USA Today reported on one of the biggest successes of the Affordable Care Act–more than 2.65 million Medicare recipients have saved more than $1.5 billion on their prescriptions this year, a $569-per-person average, while premiums have remained stable.  The Department of Health and Human Services announced in August that 2012 Medicare prescription drug plan premiums would average about $30 a month, compared to $30.76 in 2011.

A provision in the health care law put a 50% discount on prescription drugs in the "doughnut hole," the gap between traditional and catastrophic coverage in the drug benefit, also known as Part D.   Seniors who reach the doughnut hole in prescription benefits receive a 50% discount on name brand prescription drugs. Drug companies must provide the discount to participate in the prescription plan. Before the health care law took effect, Medicare patients had to pay full price for their prescriptions once they reached the gap in coverage.

Also, more than 24 million people, or about half of those with traditional Medicare, have gone in for a free annual physical or other screening exam since the rules changed this year because of the health care law.  Preventive care should lower the cost of future care.

 

The Obama administration recently announced $1 billion in funding to hire, train and deploy health-care workers, part of the White House’s broader “We Can’t Wait” agenda to bolster the economy.  Grants can go to doctors, community groups, local government and other organizations that work with patients in federal health-care programs such as Medicare and Medicaid. The funds are for experimenting with different ways to expand the health-care workforce while reducing the cost of delivering care. There will be an emphasis on speed, with new programs expected to be running within six months of funding.

Health-care employment is growing steadily, with more than 300,000 jobs added in the past year, according to the Bureau of Labor Statistics.  The bureau projects total employment in health care to grow by 3.2 million jobs by 2018, more than in any other sector.

The need for a larger health-care workforce will probably become particularly acute in 2014, when the health-care overhaul is expected to expand health insurance coverage to millions of Americans. By 2019, the nonpartisan Congressional Budget Office projects, 32 million more Americans will have gained health insurance coverage.

That has left federal agencies looking to alternative ways to deliver care, ones that may rely more on community-based care and less on trips to the doctor’s office. Under this new program, organizations may be able to explore how community workers, volunteers, pharmacy techs or clinic managers could play a larger role in the health-care workforce.

The Center for Medicare and Medicaid Innovation, created as part of the Affordable Care Act, will administer and oversee the program, called the Health Care Innovation Challenge.

 

The Galveston Daily News reported the wrongful death lawsuit filed on behalf of Rachel Mohr after Regent Care Center failed to prevent her fall, appropriately assess her after the fall, and transfer her to the hospital for emergency care.  Mohr was a high fall risk, but a care plan and nursing interventions to prevent a fall weren’t followed: low bed position and floor mats and a bed alarm weren’t used contrary to a physician’s orders.

On March 4, Mohr was heard yelling for help and found on the floor next to her bed. Mohr suffered head trauma and was bleeding after the fall.  Instead of doing an assessment or transferring her to the hospital, nursing home employees placed her back in bed.  Mohr was later discovered unconscious and nonresponsive.  Mohr was finally taken to the hospital where she died from her injuries.

The lawsuit also claims Regent Care Center’s nurses were not adequately trained or apprised of Mohr’s care plan.

Relatives requested on 10 occasions and provided authorization for copies of Mohr’s medical chart, but Regent Care Center refused to provide the chart.  “Defendants refused to produce the chart on the basis that its lawyer had the chart and further refused to provide the lawyer’s identity and contact information,” the lawsuit claims.  Residents and their family members have a right to be provided a copy of the chart within 48 hours of a written request.  But nursing homes often send the chart to lawyers to "fix" any blanks or other documentation failures.

Relatives attempted to settle out of court with the center for $275,000, according to a letter which is on file with the lawsuit.
 

Journalist Robert Garrett wrote a great article for the Dallas News about the failure of Texas to penalize nursing homes that neglect and abuse residents.  Current and former inspectors say that they’re being discouraged from reporting bad care and unsafe conditions. Experts fear that elderly and frail residents are at risk of abuse and neglect as some operators routinely cut corners and understaff facilities. 

