R&R Insurance Blog

The first cut of the Wisconsin Health Insurance exchange markets have been announced and it looks like slim pickins! Wisconsin's "big 3" (United Healthcare, Humana and Anthem) are not participating in the small group exchanges.

Also, keep in mind that for Wisconsin’s Exchange, we have 16 different rating regions and carriers can file for just specific ones. Carriers have until 9/15/13 to sign contracts/pull out.

Wisconsin Exchange Carriers for Individual and small group markets.

Any way you look at it - this is slim pickins for Wisconsin businesses. There are other options for avoiding the exchanges and the "taxes". More about self funding your health insurance.

Join our group on LinkedIn: Obamacare: Strategies for Business to Survive. We welcome you to join in the conversation with our LinkedIn group dedicated to discussions for business owners on Obamacare: Strategies for Business To Survive. Read articles, download documents, join the conversation, and add your expertise!

Learn how Voluntary Benefits are impacting small businesses and their ability to attract and retain employees during this time of benefit change.

Do you ever find yourself forgetting things that you want to remember? Try a couple of these tricks and let us know how they work.

Remember Names - Look, snap, and listen to their name. Too often, we don’t pay attention. Now make a mental picture (snap!) of their name and face, and mentally connect them.

Get Everything on Your List - Make up a story using the items you need — the more absurd and dramatic, the better!

Recall Online Passwords - Create a template that you personalize for each site. For instance, you might start with a word-number combo that’s meaningful to you, then tack on the initials of the website that needs a password. Example: CoCo was your first pet, and you got him when you were 11 and you're logging into R&R: rrCoco11

Never Miss a Birthday - Use technology! Facebook will send you an email every weekend reminding you of coming birthdays: Go to the "Accounts Notification" page to opt in. Also, while you're logged in like R&R!

When was your last insurance review? Contact a R&R knowledgebroker and we will review it to make sure nothing was forgotten!

The causes of absenteeism are varied, and so is the impact on companies - from decreased productivity to a reduction in profit and morale.

Some employers are finding better ways to manage employee absence. Research shows a direct correlation between these five major employer practices and a better absence management program:

1. A full return-to-work (RTW) program, starting with a written RTW policy and a list of alternative duties for light duty clearance.
2. Referral process for employees to health management programs.
3. A central leave-reporting system for STD and FMLA.
4. Detailed reporting for disability and FMLA usage patterns, costs etc.
5. Use the same resource for STD, FMLA and other benefit programs

7 Positive Outcomes of an Absence Management Program

1. Enhanced productivity
2. Reduction in lost-time claims
3. Decreased overall absenteeism
4. Direct cost reduction
5. Better return-to-work ratios
6. Lower workers compensation premiums
7. Improved employee morale

Employers are recognizing the importance of managing absences, but most have a long way to go in managing their overall presenteeism program.

Implementing strategies to help workers stay healthy is critical to controlling costs. At R&R, we take wellness to a whole new level. Wellness programs will increase the health and longevity of employees and their families –which means that businesses can have a lot of control over their health insurance costs and the productivity of their employees – control that they don’t know they have. At R&R Insurance, we call this program WellCompForLife!

Join our upcoming Work Comp Seminar to learn more!

There's a lot to keep track of over the next six months, so let's get right to the list. Here are 15 Affordable Care Act requirements that will become effective on Jan. 1, 2014:

1. State Health Insurance Exchanges
Each state must establish a health insurance exchange (or HHS will do so) for use by the uninsured and small employers with 100 or fewer employees (states may set the cap at 50 employees). The exchanges will offer fully insured insurance contracts that provide essential health benefits at differing levels of coverage (bronze, silver, gold, and platinum). Employees of small employers who offer health insurance coverage through an exchange may pay their employee premiums for such coverage on a pre-tax basis through the employer’s cafeteria plan.

2. State Health Insurance Exchange Tax Subsidies
Individuals who do not have affordable minimum essential coverage from their employer will be eligible for tax credit subsidies for their health insurance purchase on a state exchange if their income is below 400 percent of federal poverty level. (In 2013 the federal poverty level for a household of 1 in the 48 contiguous states is $11,490, therefore 400% of that would be $45,960.

3. Individual Mandate Tax Penalty
Individuals are required to obtain minimum essential health coverage for themselves and their dependents or pay a monthly penalty tax for each month without coverage. The monthly penalty tax is one-twelfth of the greater of the dollar penalty or gross income penalty amounts. The dollar penalty is an amount per individual of:

• $95 for 2014 (capped at $285 per family
• $325 for 2015 (capped at $975 per family)
• $695 for 2016 (capped at $2085 per family)
  These dollar penalties will be indexed for inflation starting in 2017.

