Kaiser Health News and the Washington Post collaborated on a story about the overpayment of medications for Hospice patients.  New Medicare guidance aims to stop the federal government from paying millions of dollars to hospice organizations and drug insurance plans for the same prescriptions for seniors. The new measures direct insurers not to pay for any prescriptions for hospice patients until they receive confirmation that the drugs are not covered instead by the hospice provider.  The patient or doctor, with the hospice provider’s agreement, must explain to the insurer why the drug is not related to end-of-life care. The insurer may deny coverage for a number of reasons, including if the doctor or hospice did not explain sufficiently why the drug was unrelated to the terminal illness.

Medicines for Medicare patients receiving hospice care generally are paid in two ways. Drugs related to palliative and comfort care are supposed to be covered under the fixed-rate federal payments to the hospice. Drugs for diabetes, heart disease or other chronic conditions still used by these patients but not directly related to their terminal illness are covered by Medicare Part D prescription drug plans, which are heavily subsidized by Medicare, with beneficiaries picking up roughly 25 percent of the bill.

The new measures are a response to a 2012 investigation that found Part D prescription drug plans paid more than $33 million in 2009 that should have probably been covered by the hospice benefit. That was for analgesic, anti-nausea, laxative and antianxiety drugs, as well as prescription drugs used to treat pulmonary problems and amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. Beneficiaries paid nearly $4 million in copayments, the report by the Department of Health and Human Services’ inspector general found.

About 1.1 million Medicare beneficiaries received hospice care in 2009 and 437,121 filled prescriptions through their Medicare drug plan, according to the report.

 

 Allegations against a nursing home in Illinois claim that the facility waited a full half an hour before calling for EMS to assist a choking resident. The resident was found unresponsive at 11:45 and ambulance service was not contacted until 12:15. Even then, the ambulance service reports that they were told the situation was for a non-emergent transfer, likely further delaying response time.

The allegations go on to claim that by 12:38 p.m., Pauline Hendricks was cyanotic (blue), hypotensive (low blood pressure) and unresponsive with clumps of food in her mouth. Furthermore, the suit claims no staff members checked on Ms. Hendricks between the time she was first discovered unresponsive until the time EMS arrived on the scene. Ms. Hendricks was transported to a hospital, but died later that day.

The suit is against the facility, its owner (a holding company), a nurse, the doctor involved, as well as the corporation for which he works. The claims made include that the facility was not adequately staffed, did not have adequate policies, failed to assess the patient, or immediately call for an ambulance. As for the owner, the suit claims it “inappropriately allocated excessive funds to itself and/or its owners, shareholders, officers, employees and/or controlling members, thereby draining [the facility] of the resources necessary to maintain sufficient and appropriately trained staff.”  See full article here.

 A hidden camera placed in a room in a nursing home facility in western New York has led to felony charges for 17 members of the staff. The patient, who was only 56, suffered from a neurological disorder which left him completely unable to care for himself. According to the allegations, the staff there failed to dispense medicine, check on him, provide incontinent care, and provide liquids. The staff members then falsified documents saying that they had done all of these tasks. The staff involved have already been fired by the facility “for neglectful care of one resident.”

The nurses and nurses’ aides have been charged with first-degree falsifying business records, a felony; first-degree endangering the welfare of an incompetent or physically disabled person, a felony; and willful violation of public health laws, a felony. Conviction of a class E felony carries a prison sentence of up to four years.

The facility has 270 beds devoted to residential care, and had 6.2 deficiency citations per 100 beds, far worse than the state average of 2.2. Eleven of the seventeen citations involved quality of care. The facility also receives 44.8 complaints to the state for every 100 beds. This is again, far higher than the average 34.1.

Regarding the criminal charges against the employees, “The charges are against each individual for various times during the shifts, 24 hours a day during the time that the camera was operational,” said Attorney General Thomas Schlief. There will no doubt be follow-ups on this story as the high profile case proceeds in the coming months.  See articles here, here, here, and here.

 Ken Myers is a father of three and passionate about great care. He’s always looking for ways to help families find the support they need to live fuller, richer lives. Find out more about expert care by checking out @go_nannies on Twitter.  Ken explains GoNannies below:

About GoNannies: Business and Benefits
You can never be too careful when it comes to choosing the right person to provide care for your relatives. Although some of the elderly are capable of maintaining themselves, others may require greater assistance. Care can be provided in a variety of ways to help those that are advancing in years. GoNannies.com can help you find the right person for to fit your requirements.

Available Services

GoNannies.com is more than just a nanny service. It is a company that provides care to the human element regardless of age. Whether you need help with your child, elderly parent or simply need someone to assist you throughout the day; you can find the help you need. Some of the services provided include:
• Child Nannies
• Senior Care
• Housekeeping
• Personal Assistants
• In-house Chefs
• Domestic Care

Child Nannies – Experienced and versatile staff wait to care for your child. Handpick those individuals you want to interview in order to find the right person for your family dynamic.

Senior Care – There is a wide range of care that a senior could need. This could range from general help around the house to full physical assistance. Qualified professionals are available to help with every contingency.

Housekeeping – Whether you need help around the house or want to provide a method for your aging parents to relax, professional housekeepers can be of a great benefit.

Personal Assistants – For those that seem too busy to breathe most days, a personal assistant can help keep family and career balanced. Sometimes an extra pair of hands is all you’ll need in order to maintain or even improve your lifestyle.

