Dr. Carrol F. Landrum- Caring for a Community

Dr. Carrol F. Landrum, an 88 year old physician who has been practicing medicine for approximately 55 years in rural and poverty stricken communities in Mississippi, is facing the loss of his medical license. Not only has Dr. Landrum served his local community of Edwards for decades, he also served his country as a WWII veteran. Currently he is the only practicing physician in Edwards.

For the last two years he has operated a mobile practice as a way to see & treat some patients in his community. Most of the patients that Dr. Landrum treats from his mobile practice would typically go without medical treatment. Dr. Landrum’s patients are predominately low-income and/or disabled persons, and many do not have transportation to go visit a doctor at their office. There are also many times that Dr. Landrum provides medical care to people in his community without being paid anything at all. Despite the fact that Dr. Landrum is able to reach those who would not have access to healthcare, the Mississippi State Medical Board is attempting to revoke the doctor’s ability to see any patients. The board feels that using a car for an examination room is not an acceptable way to treat patients. As a result the board set a date for the doctor to surrender his license in January. The date past and Dr. Landrum refused to surrender his medical license. http://goo.gl/7XiIvu

If Dr. Landrum is stripped of his ability to practice medicine, it will affect more than just the doctor. It will affect an entire community as well. Since Dr. Landrum has been threatened with the loss of his license, some of the residents in the community have organized a fundraiser to assist the doctor in obtaining new office space. Previously Dr. Landrum had office space, but was forced to leave due to increased gang activity and violence in the area.

It seems that there should be some type of solution to this issue that the state medical board could offer, besides Dr. Landrum surrendering his license. Mississippi is currently ranked the unhealthiest state in America and the state also ranks the highest for the number of residents living in poverty. You would think that the board would be looking for ways to legally operate mobile practices or provide physician home visits to care for those who are unable to have access to care otherwise. http://goo.gl/uHXdlP

Hopefully Dr. Landrum will be allowed to maintain his license and practice medicine in his community. It is obvious that so many are depending on the doctor to help them manage everything from the common cold to chronic diseases that require ongoing monitoring and treatment (ex: asthma, congestive heart failure, diabetes, etc.…) Since the deadline for Dr. Landrum to surrender his medical license (and he did not comply) there hasn’t been any additional action taken to end the doctor’s ability to practice medicine. For the sake of the residents in the Edwards community and Dr. Landrum, let’s hope that it remains that way.

Enjoy the rest of your week!

Temp Chicks

We’re Back

On behalf of Temp Chicks, we want to apologize for the long & unexpected absence from the blog. We thank all of our followers for sticking with us & continuing to follow the blog. We are looking forward to 2015 and all of the changes in healthcare that are sure to follow. We have plenty of ground to cover- from U.S. Supreme Court cases that could create a ripple effect across the country, to key state healthcare issues & hot topics.

Later on today we will publish our very first blog of the year. We hope that you enjoy it. The break is over… The Temp Chicks are back!!! Have a great day!

Temp Chicks

Patient Data Compromised at 2 Local Hospital Systems

Over the last few months at least 2 hospital systems have reported that there have been incidents where patient data has been compromised. One of the incidents affects over 4 million patients treated within an entire hospital network. It leads some to question whether or not hospitals (or any other type of facility/agency) are adequately prepared to protect confidential patient information. With cyber attacks increasing in frequency, it seems that anyone who deals with patient data would be exploring additional mechanisms to protect themselves from being susceptible to cyber attacks. The second breach is a result of a thumb drive being stolen from administrative office with the hospital system. The last attack calls into question whether or not there are internal policies & protocols in place that would have prevented this incident. Both incidents will lead for various fines and penalties for both agencies. The total cost and impact of the breach of the patient information is something will never really know.