The gross income penalty is a percentage of household income in excess of a specified filing threshold of:

• 1 percent for 2014
• 2 percent for 2015
• 2.5 percent for 2016 and later years
  In no event will the maximum penalty amount exceed the national average premium for bronze-level exchange plans for families of the same size. Minimum essential coverage includes Medicare, Medicaid, CHIP, TRICARE, individual insurance, grandfathered plans, and eligible employer-sponsored plans. Workers compensation and limited-scope dental or vision benefits are not considered minimum essential health coverage.

4. Automatic Enrollment
Employers with more than 200 employees who maintain one or more health plans must automatically enroll new full-time employees in a health plan. The employer must give affected employees notice of this automatic enrollment procedure and an opportunity to opt out. State wage withholding laws are preempted to the extent that they prevent an employer from instituting this automatic enrollment program. The final effective date will be established by DOL regulations.

5. Pre-Existing Condition Exclusion Practices Eliminated
Pre-existing condition exclusions no longer will be allowed in group health plans or individual insurance policies, not even the limited exclusions previously allowed under HIPAA. This also applies to grandfathered plans.

6. Ninety-Day Maximum Waiting Period
Group health plans and health insurance issuers may not impose waiting periods of more than ninety days before coverage becomes effective. This also applies to grandfathered plans.

7. Cost-Sharing Limits
Group health plans, including grandfathered plans, may not impose cost-sharing amounts (i.e., copays or deductibles) that are more than the maximum allowed for high-deductible health plans (currently these limits are $5,000 for an individual and $10,000 for a family coverage). After 2014, these amounts will be adjusted for health insurance premium inflation.

8. Annual or Lifetime Limits
Group health plans, including grandfathered plans, may no longer include more than restricted annual or any lifetime dollar limits on essential health benefits for participants. Limits will possibly exist in and after 2014 for non-essential benefits.

9. Wellness Program Health Plan Discount
The maximum premium discount an employer can offer under its health plan for participation in a wellness program is 30 percent. (It is possible that this could increase this maximum discount to 50 percent in the future.)

10. Coverage for Those in Clinical Trials
Insurers and health plans, unless grandfathered, may not discriminate against an individual for participating in a clinical trial. If a plan covers a qualified individual, it may not deny or impose additional conditions for participation in a clinical trial.

11. Employer Minimum Essential Coverage Reporting
All employers providing minimum essential coverage must file information with the IRS and plan participants.

12. Large Employer Health Information Reporting
Large employers and employers with at least 50 full-time equivalent employees must submit annual health insurance coverage returns to the FTEs and the IRS. The returns must certify whether the employer offers health care insurance to its employees and, if so, describe the details regarding plan participation, applicable waiting periods, coverage availability, the lowest cost premium option under the plan in each enrollment category, and other information.

13. Medicaid Expansion
The U.S. Supreme Court in effect ruled that the requirement for states to offer Medicaid benefits to all persons with incomes at or below 133 percent of the federal poverty level is optional with each state. States that participate in the expansion will receive full reimbursement of their additional Medicaid costs from the federal government until 2017. At that time, reimbursement will gradually decline to 90 percent of extra costs in 2020 and thereafter.

14. Health Insurance Nondiscrimination Requirements
Code Section 105(h) currently taxes the benefits received by highly compensated employees (HCEs) under discriminatory self-funded health plans. PPACA has extended these nondiscrimination rules to insured plans. Employers with discriminatory insured arrangements will need to consider changing them. Grandfathered plans are exempt from this rule. This new requirement was originally intended to be effective for plan years beginning on or after September 23, 2010. The effective date was postponed in 2010 until IRS publishes a notice, which has not yet been issued. The provision may not be effective in 2014 but it most likely will be.

If you're starting your own business - Good for you! It's a big leap of faith and can often times be a big hit on your pocket book. If you're leaving a full-time employer to make this move, chances are you are also walking away from your health insurance coverage - or some form of it anyway. For those that have health insurance currently, but are making the move, here are some suggestions that will help you either find health insurance or try to extend what you've got for the first year or so.

