What are the factors (e.
g. , timely and appropriate clinical services) that determine whether patients at risk for pressure ulcers receive proper skin care? For the patients who are at the risk of the pressure ulcers, it is imperative for the health care providers to carry out comprehensive skin assessment which is a procedure by which the complete skin of the patient is inspected for any irregularities.It necessitatesobserving and touching the skin from head to toe, with a specificstress over contours of the bones.
As the first stage in pressure ulcer anticipation, comprehensive skin valuation has many of significant objectives and purposes (DeFloor, 2005).These comprise: ?Manage moisture ?Quality skin care ?Optimize nutrition and hydration ?Minimize pressure ?Recognizesome pressure ulcers that might be existent. ?Help in risk stratification; some patients with a present pressure ulcer are at danger for added ulcers. 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, orqui tam relator, under the False Claims Act.The Federal False Claims Act is broadlyconsidered as the most operative tool in fighting fraud against the centraladministration. Any individuals or bodies with proof of scam against federal programs or agreementsmightlitigate a qui tam complaint.
Though, if the administration or aindividual has already filed a False Claims Act lawsuit founded on the similarproof as the hospital then the hospital cannot fetch a lawsuit. An act under the False Claims Act is essentialto be filed, in camera and under closure. The grievance and its subjectsneedto be kept private until the seal is broken.The grievance is not attended on the perpetrator. If the complainantdisrupts seal, his or her grievance could be discharged (McHugh, 2011). The hospital federal false claims actmight be approved by the U. S Department of Justice.
Adiscrete individual mightfile a “qui tam” act. This indicates the individual files an act from the government’s side. The healthcare professional at the hospital need to take photographs and other proofs available with them to move the court for getting the reimbursement for the condition that was present before the patient came to the hospital.
Also, physician who was in-charge at the time of discharge from the skilled nursing facility can act as a whistle blower in this case since he is the only one who can testify in the court that the pressure ulcer developed at the nursing facility and not at the hospital. The nurses and other support staff can file the “qui tam” action as an individual as they might be present when the patient was analyzed for pressure ulcer problems or signs. 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? The policy of CMS to limit the reimbursement of the hospital acquired conditions is aimed towards restricting the incidences of pressure ulcers and other hospital acquired conditions. When the reimbursement will be limited, the healthcare facilities will take care of the certain procedures laid out for precautionary measures that need to be taken for avoiding the hospital acquired conditions.It’s actually just a protection and business deal between the hospital and the federal administration. If the hospital has a patient that obtainsanavoidabledisorder, rather than pay for it, Medicare will merelyrecompense for the ones that were there at the time of admission(POA).
Hospitals will want to evaluate patients precisely. Physician’sdevelopmentproceedings are key to repayment.They needto reproduce and record mattersat the time of admission. This will ensure that hospital is not asking for the financial incentives for treating the problems that were acquired because of the negligence or lack of care at the hospital(Gray, 2007).The policy looks unfair to the hospitals from the viewpoint of healthcare facilities but it is good for the patients as this will improve the care and precautionary measures taken to avoid the development of pressure ulcers.
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?In order to avoid the situation in which the previous healthcare facility sends the patients with existing conditions, the hospital can take following steps for the future cases(McHugh, 2011). ?Carrying out pressure ulcer admission valuationfor every patients ?Review risk for all patients at the time of the admission ?Methodicallyreview skin at the time of the admission ?Control if there are additional abrasions and skin-related issues influencing to pressure ulcer progression, such as disproportionately dehydrated skin or moisture related skin injury (MASD). ?Classify additional significant skin circumstances. ?Deliver the statistics essential for computing pressure ulcer occurrence and pervasiveness.References DeFloor T, Schoonhoven L, Fletcher J, et al. (2005), Statement of the European Pressure Ulcer Advisory Panel: pressure ulcer classification. J Wound Ostomy Continence Nurs;32:302-6.
Gray M, Bliss DZ, Doughty DB, (2007), Incontinence associated dermatitis a consensus.J Wound Ostomy Continence Nurs;34(1):45-54. McHugh, M.
Van Dyke,K. Osei-AntoA, (2011), Medicare’s Payment Policy for Hospital- Acquired Conditions: Perspectives of Administrators from Safety-Net Hospitals, Medical Care Research and Review.