Health care literacy appears to be falling into categories-what is wanted, what is needed, and what would be nice in a perfect world.
As professionals we have the obligation to provide quality, understandable, evidence based care that is individual specific following MD orders.
navigating the health care system goes into PCP, Specialists, hospitals and long-term facilities, home health, insurances, medical personal, and a multitude of agencies
we also have the responsibility to teach and co-ordinate BUT ultimately the responsibility falls on patients and family members.
Seems like informed decisions are the key.
Sunday, April 15, 2012
Saturday, March 31, 2012
interesting learning experience in the world of authorizations
I am constantly amazed at "professionalism" in the health care field as it related to health care literacy. The current world of health care coverage requires coordination and cooperation between physicians, patients and families, providers of services and insurance companies.
Recently I have tried to engage my colleagues in the process for requesting and obtaining authorization from insurance companies for payment for the services we provide.
There are criteria for the services covered as well as restrictions on the individual plans. Also the services requested have start and end dates as well as number of visits approved
I struggle with daily reminders to field staff. I believe that part of health care literacy is the responsibility of health care providers to assist the patient in negotiating all aspects of their care- including services provided by the insurance companies.
Defining care as covered by insurances fall under 2 on-going dilemmas for professionals. One of those is the patent's right to be compliant or non-compliant. Another issue revolves around providing care that falls under the categories of necessary, needed, and nice. The grey area seems to exist now in home health care and the multitude of insurance plans. i am always told with my dealings that this call may be recorded and authorization is not a guarantee of payment.
There have been changes. To assist my co-workers I have attempted to educate and update. I have tried a 3o minute power point, a 6 minute power point, and short reminders and explanations to individual staff members as appropriate. The information has been well received, but not utilized on a day to day basis. I wonder how to address this issue.
I have been working through the thoughts of professional responsibility and accountability as the team provides care to patients. Also there is the issue that being "educated" professionals we each need to follow the processes. HUMMM....interesting thought. But it is a matter of being held accountable to assist all the elements of providing the care. It is not "just about me". Ultimately providing care requires the ability to put "all the pieces together" providing compassionate and competently appropriate care that allows the company to generate revenue and pay the bills following guidelines for services and best practices. All the time following the mission of the facility that employs us.
Dr. Rudd has done great work about negotiating the patient through the maze of healthcare. Unfortunately nursing and others have not appeared to catch up with the changes in the new professional responsibility and accountability in the climate of "services rendered". Medicare and Insurance audits as well as new restrictions on rehospitalization re-imbursement add a strange new health care literacy needed for the professional.
Recently I have tried to engage my colleagues in the process for requesting and obtaining authorization from insurance companies for payment for the services we provide.
There are criteria for the services covered as well as restrictions on the individual plans. Also the services requested have start and end dates as well as number of visits approved
I struggle with daily reminders to field staff. I believe that part of health care literacy is the responsibility of health care providers to assist the patient in negotiating all aspects of their care- including services provided by the insurance companies.
Defining care as covered by insurances fall under 2 on-going dilemmas for professionals. One of those is the patent's right to be compliant or non-compliant. Another issue revolves around providing care that falls under the categories of necessary, needed, and nice. The grey area seems to exist now in home health care and the multitude of insurance plans. i am always told with my dealings that this call may be recorded and authorization is not a guarantee of payment.
There have been changes. To assist my co-workers I have attempted to educate and update. I have tried a 3o minute power point, a 6 minute power point, and short reminders and explanations to individual staff members as appropriate. The information has been well received, but not utilized on a day to day basis. I wonder how to address this issue.
I have been working through the thoughts of professional responsibility and accountability as the team provides care to patients. Also there is the issue that being "educated" professionals we each need to follow the processes. HUMMM....interesting thought. But it is a matter of being held accountable to assist all the elements of providing the care. It is not "just about me". Ultimately providing care requires the ability to put "all the pieces together" providing compassionate and competently appropriate care that allows the company to generate revenue and pay the bills following guidelines for services and best practices. All the time following the mission of the facility that employs us.
Dr. Rudd has done great work about negotiating the patient through the maze of healthcare. Unfortunately nursing and others have not appeared to catch up with the changes in the new professional responsibility and accountability in the climate of "services rendered". Medicare and Insurance audits as well as new restrictions on rehospitalization re-imbursement add a strange new health care literacy needed for the professional.