How to Get or Keep Health Insurance if You Are Self Employed

1. Enroll on spouse's plan
   If you have an insured spouse that has health insurance, this is probably your most affordable option. On average, workers pay $4,129 toward their annual health insurance premiums. This averages to $344 a month. You'll be hard pressed to find individual health insurance for that price. (Younger workers are taking a huge increase with reform, and older workers, well, they are more risky - so your age may not get you a better price in the new age of reform).
2. COBRA Extension
   Under the COBRA (Consolidated Omnibus Budget Reconciliation Act), employers are required by federal law to offer COBRA extensions for health and dental coverage up to 18 months for you an your dependents when you leave your job. Drawback: It's really expensive. If you have planning time before you leave, consider dropping to the lowest cost plan your company offers - when the enrollment period allows. This will at least get you a lower monthly COBRA payment.
3. Purchase your own policy
   Be leery of websites that offer you dozens of quotes for affordable health care insurance. Sure you'll get some numbers - sometimes too many numbers. But once they have your information, you'll be hounded by a plethora of independent insurance agents all clambering for the same piece of business - yours! Health insurance rates are set by the federal government - so no one company is going to be different than the other - the real difference is service from an independent agent. An independent agent can provide free quotes and handle all of the shopping for some of the best choices and value in health care coverage. An independent agent knows the marketplace, knows the product, knows the carriers and most of all will get to know you and your needs, and protect you - that's their job. See 5 Mistakes to Avoid When Buying Individual Health Insurance and 7 tips on How To Pick The Best Individual Health Insurance Coverage.
4. Join a professional organization that offers a health insurance benefit
   Some professional and trade associations offer health insurance with group coverage rates. If you are over 55, consider AARP.org. The National Association for the Self Employed offers insurance plans as well. Chambers of commerce or business alliances can often have a consortium offering for health care insurance too - check with your local chamber of commerce for their options.
5. Opt to hire one person - making your own small group
   Because individual insurance is fairly expensive, some self employed people have opted to hire an additional employee to qualify them as a small business. Most independent agents like R&R Insurance can offer group premiums with 2 or more employees - this could make a significant difference in your monthly cost.
6. Stay employed
   Probably the least desirable for someone with an entrepreneurial spirit, but the suggestion to stay employed is worth mentioning. Stay employed either with your current company or with a company that offers health insurance coverage for the minimum number of hours a week - most often times its 30 hours a week. This keeps your pocket book in line, continues coverage for your family and gives you more time to chase your dream - although a little more slowly.

For more information on insurance for self employed individuals please visit our website. R&R Insurance Services is an independent insurance agency serving all of Wisconsin. We offer businesses and families access to affordable insurance coverage with excellent 24/7 service. For more information on individual health care plans contact knowledgebroker Donna Wahl.

Related articles:

The Secretary of Labor shall have the power, in order to determine whether any person has violated or is about to violate any provision of this title or any regulation or order thereunder...to make an investigation, and in connection therewith to require the submission of reports, books, and records, and the filing of data in support of any information required to be file with the Secretary under this title...

The above is a small part to the DOL's "Intent to Audit' letter employers have or will be receiving. There is an extensive push from the DOL to police ERISA and PPACA compliance to the extent that their 2013 budget included the hiring of more than 1000 auditors! However, the biggest issue is that most employers don't know that they are out of compliance or how to become compliant.

The DOL's audit letters are looking for information and documentation concerning particular aspects of the PPACA, such as the plan's grandfather status, coverage for adult children, lifetime and annual limits, and claims and appeals procedures

Employers should consider taking a serious look at their group health plans, not only for compliance with the PPACA, but also with the long standing mandates for group health plans - ERISA, HIPAA, COBRA and others laws.

If you have any questions regarding your ERISA, HIPAA, or PPACA compliance or any issues regarding your health insurance or benefits packages, please contact knowledgebroker Jane Shevey.

There is no doubt that voluntary benefits have moved into the benefits mainstream. Today, voluntary benefits are rightly regarded as a high value benefit strategy by both employers and their employees. Voluntary benefits satisfy employee preference for more benefits choice without adding to a company’s benefits budget.

The biggest challenge with voluntary benefits is choosing the right products that will drive employee participation and satisfaction during this time of extreme workforce diversity – one that is multigenerational, at different life stages and experiencing different economic circumstances, and at a time of immense changes in benefits offerings. There are now four generations in the workforce with a variety of personal needs, as well as fundamental differences in attitudes and expectations that will shape the future of voluntary benefits.

