Full Episodes Worth 11 Times More Than LUPA Episodes
Among the most costly groups of Medicare patients are those subject to LUPA. Using the most recently available national claims database, Healthcare Market Resources’ research shows that a full episode patient is worth 11 times more than a LUPA episode patient. Furthermore, the indirect costs in servicing a patient – including intake, medical records, billing and quality review – are practically the same regardless of whether it is a LUPA or full episode. The average labor cost per visit is also higher for a LUPA episode, since the added effort of the initial and discharge visits are balanced by fewer “regular” visits. LUPA episodes are financially unattractive and, therefore, every effort should be made to minimize their frequency.
Understanding Why LUPAs Occur Can Help Minimize Them in the Future
There are three types of LUPA episode patients based on the reason for the adjustment: Inevitable episodes, intake episodes and operational episodes. By understanding why an adjustment is made, an agency can take steps to minimize the occurrence of LUPA episodes in the future:
1. Inevitable LUPA Episodes
These types of LUPA episodes are very difficult to prevent. They can happen if a patient is readmitted to the hospital or transferred to hospice before a treatment plan is completed. Another example of an inevitable LUPA episode is a patient service who requires a re-certification period, but achieves the treatment plan goals before completion of the full episode visit level. Other than making sure that the transfer to hospice occurs after the fifth visit, there is little that your agency can do to prevent these inevitable LUPAs.
2. Intake LUPA Episodes
As you can see in the Metrics Matters section of this newsletter, patients with certain primary diagnoses are more likely to generate LUPAs than others. The prime offenders – diagnoses that generate the most “intake” LUPA episodes – include:
B12 shots (Blood)
Once your agency has decided to admit a patient with one of these diagnoses, there is little that you can do to avoid the LUPA. If your agency has programs that serve these patient populations while your competitors do not, you’ll likely end up with a disproportionate number of LUPA cases. Several of Healthcare Market Resources’ Market Profile Reports can help your agency determine if it’s bearing the burden of LUPA diagnoses for your community.
Certain referral sources, such as ambulatory surgery centers, may also generate a disproportionate number of LUPAs because of the limited needs of their patients. Only an agency that is built around a per-visit model rather than an episode model may have the cost structure to serve these patients. As the impact of the reimbursement cuts begin to affect the survivability of home care agencies – especially local visiting nurse associations (VNAs) – tough decisions may have to be made as to whether an agency can afford to continue to serve these patient populations, particularly if the long-term survivability of the agency is at stake.
3. Operational LUPA Episodes
Frequently caused by patients missing visits, this type of LUPA is the most preventable. Monitoring these “absences” on a real-time basis and holding staff accountable for rescheduling the visit is essential. Also, your agency can contact projected LUPA patients between visits to see if their condition has changed. If a patient’s condition has changed, your agency can respond by contacting the physician to get an assessment visit authorized. In any case, this practice is good customer relations. Additionally, agencies should conduct periodic chart reviews to determine how many LUPAs were preventable.
LUPA Rates Vary Among Different Markets
LUPA rates also vary significantly from market to market. Healthcare Market Resources demonstrated LUPA levels vary dramatically by state, for example, in a previous newsletter article, “Metrics Matters: What Percentage of Your Home Care Patient Episodes Are Subject to LUPA?” In fact, we found a negative.65 correlation, which is statistically significant, between recert rates and LUPA levels. That means the higher the recert rate, the lower the LUPA levels. This strong correlation indicates that LUPAs are less likely to occur if agencies serve a highly chronic population.
Each market has its own LUPA level, caused by:
The types of patients referred to home health
At what point in the disease process patients are referred
How long agencies are “allowed” to keep patients.
Managing your agency’s percentage of LUPA patients can have a significant impact on your financial results.…
Full Episodes Worth 11 Times More Than LUPA Episodes
Gluten allergy symptoms is once the allergen comes in contact with the small intestines, causes the immunity mechanism to attack the lining of the colon. This attack on the mucosa of the small intestines of the victim of an allergic reaction to gluten weakens the belly and may cause heavy health issues in the future. The delicate coating is answerable for soaking up vitamins and nutrients in our body.
