New York Magazine reported that 63,000 Americans died of a drug overdose.  About 42,200 of last year’s drug deaths were linked to opioids, up from 33,000 the year before. In October, President Trump declared the opioid epidemic a public-health emergency – but declined to call for a single dollar in new funding to address the crisis.  Nothing is being done about it.  It is a national tragedy that affects every strata of society.

This epidemic of drug deaths reduced life expectancy in the United States for the second consecutive year — the first time that’s happened since the early 1960s. Beyond the incalculable human toll of all this death, the opioid crisis cost the American economy $504 billion in 2015 alone, according to the White House Council of Economic Advisers.

The most effective remedy for opioid addiction, bar none, is medication-assisted treatment (MAT). Under MAT, addicts are provided with methadone and buprenorphine — less powerful opioids that satiate most addicts’ cravings, and arrest their withdrawal symptoms, without inducing heroin’s debilitating, euphoric high. Decades of research, the World Health OrganizationCDC, and National Institute on Drug Abuse have all demonstrated MAT’s efficacy. Some studies suggest that the treatment reduces mortality among drug addicts by more than 50 percent. And yet, the therapy is only available in about 10 percent of America’s conventional drug-treatment facilities.

The Nation had an article about “Non-disclosure agreements” (NDAs) which effectively bound victims to secrecy, barring them from publicly revealing their stories.  NDAs are part of an arsenal of legal tools that employers and insurance companies have at their disposal to protect both their reputation and their bottom line—but those tools often come at the expense of victims.  Another is “forced arbitration,” a provision in many contracts that requires victims to channel their disputes through an extralegal negotiation process, rather than through the courts. Under Obama, the Consumer Financial Protection Bureau had banned forced arbitration in employment contracts, but last month Trump and Congress killed that protection.

According to the National Women’s Law Center (NWLC), both forced arbitration and NDAs have in many workplaces become a standard tactic to preempt workers from taking legal action or disclosing sexual-harassment and -assault charges. These agreements force workers to sign away their rights in exchange for a job, by making them agree to settle future disputes outside the courts through an opaque negotiation process controlled by management and lawyers—effectively sentencing women to silence before they ever step into a courtroom.

“The Equal Employment Opportunity Commission estimates that 75 percent of abuse incidents go unreported, yet “anywhere from 25 percent to 85 percent of women report having experienced sexual harassment in the workplace.” Many are deterred by fear of retaliation—three in four respondents feared being re-victimized, in other words, for speaking out. But the commission also stresses that forced arbitration works against the public interest “by requiring individuals to submit their claims to private arbiters rather than public courts,” and the ability to rely on forced arbitration “can also weaken an employer’s incentive to proactively comply with the law.” Both policies, non-disclosure and mandatory arbitration, drive consumers and workers into silence and powerlessness by keeping their cases out of court.”

According to NWLC Vice President for Workplace Justice Emily Martin, “Congress could act to prohibit employers from requiring mandatory arbitration of harassment and discrimination complaints.”

Danny Tyree at the Casper Star-Tribune had a wonderful editorial for those in nursing homes without friends and family to visit during the Holidays.  Merry Christmas and Happy Holidays to everyone!

“At this festive time of year, it is good to remember those who will probably never again personally experience “city sidewalks, busy sidewalks, dressed in holiday style.”

Individuals who are fortunate enough not to have close relatives in nursing homes may feel that they have “dodged a bullet” and can unashamedly concentrate on “me me me”; but visiting my mother-in-law at the nursing home over the last two years has humbled me and opened my eyes to opportunities for compassion.

Even if you don’t have blood relatives or in-laws who are shut-ins, you owe it to yourself to check out the patient directory at the nearest facility. You may find the sixth-grade teacher who helped you choose your mission in life, the kindly neighbor who gave you shelter those times you accidentally locked yourself out of your house, the coach who taught you the value of persistence, the beloved aunt of your childhood sweetheart…

 I realize that nursing homes are outside the comfort zone of many of us (“The smells! The moaning! The bodies that would no longer make the cover of ‘GQ’ or ‘Sports Illustrated’!”); but most of those patients went outside their own comfort zones many times leaving familiar surroundings to find a good job, traveling halfway around the world to fight for freedom, raising stepchildren who clung to memories of their “real” father/mother, marching for civil rights, etc.

The Christ child we celebrate at Christmas certainly came outside his comfort zone. He left the right hand of God, endured the aches and sorrows of the Human Condition and was mocked and crucified. He set a high standard for us.