How should voluntary benefits be mixed and matched to provide a flexible product suite with broad appeal? What features will drive positive participation? Psychological, emotional and economic issues come into play in any purchase decision and the decision to open one’s wallet to buy a voluntary benefit is no exception.

A voluntary benefit must offer a solution to a real-life problem that could be experienced by the employee. It is important to offer a broad and rich portfolio of voluntary benefit products to enable individuals to identify “benefits that work for me” in the available mix. Voluntary benefit options that seem more personally relevant can contribute to an employee feeling more valued by the employer and more loyal to the organization.

Insurance needs change with life transitions – a new baby, a teen driver, or divorce. Help employees navigate this by connecting their new needs with a suggested suite of relevant benefit solutions to consider as changes occur - a generational approach.

Examples of generationally appropriate features could include guaranteed issue with no eligibility restrictions for pre-existing conditions, which might be more important for an older workforce. Whereas portability of the benefits may appeal more to younger workers who expect to change jobs more often.

In the end, designing the optimal voluntary benefit strategy is not only good for your employees; it also has advantages for the business. It contributes to a robust and competitive benefits program to attract and retain talent without adding to benefit costs. And it generates goodwill towards the company which can translate into increased employee loyalty and productivity.

For more information about voluntary benefits and their increasing role within today's benefits landscape, contact knowledgebroker Stephanie Riesch-Knapp.

Related articles:

Voluntary Benefits to the Rescue!

Forty-four percent of surveyed employees are concerned that their employer may reduce their benefits. As well, two-thirds are very concerned about having access to affordable health insurance as well as having enough money to cover increasing out-of-pocket medical costs.

These concerns have a negative impact on employee productivity. Employees who report being concerned about having access to affordable health insurance are also more likely to report distraction and stress at work and a decrease in their work quality.

Here are 3 ways you can reduce the stress that reform changes are having on your employees, and preserve productivity in the face of health care reform:

1. Offer supplemental Health Options
   Voluntary supplemental health benefits such as accident, critical illness, dental, disability and vision coverages help employees cope with unplanned medical costs.
2. Cultivate Wellness to Promote Productivity
   Healthy employees mean fewer costly medical interventions and absences and more productive employees. Wellness programs can work with proper communication, management buy-in and education.
3. Keep Employees in the Loop
   Health Care Reform is a complex issue, and many employees are in the dark about how it will impact them. An ongoing communication plan to keep employees informed as the company considers its options and makes decisions can reduce concerns and help maintain productivity.

At R&R, we take wellness to a whole new level. Wellness programs will increase the health and longevity of employees and their families –which means that businesses can have a lot of control over their health insurance costs and the productivity of their employees – control that they don’t know they have. At R&R Insurance, we call this program WellCompForLife!

Join the WellCompForLife discussion on LinkedIn!

For more information about WellCompForLife, about self-funding your health insurance plan, health care reform or basic employee benefits questions, contact knowledgebroker Laura Stehno.

New Interim Rules for Affordable Care Act Retaliation Claims
By Daniel Finerty, Lindner & Marsack, S.C., Posted with permission

The Affordable Care Act (ACA) created a new retaliation claim for employees to file with the Department of Labor, and in federal court, against their employer. Because of the relatively short timeframes associated with these claims, it is critical for employers to carefully document the reasons for any adverse employment decision which affects an employee who may be engaged in activity the ACA views as protected.

This summary provides additional information regarding these ACA retaliation claims, the Department of Labor’s Occupational Safety and Health Administration (OSHA) procedure, and the employee’s option to withdraw the complaint and proceed in federal court and and the employee’s option to proceed in federal court.

The “Protected Activity” Component

The ACA provides incentives to both individuals without health insurance, and to employers who do not provide health insurance, to obtain or provide health insurance. In order to carry out these mandates, Section 1558 of the ACA prohibits employers from retaliating against any employee for engaging in any activity that is protected by the ACA.

Generally, to establish a claim for retaliation under the ACA, an employee must establish (1) that s/he engaged in protected activity, (2) was subject to an adverse employment action by the employer, and (3) that the protected activity, alone or in combination with other factors, affected in some way the outcome of the employer’s decision. An employee can bring a claim for retaliation if they have suffered some adverse employment action because: • The employee receives a subsidy to purchase health insurance; •The employee provides information to an employer or a government agency regarding a real or perceived violation of the ACA; •The employee testifies in a proceeding regarding a violation of the ACA; •The employee assists or participates in an investigation of a possible violation of the ACA; or •The employee objects to or refuses to participate in any activity, policy, practice or assigned task which the employee reasonably believes to be a violation of the ACA.