The symptoms of gluten allergy are the same as those that occur as a result as other food allergies, these include swelling and itching of the tongue, throat and mouth, diarrhea, hives, fatigue, rash, weight loss, stomach cramps, runny nose and sore itchy eyes to name but a few. The symptoms of gluten allergy can range from mild to life threatening, depending on the individual.
One difficulty with gluten intolerance symptoms is that they often begin in a subtle manner. If you develop gluten intolerance, you may not suddenly experience severe pain or obvious discomfort relating to your diet. They typically begin with gas and bloating accompanied by mild fatigue. Some experience a dull, mild stomach pain.
However there is another condition which is known as gluten intolerance which is often confused with gluten allergy. This is a more serious condition which will not have the symptoms similar to gluten allergy symptoms. In fact there will be no symptoms after eating gluten until much damage has already taken place.
A person’s gluten allergy symptoms, or gluten intolerance symptoms, will usually start so subtle that you don’t even think of them as symptoms of anything. You’ll experience perhaps a little indigestion there, a little bloating here… If left untreated for any period of time, however, celiac disease symptoms grow more numerous and more severe.
Gluten intolerance, or its clinical name, celiac disease, is an autoimmune disease, not an allergy. This means when you consume gluten, that gluten triggers your body to attack itself. While the results of this autoimmune response can be severe, it can take a long time for those results appear, sometimes even years. So don’t mistake a gluten intolerance for a wheat allergy. An allergy is not an autoimmune disease.
Later stages of celiac disease are similar to severe malnutrition, only people don’t think they could be experiencing malnutrition because they believe they’re eating plenty of healthy food. However, if you are unknowingly gluten intolerant and you are eating foods which contain gluten, no matter how healthy you eat you can become malnourished.
The normal symptoms of gluten allergy are triggered by a histamine reaction, which is caused by white blood cells in the body called basophils and mast cells overreacting to the influx of the Immoglobin E. This results in the characteristic symptoms of an allergic reaction, such as watery eyes, sneezing, hives or a skin rash, and stomach discomfort or pain. If suffering from these symptoms, the use of an antihistamine may be beneficial. The severity of symptoms, and well and the number and type of symptoms can very person to person.
This usually involves a small intestinal mucosal biopsy, whilst this sounds scary the procedure is safe and is usually performed at the time of a gastrointestinal endoscopy. In other words a small camera is inserted down your throat that enables the doctor to look at what’s going on down there and perform the biopsy. This will allow the doctor to make a proper diagnosis.
If you suffer with gluten intolerance or sensitivity or Coeliac Disease then you will know the feeling of stomach cramping, pain, gas, constipation or diarrhea. People who have Coeliac Disease cannot eat food products containing gluten because it is a digestive disease that damages the small intestine and interferes with the absorption of nutrients from food, and if a person suffering with Coeliac or gluten intolerance consumes gluten in any form, the immune system responds as if it were toxic by either destroying or damaging the villi which lines the small intestine.…
A healthy nutrition is imperative for a sound mind and active body. Many people especially youngsters blindly follow whatever they watch in glamorous TV ads and magazines. Most of the times there is fake information told that impair or adversely affect bodily functions instead of going towards improvement. Given here are some important tips that are to be considered seriously.
Recent studies reveal pomegranate keeps prostate cancer from progressing further; improves flow of blood in patients with cardiac ailments and prevents arteries from becoming hard. The fruit has antioxidant tannin, anthocyanin and polyphenol that make it a perfect choice for heart patients. Its seeds that are really delicious can be mixed with yogurt or in green salad to make it more toothsome as well as nutritious.
The purple family
A recent research has shown that purple foods such as grapes, eggplant and berries etc. help decrease the risk of metabolic syndrome-a condition in which the patient has the risk of multiple illnesses simultaneously, such as Type II diabetes, stroke and heart disease. To get the maximum benefits out of the fruit, it’s recommended to have it in 100 % pure form instead of taking grapes blend. Concord grape juice is highly nourishing.
