Long-Term Care Survey Alert

The CDC recently published new hepatitis B vaccination guidance that could affect your residents. A Dec. 23 issue of the agency's Morbidity and Mortality Weekly Report (MMWR) notes that "since 1996, a total of 29 outbreaks of HBV infection in one or multiple long-term-care (LTC) facilities, including nursing homes and assisted-living facilities, were reported to CDC; of these, 25 involved adults with diabetes receiving assisted blood glucose monitoring (1; CDC, unpublished data, 2011)."

The Advisory Committee on Immunization Practices (ACIP) suggests that "Hepatitis B vaccination should be administered to unvaccinated adults with diabetes mellitus who are aged 19 through 59 years (recommendation category A; evidence type 2)," states the MMWR article. "Hepatitis B vaccination may be administered at the discretion of the treating clinician to unvaccinated adults with diabetes mellitus who are aged ≥60 years (recommendation category B; evidence type 2)."

"This recommendation is long overdue," comments James Marx, RN, MS, CIC, an infection preventionist with long-term care expertise. "Common use blood sugar testing equipment has long been recognized as a common source of bloodborne pathogens," says Marx, principal of Broad Street Solutions in San Diego, Calif. And "hepatitis B is vaccine preventable. While most young people under 30 years old born in the United States have been vaccinated, the large number of older diabetics are vulnerable. This is a new recommendation and not part of any enforceable regulation (as of now). Facilities should include hepatitis B vaccine screening as part of routine admission assessments," Marx tells Eli.

Do you have patients taking Pradaxa? On Dec. 7, the U.S. Food & Drug Administration announced in a statement that it "is evaluating post-marketing reports of serious bleeding events in patients taking Pradaxa (dabigatran etexilate mesylate)."

CMS has not instituted any delay or elimination of ICD-10, which means you'll need to be ready to use the new code set by Oct. 1, 2013 -- less than two years away. And contractors, vendors, and individual states are steadily readying their systems for ICD-10 claims processing.

Medicaid: Because Medicaid rules and policies vary on a state-by-state basis, you may be expecting states to be on different pages when it comes to ICD-10 implementation. But that would be an inaccurate assumption, CMS reps said during a Nov. 17 "ICD-10 Implementation" call.

"I can tell you that most states are still conducting impact analyses and gathering business requirements for the things needed to accommodate the implementation of ICD-10," said CMS' Elizabeth Reed during the call. "CMS currently conducts bi-weekly calls with the states and is currently offering state-specific technical assistance training. I would encourage providers to get on their respective state list serves to stay in tune with state communications and testing requirements," she added.