The state has stopped imposing the most severe penalties, such as revoking a home’s license and government contracts, or seeking a court-appointed overseer.  Four employees who performed inspections for the state in recent months told The News that their superiors often resist letting them cite homes for possible life-threatening abuse and neglect.  Without that implicit threat, corporate owners will treat minimal fines as a cost of doing business instead of correcting the problem.

The Dallas News investigated and found:

State regulators whose job is to keep shoddy operators from owning or running homes have done cursory, and at times inaccurate, background checks that in at least one case failed to keep out a federally banned health-care provider.

State budget cuts have reduced staff by about one-fourth since 2001, even as the number of nursing homes in Texas is virtually unchanged, at about 1,200.

Legislative changes, especially limits on lawsuit damages passed in 2003, have virtually eliminated trial lawyers as de facto watchdogs of nursing homes. Other changes limited the state’s ability to fine nursing homes and have created an industry-friendly cadre of “quality monitors.”

After inspectors discovered practices endangering the lives of elderly and disabled residents, the state regulatory agency hasn’t gone after the homes’ licenses.

AARP said the state’s relatively infrequent use of harsh sanctions “raises serious concerns about the agency’s commitment to quality.”  AARP , a leading advocacy group for seniors, recently gave Texas poor marks for quality care. Using data from the federal government, it ranked Texas 34th among states in avoiding bedsores for high-risk nursing home residents and 42nd in preventing hospital readmissions.

In 2001 (the nursing home industry spent as much as $575,000 during the 2001 session),
Republican lawmakers removed about 45 of the 557 inspector positions and converted them to “quality monitors” who try to help operators solve persistent problems, such as bedsores. Today, the inspector force has dwindled to about 400.  And the quality of care has suffered.  Budget documents show that state nursing-home enforcement has remained on tight rations.  For the last several years, inspection teams have had fewer people and spent less time at a home during annual visits than in previous years.

 

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The NY Times had an informative article on the state of care in New York’s adult homes.  The Times undertook its own analysis of death records and found disturbing patterns: some residents who were not supposed to be left alone with food choked in bathrooms and kitchens. Others who needed help on stairs tumbled alone to their deaths. Still others ran away again and again until they were found dead.

In New York, it is unusually common for developmentally disabled people in state care to die for reasons other than natural causes.  "One in six of all deaths in state and privately run homes, or more than 1,200 in the past decade, have been attributed to either unnatural or unknown causes, according to data obtained by The New York Times."   State officials in New York cannot even agree on how many people are dying. The Office for People With Developmental Disabilities says 933 people in state care died in 2009. The Commission on Quality of Care says 757 did. Neither agency could explain the discrepancy.

New York has made no effort to track or investigate the deaths to look for patterns or trends, resulting in the same kinds of errors and preventable deaths, over and over.  The state does not even collect statistics on causes of death, leaving many designated as “unknown,” even after a medical examiner has made a ruling.

The records shows neglect may be contributing to those unexplained deaths. The average age of those who died of unknown causes was 40, while the average age of residents dying of natural causes was 54.

New York, like most states, relies heavily on the operators of the homes to investigate and determine how a person in their care died and, in a vast majority of cases, accepts that determination without investigation or corroboration.  Courtney Burke, the commissioner of the Office for People With Developmental Disabilities, which operates and oversees thousands of group homes, acknowledged that her agency suffered from a lack of transparency and what she called “a culture of nonreporting.”

The problems in the New York system appear especially troubling given that the state spends $10 billion a year caring for the developmentally disabled — more than California, Texas, Florida and Illinois combined — while providing services to fewer than half as many people as those states do.

 

American Medical Associatiion reported a new AMA report alleging that the average expense payments for professional medical liability insurance increased in real terms by 43 percent from 2005 to 2010.  According to the report, indemnity payments have generally been stable over the past decade, particularly since 2005.  The disposition of claims has remained relatively unchanged over time.  Most claims are dropped, dismissed or withdrawn, and 63.7 percent of claims in 2010 fell into this category. Another 25.4 percent of 2010 claims were settled, and fewer than 10 percent of claims were decided by trial verdict.  Of the claims that went to trial, 93.4 percent were decided in favor of the defendant.  So less than one percent of claims are successful at trial.  Where is the need for more tort reform?

