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PubMed2002

[Disorders requiring nursing care and the period before recognized as needing nursing care (active life expectancy) in relation to nursing care insurance].

PURPOSE: To measure the state of health of the elderly population, active and dependent life expectancies were calculated based on the number of people needing nursing care. For this purpose, active life expectancy was defined as the period before nursing care was recognized by insurers as being required. Moreover, to cast light on disorders requiring nursing care, age-adjusted nursing time needed for different ailments per ten thousand elderly population was calculated. SUBJECTS AND METHODS: Subjects were those 65 years or over living in Taihaku-ku, Sendai City, recognized as needing nursing care by nursing care insurers. The period before being recognized as needing nursing care was calculated using the Sullivan method, and termed the active life expectancy. Dependent life expectancy = life expectancy - active life expectancy. The number of those needing nursing care caused by each disorder diagnosed by attending physicians, was also age-adjusted by the reference population and multiplied by the nursing time needed for each level of nursing, resulting in the age-adjusted nursing time needed per ten thousand elderly population. RESULTS: Those recognized as needing nursing care were 7.5% (7.7% after age adjustment) of the male elderly population, and 12.5% of the female population (10.7% after age adjustment). For men, the active life expectancy was 16.1 years for the age of 65, 9.2 years for 75 and 4.4 years for 85, while the dependent one was 2.0-2.1 years for all ages. For women, the active life expectancy was 19.3 years for the age of 65, 11.1 years for 75 and 4.8 years for 85, while the dependent one was 4.6-5.3 years. The age-adjusted nursing time needed per ten thousand elderly population was 874 hours for men and 1,125 hours for women: of the time 51% was for men with cerebrovascular disease (40% for cerebral infarction), 11% for men with dementia; 37% for women with cerebrovascular disease (26% for cerebral infarction), 20% for women with skeletal diseases, 18% for women with dementia. CONCLUSIONS: The active life expectancy for women is longer than for men, by 3.7 years for the age of 65, by 2.3 years for 75 and by 0.5 years for 85. The dependent life expectancy for women is also longer than for men, by 3.2 years for the ages of 65 and 75 and by 2.6 years for 85. Thus, nursing prevention is an urgent issue, especially for women. The disorders requiring particularly long age-adjusted nursing time are carebrovascular disease (particularly cerebral infarction), dementia and skeletal disorders (particularly among women).

Age Factors↗
PubMed2005

Third-party reimbursement for nurse practitioners' services on trauma teams: working through a maze of issues.

Third-party payers reimburse for physician services performed by nurse practitioners, if the services are within the scope of practice of a nurse practitioner and the payers' rules are followed. However, some hospitals and trauma services have been reluctant to bill the services of nurse practitioners they employ or to hire nurse practitioners, because the rules are complex, vary from payer to payer, can be difficult to find, and because operations are not always set up so that nurse practitioners' services are bundled in ways which conform to the rules. Medicare has developed detailed rules on billing nurse practitioners' services, but neither Medicaid nor commercial payers necessarily follow Medicare's rules. The situation is further complicated by wide variations in state law governing nurse practitioner scope of practice and requirements for physician collaboration. Despite all of these variables, it may be worth the time and effort to sort out the requirements for utilizing nurse practitioners and billing for their services, considering the limitations on residents' hours, the data on quality of nurse practitioners' clinical services and the potential for generating revenue. This article describes the legal and business issues, provides the general rules for billing nurse practitioners' services, and provides a plan for obtaining third-party payment for nurse practitioners' services on trauma teams.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2006

[Managing chronic illness implications for the health care system].

Although chronic diseases build the main focus of health problems, the German health care system is not sufficiently prepared to deal with the new challenges. The reasons are diverse, but one of the most decisive is that the various consequences in dealing with chronic disease are scarcely noticed by the health service. These consequences are brought out by the following article by referring to the available literature and our own studies and are discussed in its implications for a needs-driven design of care. Special attention is paid to care, because it increasingly assumes a key role in the treatment of chronically ill, which still faces barriers in this country. These discussed are also.

Aged↗
PubMed2003

Practice management: billing for nurse practitioner services.

Utilization of Nurse Practitioners (NPs) in otolaryngology practices is increasing. Otolaryngologists now employ NPs to assist with patient care responsibilities in a variety of settings, from solo practice to large academic groups. This article addresses the appropriate third-party billing methods for NP services.

Accounting↗
PubMed1995

Resident selection in a Connecticut nursing home. A view from within.

Using data from a year of participant observation, this study provides a detailed description of resident selection procedures in a for-profit Connecticut skilled nursing facility. A system of multiple payers for nursing home services created a hierarchy of admission preferences that privileged those who could pay and denied access to the least profitable and the sickest individuals. Prescreening and waiting list juggling were strategies employed by the home to maximize the selection of private-paying residents and residents requiring the least care.

Connecticut↗
PubMed1992

[Eligibility for intensive nursing care. Part 1: Guidelines and current experience].

Against the background of the planned statutory Pflegeversicherung (insurance for nursing care) in Germany, a report is presented on experience gained to date with the new Leistungsbestand "Schwerpflegebedürftigkeit" (situation requiring social benefit "urgent need of nursing care") (Para. 53 ff. SGB V). The experience gained so far is of particular interest since, for the first time on a large scale, monetäre Erstattungsleistung (the provision of a monetary entitlement) replaces the Sachleistungsprinzip (benefit in the form of services) that is otherwise applied in the area of health insurance. It is intended that this form of entitlement will form the core of the planned nursing care insurance scheme.

Persons with Disabilities↗
PubMed1998

Supplemental health insurance ownership in Israel: an empirical analysis and some implications.

Many Western nations are implementing (or considering) changes in their health care systems. An integral component of these changes (or debates) refers to the functioning and regulation of the supplementary health insurance market. However, only limited empirical evidence exists on the functioning of the market, which is prone to the problems of moral hazard, adverse selection and risk selection. This paper presents an empirical analysis of ownership patterns of four supplementary insurance policies (acute care, nursing care, dental care and emergency intensive care) in the Israeli population aged 45- 75 in 1993. It further discusses some social policy and regulation issues related to the supplemental health insurance market in the post-1995 era of the Israeli National Health Insurance.

Aged↗
PubMed2004

Coding for NP care.

Explore the source record for details and available documents.

Centers for Medicare and Medicaid Services, U.S.↗