We cheat ourselves when we let our hectic schedules push nursing home visits way down our priority list. We rush home to watch a History Channel documentary when we COULD learn about the Great Depression or the Korean War or the Apollo program from someone who was there. We make a mad dash to the bookstore to grab the latest romance novel instead of listening to a real live senior citizen reminisce about the person who was the light of their life for 50 years.

Certainly, the patients who suffer from glaucoma or osteoporosis or confinement to a wheelchair but who remain mentally alert are in need of reassurance, to handle the monotony, loneliness and challenges to their dignity. Even patients who have doting relatives will appreciate an extra visit.

Giving the gift of time to someone who can’t repay you in material things can be so much more rewarding than the obligatory ritual of handing a $20 Taco Bell gift card to the co-worker whom you know will reciprocate with a $20 Olive Garden gift card.

Nothing about this column is intended to limit your kindness to the holiday season. Trees and ornaments may be packed away, but the emotional needs remain.

I hope the holidays start you on a year-round program of tending to the vulnerable. It is a two-way gift that keeps on giving.”

The Sun Sentinel reported the disturbing story of a nursing home owner, Dr. Jack Michel, who was allowed to take over the Rehabilitation Center at Hollywood Hills even though he’d been hit with a $15.4 million fine years earlier to settle claims that he and others swindled Medicare and Medicaid.  Dr. Michel was a key figure in a civil suit brought by the U.S. Department of Justice for massive health care fraud.

Incredibly, it is common practice in the health care industry to allow people and corporate entities found guilty of fraud to write checks to the U.S. government then continue operating nursing homes and participate in the very programs they were guilty of defrauding.  He had been accused by the government of taking kickbacks for hospitalizing elderly patients when they didn’t need to be hospitalized.

“Why was he allowed to take over the nursing home after having been accused in federal court of bilking Medicare and Medicaid?”

“A civil settlement with no admission of wrongdoing does not preclude purchasing a nursing home. There is no law or statute that precludes it,” Michel’s lawyers, Julie W. Allison and Geoff Smith, said.  “Many health care professionals — including those who have gone on to hold elective office — have served in companies that have settled claims with DOJ,” the attorneys said in the statement released to the Sun Sentinel. They were referring to Florida Gov. Rick Scott, who founded HCA but left in 1997 in the midst of a federal investigation that led to a $1.7 billion health care fraud settlement.”

Michel and his companies agreed to five years of “special monitoring”, but were never expelled from participating in Medicaid or Medicare — a vital element to running a nursing home.

In fiscal 2007, the year of Michel’s settlement, the government barred more than 3,300 service providers from federal health insurance programs for misconduct, usually criminal, according to statistics from the U.S. Health Care Fraud and Abuse Control Program. That same year it collected $1.8 billion in civil settlements. By fiscal 2016, it was up to $2.5 billion.  As of mid-November, the federal government had about 380 of these “Corporate Integrity Agreements” ongoing nationwide with hospitals, hospices, pharmaceutical firms, nursing homes, diagnostic imaging centers, doctors and others, according to the U.S. Health and Human Services Office of Inspector General’s web site.

Harvard health care Professor David Grabowski, who’s researched the economics of long-term care, said policy makers in Florida and other states should consider tightening the criteria for owning a nursing home, given the approval of Michel.

Fox Business reported on the U.S. health epidemic of diabetes as more than 114 million Americans are now living with diabetes or pre-diabetes, according to a report released by the Centers for Disease Control and Prevention (CDC) Opens a New Window..

The International Diabetes Federation reports that the number of people living with diabetes worldwide has tripled since 2000, costing $850 billion annually.  According to the CDC, Type 2 diabetes accounts for 90% to 95% of all diabetes Opens a New Window.cases and is linked to obesity and an inactive lifestyle.

 

 

Forbes reported on Omega Healthcare Investors (OHI) which has long been a popular choice for income advisors. The real estate investment trust focuses on nursing homes and health care facilities–sectors that benefit from an aging population.  Based in Hunt Valley, Maryland, Omega is a real estate investment trust that provides financing and capital to the long-term health care industry, especially skilled nursing facilities.  The company owns or holds mortgages on more than 900 assisted living facilities, nursing homes and specialty hospitals in the United States and Britain. Omega recently announced the acquisition of 15 skilled nursing facilities in Indiana, which will make it the nation’s largest owner of post-acute-care centers.

Omega Healthcare Industries just raised its dividend for the 21st straight quarter.  The stock now pays an amazing 9%. This is only the third time in the last ten years that Omega Healthcare has paid this much.