The “protected activity” element may be established by the employee in a number of ways, as explained in the following examples:

Example 1: After reviewing the health insurance plan benefits offered by the employer, an employee informs the employer that s/he does not believe any of the plans offer the minimum required coverage. The employee has likely provided information to the employer regarding a real or perceived violation of the ACA and, in doing so, engaged in protected activity. If the employer subsequently disciplined or terminated the employee adverse shortly after protected activity, the action may create an inference that the protected activity was a contributing factor in the adverse action.

Example 2: After informing the employer that its health insurance plans do not provide the required minimum coverage, the employee informs the employer that s/he will secure coverage through the state’s health insurance exchange and obtain the tax credit for doing so. Because the employee has informed the employer of his or her intent to seek the subsidy, if the employer subsequently disciplines or terminates the employee as a result of a belief that the employee will seek and receive the subsidy, a finding of retaliation may result.

Example 3: After the employee obtains the tax credit and the employer is charged a penalty for failing to provide minimum coverage which pushed the employee toward the exchange. After receiving notice of the tax penalty, the employer attempts to “charge back” the penalty to the employee by reducing the employee’s wages. The employer may have just violated the ACA retaliation provision because the employee’s receipt of the tax credit is protected activity and the receipt of the tax penalty caused the employer’s decision to “charge back” the penalty against the employee’s wages.

The Department of Labor regulations specifically note that the area of employee’s receipt of the tax credit may be fertile ground for retaliation claims. Because some employers who do not offer affordable health insurance may be assessed a tax penalty by virtue of an employee’s receipt of the tax credit, “the relationship between the employee’s receipt of a credit and the potential tax penalty imposed on an employer could create an incentive for an employer to retaliate against an employee.” 78 Fed. Reg. 13,222 (Feb. 27, 2013).

The OSHA Procedure

OSHA has issued interim rules establishing the procedure for bringing these claims. To pursue a claim, an employee must file the complaint with OSHA within 180 days of the alleged violation. After filing, OSHA will share the complaint with the IRS, the Treasury Department, the Department of Health and Human Services, and/or any other relevant branches of the Department of Labor.

Initially, retaliation complaints are screened to determine if the employee has made a plausible argument that retaliation has occurred. If OSHA believes a violation may have occurred, it can issue a preliminary order reinstating the employee. Regardless of whether such an order is issued, employers typically will have twenty (20) days to submit a position statement. Sixty (60) days after filing that position statement, OSHA will issue its findings and conclusions.

If OSHA determines a violation has occurred, it can order reinstatement, back pay, compensatory damages (for emotional distress), interest on the damages awarded, attorney fees and costs. Alternatively, OSHA may find that no relation occurred and can dismiss the claim. Within 30 days of either finding, the losing party can file objections or a request for a hearing. Employers should note that OSHA may order reinstatement, even when the employer has filed objections to a finding of a violation.

An appeal of an adverse decision, including retaliation claims on which OSHA found no violation to have occurred, will lead to a hearing before an administrative law judge. At this hearing, the employee must prove that protected activity was a contributing factor in the challenged adverse employment decision.

If the employee establishes that the protected activity was one of several factors leading to the challenged employment decision, the employer then must prove, by clear and convincing evidence, that the same employment decision would have been made regardless of any protected activity.

After the hearing, the ALJ will issue a written decision. This decision becomes final unless either party files objections with the Department of Labor’s Administrative Review Board (ARB) within 14 days of the decision. The ARB has the right to accept or reject the request for review. If the ARB does not accept the request for review, the parties can appeal the ALJ’s decision to the relevant federal court of appeals. If the ARB elects to review the decision, it must issue its own decision within 120 days after all briefs have been submitted. After the ARB issues a decision, the parties then have 60 days to appeal any aspect of the ARB’s decision to the court of appeals.

The Federal Court Option

Employees also have the right to go into federal court any time before a final decision has been issued by the Department of Labor. Employees simply dismiss their administrative claim and pursue it in federal court.

One reason an employee may elect to go to federal court is that an ACA retaliation claim, if it survives an employer’s attempts to dismiss, will be tried to a jury. A jury can award the employees the same remedies in federal court, along with those the court can order, including reinstatement, back pay, compensatory damages, attorney fees and costs.