Considered just an important ingredient of garlic bread, curries, sauces and salad dressings; garlic now has been given a higher rank among foods for its immense benefits to heart patients. It lowers cholesterol and triglycerides. It also prevents thrombosis, a disease in which plaques are formed in blood. High blood pressure can be lowered to normal with garlic extract.
Liquid vitamin supplements
There is so much hype about liquid vitamins taken as supplements. These are best for those who are unable to tolerate or ingest vitamin pills. As compared to normal supplements that are 10 -20 % absorbed in the blood, liquid vitamins are easily absorbed 60 -70% which is a good news to all those out there not happy by spending a hefty amount on pills and not getting desired results. These liquid supplements also increase energy without stimulants.
The only disadvantage is that about 50% of the liquid vitamin supplements are destroyed in the stomach owing to absence of protective layer around. An important thing is to do regular physical exercise while taking multivitamins to assist them work more efficiently.
Latest research has revealed it’s a healthy and harmless way to reduce weight. To all obese persons, say goodbye to fattening drinks, shakes, coffee and black tea. Include green tea in regular diet that comes with zero side-effects.
A heavenly dessert now awarded to have been containing medical properties. A rich source of antioxidants, dark chocolate or cocoa powder is beneficial for health as opposed to past beliefs that it’s a junk food. The myth is gone now; so take moderate amount of dark chocolate or cocoa. Combine with berries, oranges, nuts, grains, milk or any sumptuous accompaniment that satisfies your taste buds. However, try to avoid milk chocolate that is relatively unhealthy.
The best practice is to have a diet plan from an expert certified dietitian. Don’t forget to update based on new findings. Stay away from old myths and rumors.…
Is your life ruled by both vegetarianism and depression? If so, the cause of your depression may stem from a seemingly innocuous B vitamin deficiency.
It may come as a surprise to some, but contrary to popular dictate, human beings are not natural vegetarians. We are omnivores – our teeth confirm it. We have rending and tearing incisors, just as predators do; and we have grinding molars, just like herbivores.
Another piece of hard evidence exists: Humans need vitamin B12, which is only found in red meats. A lack of vitamin B12 can cause, among other things, severe depression.
Where there is cyanocobalamin (B12) deficiency, there will also be pyridoxine (B6) deficiency too. If you are vegan or vegetarian, it is vital that you supplement your diet artificially with these 2 vitamins. Take B6 or a multiple B-Complex vitamin is recommended – but you should go one step further. Have your doctor check your B12, and if it reads as deficient, be aware that the only effective way to supplement is to receive regular subcutaneous B12 injections (or eat red meat!)
Besides depression, other indicators of B6 deficiency include:
• Skin sensitivity
• High blood pressure
• Trouble sleeping; or quality of sleep
Indicators of B12 deficiency include:
• Memory problems
• Cognitive confusion
• Paralysis (in extreme cases)
• hair loss
Many people diagnosed with fibromyalgia in fact have later been proven deficient in B vitamins. Therefore it is especially important for anyone suffering from depression to be as proactive as possible, and insist on having their B12 levels tested.
A Simple Cure
It’s worth noting that there are certain patients whose levels of B12 test within the accepted range who do experience an almost-immediate boost in their physical energy levels, along with a reduction of depression, when given B12 injections anyway. These are typically patients who have been chronically depressed for years.
In some ways, B vitamins are among the safer vitamins to take: any excess is excreted through the bowels, bile and urine (turning the latter bright yellow.) However, you should know that taking more than the recommended dose of B6 can cause severe nightmares, while ingesting even the slightest overdose of B3 – Niacin – can cause a particularly unpleasant “Niacin flush”, in which blood rushes to your face and you feel quite peculiar for a period of time.
We’ll leave the last word to 12-year-old Michael M.: “If Jesus had meant us to be vegetarians, he would have fed the multitude on loaves and beans, instead of loaves and fishes.”
If you are a vegetarian you will naturally not agree with this unique viewpoint – but do get your B vitamin levels properly checked, in case they are low. The cause of your depression just may be as simple as that.…
There’s a lot of to-do going on about natural vitamins having an edge on the synthetics. And, truth to tell, going natural sure sounds good. The way God intended and all.