Overall, the big picture for skilled nursing facility demand looks great. The industry, which is actually seeing supply decrease as demand increases, is projected to be in a supply deficit within the decade.  Total patient days at skilled nursing facilities are increasing, and are projected to accelerate higher in the coming years.

U.S. News had an interesting article discussing how Louisiana‘s payments to private nursing homes for taking care of Medicaid patients have risen substantially over the last decade increasing profits even as their occupancy rates stayed flat, according to an audit.  The state Medicaid program spent $8.7 billion in federal and state dollars on nursing home care for people who are elderly or disabled from 2006 through 2016, as daily rates paid to about 260 nursing homes increased 54 percent from $112.34 to $172.82.  In the last budget year that ended June 30, Medicaid payments to the facilities reached $1 billion.  Occupancy rates over the same period, however, “have generally remained the same,” growing by less than 1 percent.

One easy explanation is that the nursing home industry is powerful and a hefty campaign contributor at the state capitol.  In fact, inadequate monitoring and enforcement caused the department to fail to recoup $3.2 million in Medicaid payments for ineligible patients in 2014.

 “Even with the increasing payments to nursing facilities, Louisiana continues to rank poorly in regards to quality of care,” auditors wrote.
 Auditors also said the Louisiana Department of Health needs to improve its oversight of payments to ensure they’re accurate. They said the agency should issue penalties for late cost reports from nursing homes and tougher sanctions for facilities that have repeat audit violations.

The L.A. Times reported the latest on the beneficial effects of ObamaCare.   A report – based on a state-by-state survey of data collected by the federal government – provides powerful new evidence that insurance gains made through the 2010 healthcare law are helping millions of patients get needed medical care.  Americans are no longer putting off doctor visits or struggling with medical bills, according to a new report examining the effect of the Affordable Care Act.

“The Affordable Care Act has put access to healthcare in reach for millions of Americans, particularly for people in states that embraced the law,” conclude the authors of the report, published by the nonprofit Commonwealth Fund.  Across the country, the law is credited with extending health coverage to more than 20 million previously uninsured Americans and dropping the nation’s uninsured rate to the lowest levels ever recorded.

An increasing number of studies have found similarly dramatic improvements in patients’ access to care after they get coverage.

“The fact is health insurance helps people get access to care, gets them better preventive care and more regular care for chronic medical conditions,” said Dr. Benjamin Sommers, a health policy researcher at Harvard who has extensively studied the effect of health insurance.

Between 2013 and 2016, the share of adults reporting that they delayed medical care because of concerns about cost declined in 45 states.

The percentage of adults at risk of being in poor health who had not been to the doctor in the previous two years declined in 37 states.

And the share of working-age adults with high out-of-pocket medical bills fell in 35 states between 2013-14 and 2015-16, according to the report, which is based on census data and national health surveys overseen by the Centers for Disease Control and Prevention.

These gains were particularly pronounced among low-income Americans, who have arguably benefited most from the 2010 law’s coverage expansion.

 

Politico reported that many insurers in the Affordable Care Act market are on pace to record profits this year for the first time, according to a POLITICO analysis of 31 regional Blue Cross Blue Shield plans, many of which dominate markets in their states.  The POLITICO analysis shows that insurers, on average, spent 78 percent of premium revenues on customers’ medical claims through the first nine months of this year.

“The political narrative is over a market in crisis, and that’s just not how the market actually looks right now,” said Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation, a nonpartisan research group. “At this moment, the individual insurance market looks quite stable and most insurers have achieved profitability.”

However, Trump’s reckless decision to cut off subsidy payments that insurers rely on to reduce the costs for low-income customers means plans will take a more than $1 billion financial hit, according to the National Association of Insurance Commissioners.

The Buzz had a peculiar story about Rick Scott’s attempt to hide and cover-up the neglect and abuse in Florida’s nursing homes.  Recently, with no announcement or notice, AHCA wiped its website clean of all nursing home inspections, shielding the industry to the detriment of consumers.

For many years, Florida’s Agency for Health Care Administration’s website included links to inspections of nursing homes, retirement homes and hospitals. They were available with a few keystrokes with very few redactions. The agency then began to heavily redact the reports — eliminating words such as “room” and “CPR” and “bruises” and “pain” — and rendering the inspections difficult to interpret for families trying to gauge whether a facility is suitable for a loved one.  AHCA says the redactions were necessary to protect medical privacy, though patients were identified only by number.

In the past year, the state spent $22,000 for redaction software that automatically blacks out words the agency says must be shielded from the public. Those same words were available on a federal website unredacted. Elder and open-government advocates said the newly censored detail did more to protect the homes than patients.