Thought I'd see if anyone else has heard this... I haven't researched this yet, but just had an attending state to a first year resident...
on a pending admitted CHF'er...
"remember to order aspirin on that patient, that is tied into my salary"
Huh? Not that, "hey, he's SOB, has a pacemaker, this is protocol for CHF"
Is there some partnership with meds? Is there a kick back for ordering certain meds for certain types of diagnosis? Are MD's actually reimbursed by an insurance company based on certain protocol?
I have no idea, so just throwing out the bait line...
Measure 28 for PQRS (Physician Quality Reporting System) - Aspirin at arrival for AMI.
Incentive payments peaked at 2% in 2009 and 2010 but dropped to 1% for 2011 and 0.5% for years 2012-2014. Beginning in 2015 there will be a penalty when the measure is not met.
The measure is met if the aspirin was taken at home within 24 hours, was given en route by EMS, was refused or has an allergy. These variances need to be documented in order for the provider to meet the core measure.
Other ED measures include: EKG in adults 40 years and over for non-traumatic CP, EKG in adults 60 years and older with syncope and those with CAP need VS, O2 saturation and mental status assessment documentation with empiric antibiotic treatment.
Hospitals are now evaluated on how quickly (and if) they administer particular treatments. They have a list of benchmarks that go with each diagnosis and keep track of how well the facility is jumping through those hoops.
For example, they want the door-to-cath lab time to be so many minutes or less for chest pain and administration of aspirin for possible MI to be higher than a certain percentage.
I'm sure the new docs are getting pressure from the old docs (who, having the medical basics down pat, may find it easier to take these additional expectations in stride) because the numbers affect all of them when it's time to look at getting a raise.
Several years ago, the unit where I work came in under the approved numbers for something and it really put a damper on our yearly evals. The entire unit felt the sting and it hasn't happened since.
hospitals also follow these to meet insurance requirements.... it just makes one wonder, then, are insurance companies ensuring the QUALITY and standards of our healthcare?? Are they ensuring patients have the correct protocol followed? Or if something is ordered outside of this, do they deny? Will docs then say "oh, that's not required and not reimbursed, so I'm not ordering that..."
Ordering ASA for AMI patients (not CHFers) is probably tied to Core Measures or the Value Based Purchasing (VBP) Rule from CMS, which impacts Core Measures and HCAHPS (Patient Satisfaction). Using VBP, CMS will redistribute funds to participating hospital depending on performance in Core Measures and HCAHPS. So CMS will pay you more for doing well with the Core Measures.
One of the Core Measures is ASA on Admission for AMI patients. Since complying with Core Measures impacts reimbursement from CMS, many hospitals use Core Measure performance on a physician's contract / salary. The more you comply with Core Measures, the more $$$ you get!
the more money THEY may get... I don't see that reflected in nursing salaries or ever even discussed in a yearly eval. Hey, such and such nurse, you were 100% in administering meds for our core measures (CHF, Pneumonia, etc) and you will get the full 3% raise"
I think NURSES need to be reimbursed based on acuity and how quickly we see and move patients along. Some nurses would be paid horribly, while others would be nicely compensated. And I'm talking about trending a nurses performance, not per day, since we know acuity and patient loads fluctuate.
So what happens if the patient suspected/feared MI and took aspirin on their own before admit? Would documentation of such be sufficient to cover fannies?
yes. We document if they took their home aspirin and supplement to get it to 325 mg if they only took their 81 mg.
This is one of the core measures. If the any one of the standards are not met then payment is not made. We have one person responsible whose only job is to check all of our charts just to make sure all the standards are met so payment will be received.
I see a lot money left on the table due to hydration and therapeutic infusion stop times not documented. Do you think staffing budgets would increase if more reimbursement occurred or would that money be diverted to other expenditures in the ED?
UnionRN2: Is anyone assigned to check the MARs for infusion times? Some NMs are very proactive with this.
Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
hospitals also follow these to meet insurance requirements.... it just makes one wonder, then, are insurance companies ensuring the QUALITY and standards of our healthcare?? Are they ensuring patients have the correct protocol followed? Or if something is ordered outside of this, do they deny? Will docs then say "oh, that's not required and not reimbursed, so I'm not ordering that..."
So what you're saying is we can trust that all docs will order the best treatment for the patient, whether its evidence based or not, and all insurances, including private and government should just cover it, no questions asked.
How dare there be a standard recommended by ACC/AHA. Just who do those guys think they are?
FWIW The latest guidelines that include aspirin were published in 2005.
So what you're saying is we can trust that all docs will order the best treatment for the patient, whether its evidence based or not, and all insurances, including private and government should just cover it, no questions asked.
How dare there be a standard recommended by ACC/AHA. Just who do those guys think they are?
FWIW The latest guidelines that include aspirin were published in 2005.
I know about the guidelines....
my point is more the bigger picture. What is ordered by a doctor and how it is then paid. Who decides what is appropriate? Obviously the doctor. More to the point, the insurance company decides what is appropriate and what it will pay for. So in that vein, who decides what insurance companies will approve or deny? What rules govern them? Are doctors taught in school that their standard of care/practice is largely based on insurance payments??
If a doctor orders a medication that is not a specific treatment for a Migraine, but that has an unintended benefit for a Migraine sufferer. Will the insurance company deny these meds, unless it's justified?
I don't know. This whole post has opened up the issue that I have between insurance companies and doctors autonomy for taking care of patients. It disgusts me.
"congress relied on states to adopt and enforce national insurance standards in part because the federal government does not have personnel or administrative capacity to regulate insurance on a broad scale." (umm. yikes!)
psu_213, BSN, RN
3,878 Posts
Yes, ASA is tied to salary. If they do not order ASA on chest pain pts. they will have a salary of $0.....