Saturday, March 17, 2012

Discovering Your Talents and Gifts - (Finding Your Something)

Finding Your Something

Discovering your talents (your Divine Gifts) will bring you closer to understanding your purpose, your reason for being here. Discovering your talents and gifts can make you happy, content and fulfilled which in turn will make you a blessing to others.
Seek Spiritual Guidance
Because the Master of the Universe has placed these special gifts within us, it might be wise to seek His guidance to discover what they are. 

Let’s go to the Scriptures to see what the Word of God says about this.

 Romans 12: 6 - 8 (New International Version) -   We have different gifts, according to the gifts given us. If a man's gift is prophesying, let him use it in proportion to his faith. If it serving, let him serve; if it is teaching, let him teach; if it is encouraging, let him encourage; if it is contributing to the needs of others, let him give generously; if it is leadership, let him govern diligently; if it is showing mercy, let him do it cheerfully.

I Corinthians 7: 7 (New International Version) - I wish that all men were as I am. But each man has his own gift from God; one has this gift, another has that.

I Peter 4: 10 (New International Version) - Each one should use whatever gift he has received to serve others, faithfully administering God's grace in its various forms.

The Scriptures indicate that we have all been given individual, specific gifts. Trying to operate in other gifts and talents only causes frustration, stress, disappointment, depression, unhappiness, misery, dissatisfaction, anger and no passion in what we are doing. We are just simply trying to get through life, and then what? We don't feel that we have anything to look forward to and we feel that life has no purpose.

When operating in our God given gifts, we are happy and fulfilled. Our gifts and talents ultimately help others and can be a real blessing to them. You cannot operate properly if you are trying to be something you are not supposed to be, it’s like telling a fish to live out of water and survive.

Sometimes we find ourselves struggling against ourselves.  We find ourselves paddling upstream in our careers and in our lives and wondering why we are not going very far or very fast.  This is because we are operating outside of our gift.

Have you been ignoring the people around you (family, friends, colleague’s etc.) who are always telling you how good you are at something?  I’ll bet most of the time you just blow them off and say “ah, that’s nothing” – sound familiar?   I will go back to what I asked in the beginning.  What do you enjoy doing?  What comes easy to you?  What would you do for free?  Think about it and I can almost assure you that you have found your calling.

Discover Your Calling
Each of us has a high calling that we are obligated to follow. When we follow our calling, this brings God great glory and us great joy. The quest to discover our calling begins with four facts that we should know for certain:

 1. Our calling is embodied in our gifts, both natural and spiritual, that were given to us intentionally by divine design.

2. Our gifts come with a responsibility: "As each one has received a special gift, employ it in serving one another as good stewards of the manifold grace of God.
 (1 Peter 4:10).

 3. Our gifts allow us to do excellent work, make our greatest contribution to the human race, and do the "good works" God had in mind when he designed us.

 4. Sometimes this is difficult. What God has in mind can be costly, inconvenient, and countercultural.  In other words, sometimes we may have to step outside of our comfort zone.

Stepping outside of our comfort zone is usually very scary for most of us but this may be just where we need to go to get to the place that we need to be.

Embrace Your Calling
I urge you to seek God’s guidance as you start to become more aware of your specific gift or talent.  You could have the gift of communication, the gift of listening, the gift of singing, building, cooking, organizing, hospitality, or even caring for hurting people and a strong desire to help them have a better way of life.   There are many, many gifts you just need to find yours.  Once you have found it, embrace it.  Don’t get distracted or start to doubt because your gift may not make you a millionaire or your gift may not make you famous or your gift seems to be a lot of work or your gift seems so insignificant.

Take stock of your talents. Don't minimize them. Don't belittle or bury them. Don't say, oh, I'm just a kidney, I'd rather be a mouth. Or I'm just a big toe; I'd rather be an eye. And of course, don't get proud and say, "Look at me. I'm a hand; look at that old toe over there." We're all needed. We're all important. And it is from the small and simple things that great things are brought to pass. Thank the Lord for the gifts you've been given, use them to the best of your abilities and God can do great things through you.
To Your Continued Success  ~ Miss Julia



Tuesday, March 6, 2012

Discovering Your Talents and Gifts - What is Your Something?