 

Many friends and acquaintances during this Holiday Season have asked me what I thought about their child’s plan to go to law school.  They are shocked at the cost of tuition and am asking themselves if a job will be there for them after school.  With the passage of tort reform and the vilification of trial lawyers, it is a difficult question to ask.  The answer depends on why you want to become a lawyer:  Is it to good or do well?  If it is to do good–protect vulnerable members of the community, seek justice, check government abuses of power–then go get a legal education.  If it is to make money, then go to medical or business school.

In the past 20 years, the share of Gross Domestic Product related to legal services has deteriorated significantly despite the propaganda from the U.S. Chamber of Commerce and insurance industry.  In the late 1980s with all those corporate mergers and takeovers, the legal services sector represented slightly more than 2% of GDP.   As of 2009, that figure had declined to 1.37%.  The demand for legal services has been declining.  The practice of law as an economic entity appears to be a dying industry in decline.

The rate at which American law schools are producing lawyers outstrips the demand for new lawyers.  The Bureau of Labor Statistics estimates that the economy will produce an average of approximately 24,400 new jobs for lawyers per year over the next decade.  ABA-accredited law schools are producing 45,000 new graduates per year, while non-accredited schools produce several thousand more. 

Since 1985, tuition at private law schools has increased by 2.5 times in real terms, while resident tuition at public law schools has increased more than fivefold, again in real terms.   Law schools continue to raise tuition at far faster than the rate of inflation while demand diminishes.  The total cost (tuition and related expenses, plus opportunity cost) of attending law school will be approaching $300,000 for many students and will be at least $200,000 for the vast majority. For these graduates, law school will have turned out to have been a bad investment.

Why do you want to go to law school?  Think before you decide.

See original source at Lawyers, Guns and Money blog and The Law School Tuition Bubble.

Buffalo Business First reported the arrest of a nursing home owner/operators in Buffalo for federal charges of wire fraud and making false statements to law enforcement officials. Marc Irwin Korn was charged in a five-count indictment by a federal grant jury in Buffalo, according to U.S. Attorney William Hochul Jr.   Korn is owner of Senior Associates LLC of Amherst, which operated the Fairchild Manor Nursing Home and Rehabilitation Center in Lewiston and the Batavia Nursing Home and Rehabilitation Center. 

Officials accuse Korn of taking more than $300,000 for his own personal use using two different schemes. The indictment alleges Korn took over $150,000 from funds donated to the American Friends of Assaf Harofeh Medical Center while serving as an officer of the charity.  The charity was founded in 1975 and is designed to raise funds for properties in the Middle East.  He also diverted more than $167,000 from nursing home equipment leasing agreements, with the funds deposited into Health Care Alliance Inc., the bank account of one of his business entities. The funds were used for personal expenses, including salon visits, college tuition, clothing and antiques.

The siphoning of tax payer money is a common problem in nursing homes.  Money that is supposed to be used for patient care ends up in the owner’s pockets through shell companies and kickbacks.

 

Kaiser Health News had an interesting article about Maine’s attempt to control health care costs by limiting the amount an insurance company can profit from being a middle man in the health care industry.

A lawsuit brought by a Maine unit of WellPoint – one of the nation’s largest health plans. Anthem Health Plans of Maine argues that regulators violated state law and the U.S. Constitution when they reduced requested premium increases in each of the past three years, depriving the company of "a fair and reasonable return."  How do you determine what is a fair and reasonable profit?  The insurance industy is challenging the authority to determine what is fair and reasonable.

The main issue is whether the rates approved by Maine regulators were "inadequate."   Maine regulators and the attorney general say that state law and the Constitution allow them to ensure consumers are not overcharged by a financially healthy company. Anthem, they said, was strong financially and wouldn’t be harmed by a smaller profit margin.

Many states have laws similar to those in Maine. The District of Columbia and 26 states have the authority to veto rates deemed excessive for some types of insurance, generally policies sold to individuals and small businesses.  

Several states are increasing oversight of premium increases.  In New Mexico, lawmakers approved a law expanding regulators’ review of insurers’ finances to include how much they hold in surplus and reserves. Growing financial reserves were cited by Oregon regulators in July when they reduced a requested 22 percent increase by Regence BlueCross Blue Shield to 12.8 percent, even though that meant the insurer would lose money on policies sold to individuals.