Almost 2 weeks ago Community Health Systems announced that hackers had compromised their entire computer system. Community Health Systems operates 206 facilities in 29 states. The hackers were able to gain access to patient data for an estimated 4.5 million patients who either received treatment at one of their facilities or anyone who was referred to their facilities by outside doctors. This attack impacts 4 hospitals here in North Carolina- Davis Regional Medical Center (Statesville), Lake Norman Regional Medical Center (Mooresville), Martin General Hospital (Williamston), and Sandhills Regional Center (Hamlet). In this situation the hackers were able to steal the names of patients, social security numbers, their physical addresses, birthdays, and also the phone numbers of the patients that were associated with the hospital system for the last 5 years.

While the breech within the Community Health Systems network was reported recently according to the investigation conducted by an outside cyber security team, the actual attack occurred during April & June of this year. It is also believed that the hackers are a group from China that is also suspected of engaging in corporate espionage in the past. Due to the nature of the attack the cyber security team is now working with the FBI to attempt to put an end to the activities of the hackers.
http://www.foxbusiness.com/industries/2014/08/18/community-health-systems-says-data-stolen-in-cyber-attack/

The second hospital system that reported a recent breech of confidential patient information, this time it was Duke University Health System. The health system announced that a thumb drive was stolen from one of their administrative offices. According the information released, the thumb drive was not encrypted (an internal security mechanism that typically requires a password to access data) and the thumb drive contained various types of patient data. The data was isolated to patients who were seen at Duke Children’s Health Center & Lenox Baker Children’s Hospital for the last 6 months (December 2013 thru January 2014. The data stored on the thumb drive included: patient names, names of their physicians, medical record numbers, and in some cases the name of other Duke University Health System facilities that they have received services. http://www.newsobserver.com/2014/08/29/4107042/stolen-thumbdrive-had-duke-medicine.html#storylink=cpy

In the case of Duke, the incident was noticed much quicker than the breach with Community Health Systems. The incident was recognized in 6 months of the theft. Compared to those who were involved in the Community Health System breach that occurred over years. Duke is working with law enforcement to determine how the theft occurred. According to Duke’s news release, to date none of the patient information had been used.

Regardless of whether the information is used or not, both situations are considered HIPPA violations and both agencies are highly likely to face fines and sanctions from federal agencies. They are also susceptible to face civil lawsuits from the patients whose information was compromised by the 2 separate incidents. According to various sources, fines for healthcare related breaches are some of the most expensive fines. On a positive note, one of the sanctions that could come out of the breaches is that both agencies are ordered to make “corrective actions.” Which might force both agencies to comply with orders to increase their current IT security infrastructure and precautions & protocols.http://www.beckershospitalreview.com/healthcare-information-technology/how-much-will-the-chs-breach-cost.html

 

Have a great day!

Temp Chicks

 

 

Will NC Allow Agencies to Add or Obtain a New License to Provide In-Home Aide Services in the Near Future?

The Journey Begins Sign

Since July 1, 2011 North Carolina’s Division of Health Regulation Service (DHRS) Acute and Home Care Licensure and Certification Section (a division of North Carolina Department of Health and Human Services) has placed a 3-year moratorium on issuing new Home Care Agency licenses for in-home aide services. This July marks the end of the 3-year moratorium and many aspiring Home Care Agencies and current Home Care Agencies that are looking to expand the services they offer. Many are wondering if DHRS will lift the ban. As of May 2014 according to data published by DHRS, there are currently 1,000’s of Home Care Agencies across the state of NC offering different services that range from Private Duty Nursing, Infusion Services, Hospice Services, Medical Social Work, and in-home aides.