Conclusion

The retaliation provisions of the ACA create another avenue for current and former employees to challenge discharge, discipline, or any other employment decision with which they disagree. Because of the relatively short timeframes associated with these claims, it is critical for employers to carefully document the reasons for any adverse employment decision which affects an employee who may be engaged in activity the ACA views as protected.

Daniel Finerty of Lindner & Marsack, S.C. can be contacted at (414) 273-3910 or by e-mail to dfinerty@lindner-marsack.com. For more information, employers can visit the Department of Labor’s website, where the Department has posted information on filing ACA retaliation complaints at http://www.osha.gov/Publications/whistleblower/OSHAFS-3641.pdf.

© Lindner & Marsack, S.C. 2013. All Rights Reserved. The foregoing is a general discussion of a legal issue and is not intended to be, nor should it be construed as, legal advice.

Great article on improving patient safety for care giving facilities such as hospitals and nursing homes. Read full article in Amednews.com, by Kevin B. O'Reilly.

These are things hospitals and nursing homes should be doing to protect patients.

1. Improve Hand Hygiene
   Rates of hand washing are low, averaging 39%, with many doctors and nurses underestimating the activity's safety value. Research shows that effective hand hygiene initiatives improve knowledge of when to clean and how to clean, require demonstration of the knowledge, ensure that alcohol-based rub and gloves are available at the bedside, and guarantee that compliance is monitored continuously
2. Use barrier precautions to stop the spread of infections
   Along with hand hygiene, barrier precautions are key to reducing the 1.7 million health care-associated infections that occur in the U.S. each year, which the CDC says kill about 99,000 patients annually.
3. Implement care bundles to prevent central-line associated bloodstream infections
   About 250,000 bloodstream infections occur each year in the U.S., and these infections can triple hospital stays from seven to 21 days. Bloodstream infection rates in ICUs fell by nearly 60% between 2001 and 2009 thanks to wider use of a prevention protocol bundle.
4. Use real-time ultrasonography when placing central lines
   Using portable ultrasound machines to get a real-time, two-dimensional view while placing the catheter has been shown in randomized trials to lower infection rates and improve other outcomes. For every 1,000 patients, ultrasonography-guided central-line placement helps avoid 90 complications, research shows.
5. Use protocols to reduce catheter-associated urinary tract infections
   The most important step in preventing catheter-associated UTIs is to reduce use of indwelling urinary catheters. At least 21% of catheters are placed in patients inappropriately — for example, as a substitute for extra nursing care — and they often are left in long after they are needed.
6. Employ preoperative checklists to reduce surgical complications
   The most well-known surgical safety checklist is one devised in 2008 by WHO, which cut mortality rates from 1.5% to 0.8% at sites in industrialized nations and developing countries. The checklist also helped reduce the surgical complications rate from 11% to 7% over six months involving nearly 4,000 procedures.
7. Improve venous thromboembolism prophylaxis
   Between 350,000 and 600,000 Americans develop deep vein thrombosis each year. One key to improving use of these prophylactic interventions is health information technology that helps identify patients at higher risk for VTE. Medical and mechanical interventions can prevent VTE, Dr. Haut says. Low-dose unfractionated heparin and low-molecular weight heparins such as enoxaparin and warfarin are effective. So are compression stockings and pneumatic compressing devices.
8. Use preventive intervention care bundles to cut rates of ventilator-associated pneumonia
   Pneumonia linked to endotracheal intubation accounts for 25% of ICU infections and is responsible for half of intensive care antibiotic use. Research shows that preventive intervention care bundles can cut rates of ventilator-associated pneumonia by as much as 40% among adults and children.
9. Avoid hazardous drug abbreviations
   About 15,000 medication errors a year have been linked to using abbreviations such as “u” for “unit” and “q.d.” instead of “once daily.” Implementation of computerized physician order entry systems also can help eliminate the vestiges of this problem.
10. Use multi-component interventions to prevent pressure ulcers
    About 2.5 million Americans develop bedsores each year, and about 60,000 patients will die from complications related to pressure ulcers acquired in U.S. hospitals. One bundle of preventive care measures has reduced pressure ulcers by 90% at a large health system, from a rate of 5.7% of patients to less than 0.5%. The bundle, dubbed SKIN, calls for continual assessment of the skin of at-risk patients, regular turning of these patients, management of incontinence to prevent soiling that can contribute to bedsores, and nutritional assessment for malnourishment that can enable the ulcers.

Health care organizations in Wisconsin wanting to know more about how to reduce their risk and liability exposures, contact knowledgebroker Jeff Thiel.