Resources and Risk Management
Valuable Resources Available Online: Clinical Practice Guidelines
American Medical Directors Association (AMDA). The American Medical Directors Association has two new guidelines available: A Tool Kit for Implementation of the Clinical Practice Guidelines for Pressure Ulcers and Common Infections in Long-Term Care, both of which were introduced in 2004.
The Tool Kit provides up-to-date information to assist facilities in becoming compliant with recent revisions to the Centers for Medicare and Medicaid Services (CMS) Guidance for Surveyors and Investigative Protocol: Pressure Ulcers for Tag F-314 that became effective on November 12, 2004.1 Designed to assist medical directors, physicians, and the clinicians who work with them through each step of implementing a pressure ulcer prevention and management program in a long-term care facility, the Tool Kit provides 1) template letters to facility staff as well as family members, alerting them to the facility’s pressure ulcer initiative; 2) a summary of physician responsibilities, 3) a Task Assignment Grid to select individual staff members to perform specific tasks in pressure ulcer management, 4) policies and procedures, 5) a one-page check list for policies and procedures implementation, 6) a list of Quality Indicators for the Pressure Ulcer Guidelines, and 7) a laminated Measurement Tool for Clinical Practice Implementation that contains a suggested quantitative process and clinical outcomes measures related to implementation of the pressure ulcer clinical practice guidelines.2
The kit may be purchased by AMDA members and non-members. For additional information, visit: https://www.amda.com. A Clinical Corner with articles, CME programs, and other tools and resources pertinent to pressure ulcer treatment and management in long-term care are also available at this site.
National Guideline Clearinghouse. Another valuable site is the National Guideline Clearinghouse (https://www.guideline.gov) where literally hundreds of guidelines are posted. Most can be downloaded without charge. Here are just a few of particular interest to the readers of this journal:
American College of Gastroenterology
Management of Crohn’s Disease in Adults
American Society of Gastroenterology Endoscopy
Acute Chronic Pseudo-Obstruction
American Society of Colon and Rectal Surgeons
Practice Parameters for the Surveillance and Follow-up of Patients with Colon and Rectal Cancer
Practice Parameters for the Treatment of Patients with Dominantly Inherited Colorectal Cancer (Familial Adenomatous Polyposis and Hereditary Non-Polyposis Colorectal Cancer)
Practice Parameters for the Treatment of Sigmoid Diverticulitis
Association of Rehabilitative Nurses
Practice Guidelines for the Management of Constipation in Adults
Medicare Targeted in 2005 Government High-Risk Series
The High-Risk Series report is issued by the Government Accountability Office (GAO) every 2 years (the last was in 2003) and identifies areas at high risk because of their greater vulnerabilities to fraud, waste, abuse, and mismanagement; or major economy, efficiency, or effectiveness challenges. Although the 95-page 2005 Update focuses mainly on Homeland Security and Defense, it also lists the Medicare, Medicaid, and federal disability programs as three of 25 high-risk government programs. Recognizing the additional burden on the CMS created by the Medicare Prescription Drug and Modernization Act of 2003 (MMA), the report acknowledges that the challenges to CMS are substantial. The prescription drug benefit is estimated to cost $8.1 trillion in today’s dollars over the next 76 years. Absent reform — and with the prescription drug benefit effective in 2006 — the report cautions that the program will be fiscally unsustainable. The report admonishes CMS for not making or being slow to adjust payments or use claims data to target areas of fraud, abuse, and overpayment. The GAO states that the CMS could have saved millions of dollars in payment and beneficiary copayments had it revisited its payment policy for certain services and supplies. In a study of the Medicare claims appeals process, GAO found that less than half of the appeals were decided within the statutory time frame. The report urged CMS to accept GAO recommendations in order to preserve the integrity and effectiveness of the Medicare program. The truth is that it will likely take legislative action to make necessary changes in these areas.
1. Turnbull GB. Revised guidance to surveyors for pressure ulcers effective end of 2004. Ostomy/Wound Manage. 2005;51(1):24–25.
2. American Medical Directions Association webpage. Available at: www.amda.com. Accessed January 27, 2005.