There is some speculation that there are hundreds of applications that have already been filed with DHRS in an effort to be one of the first agencies in line to be issued a license to offer or add in-home aide services to their agencies. However many are still question whether or not the moratorium will actually end in July. So far there has been no indication from the DHRS that they intend to begin to accept applications again on a specific date or that they will be extending the moratorium until further notice (or another specified date.) It seems that there are so many unanswered questions at this point as far as in-home aide services are concerned at this point. Which leaves many to begin exploring alternative options with so much uncertainty and July 11th quickly approaching.

welcome

What some people fail to understand is, everyone that is sick or who might have a minor injury, or may undergo a minor surgical procedure does not belong in the hospital or a nursing home or rehabilitation facility. Many times procedures can be provided in an outpatient setting, which would allow patients to recover in the comforts of their own home. In some cases those who have had minor injuries and/or procedures just need a little assistance and that’s where in-home aides play such a valuable role. In-home aids are able to assist with things like meal preparation, medication reminders, and can assist with allowing other healthcare providers to gain access to the patient/client so that they can receive additional medical treatment in their home. Aides often times make being at home a safer and a more comfortable environment for some and provide an additional support system in other situations while loved ones go to work.

With proper monitoring and management of in-home aides and protocols in place to follow-up with the satisfaction of the patient/client, quality service can be provided without wasting tax dollars or other insurance benefits (which ultimately drives up the cost of care for other patients.) When the announcement was made and the moratorium was put into effect in 2011, no reason or rationale was ever given, and to this day there is still no known reason. Until July, those of us in the healthcare industry will wait and see what DHRS decides to do.

Make this short week a great week!

Temp Chicks

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The Evolution of Nursing…Fewer Options for Some

In a field that many consider to be stable, things are changing. For those that don’t know, the nursing environment is changing- it isn’t the same way it was even 10 years ago. For nurses that are Licensed Practical Nurses (LPN’s) or Associate Degree Nurses (ADN’s) the opportunities for employment are becoming limited. LPN’s are being squeezed out of places where they normally flourished like assisted living facilities or long-term care facilities (nursing homes) and now they are being replaced with Medication Technicians (or Med Techs.) Yes, Med Techs have to be supervised, however they can provide medications to patients/residents for a lower fee compared to a nurse (even if the nurse is an LPN.)

ADN’s are also seeing changes in their options for potential places of employment. For so many years ADN’s were viewed as being no different than nurses who went to 4 year colleges and/or universities and earned their undergraduate degree in nursing. However times are also changing for ADN’s as well. Many hospitals are moving to no longer allow ADN’s to work within their major hospitals in an inpatient setting, however they are allowed to work in their hospital owned outpatient clinics.

With this new twist in the ever-evolving field of healthcare, it always leaves one wondering what’s to come next. While it might seem like a way to save money by hiring Medication Techs to provide patients/ residents with one aspect of care that is vital to a portion of their daily needs. It seems like it increases the pressure and responsibility on whatever nurse is on duty (regardless of whether it is an ADN, LPN, or RN.) Not only is the nurse responsible for the administration of medication by the Med Techs, they are also responsible for any other staff such as CNA’s too. And anyone who has even witnessed staffing or managed staffing for a facility like assisted living or long-term care knows that it is pretty rare for all of your staff to show up. Guess we’ll see how this plays out.

Make it a great week!

Temp Checks

 

Growing demand for primary & speciality care…how about a nurse practitioner?

It is estimated that in about 2 years we will be short approximately 29,000 physicians in the United States. By 2020 that number is excepted to grow to somewhere near a deficit of 45,000 physicians. Whether the demand for primary and specialty care comes from the “baby boomers” or from the increase in access to care, now that many more people have access as a result of the Affordable Care Act. The demand for care is not going away and it it is only going to increase as time goes on. Many practices are faced with the challenge of determining how to keep their overhead as low as possible, while still maintaining their current patient panel & attracting future patients as well, and also providing all of their patients with high quality care.  Some experts believe that the deficit of physicians leaves a void that can be filled by medical professionals like nurse practitioners.  A new trend among the health care industry is looking towards nurse practitioners to provide primary care services in collaboration with a physician. This model of care seems to be working because the trend is growing across the U.S. and abroad & nurse practitioners are in very high demand.  http://www.chillicothegazette.com/article/20140208/NEWS01/302080029/Nurse-practitioners-physician-assistants-might-help-address-doctor-shortfall However there appears to be a gap in the current number of physicians and the number of active nurse practitioners and physician assistants. But data also shows that there have been an increase in enrollment in both career fields, which makes many experts hopeful about the future. Yet they are still cautious about what is to come in the next few year  to help with the growing number of people that will be seeking medical care immediately.