Discovering Your Talents and Gifts

What is Your Something?
My favorite thing to say is that -  Everybody came here with something”.  Some special gift, some special talent.  Many people find out early on what their ‘something’ is while others spend a lifetime trying to discover their ‘curve ball’.  Everyone is good at something.  It may be writing, singing, speaking, working with your hands, cooking, gardening, drawing etc. Some people can manage well, some are creative, some can sell, the list goes on.  When you understand what you are interested in and what you are good at, you can make fulfilling career choices and discover your major definite purpose. Think about the things that you like, the things that you really enjoy doing, the things you would do for free and chances are you will soon discover your ‘something’.

Think about where you are right now.  Do you find yourself frustrated with life? Do you feel like a fish out of water? Do you long for peace and happiness?  If any of these describe you in any way I urge you to dig deep within and examine  these questions - what profession did you choose for yourself?  Did you choose your profession because it pays well?  Did you choose your profession because your mother or father wanted you to or perhaps you are carrying on a family tradition.  Whatever you are doing for whatever reason~ ARE YOU FULFILLED?  If you are not fulfilled then ask yourself these questions -  What are your dreams?  What makes you happy?  What do you enjoy doing?  These are areas you need to really explore.

So How Do You Know What Your Gifts and Talents Really Are?
Take a few minutes to think about yourself. You already possess many abilities, things you accomplish without even thinking about it, without effort. Many things you have learned and mastered are now easily achieved. What talents of yours have been fully activated? These are the talents you use routinely, things you can do easily.

Make a list of everything you can do easily and things you really enjoy doing. There is no limit to how long your list should be.  You may find 5-10 or 20-30 items on your list.  You may be surprised to learn about all of the abilities and qualities that you already possess. You will also discover that you have more than your obvious, visible talents, you also have stored talents. These stored talents are talents you know you have but you are not using them. Now you may have excuses for not using them like,  “I’m too busy, I don’t dare to, I’m not sure if I’m good enough at that, I’m afraid to make a fool of myself, I’m too old to start that now,” and so on.  Sound familiar?  However, another reason may be that you fear your life might well take a totally different turn when you start focusing on this talent of yours!

It’s possible that you alone are aware of your talent for singing or acting. Maybe you’re a writer in disguise. But you’re afraid to come forward out of fear. You are afraid that you’re not good enough after all, or that you would have to quit your current way of living when you are truly “discovered!”

Review Your List of Talents
This list that you created of your talents contains your key talents. Key talents are qualities that are outstanding  that you are known for, qualities that are so typical for you that, if one took them away from you, you wouldn’t be the same person anymore. What are these talents or qualities? Can it be your enthusiasm, your communication skills, your creative skills, your sensitivity, your organizational talents, your brilliant voice, your expertise in a given area or what? What talents do you have that are such a big part of your identity that your friends cannot imagine you without them. These are the most visible and outstanding. What are you known for? What would your friends say about you if they had to describe you in just a few words?

These key talents and qualities are your gifts (from God) the core of your mission on earth. They are the purpose of your life. Discovering your talents (your Divine Gifts) will bring you closer to understanding your purpose, your reason for being here.  Discovering your talents and gifts can make you happy, content and fulfilled which in turn will make you a blessing to others. 

To Your Continued Success  ~
Miss Julia

Friday, December 16, 2011

10 Ways to Help Nurses Improve Patient Satisfaction

10 Ways to Help Nurses Improve Patient Satisfaction

Rebecca Hendren, for HealthLeaders Media , September 6, 2011

Improving patient satisfaction is a financial imperative. Nurses are on the frontline of patient interaction and can make or break the patient experience. So why do we make it so hard for them to have positive interactions with patients?

Here are 10 changes to nurse procedures and working conditions that would improve patient experience. Some are simple, others more complex, all are effective.

1. Scripting: Many fear that scripting means fast food restaurant–type rote responses. In fact, it’s a useful tool when handled correctly. Scripting empowers nurses with tools to make their communication with patients easier. Regular discussion and training about patient interactions ensures nurses know what is expected. A scripting example: the hospital expects that all nurses will introduce and identify themselves and their professional credentials to new patients, and explain the treatment regimen. Scripting gives nurses tools for handling issues such as delayed procedures and lost test results. It also gives them tools for difficult situations such as deescalating angry patients.

2. Supplies: Keep frequently needed supplies in patient rooms and restock regularly. Maintain a multitude of stockrooms and supply cupboards and don’t make nurses walk miles to track them down. It’s frustrating for patients and staff when nurses have to stop what they are doing to track down supplies.

3. Uniforms: In many hospitals, RNs are indistinguishable to patients from the people delivering their meal trays. Consider choosing a defined scrub color for RNs to ensure that patients know who they can talk to and who is looking out for them.