Saturday, January 21, 2012
A thought......
Collaboration and coordination across the continuum is vital to help place patients where they want to be placed in their world.
caring for each other-relationship based care-a great concept
ll I have attended multiple meetings and a wonderful conference as well as researching and discussing Relationship Based Care over the last few years. Caring for ourselves, our patients and families, and each other forms a great foundation for doing what we do in the world of nursing.
Accountability, responsibility, and expectations all intertwine in the world of nursing. This brings me to the importance of knowing about the concept of "living outside the world of nursing". Images and perceptions by patients, families, physicians, and employers often clash with what we do as nurses. How we address issues through knowledge and professionalism with added competencey and compassion often plays a part on how our deliverance of health care information is heard and incorporated into the lives of our patients.
Knowing our scope of practice as well as our facilities mission statement, policies,and procedures is vital to protect our licenses as we work in an ever-changing hhi-tech world.
Grounded in theory and evidence-based has taken the place of "we just know". No longer can we blindly assume patient and family expectations are the same as ours. To team work at all levels of healthcare, I am just as proud today as I was 40 years ago to be a part of nursing. As always I too am evolving.
collaboration and coordination acros the continuum
I believe that nurses need to embrace the knowledge that care of patients go beyond the hospital bed providing health care "across the continuum".
In order to do this, as professionals we need to know what we are doing.
Following MD orders and Scope of Practices are essential. Keeping up with ever-evolving researched best practices brings competencey to "what we do" for the patients and each other. Collaboration and communication can not be under rated.
While some parts of nursing have not changed-there is a real cost. As nurses I believe we have a responsibility to people, resources, and quality. Furthermore there is an accountability to patients, families, physicians, peers, insurance, and facility that employs us by plannning our care through measurable goals and positive outcomes. We can not be stagnent. As always patients' expectations may differ from those expectations from medical staff.
We are only "invited" into a part of the patient's life.
And we need to celebrate the successes of our patients, our colleagues, and ourselves.
Saturday, September 17, 2011
thoughts on words-beyond the written
the importance of connections can not be underestimated in the world of health care literacy.for those who are in the "non-print" world we as professionals must find ways to include and engage our patients with compassion and a non-judgemental attitude. we need to make the "invisible" "visible" and connect the meanings of the words to a meaning for the audience. the old adage "if at first you don't succeed" has life changing and life-sustaining importance to patients.
knowing our audience takes on special meaning when nurses provide important information to patients. we need to know the limitations, strengths, and support systems that individuals have. how we approach a teenager and a non-custodial or custodial parent, an elderly patient with symptoms of dementia and an adult care giver, parents of a non-verbal infant when the parents only speak German or Chinese, or an educated engineer familiar with jet-propulsion " there are no one-way guarantees that what we say is what is heard. perhaps that is why some of the new medical initiatives that connect patients across the health care continuum are so important. did the patient remember their reading glasses? did the parent show up 1/2 way into the appointment with the teen ager? is the dementia gaining control of the activities of daily living that frustrate patient and care-giver? these are all issues that influence how the important information nurses try to give the patient. BUT ultimately what is the information the patient and family need to connect with their everyday world of living? What can we change as health care providers and when do we adjust our expectations to fit the patient and family expectations?
knowing our audience takes on special meaning when nurses provide important information to patients. we need to know the limitations, strengths, and support systems that individuals have. how we approach a teenager and a non-custodial or custodial parent, an elderly patient with symptoms of dementia and an adult care giver, parents of a non-verbal infant when the parents only speak German or Chinese, or an educated engineer familiar with jet-propulsion " there are no one-way guarantees that what we say is what is heard. perhaps that is why some of the new medical initiatives that connect patients across the health care continuum are so important. did the patient remember their reading glasses? did the parent show up 1/2 way into the appointment with the teen ager? is the dementia gaining control of the activities of daily living that frustrate patient and care-giver? these are all issues that influence how the important information nurses try to give the patient. BUT ultimately what is the information the patient and family need to connect with their everyday world of living? What can we change as health care providers and when do we adjust our expectations to fit the patient and family expectations?
Subscribe to:
Comments (Atom)
