Mr. A suffered a cerebrovascular accident, which has affected his ability to comprehend and communicate. Mr. A needs someone to consent for percutaneous endoscopic gastrostomy placement, but he lacks the capacity for decision-making, as certified by two physicians.
A PICC line allows the medications to quickly reach the source of infection—but unfortunately, it also provides an easy route for the patient to use illegal drugs to get high. And sending an active or recent substance abuser home with a central line of any kind presents legal and ethical risks.
CMS’ Chronic Care Management service is aimed at strengthening access to chronic care management services in primary care settings while reducing costs, and a report on the program prepared by Mathematica Policy Research for CMS indicates its doing just that.
Transitions of care are a time when lapses can occur and problems can arise. Transfers are one of those transitions, and asking the right questions can help ensure problems aren’t overlooked, including ones that could later interfere with quality.
Jerry and Bob are twins who, up until six months ago, lived with their mother. When she died suddenly and her home was foreclosed, the two brothers found themselves homeless. Neither of them has a job, and both are disabled: Jerry has a physical injury caused by a past construction job, and Bob has severe cardiac disease. On the coldest night of the fall season, Bob is stricken with severe chest pain that is unrelieved by oral nitroglycerin.