4. Hourly rounding: Make a commitment to hourly rounding, and you will see patient satisfaction go up and call bell usage go down. Patients feel better when they know someone will be in to check on them within an hour. Alternating visits between RNs and nursing assistants ensures that the time commitment is manageable – and helps both groups plan their workflows since they no longer will spend so much time running after constant call lights.

5. Sitting down: Something as simple as sitting down when talking with patients can make a huge difference in satisfaction scores. Sitting down at the bedside implies that the nurse has time for the patient and is actively interested in the conversation.

6. Patient education: Make time for patient education. Nurses are pulled in a thousand different ways and often feel obligated to complete patient education as quickly as possible. But this time spent one-on-one means so much to patients. We know that patients often are too overwhelmed or intimidated to process information provided by physicians during initial diagnosis or post-procedure, and they look to nurses for easy-to-understand translation of difficult or complicated news. Put a value on this time with patients so that nurses will prioritize it.

7. Bedside report: Instead of conducting report at the nurse’s station or break room, do it at the bedside. Patients should be empowered to take an active part in their care. Increase their autonomy by discussing report in their presence and encouraging their involvement.

8. Nurse-led initiatives: Don’t simply hand down service improvement programs from above and tell nurses what to do. Programs driven by nurses have ready-made support and are often much more effective. Nurses will be more engaged in improving patient satisfaction when they develop ideas themselves and are accountable for success or failure.

9. Nurse empowerment: Nurses with autonomy over their practices provide better patient care. Ensure that the nurse practice council is robust and able to make decisions about clinical practice. Empower a nurse staffing committee to make decisions about safe patient care.

10. Demonstrate caring: According to Gallup polls, nurses are the most trusted professionals in the country. People can relate to nurses, whereas physicians can be intimidating to ordinary patients. The best patient satisfaction scores happen when patients feel genuinely cared for and cared about. Most nurses do this automatically. They bring an extra blanket or sit down and hold a patient’s hand for a few short minutes to provide comfort. Value these small details and recognize them publicly so that nurses know these parts of their role are just as important as the rest.

All for The Patient   ~ Miss Julia

Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She and manages The Leaders' Lounge blog for nurse managers. Email her at

Thursday, December 1, 2011

Listen Up Administrators- Here are 5 Reasons Nurses Want to Leave Your Hospital

5 Reasons Nurses Want to Leave Your Hospital

Your nurses have one eye on the door if you do any of the following.

Although economic woes abound, nurses are planning their exit strategies and will make a move when things improve. A recent survey from healthcare recruiters AMN Healthcare found that one-quarter of the 1,002 registered nurses surveyed say they will look for a new place to work as the economy recovers.

Are your nurses engaged, committed employees? Or are they biding their time until they can go somewhere better? To predict whether you face an exodus, take a look at the following five reasons why your nurses want out.

1. Mandatory overtime
Nurses work 12-hour shifts that always end up longer than 12 hours due to paperwork and proper handoffs. At the end, they are physically, mentally, and emotionally exhausted. Forcing them to stay longer is as bad for morale as it is for patient safety.  Some overtime is acceptable. People get sick, take vacations, or have unexpected car trouble and holes in the shift must be filled to ensure safe staffing. Nurses are used to picking up the slack, taking overtime, and pitching in. In fact, overtime is an expected and appreciated part of being a nurse. Many use it to help make ends meet. Mandatory overtime, however, is a different matter. Routinely understaffed units that rely on mandatory overtime as the only way to provide safe patient care destroy motivation and morale. Take a look at the last couple of years' news stories about RN picket lines. Most include complaints about mandatory overtime.

2. Floating nurses to other units
One nurse is not the same as another. Plugging a hole in a geriatric med-surg unit by bringing in a nurse from the pediatric floor results in an experienced, competent nurse suddenly becoming an unskilled newbie. A quick orientation won't solve those problems. Forced floating is usually indicative of larger staffing problems, but even so, its routine use is dissatisfying and compromises patient safety.  Instead, create a dedicated float pool staffed by nurses who volunteer and who can be prepared and cross-trained. Institute float pool guidelines that nurses float to like units. For example, critical care nurses find a step-down unit an easier transition than pediatrics.  Float pool shifts open up options for nurses who need more flexibility and offering a higher rate means you'll never be short of volunteers.

