Restructuring DHHS in North Carolina

This year North Carolina’s Department of Health and Human Services has remained under the spotlight of the General Assembly, as well as the residents of the state. DHHS has faced many issues over the last year; ranging from potential sanctions from the federal government due to backlogs with the food stamp program to legislators questioning the ability of the leadership of the agency. Now DHHS Secretary Dr. Aldona Wos is preparing to face the joint oversight committee to discuss multiple issues regarding the status of the agency. The most serious topics of discussion are things such as: updates on restructuring of DHHS, costly contracts for consultants, ongoing issues with the NC Fast (food stamp program), reviewing fiscal performance for 2013-2014, and reviewing the overall budget for Medicaid.

Both Democrats and Republicans share some of the same concerns when it comes to DHHS. While other concerns are split between the two parties. Democrats seem to have their sights set on obtaining answers to the inability of DHHS to completely resolve the backlog with the NC Fast and NC Tracks applications and their ongoing software issues. The Republican leaders are more concerned with the lack of predictability regarding Medicaid costs for the state and they are also proposing privatizing Medicaid. The oversight committee will also be looking into the accuracy of fiscal data that has been presented previously and recently regarding whether or not DHHS ended fiscal year 2013-2014 with a surplus or not. Secretary Wos recently informed legislators with reports stating that the Medicaid program had a surplus of $63 million. However in April, the CFO of DHHS projected a shortfall in the ballpark of $120-140 million for the same fiscal year. Which leaves many legislators questioning how Secretary Wos obtained her figures and whether or not the data they are provided is accurate or not. http://goo.gl/ZELxw7

Some Republicans have suggested that the state’s Medicaid program no longer remain under the control of DHHS. In addition to removing Medicaid from DHHS’ control, there have also been suggestions that a new state governed agency be created to provide oversight for Medicaid. Secretary Wos disagrees with the suggestion to remove Medicaid from DHHS. Her rationale is that removing the Medicaid program from DHHS would undermine plans to restructure the entire agency, which would be the first major overhaul of DHHS since the late 70’s. Under the Secretary’s restructuring plans, DHHS would create five separate divisions that would create an agency that can better serve the residents of North Carolina. http://goo.gl/bSr318

There seems to be concerns across the board regarding many aspects of what is going on with DHHS. Hopefully in the upcoming hearings and meetings held by the joint oversight committee there will be some clarification on many of the issues that surround DHHS. Whatever happens Secretary Wos should be prepared to not only answer the many questions and concerns of the committee members, but also be prepared to provide data/evidence to support what she is reporting. Otherwise concerns about DHHS will continue to linger in the minds of committee members and the residents of North Carolina.

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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!

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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!

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Starving for Assistance Pt. 2

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Earlier this year on February 11th many North Carolinians took a deep sigh of relief; when the NC Department of Health and Human Services Secretary Dr. Alona Woss declared that NC had met the February 10th deadline imposed by the United States Department of Agriculture and the goals they had outlined that the state needed to meet. http://www.ncdhhs.gov/pressrel/2014/2014-02-14_FINS_deadline_met.htm At that time the USDA imposed the deadline, it also warned the state failure to meet the deadline could result in the state losing $88 million in federal funding, which the state uses to pay for administrative costs associated with running the food & nutrition Services programs for the state.

Unfortunately its been about 30 days and the state is now facing another deadline, again imposed by the USDA, and again the state stands to lose $88 million in federal funding. This time the USDA is mandating that NC handle any applications that have been waiting to be processed for 30 days or more (which is considered “untimely”, legally applications are supposed to be processed within 30 days) and process all emergency requests for assistance that have been waiting more than 7 days. Secretary Woss gave a report to the NC Legislative Oversight Committee on March 12th and at that time she reported that the state had made progress in decreasing the number of backlogged food stamp applications to 1,700. She also continued to point out that counties are doing everything they can to clear the backlog. However she also pointed out that there are still things that are hindering the process of clearing the backlog. http://www.news-record.com/news/local_news/article_011ec218-b6b5-11e3-bead-0017a43b2370.html