But like with so many things, the devil’s in the details.
The major sources of natural vitamin B vitamins are wheat and yeast. Well, if you have candida-a constant concern with thyroid and adrenal problems-you don’t want to throw yeast down the old hatch. Same thing if you have a mold allergy.
And wheat? Anybody with a digestive system dancing the fandango should consider the possibility of an allergy. Medicine’s finally realizing the disaster of one such, a sensitivity to gluten. And no wonder since they’ve pumped the gluten content in today’s wheat way, way up-because it makes bread “fluffier.” So much for natural.
Natural vitamin C, meanwhile, often comes from corn-to which untold numbers of people are allergic. And who knows if the corn is genetically modified, as most of it is?
A lot of vitamin pills contain corn starch as a binder, which is why I talk about capsules so much-not so many fillers.
And natural vitamin E tocopherols can come chock-a-block full of evil soy. And some E comes to us from wheat germ, which, of course, takes us back to the whole gluten story.
On the other hand, some vitamins, like vitamin A, are better in their natural, animal-based form. Which means, of course, that most vitamins offer us synthetic, plant-based forms of vitamin A.
And natural, plant-based vitamin/mineral products come up way short in minerals, too. Since almost all of us are mineral deficient, this is a very bad thing.
So, what about synthetics then? Well, it depends. Our bodies are happy to join forces with synthetics that look like the real thing, bio-identical as it’s called, but sometimes the supplement people decide they have a better idea.
And maybe their idea looks good on paper. A lot of things look good on paper. I used to write software, and I guarantee you everything I wrote looked swell on paper. But sometimes when a computer got its innards on my fabulous code, things fell apart. In fact, I’ve been known to yell at computers for their intransigence, for all the good it did me.
Our bodies are like that, too. If something unrecognizable comes down the hatch, things fall apart. Not as quickly as with a computer, though, and that’s a pity. The sooner we know, the better off we are.
So, it’s not just any natural, and it’s not just any synthetic.
Let’s talk, then, about a natural turned into a synthetic. It’s called an isolate, wherein they strip away all the so-called extra parts of something natural to get down to the “active ingredient.” They isolate it.
Our bodies don’t think much of isolates. Fact is, they don’t recognize them without their missing parts and start defending themselves against the foreign attacker.
This is how a lot of prescription drugs do us in. It’s a big reason why “properly prescribed, properly taken” prescription drugs kill more than 100,000 people a year in the U.S. alone.
To get a patent, pharmaceutical companies have to come up with something that doesn’t naturally occur in nature. (Well, that’s the law, which is sometimes observed, sometimes not.) Patents generate the big bucks. Big, big, big bucks. Really big bucks. Really big.
And so we get isolates, which never occur in nature, alien life forms that they claim will make life better. Riiight.
And it’s not just prescription meds. Big Pharma’s muscling into the vitamin/mineral world, too.
When vitamin D hit the news, pharmaceutical companies jumped all over it, racing to get a patentable version by isolating one part of the whole. Last I heard their “new, improved Vitamin D” was bumping people off instead of doing them any good.
Just say no to isolates.
And stay alert. As you see, just any old vitamin or mineral won’t do.…
Cellulite is a tough situation for most people to handle. It can quickly get out of hand if you don’t take care of the problem. Thankfully, there are great article such as the one below that teach people how to avoid getting cellulite. Even if you have it, there are tips and tricks below that will help you quickly get rid of it, so keep on reading!
If you want to get rid of cellulite, your diet could be the answer. Eat enough vegetables and fruits. The alkaline ash they leave behind will soon have you looking your best. Juicing is another way to help improve your skin.
Both men and women can have cellulite, but women are more likely to be affected by it. The reason for this may be partly hormonal, or it may be the result of the type of fat and connective tissue females typically have. The condition is not well understood, and more research is required.