3. Non-nursing tasks
Nurses are already understaffed and overworked. Hospitals with too few assistants rub salt on the wounds. RNs shouldn't have to take time from critical patient care activities to clean a room or collect supplies. Gary Sculli, RN, MSN, ATP, patient safety expert and crew resource management author, offers a vivid analogy. Imagine if half way through a flight you saw the pilot come down the aisle handing out drinks because the plane was short staffed. It just wouldn't happen.
Yes, cleaning a room is important, but don't force nurses' attention away from their patients. Distractions are dangerous and compromise patient safety.

4. Bullying and toxic behavior
Bored of hearing about this topic? So am I. So are nurses. Nothing makes nurses want to walk out the door more than toxic colleagues—whether physicians, nurses, or anyone else—who are allowed to behave badly.  It's not enough to have a zero-tolerance policy. Enforce it. Preach it. Talk about the importance of respectful behavior. Explain expectations, not just at orientation but at multiple times through the year. Send information via emails, hold continuing education classes, and have the topic as a standing item on meeting agendas.  Give managers the tools to confront problem employees and back them up when they do. Have a plan in place to educate offenders. If the behavior continues after that, fire them. Support managers through this work. Nurses would rather work a nurse short than keep a disruptive employee who sabotages the morale and cohesiveness of the others.

5. Bad managers
You've heard it before: People don't leave companies, they leave managers. Yet hospitals still don't pay enough attention to leadership skills for nurse managers. Bad nurse managers who don't know how to lead are retention nightmares. Skilled managers are retention magnets.  Some hospitals have good managers who are stretched so thin they become bad ones. How can anyone focus on the professional development of their staff if they're overseeing several units with umpteen nurses across all shifts? Annual performance reviews shouldn't be the only time the manager and nurse engage in conversation. Nurse managers must help staff reflect on growth and plan for the future. 

These five reasons affect every aspect of nursing workload and contribute to fatigue and burnout. Don't forget that nurses always know when their colleagues at the hospital across town are happier.

Take from a Nurse ~ Miss Julia

Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She and manages The Leaders' Lounge blog for nurse managers. Email her at

Friday, November 25, 2011

Top 12 Uncertainties Hovering Over Healthcare

If ever there was a year in which "anything could happen" in healthcare, 2012 just might be it. Numerous major decisions, regulations, and policy rollouts loom, including how severely physicians' pay will be cut and whether the Affordable Care Act itself is a constitutional document. We look at a dozen potential game changers. Get ready for 2012. It's going to be a wild ride, for sure.

1.The Joint Select Committee on Deficit Reduction, a.k.a. the Super Committee
This bipartisan panel has just hours – by Wednesday Nov. 23 – to come up with a plan to reduce all federal spending by $1.2 trillion over 10 years to avoid the "sequester," which would mean an automatic 2% across the board cut in payments to Medicare providers starting in 2013. 

As of this morning (11/25/2011), reports indicated they were at an impasse defined by party lines.  For some health leaders, this may be a good thing, as some proposals being aired behind the Super Committee's closed doors would target Medicare spending even more than the 2%.
Congress, of course, makes the rules, and Congress could decide to change the rules, as some elected officials hope.

2.The Sustainable Growth Rate
No story about healthcare in 2012 is complete without a mention of the 27.5% guillotine hovering over physician Medicare fees effective Jan. 1. The
 Medicare Payment AdvisoryCommission backs a plan to repeal the SGR at a cost of $200 billion.  It would freeze pay for primary care physicians for 10 years. It would cut by 5.9% pay for specialists for three years, and freeze their pay for the remaining seven.  This of course pours more gas on the flames of tension that already exist between primary care providers and their specialist partners, even as they attempt to form integrated delivery systems that streamline care and avoid unnecessary services. Many healthcare leaders suggest that if the Super Committee comes up with some plan, imbedded within it will be a remedy for the SGR.

3. The Supreme Court on the PPACA
The constitutionality of the Patient Protection and Affordable Care Act is up for argument with five and a half hours of set aside for debate in March, and a decision expected in June, right in the middle of the presidential campaign. Justices are expected to consider a number of aspects of the 2010 law, not just the legality of the individual mandate, which requires most Americans purchase health insurance by 2014. 

For starters, they're expected to decide four other key issues 
• Whether the law is valid without the individual mandate.
• Whether other parts of the law, such as the one prohibiting health insurers from rejecting applicants based on pre-existing conditions, are valid.
• Whether the court is legally empowered to rule on the mandate before it takes effect in 2014 or must wait until after.
• Whether the new law's tremendous expansion of the Medicaid program to more beneficiaries – in which states must pay a gradually increasing portion of the cost of these enrollees – meets constitutional muster.