Instead of patients having to wait weeks to be seen at a practice that is understaffed or seeking another physician who can see them sooner.  By adding a nurse practitioner to one’s practice; patience are afforded a continuum of care by establishing & maintaining a relationship with a primary care physician and/or a medical home. The primary care physician becomes the nucleus of their health care. . The nurse practitioner typically works in collaboration with the physician to provide care for patients, and ultimately this will improve the patient’s health care, and improve upon overall clinical outcomes.  http://www.dispatch.com/content/stories/editorials/2014/02/04/1-health-care-needs-nurse-practitioners.html Nurse Practitioners can perform just about everything that physicians can do and they can work in a variety of settings pretty autonomously. They can work in inpatient or outpatient settings, diagnosis & treat medical conditions, prescribe medications (depending on the state), perform procedures, and admit patients to the hospital.

 stethascope

In North Carolina in order for a nurse practitioner to practice they are required to have a collaborative agreement in place with a Primary Supervising Physician, according to the North Carolina Board of Nursing. http://www.ncbon.com/myfiles/downloads/np-rules.pdf Over the past few years here has been some push for states to eliminate the collaborative agreement after nurse practitioners have been practicing for a few years. In some cases the agreement becomes a barrier for those nurse practitioners who want to practice on their own and or who are not at the same practice as their Primary Supervising Physician. And in other cases  some nurse practitioners have been asked to pay high rates as somewhat of a “supervision fee” by their supervising physician.”

Over time it seems that more physicians will become more  open to the idea of working with nurse practitioners. Eventually they will see the value of what they can bring to their practice, while also providing a cost effective alternative to hiring another physician. There seems to be a growing demand in requests to recruit nurse practitioners from a staffing perspective as well. Perhaps with the growing demand for nurse practitioners we will see some changes in the way that they are governed & managed over the next few years- since they are reporting to the state nursing board and the DEA at the federal level.

It’s almost the weekend, hang in there!

Temp Chicks

Today’s Blog is dedicated to 2 of our favorite nurse practitioners Mrs. T. Gibson & Ms. T. Starkes- two amazing, overachieving, talented, & intelligent, nurse practitioners that we would let treat us any day! We love you ladies! XOXO

Starving for Assistance Pt. 1

EBT CardOld school food stamps

The past few months have been pretty rough for the North Carolina Department of Health and Human Services. DHHS Secretary Dr. Alonda Wos has faced questioning multiple times regarding the ongoing issues that have plagued the department she oversees. Two major issues that have come to everyone’s attention lately are 1.) NC FAST, the system that processes requests for food stamps and other assistance programs and 2.) NCTracks the Medicaid payment system, which processes payments to healthcare providers who treat Medicaid patients. The food stamps have become a great concern for many around the state, especially because the United Stated Department of Agriculture has set a February 10th deadline for the state to make some significant progress towards resolving the backlogged food stamp and other nutrition assistance program initial & recertification applications. If the state fails to make enough progress to address the backlogged applications the USDA could potentially withhold approximately $88 million in funding; which essentially covers administrative costs associated with running the food stamp program annually. http://www.northcarolinahealthnews.org/2014/01/24/new-usda-letter-shows-food-stamp-program-federal-funds-in-jeopardy/ As DHHS Officials began to review the pending cases they, did report there were numerous cases of duplicate applications, especially for those who had been waiting longer periods of time.

