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!

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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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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!

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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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Even in this Economy there is still bad Business

note_desk_paper_237717_l  In the staffing business there really is very little time to get to know your staff or even your clients. I am a firm believer in doing the most thorough background & referece checks on potential staff as possible. And it also seems approrpriate that you would want to do some type of background check with regards to a potential client and/or the facility that you may be providing staffing to. While the prospect of income and building your client base may seem very enticing, every offer to provide your services may not be in the best interest of your business or even your staff. Your business is your brand and the clients and standards that you maintain speak for you, without you having to say a word. Although something may seem like a great idea when you initially hear about it, you always have to consider the long-term impact that working with a particular client could have on your business, your staff, & your brand. (Please don’t misunderstand me, I am not advocating that you use/abuse your clients because of what you think that they can do for you in the long-term.) However, I am advocating for keeping the lines of communications open at all times between your agency & your clients, as well as your agency & your staff.

There is a fine line to walk at all times for the agency. The agency is constantly attempting to keep the clients satisfied, as well as doing the same for the sfaff, & also ensuring that the staff are not being placed in jeopardy, & neither are their professional license.  As the agency you are the biggest advocate that your staff have. There may be times when you have to respectfully decline to provide services to a client, even after you have signed on to provide them services. There are going to be occassions where things are not always the way they seemed. The best thing you can do is try to end the business relationship respectfully within the guidelines of your contract and on “good terms.” (Good terms= no outstanding invoices, no bounced checks, no yelling matching, or name calling,…)

Despite the desre to always want to please your client, there are some situations where you have no choice and you are unable to do that. When it comes down to questionable judgement or lack of policies/protocols that could potentially lead to staff jeopardizing their professional license or certification- there is no choice, you defend your staff. It would be irriesponsible for an agency to not take some type of action to at least investigate the concerns of their staff and/or remove their staff from that type of environment. Some people say that is the beauty of staffing agencies, clients (in some cases agencies) don’t really have to worry about long-term committments.

Ultimately it is easier to get out of a poor environment before it becomes a serious problem that really can’t be resolved or fixed with a 30 day notice to discontinue providing services

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