4.  Hospital Readmissions
Hospital providers are anxiously awaiting several key decisions from the Centers for Medicare & Medicaid Services over how the agency intends to interpret and apply penalties against hospitals that have higher than expected rates of 30-day readmissions in three disease categories: heart failure, heart attack and pneumonia.

Several providers and analysts we spoke with said the agency has failed to adequately address two issues: how it will deal with scheduled readmissions, which some hospitals have many more of than others (such as certain elective cardiovascular procedures), and how they will determine a formula to adjust for variation in risk in diverse patient populations across the country.
Several leaders we spoke with said they expect numerous refinements in coming months.

"Our concern is that they're not excluding planned scheduled readmissions," said Don May, Vice President for Policy at the American Hospital Association. "The re-admissions issue is a very messy area," says Paul Keckley, Executive Director of the Deloitte Center for Health Solutions. CMS has contracted with a team at Yale's Center for Outcomes Research and Evaluation to come up with risk adjustment formula. Keckley expects CMS will roll out some measure for applying these penalties sometime before March 30, probably for comment. Hospital executives, however, fear two other ramifications from the re-admissions penalty. One is that their emergency departments will be the subject of greater scrutiny from auditors to assure patients who need to be readmitted within 30 days are not put into observation categories or sent home simply to avoid a penalty. The second concern is how they will react to negative publicity if their hospital shows up as one with higher rates of avoidable 30-day readmissions on the federal website, HospitalCompare.

 5. More Civil and Criminal Penalties
The Department of Justice is gearing up in an unprecedented way to punish and curtail fraud, waste, and abuse, which means imposing much more scrutiny on providers.
Armed with more new legal tools, hundreds more investigators, task force operations in more cities, and $350 million more to spend over the next 10 years, HHS is poised to broaden its pursuit of healthcare crooks, holding those it catches as a example of this enhanced national priority.

Concurrent with this, look to the Office of Inspector General to be more involved in quality issues, perhaps stemming from the agency's November, 2010 report that found that of nearly one million Medicare beneficiaries discharged from hospitals in just one month – October of 2008 – one in seven experienced an adverse event and nearly half of those were preventable medical errors, substandard care and inadequate patient monitoring and assessment.

Senators Tom Coburn and Tom Coburn, have been pushing their bill, called the FAST Act, (Fighting Fraud and Abuse to Save Taxpayer Dollars) which if passed, would strengthen and add new ammunition to fight fraud. For example, FAST would increase penalties, curb theft of physician identities that gives way to abuse, and establish more strategies to prevent the federal government from paying for suspected fraudulent claims when it has so much difficulty recovering the money later.

6.  More Aggressive Health Plan Premium Rate Review
In 2011, the federal government gave away $100 million to help states develop expertise and oversight over health plan premium increases. And while some states are moving forward with such programs, even creating special new agencies, others have held back. HHS Secretary Kathleen Sebelius says her agency is "committed to fighting unreasonable premium increases," such as the 39% requested by Anthem Blue Cross of California last year for 800,000 customers.
The ACA, her agency says, requires health insurers that want to increase their rates by 10% or more in the individual and small group markets as of Sept. 1, 2011 "to submit their request to experts to determine whether the rates are unreasonable." How aggressively the states and the federal government choose to push back on those increases will be a trend that will become apparent next year. And if they are aggressive, health plans many push those costs on to the shoulders of hospitals and physicians with lower value contracts, limiting their ability of providers to continue the practice of shifting the cost of caring for the underinsured.
Nate Kaufman, of Kaufman Strategic Advisers, says the increased scrutiny states and federal agencies are giving on rate review of healthcare premiums, "is one of the biggest issues out there now."

7.  Who Will Lead CMS? 
With partisan politics apparently precluding the permanent appointment of Donald Berwick, MD, as CMS administrator, he is expected to leave the agency by year's end.  The expected heir is his principal deputy, Marilyn B. Tavenner, former Virginia Secretary for Health and Human Services and former HCA Group President. Also unclear are the fates of HHS Deputy Administrator Steve Larsen, CMS Chief Medical Officer Patrick Conway, MD, and acting director of the new Center for Medicare and Medicaid Innovation, Richard Gilfillan, MD, who left his post as president and CEO of Geisinger Health Plan. These men helped Berwick steer the agency through some of its most controversial program launches.

8. The Patient-Centered Outcomes Research Institute
Now well underway, this 21-member panel enabled by the Affordable Care Act and appointed by the General Accountability Office will make recommendations about the evidence of effectiveness medications, diagnostics, medical devices and even types of surgery and other "health practices." By 2014, PCORI's budget may grow to more than $500 million, according to an August
 commentary in the Journal of the American Medical Association.

