The New York Times reported the investigation into pharmacist’s mistakes and fraud at nursing homes.  Pharmacists responsible for reviewing the medication of patients in California nursing homes routinely allowed inappropriate and potentially lethal prescriptions of antipsychotic medications, and failed to correct other potentially dangerous drug irregularities, according to recent state investigations.


In reports obtained by The Bay Citizen, the department found that in 18 of the 32 investigations conducted in California nursing homes between May 2010 and June 2011 — 17 of the 32 were in the Bay Area — pharmacists failed to red-flag cases in which residents were inappropriately prescribed powerful antipsychotic medications like Seroquel, a drug used to treat schizophrenia. Pharmacists also overlooked or approved cases in which medications were prescribed at questionable levels or in unsafe combinations that could put patients at risk of seizures, accidents or even death, according to the public health department.

The state investigations also showed a “probable correlation” between the inadequate review of nursing home patients’ medications by pharmacists and the failure of those nursing homes to pay a fair market rate for the pharmacists’ services. A 1982 anti-kickback law requires nursing homes to pay a fair rate for pharmacy services to discourage consulting pharmacists from endorsing or extending the prescriptions of expensive, and potentially dangerous, drugs.  A majority of the nursing homes where the state found patients who were inappropriately prescribed antipsychotic medications were paying below-average fees for pharmacy services.  The state anti-kickback law bans nursing homes from accepting below-market rates “from any pharmacist or pharmacy as compensation or inducement for referral of business to any pharmacy.”

“The consultant pharmacists’ review, which is intended to identify unnecessary or potentially inappropriate drugs among nursing home residents, is defective in the state of California,” said Dr. Jonathan Evans, a geriatrician and the vice president of the American Medical Directors Association. He called the problem “widespread.”

A report last year by the United States Department of Health and Human Services revealed that, in nursing homes nationwide, at least 40 percent of all Medicare claims for so-called atypical antipsychotics, like Risperdal, are inappropriate, given in excessive doses, given for too long, given without the need for use, without adequate monitoring or “in the presence of adverse consequences” and should be reduced or discontinued.




The New York Times reported that the Obama Administration will require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment.   Under the new standards, if a company has just one product covered by Medicare or Medicaid, it will have to disclose all its payments to doctors other than its own employees. The federal government will post the payment data on a Web site where it will be available to the public.   Companies will be subject to a penalty up to $10,000 for each payment they fail to report. A company that knowingly fails to report payments will be subject to a penalty up to $100,000 for each violation, up to a total of $1 million a year.

Critics and researchers have found evidence that such payments influence doctors’ treatment decisions and contribute to higher costs by encouraging the use of more expensive drugs and medical devices. Consumer advocates agree that disclosures increased the likelihood that doctors would make decisions in the best interests of patients, without regard to the doctors’ financial interests.

Large numbers of doctors receive payments from drug and device companies every year — sometimes into the hundreds of thousands or millions of dollars — in exchange for "providing advice and giving lectures".   The Times has found that doctors who take money from drug makers often practice medicine differently from those who do not and that they are more willing to prescribe drugs in risky and unapproved ways, such as prescribing powerful antipsychotic medicines for children.

Medicare and Medicaid, the programs for older Americans, the disabled and the poor, spend more than $100 billion a year on drugs and devices.


ProPublica’s Charles Ornstein and Tracy Weber report that Iowa Republican Sen. Charles Grassley is asking 34 states what steps they are taking to investigate doctors who are prescribing antipsychotics, anti-anxiety drugs and painkillers to Medicaid patients at levels far higher than their peers.

For instance, in his letter to Ohio, Grassley notes, "that the top prescriber of the anti-psychotic Abilify wrote 13,825 prescriptions in 2009 – about 54 prescriptions per weekday. Ohio paid $6.7 million for those prescriptions….The biggest prescriber of another anti-psychotic, Seroquel, wrote 18,890 scripts at a cost of $5.7 million. Grassley wrote the tally would amount to nine prescriptions per hour." Grassley went on to explain to Ohio officials that he had concerns about the oversight and enforcement of Medicaid abuse in the state and that the numbers presented to him were "quite shocking."

Grassley has asked state officials to tell him by Feb. 13 what action, if any, "they have taken against top prescribers, whether those doctors are still eligible to bill Medicaid, whether any of the doctors were referred to their state medical boards for investigation, and what systems have been set up to track possibly excessive prescribing, among others."

“These types of drugs have addictive properties, and the potential for fraud and abuse by prescribers and patients is extremely high,” Grassley wrote in Monday’s letters. “When these drugs are prescribed to Medicaid patients, it is the American people who pay the price for over-prescription, abuse, and fraud.”

Grassley, the senior Republican on the Senate Judiciary Committee, has long argued for greater transparency in health care. The painkillers and mental health drugs Grassley is inquiring about are among the top drivers of Medicaid drug spending.

Ornstein and Weber had previously reported that Florida allowed at least three physicians to keep treating and prescribing drugs to the poor amid clear signs of possible misconduct.

A number of the top-prescribing Medicaid doctors around the country are listed in ProPublica’s Dollars for Docs database  of payments made by 12 pharmaceutical companies to physicians for speaking and consulting Medicaid, jointly funded by the states and federal government, provides health care coverage to about 60 million low-income enrollees.



The Kaiser Health News reported the potential for a shortage of nursing homes for the babyboomers. The first baby boomers hit age 65 last year. By 2030, 20 percent of the U.S. population will be at least 65, up from 13 percent today. In that same period, the number of 85-year-olds will increase more than 50 percent and the number of 100-year-olds nearly triple. But the number of nursing homes dropped almost 9 percent from 2000 to 2009.