If you’re a smoker, stop the habit now. You may not realize it, but that smoking is increasing your issues with cellulite as it adds toxins into your body and affects your skin’s supply of food. Your skin will respond very kindly to you dropping this habit. Over time, you’ll see a lot less cellulite.
To help minimize the appearance of cellulite on the skin, consider taking action to improve the circulation in the affected areas. By massaging the skin vigorously with a hand or with an electric massage tool, it is possible to accomplish this goal with ease. The bumpy look of the cellulite will soon be far less noticeable.
You can improve the appearance of cellulite by using a loofah and vigorously scrubbing at the area of concern. This will reduce the lumpy appearance and restore blood flow to the area. This will help, especially when paired with exercises that target the areas of unwanted cellulite on your body.
Consider a body brush as a tool to manage your cellulite. This helps to exfoliate your skin. It can also stimulate circulation and boost lymphatic flow. This process will allow your skin cells to drain, which can mitigate the effects of cellulite. Try doing it twice a day using long strokes for best results.
Would you like a permanent solution to cellulite problems? A massage is the best way to make those lumpy, bumpy thighs look tight and taut once again. Whether you go out to the spa or have a loved one rub you, you can see results quickly.
Beat cellulite through massages. There are many benefits from getting a massage, including promoting circulation, lymphatic drainage, and reducing stress. All of these factors play a role in cellulite, so by getting a massage, you are helping reduce cellulite. Just make sure you are getting massages from a professional who knows what they are doing.
As you can see from the above article, nobody should have to deal with cellulite when they have solid tips as the ones here. Keep this information close by whenever you see cellulite begin to appear, and use it to your advantage so it never becomes a big problem in your life. Let others know of these great tips so they too can benefit from never having to deal with cellulite.…
Arthritis can reference more than 500 different conditions, which affect a similar number of joints. Rheumatoid arthritis is the most common kind. This type of arthritis typically manifests itself during the later years, and if not treated properly, it can force unpleasant and far-reaching changes on one’s lifestyle. This below article discusses valuable information about arthritis.
Reduce the stress in your daily life. Stress causes your body to release the neurochemical cortisol, while causes inflammation. People with arthritis should know that inflammation is the main cause of the pain and stiffness of arthritis. Reducing stress reduces your body’s production of these chemicals, which relieves your symptoms.
If you are a smoker, consider quitting, and if you don’t smoke, avoid cigarettes. Nicotine reduces the blood flow to the extremities which can reduce inflammation short term. You should understand though, that this lessened blood flow can cause significant damage to your joints, which will result in greater arthritis symptoms.
Be sure to move throughout the day. Remaining in the same position for a long time puts more stress on your joints than if you shift positions. Be sure to take regular breaks to stand and stretch and make sure that your work environment is set up to allow you to protect your joints.
Discuss your arthritis with the younger members of your family. Small children may be concerned that you are injured if you are using wrist splints or walking aids. Discuss the condition with them at their level, so they can understand without fear and perhaps even assist you during a flare-up.
If health is an issue, consider implementing a weight loss and fitness routine. Weight is often a factor causing pain for people who suffer from arthritis. By just losing a few pounds, you can reduce the amount of pain you suffer. You’ll surprise yourself at how good you’ll feel just by losing a few pounds.
You may want to consider using celery seeds if you suffer from chronic arthritis. Not only are these seeds natural and healthy, but they help to reduce some of the swelling that is associated with arthritis pain and other chronic conditions. You can purchase these seeds from many health food stores.
Make sure you are getting enough sleep. The stiffness and pain that is common in arthritis can lead to debilitating fatigue, and many of the treatments for the condition can also cause fatigue. Do what you can to ensure a good night’s sleep every night, and you’ll feel better and be healthier.
Research the various forms and symptoms of arthritis. Research the many available resources available to find information regarding diet, exercise and pain control. If you take the time and do the research, you will discover new treatments and techniques to help you cope with and prevent the pain of arthritis.
One of the most effective ways to fight rheumatoid arthritis is to take care of your body. Reducing your risk factors can go a long way in helping you to live a healthy life without arthritis pain. Hopefully, the information that has been provided in the above article has offered you some practical information to apply to your situation.…