the Alfred Einstein School of Medicine's Jacobi Medical Center have found that C. diff is especially deadly for people who have end-stage renal disease (ESRD).

The researchers also found that combining metronidazole and oral or rectal vancomycin was more effective than monotherapy drug treatment for the ESRD patients with C. diff. ESRD patients were also more likely to have a relapse of C. diff infection within two months. An increased risk of relapse was seen with monotherapy drug treatment. 

To learn more, click here.

CMS Clarifies Which Tasks Can Be Delegated by Physicians

CMS has released a brief that clarifies which tasks may be delegated by physicians to other practitioners caring for Medicare beneficiaries in skilled nursing facilities. It can be downloaded here.

The brief focuses on which tasks can be delegated to non-physician practitioners (NPPs), such as nurse practitioners, physician assistants or clinical nurse specialists.

Feeding Tube Daily Care Checklist

Even the most experienced caregivers need to brush up on their skills from time to time. We encourage you to print out this Feeding Tube Daily Care Checklist and share it with your staff. Are there any elements of proper enteral care that are being overlooked at your facility?

• Check the resident for any pain, discomfort or pressure around the tube exit site.
• Check the tube exit site for skin irritation, inflammation or other signs of infection, gastric leakage or formula leakage.
• Rotate the external retention disk one quarter turn each day to relieve pressure on the skin and allow for aeration.
• Clean the tube exit site, gastrostomy tube and its external retention ring.
• Check the height of the external retention ring with the resident in both the sitting and supine positions. The retention ring should lie just on top of the skin. It might need to be adjusted if it is too tight on the skin or too high off the skin.
• Verify placement of the tube before every feeding, or several times a day for continuous feeding. This is done one of four ways: by checking the graduation marks, aspiration of gastric contents, air auscultation or, if there are any questions, by X-ray verification.
• Verify that the resident has received the amount of fluid during the past 24 hours that he/she should have received according to the physician’s orders (allow flexibility up to 150cc unless an exact fluid intake is critical for the resident).
• Change the enteral feeding bag and/or spike set per facility policy/manufacturer’s guidelines, or at least every 24 hours.
• Ensure the irrigation syringes on the bedside are labeled with the resident name, date and usage.
• Provide mouth care, including teeth, gums and tongue.

Remember, if a recently placed G-tube is pulled out, the tube tract will begin to close within two to four hours unless a new G-tube is inserted into the gastrostomy tract.

Professional Medical can meet all of your facility’s enteral feeding needs. We offer pumps, enteral nutrition, accessories and in-servicing to ensure that your residents are receiving the best possible care. To learn more, give us a call at (800) 648-5190 or visit us online at promedsupply.com. 

2% Medicare Cuts, Part of Sequestration, Began on April 1

The 2 percent cut to Medicare payments that are part of sequestration took effect on Monday.

As a result of the cut, providers will be reimbursed 98 cents on the dollar for Medicare fee-for-service claims with dates of services or dates of discharge on or after April 1, 2013. The payment adjustment will be applied to all claims after determining coinsurance, any applicable deductible and any applicable Medicare Secondary Payment adjustments.

The impact will begin to be evident in mid-April. The payment reductions are on track to cost skilled nursing facilities about $782.5 million in fiscal year 2014.

Federal Gov't. Will Pay 100 Percent of Medicaid Costs for Certain Newly Eligible Individuals

On Friday, the Department of Health and Human Services, of which CMS is a division, announced that the federal government will pay 100 percent of the Medicaid costs for certain newly eligible beneficiaries as part of the Affordable Care Act (ACA).

The 100 percent funding will only last through 2016, when it will gradually begin to decrease. By 2020, it will be at a permanent 90 percent.

Under the Affordable Care Act, states were given the option of expanding Medicaid coverage to people under the age of 65 who are earning up to 133 percent of the federal poverty level.

The federal government will also include the Federal Medical Assistance Percentages (FMAP) rate for certain beneficiaries in states that expanded Medicaid coverage before the ACA was passed in 2010.

To learn more, click here.