Secretary Wos faced questioning by the NC Legislature regarding the continued delays with the food assistance program, After hearing the new numbers and finding out the true status of things at DHHS, some of the leadership felt they had been mislead about the state of affairs at the department and the food assistance program.  The Secretary was not unable to provide concrete answers that seemed to satisfy anyone, nor did it appear that she was able to boost the morale about the ability to resolve the ongoing issues. Secretary Wos was questioned about everything from personnel decisions to whether or not the new system was actually going to work for the state or not. http://www.wfmynews2.com/news/article/301675/0/Lawmakers-Intervene-In-Statewide-Food-Stamp-Delays

Legally applications should be processed within 30 days. However based on the USDA letter to NC DHHS date January 23, 2014; NC had approximately 19, 974 untimely applications, and another 11,482 recertification applications. Secretary Wos has stated that changes in Medicaid eligibility have effected the department, as well as the implementation of the Affordable Care Act. So to address the backlog of pending applications the State sent about 200 employees to various counties around the state to assist them with things like processing applications, technical, and policy support. Some counties like Cumberland County allowed certain employees to work from home when some county social agencies were shutdown due to inclement weather. Enabling employees to work from home allowed them to continue to chip away at the pending applications. Cumberland County had the second highest number of overdue food stamp applications. The state sent four staff members to help process applications, and two others to assist with policy or technical support. http://www.fayobserver.com/news/local/article_4bf898b5-5e78-533e-bc27-0fc79fce4319.htm Other counties like Wake County; have their staff working overtime, which includes late evenings and some Saturdays. Wake County had the highest number of overdue food stamp applications for the entire state. However it appears that the county has made major progress with processing the applications. They too received assistance from several staff members of the state that were sent to help out with the backlog. http://abclocal.go.com/wtvd/storysection=news/local&id=9416016&rss=rss-wtvd-article-9416016

In the Triad & Northwestern NC Counties local agencies have been very hard at work to resolve pending applications, like other agencies all over the state. The most significant area of improvement for Triad & Northwestern NC Counties is resolving applications that were 120 days overdue- combined the local agencies reduced the number of applications from 204 to nine in the normal processing cycle and also reduced the number from 126 applications to nine in the expedited processing cycle. http://www.journalnow.com/news/local/article_d5735aac-8a9f-11e3-824e-0017a43b2370.html It is clear that the counties are stepping up and doing everything that the possibly can to help resolve the pending applications. When asked individually each county seems confident that they are capable of meeting the USDA deadline.

As of Monday February 3rd there were approximately 7,000 applications that were still pending. It’s not so much that the applications can’t be processed by the 10th. It’s more about can DHHS prevent this from happening again? Should the state be considering other options for a computer system to manage things like the food stamp program? Will there even be funding for a food stamp program after Monday? http://www.wncn.com/story/24623742/dhhs-makes-progress-in-nc-fast-backlog

In an update reported today by WFAE 90.7 in Charlotte, it is reported that unfortunately NC just barely missed the USDA February 10th deadline to clear the entire backlog of food stamp applications by approximately 25. However, the state has until the absolute and final deadline the USDA has imposed to completely resolve the backlog which is March 31, 2014. Secretary Wos stated that counties will continue to maintain the same work schedules that they have been working until the state has satisfied the demands of the USDA. Some county employees have been working long work schedules requiring their day to begin at 5 a.m. and ending at 9 p.m. and almost all counties have their staff working overtime to resolve the backlogged applications. http://wfae.org/post/nc-barely-misses-federal-deadline-resolve-food-stamp-delays

Much gratitude and respect to those who are working diligently around the state to process the backlogged food stamp and nutrition assistance applications.  Hopefully our Secretary of DHHS will find a more concrete solution to resolve the issues with the system that the state has decided it will use to process applications for assistance programs such as food stamps and nutrition assistantce. So that nothing like this happens to the residents of NC again in the future.

Temp Chicks