 However, many babyboomers will stay at home and will be healthy enough to avoid the need for skilled care. Less construction of new nursing homes and the aging baby boom generation may cause full occupancy at many nursing homes. 

Several trends are cutting into the number of nursing homes. Many homes were constructed during the 1960s under Lyndon Johnson’s Great Society programs. Often those homes are closed because they are old or, with their long hallways and large, multi-resident rooms, don’t fit what current residents want, says Robert Kramer of the National Investment Center for the Seniors Housing and Care Industry.  From 2007 to 2011, the number of under-construction nursing home units (the sections of a facility that provide only nursing care) declined by a third.

Residing at a nursing home is not cheap. The median annual cost of a private U.S. nursing home room rose to $77,745 in 2011; up almost 30 percent from 2005. People without chronic conditions have less costly options;it takes about $43,500 yearly to pay for a home health care aide who doesn’t have specialized medical skills, and $39,000 to live in an assisted living facility that provides help with activities of daily life like cooking, but doesn’t necessarily offer health care services.

If nursing homes continue to be squeezed, they may need to continue to understaff. A November 2011 report by the University of California-San Francisco concluded that poor quality of care is already endemic in many nursing homes, especially the largest for-profit chains where staffing levels have been cut the deepest to save money.


Oklahoma’s Aden Evening News on reported that thousands of pain pills are missing from Calloway Nursing Home. Police have launched an investigation.  Between 2,000 and 3,000 Lortab pills were discovered missing during a routine state audit.  Why didn’t the nursing home know it was missing the narcotics? 

Several employees are suspected of stealing and distributing the drug, but no employees have been arrested.


USA Today reported on Ohio’s first elder abuse shelter.  The abuse against the elderly especially the most vulnerable–the weak, physically or mentally disabled or both–continues to rise.  "They’re the nation’s fast-growing elderly population, and many are prime targets for abuse — physical, financial, sexual or emotional. Concern among the elderly and their advocates is mounting as the number of seniors soars and more of them live longer."   The number of people who live to age 90 and beyond has tripled in the past three decades to 2 million and is projected to quadruple by 2050, according to the Census Bureau. The number of 65-plus grew 15.1% since 2000 to 40.3 million or 13% of the total population.

The Cedar Village Retirement Community in a suburb of Cincinnati opened a long-term care facility to victims of abuse.   It is the first elder abuse shelter in Ohio and one of only a half-dozen in the country, all of them funded by non-profit groups.  Ohio’s Shalom Center for Elder Abuse Prevention at Cedar Village will care for abused seniors in four counties and provide medical, nursing and therapy services, meals, legal services, social work, pastoral care and social, recreational and educational programs.

"There is a genuine recognition by those who are concerned by the abuse of elders that there need to be appropriate safe houses for them to get them out of immediate harm’s way," says Sally Hurme, AARP’s senior project manager in education and outreach. "Nationally, we’ve been aware of the need for elder abuse shelters, but they’ve been slow in coming into fruition."

Advocates for the old are pushing for more and launching campaigns to educate communities about elder abuse and how to prevent it.  The National Academy of Sciences estimates that only one in 14 cases comes to the attention of authorities. The Elder Justice Act passed in 2010 but has received zero funding while states cut budgets.


The blog at Kaiser Health News had an interesting report about how we should measure the quality of care provided by health care providers.  There are 368 new ideas on the table this year, according to a list compiled by the Centers for Medicare & Medicaid Services. CMS estimates 60 will be adopted in 2012.   Some of the measures aim to assess specific areas of serious concern, such as the excessive use of restraints on patients in psychiatric hospitals and the percent of babies born in a hospital who were delivered by choice before a full 39 weeks of pregnancy. Others are broader, such one measuring how often families of people who died in hospice thought the program was satisfactory.

Figuring out how to fairly and accurately assess the quality of care that health providers are giving is the key to keeping costs down and prevent waste and fraud.

The measures were proposed by a variety of places. Some came from government agencies such as CMS and the Centers for Disease Control and Prevention. Others were devised by industry groups or companies such as the Hospital Corporation of America, the National Hospice and Palliative Care Organization and the American College of Cardiology. Still others come out of academic or research groups, such as the University of North Carolina and RAND.

Before it decides which measures it wants to use, CMS asked the Measures Application Partnership, a stakeholder group established by the National Quality Forum (NQF), to give advice on which measures will accurately and fairly capture provider performance. The group will issue its recommendations to CMS.


Workday Minnesota reported that Golden Living, the most profitable nursing home in Minnesota, is seeking wage freezes and givebacks from workers, jeopardizing the quality of care.  Golden Living Center – Lake Ridge in Roseville, owned by one of the largest private equity firms in the nursing home industry, made $2.4 million in profits in 2010, according to Medicaid cost reports. Yet management is seeking to cut back on staff’s pay and benefits in current negotiations with workers.  "Golden Living is demanding to freeze our wages for years and slash our wage scale by up to $3 an hour," said Brenda Hampton, a nursing assistant. "It’s getting harder and harder for us to make ends meet, but Golden Living is making millions in profits. That’s not right."

Golden Living, formerly known as Beverly Enterprises, is one of the largest nursing home chains in the United States. It has national offices in Plano, Texas, and Fort Smith, Arkansas.

Meanwhile KFVS12 reported the story of a family member so distraught over the care and treatment of her mother at a Golden Living facility that she lit her roommates’ bed on fire.