The Legislative Oversight Committee called a meeting this past Wednesday March 26th to get an update on the current state of affairs and to also hear about a new development. During the meeting on the 26th Secretary Woss shared the new information with the committee that she had just learned earlier that morning. Officials from Guilford County Department of Social Services contacted the state Wednesday morning to in form them that the numbers they reported to the state on Monday March 24th (which was 24 “untimely” applications.) http://www.news-record.com/news/article_bb4ad888-b5bc-11e3-80f3-001a4bcf6878.html Actually an analyst for the state discovered that there were over 8,000 applications that were backlogged in Guilford County. http://www.wfmynews2.com/story/news/local/2014/03/28/guilford-county-backlog-investigation/6995009/

Today with a little time to spare the Director of Guilford County’s DSS announced that his agency had met the deadline. Unfortunately several hours earlier Guilford County DSS Director Robert Williams also announced that he was resigning. http://www.wfmynews2.com/story/news/local/2014/03/31/guilford-county-dss-director-robert-williams-resigns/7117287/ Director Williams explained previously that he was under the impression that there were 3,100 backlogged cases and he was made aware of the discrepancy in the numbers when the state analyst discovered it last week. Once again North Carolinians can breathe yet another sigh of relief. The USDA will not be withholding $88 million in federal funding for the state. The question still remains- is the NC Fast system the right system for the state? And regardless of the fact that once again the state met another USDA deadline; what’s going to keep this from happening again, in another county? The one thing each of these situations have in common, is the system they are entering the information into.

 

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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.

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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!

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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.

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Blue Cross to offer gay N.C. couples family policies

Big news for same-sex couples in North Carolina. North Carolina’s largest health insurance company, Blue Cross and Blue Shield of NC has decided to reverse a systematic decision that took affect in mid-January. The decision lead to the cancellation of 20 policies for customers who were same-sex couples. After much embarassment, the company’s CEO issued a public apology. Along with the apology Blue Cross’ CEO also admitted that the company should have given more thought and consideration before making the decision to cancel policies. Blue Cross actually provides coverage to same-sex couples for their own employees and most consider the company to be “gay friendly.”

Despite consulting NC state officals regarding the cancellation of the health insurance policies; Blue Cross was still in violation of the Affordable Care Act. The cancellation of the insurance policies is considered illegal under guidelines issued by the U.S. Department of Health and Human Services. According to HHS insurance companies can’t deny coverage to same-sex couples under the Affordable Care Act. Based on the the new laws in the Affordable Care Act there are several nondiscrimination provisions in place for any insurance company that offers coverage through the federal insurance marketplace. Some of the provisions cover things specific things such as nondiscrimination of consumers based on gender identy or sexual orientation.  Blue Cross to offer gay N.C. couples family policies – News-Record.com: Local News. Blue Cross stated that their rationale for cancelling the policies was due to advice from the NC Department of Insurance, which defined marriege as a couple of the opposite sex. However the NC Department of Insurance stated that the agency had approved an amendment to it’s policies last year that would have resolved this issue and added that all Blue Cross had to do was file an amendment instead of cancelling the policies.

According to Blue Cross any policies that were cancelled will be restored retroactively. Any new same- sex couples who want to purchase health insurance will be able to buy family coverage which will be effective as of March 1, 2014. However for many couples this news comes a little late. Many couples have already purchased seperate policies due to the fact that they were not allowed to purchase family coverage with Blue Cross. Which leaves them wondering how their situation can be “fixed” at this point.

Blue Cross has also decided it will offer coverage to unmarried couples and small businesses for the first time. It seems like Blue Cross has learned a hard lesson.However it also seems like they are taking the necessary steps to resolve the mess they have made. Hopefully other insurance companies will learn from the mistake that Blue Cross made and won’t follow down the same path. It is difficult enough to find affordable healthcare coverage and navigate all the various options. There’s no need to add additional obstacles to the process. http://www.newsobserver.com/2014/01/29/3574446/blue-cross-reverses-course-and.html

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