The organization has already started the process of giving out money for research, and although it is precluded from using cost in its calculations or recommending that a treatment be covered, many health leaders are certain that will be the ultimate result. If, for example, PCORI says that a particular medication reduces symptoms only 3% of the time but causes nearly intolerable side-effects in most of those, such a conclusion will undoubtedly influence decisions about whether the drug should be covered.  Keckley says that in talking with his clients, "PCORI is a stealth player in healthcare. But they're not getting nearly as much attention as you'd think." 

9.  Meaningful Use
CMS is expected to issue rules defining Stage 2 of Meaningful Use for electronic medical records for hospitals and doctors wanting incentive payments in the first quarter of 2012, with a final rule several months later, to be ready for implementation by Oct. 1. However hospitals hope that implementation will be delayed one year, says the AHA's Don May.

"Meaningful use is a very big deal for hospitals," May says, because there's $4 billion in incentive payments for doctors and hospitals. The Stage 2 criteria are feared because CMS is expected to significantly increase the percentage of clinicians who, for example, are using computerized physician order entry to meet the meaningful use requirements. 
Expanded criteria may include making sure, for example, that a certain percentage of a physician's patients actually see their electronic health records, rather than just making those records available to them, as well as thresholds for secure messaging between patients and physician. Protocols for having patients sign advance directives are expected as well.  All of this costs money, and hospitals as well as physician groups have expressed concerns about where they'll find the money to implement EMR, and what other needed improvements they'll have to delay.
10.  Accountable Care Organizations
Regardless whether large numbers of hospitals choose one of the approved options under the Medicare Shared Savings Plan, hospitals and providers throughout the country will eagerly want to know who becomes an approved ACO, a Pioneer ACO, or an Advance Payment ACO, and what their competitors do in response.  Increasingly important will be ACOs as defined by private payers, how that impacts physician integration and employment, and how these organizations are ultimately defined.  Will there be shared savings? 
Equally of interest will be how CMS, along with the Federal Trade Commission and the Anti-Trust Division of the Department of Justice, work together to assure that ACOs don't dominate their markets, don't skimp on services, and don't pressure enrollees to influence their choice of providers.

11. Physician Payments Sunshine Act
To limit influence of manufacturers of drugs and medical equipment and supplies on physician or hospital practice, the Affordable Care Act requires those manufacturers to report payments or "transfers of value" to physicians or academic medical centers and teaching hospitals by Jan. 1, 2012. 
However, the legislation gave little guidance on what information was to be provided and how. And both providers and industry leaders are worried about how it will all be interpreted by payers and the public. To clarify the intent, CMS was required to issue regulations specifying what was needed and in what format no later than Oct. 1, but it has yet to do so.

"Everyone is eagerly awaiting these details," said Richard Bankowitz, MD, chief medical officer for Premier Inc., a quality and purchasing cooperative for hospitals and healthcare systems.
The legislation defined such transfers of value as stocks and stock options, ownership interest, dividends, profits, consulting fees, honoraria, gifts, entertainment, food, travel, education, research, charitable contributions or royalties. The data collected is to be publicly viewable, according to the ACA by Sept. 30, 2013.

12. Value Based Purchasing Incentive Payments
Although the formula for rolling out incentive payments for hospital quality has been set through 2014, hospital providers are nervous about what CMS will add to the mix for 2015, allowing them to earn back a portion or all of the 1% that all will receive in cuts to fund the program.
"We'll be seeing the results in October," Bankowitz said. 
It dropped 30-day mortality rates for heart attack, congestive heart failure and pneumonia and some eight hospital acquired conditions such as falls and pressure ulcers for 2014.  But those and several other measures are expected to creep back in or be added anew, such as all-cause readmission rates and the number of patients infected with hospital-acquired Clostridium difficile.

 Another important decision coming from CMS anticipated in the coming year is how incentive payments will be allocated and to whom. Under the Affordable Care Act, any hospital that received CMS immediate jeopardy citation would be precluded from earning back any of the 1% of payments that are cut to hospitals across the board. That's 12, and that's enough for 2012. However, this is not a complete list.  There are at least eight other influential rules and policies anticipated in 2012. 

Stay tuned for more information on health care reform from Miss Julia.

Cheryl Clark is a senior editor and California correspondent for HealthLeaders Media Online. She can be reached at cclark@healthleadersmedia.comFollow Cheryl Clark on Twitter.

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