Nurse Care Managers work hard every day to increase the quality of care for their patients. Recently, in a CSI-RI practice, a Nurse Care Manager played an influential role in one patient's treatment plan resulting in a decreased number of costly emergency room visits and improvement in the patient's quality of life.

The patient, a 53 year-old male whose diagnoses included chronic obstructive pulmonary disease, chronic cor pulmonale, chronic kidney disease, non-insulin dependent diabetes mellitus, anxiety, insomnia, personality disorder and oxygen dependency, visited the emergency room 91 times from January - June 2014, costing approximately $148,000.00.  

The Nurse Care Manager and hospital team met to develop a plan to make ER visits less social for the patient and educate him to call his primary care office prior to going to the ER. This plan included weekly visits with his Primary Care Physician, weekly phone calls and visits with the Nurse Care Manager and Social Services, coordination of care with Visiting Nursing Services, prepackaged delivery of medication and a referral to Behavioral Health for counseling and psychiatric consult. The patient's Nurse Care Manager was very involved with the patient's treatment plan and even joined the patient and his mother for the first counseling visit to foster trust between him and the counselor.

Since the implementation of this treatment plan and work with the Nurse Care Manager, the patient has decreased his ER visits. In fact, from June - July 2014 the patient did not visit the emergency room. The patient is now independently managing his Behavior Health visits, has increased his activity tolerance, lost weight and is no longer oxygen dependent. Further, the patient no longer requires weekly visits with his Primary Care Physician, but continues weekly contact with his Nurse Care Manager for support. More importantly, the patient reports better quality of life. 

New CMS rule allows flexibility in certified EHR technology for 2014

On August 29, 2014, the Centers for Medicare & Medicaid Services issued its final rule regarding changes to the Meaningful Use stage timeline and the definition of certified electronic health record technology (CEHRT) to allow options in the use of CEHRT for a 2014 EHR reporting period. The rule was published in the Federal Register on September 4, 2014.

The rule allows eligible providers to use 2011 CEHRT, or a combination of 2011 and 2014 edition CEHRT to meet Meaningful Use. Eligible professionals (EPs) must use a 2014 edition CEHRT in 2015.

Under this final rule, Stage 2 of the Meaningful Use incentive program will be extended through 2016 and Stage 3 will begin in 2017 for certain providers.  

The effective date of the change is October 1st, 2014.  It's important to read through the rule as it appears in the Federal Register, to determine whether or not you can attest that you're "unable to fully implement 2014 edition CEHRT for an EHR reporting period in 2014 due to delays in the availability of 2014 Edition CERHT".  The Rhode Island Regional Extension Center can assist you with questions and can be reached at 888-858-4815 or at rirec@riqi.org. 

Gil Bricault

Gil was enjoying a relaxing day fishing alone on a lake when he cut his hand on an old knife in his tackle box. After stopping the bleeding, Gil realized he might need a tetanus shot. Knowing the emergency room can be costly and time-consuming, he decided to call Wood River Health Services.

When Gil called his practice he was transferred to a nurse who asked a few simple questions about his injury and was able to quickly access and examine his medical records. Much to Gil's surprise, there was no need for him to get a tetanus shot because the nurse saw that he had gotten one a few years prior. She advised him to clean the wound, call back if he showed any sign of infection and to enjoy the rest of his day fishing.

For Gil, this experience reconfirmed the importance of taking advantage of the services offered to him by Wood River Health Services. He is thankful that his primary care team has taken the time to talk about the services and benefits of being a patient at a PCMH. Gil's quick access to care information during extended hours is just one example of the many ways CSI-RI patient-centered medical homes, like Wood River Health Services, are supporting the unique health needs of more than 220,000 Rhode Islanders. 

• October 2, 2014 - 7:30-9:00 am - PCMH-Kids Stakeholder Meeting - 301 Metro Center Blvd., Warwick (Committee Members only)

• October 2, 2014 - 3:00-4:00 pm - CSI-RI Selection Committee - RIQI - (Members only)

• October 3, 2014 - 8:30-9:30 am - CSI-RI Leadership (call in) - (Leadership Members only)

• October  7, 2014 - 7:30-9:00 am - Data and Evaluation Committee  - Memorial Hospital - Center for Primary Care, Pawtucket 

• October 8, 2014 - 7:00-9:00 am - CSI-RI Selection Committee - BCBS, 500 Exchange Street, Providence (Members only)

• October 9, 2014 - 12:45-7:30pm - CSI-RI Learning Collaborative, "Primary Care: The Future is Now!" - The Radisson, 2081 Post Road, Warwick, RI (attendees must have registered by September 22) 

• October 10, 2014 - 7:30-9:00 am - Steering Committee - RIQI

• October 14, 2014 - 8:00-9:30 am - Nurse Care Management Best Practice Sharing Committee - RIQI

• October 16, 2014 - 7:30-9:00 am - Practice Transformation Committee - RIQI

• October 16, 2014 - 3:30-5:00 pm - Integrated Behavioral Health Committee - RIQI

• October 17, 2014 - 7:00-9:00 am - CSI-RI Selection Committee - BCBS, 500 Exchange Street, Providence (Members only)

• October 20, 2014 - 7:00-9:30 am - South County Steering Committee - South County Hospital - 3rd Floor Administrative Conference Room

• October 24,2014 - 7:30-9:00 am - Executive Committee - Blackstone Valley Community Health Care -39 East Ave, Pawtucket, RI 

• October 24, 2014 - 9:30-11:00 am - Community Health Team Planning - Blackstone Valley Community Health Care -39 East Ave, Pawtucket, RI

• October 27, 2014 - 10:00-11:30 am - Program Evaluation Committee - Rhode Island Foundation - One Union Station, Providence, RI

• October 28, 2014 - 8:00-9:30 am - Practice Reporting Committee - RIQI