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Care by Advanced Practice Nurses Can Lower Costs and Improve Outcomes
Brooten D, Youngblut YM, Deatrick J, Naylor M, York R. Patient problems, advance practice nurse (APN) interventions, time and contacts across 5 patient groups. Journal of Nursing Scholarship. 2003;35:71-77.
Although changes in the healthcare industry have led to an increased emphasis on cost containment, care for patients with major illnesses and conditions remains complicated and expensive. Over the last 2 decades, 5 models of transitional care, expanding the role of advanced practice nurses (APNs) in helping hospitalized patients with a variety of conditions transition to the home environment, have shown that APN care can reduce costs and improve patient outcomes. Researchers reviewed 333 logs of patient contacts from these 5 studies to explore and classify the range of APN assessments and interventions. The study populations included women after a cesarean birth or after a hysterectomy, women during a high-risk pregnancy, very low birth weight (VLBW) infants, and elderly cardiac and surgical patients. APN care focused on discharge planning, setting up outpatient and home care services, and providing care and ongoing assessment in the home. In their patient logs, APNs identified more than 150,000 patient problems, with the predominant ones being physiologic among women after surgical procedure, psychosocial among VLBW infants, and behavioral among the elderly. For all 5 groups, surveillance was the most commonly reported APN intervention, followed by health teaching and counseling, and case management. Treatments and procedures generally accounted for less than 1% of care interventions and APN time. Women in the cesarean birth and hysterectomy groups received the most total interventions, while VLBW infants received the most total APN contacts. Elderly patients were followed for a shorter period of time and thus accounted for fewer APN services. Those patient groups with more APN time and contacts per patient also showed the greatest improvements in both patient outcomes and cost savings. By providing assessment, teaching, and care continuity, APNs can ease the transition to home care while helping to lower the total cost of care.
CQ
HEALTHBEAT NEWS
Oct. 7, 2004
Medicare Drug Benefit Could Be Too Skimpy, Leading Democratic Backers of Medicare Law Warn
By John Reichard, CQ HealthBeat Editor
The two
top Democratic supporters of the Medicare overhaul law (PL 108-173)
urge that guidelines for the drug benefit it establishes in 2006 be rewritten
to ensure coverage of more drugs. The current draft of the guidelines—which
lists which therapeutic categories and drug classes should be included in a
Medicare Rx drug plan—could severely limit access to many medications used by
Medicare enrollees, Senators
Baucus and Breaux said that the 146 therapeutic categories and drug classes in the draft are too few and that USP’s final version of the guidelines should be more in line with the 209 drug classes Medicare developed for its prescription drug discount card program.
The USP draft aims to spur Rx plans to cover more products by listing subdivisions of a number of the drug categories; it currently lists 235 subdivisions. Although the subdivisions are closer in scope to the 209 drug classes in the card program, the law mandates that a prescription drug plan’s benefit include at least two drugs in each category and class does not apply to the subdivisions, the senators said.
“While the recommended subdivisions reflect USP’s laudable intention to require plans to cover additional drugs, unfortunately this will not be the result,” they wrote.
That means “a more comprehensive set” of drug categories and classes in the final guidelines. USP says it must submit “draft final” guidelines to the Centers for Medicare and Medicaid Services by mid-November, and actual final guidelines by December 31.
Prescription drug plans need not comply with the guidelines but doing so helps assure that they do not run afoul of the law’s prohibition of drug formularies that discriminate against Medicare enrollees with costly conditions. In addition to passing muster on drug formularies, Rx drug plans must undergo CMS review to ensure that co-payment, cost-sharing, utilization review, and appeals features of the plans do not discriminate against high-cost beneficiaries.
USP should get the guidelines right in terms of the scope of covered drugs and not rely on the mandated availability of an appeals procedure as the safety valve that will ensure beneficiaries get the drugs they need, Breaux and Baucus said. Patients have to meet a tough standard to get a non-formulary drug covered through the appeals process, they said. Under proposed rules for the drug benefit, an appeal must establish through scientific evidence that the drug is safer and more effective than the formulary drug, they added. “However, even where a patient has met this standard, there is no requirement that the plan provide an exception,” they said.