In-House Chefs – For those that wish they had the time to provide healthier home-cooked meals, an in-house personal chef could provide nutrition as opposed to take-out.

Domestic Care – Having a household manager could be greatly beneficial in order to maintain schedules and plan various events. How often have you forgotten to make doctor’s appointments while pushing through your busy day?
Benefits of GoNannies

When choosing the right agency, you want to know that you’re making the right decision. You want to feel assured that your needs are being addressed. You want to benefit from services such as:
• Free background checks
• Live support
• Secured job postings
• Complete hiring tools

Free Background Checks – Background checks can provide a great deal of information about a potential candidate. Why settle for putting your faith in the word of someone you’ve never met?

Live Support – Regardless of your care-giving needs, GoNannies provides live support to answer any questions you may have concerning the process of finding and maintaining in-house help.

Secured Job Postings – With extensive privacy policy settings, listing your specific job doesn’t have to feel like you’re putting your information out there for the world to see. There is far more security in place at GoNannies than most alternative classified ad systems.

Complete Hiring Tools – GoNannies provides you with everything you’ll need in a hiring kit in order to help you find the most qualified individual for your requirements. Forms, interview guidelines, expert consultations and more are available.

Ann Murray contacted us to let us know about an exciting new super food.  Ambronite is a real food super meal on a mission to make healthy eating as easy as 1-2-3.  They have created the world’s first real food super meal that fulfills 100% of daily nutrition recommendations, avoids soy powder, and has no fake flavors. Ambronite tastes like oats and fresh nuts with a hint of Nordic herbs and berries. Ambronite has already raised tens of thousands of dollars in global pre-orders and launched yesterday with a creative Indiegogo crowdfunding campaign.

To create this super meal, a Finnish “food tech” team asked a bold question: What real food ingredients would be included in the “perfect” meal and how can we source those foods, combine them in right proportions for daily nutrition, and make them tasty?  The result is Ambronite, a revolutionary drinkable meal.  See video here.

 

 

Read More →

The IndyStar had a follow up report on Republican politician Eric Turner who allegedly used his power and influence to help his nursing home business.  He and his wife have an interest in a company that is invested in Mainstreet Property Group, which build nursing homes, and his son is CEO of that company.  Turner, the second highest-ranking Republican House leader, successfully pressured fellow lawmakers in private Republican caucus meetings to drop a measure that would have temporarily halted new nursing home construction.

Turner and his family members own various companies that develop and invest in nursing homes.  After spending more than a month under an ethics investigation, the House Republican leader is facing a GOP opponent tomorrow in the primary.  His Republican opponent is also disgusted by Turner’s behind-the-scenes actions to kill legislation bad for his family’s nursing home business interests.

“If somebody is elected as a public servant, we trust this person to act in the (public’s) best interest and not do anything that is self-serving,” said Parvin Gillim, 52, of Sheridan in Hamilton County.  Most  members of his own caucus said privately that his actions stepped over the line.

“If somebody has a financial interest, in some way, in an organization and there is legislation that may impact that business, recusing yourself from voting is one thing, but you should completely step away from the issue,” Gillim said.  “Personally, I think Rep. Turner had no business being in that caucus when that issue was being discussed,” he said.

House ethics rules prohibit lawmakers from sponsoring or voting on legislation in which they have a direct and substantial financial interest.  The six-member ethics panel of legislators said his “actions have not achieved the highest level of transparency.”

 

Last Friday, Congressmen Earl Blumenauer (OR-03) and Chris Smith (NJ-04) introduced HR 4543, the PACE Pilot Act, a bipartisan and budget neutral bill that would allow The Program of All-Inclusive Care for the Elderly (PACE) programs greater flexibilities to expand their successful model to care for people under age 55 who have special health risks.  This is great news for people who do not want to go to a nursing home. 

PACE integrates Medicare and Medicaid benefits for members of our society who have some of the most serious and costly health care problems. The program seeks to keep people living in the community rather than in long-term care institutions. Currently, PACE is only available to individuals age 55 or older and who are certified by their state as being eligible for a nursing home level of care.

Expansion of these programs will offer younger individuals with disabilities this same integrated, community-based option that supports their independence and quality of life.

“PACE has been a huge success,” said Blumenauer. “What we have realized is that there is a group of people out there who currently don’t qualify for PACE because of the age requirement, but would otherwise greatly benefit from the program due to serious medical conditions. This bill allows us to see how we can bring them into the fold efficiently and affordably.”

“PACE continues to provide patient centric care to many of the frailest members in our society, while enabling them to live in their homes and stay in their communities,” said Smith. “We know that all PACE participants are eligible for nursing home care, yet 90 percent continue to live at home. By removing the nursing home level of care requirement, we can help ensure that people have greater access to preventative services and treatments, thereby helping them maintain their quality of life.” 

Currently, a total of 103 PACE sites in 31 states serve about 56,000 enrollees nationwide. A number of research studies show that beneficiaries enrolled in PACE had fewer hospitalizations and nursing home admissions, and lower mortality than similar beneficiaries who were not enrolled in PACE.

Bloomberg published an interesting powerpoint on how Americans die.  33% of all deaths are people 85 years old or older.  Car collisions, drugs, suicide, and firearms which are mostly preventable seem to be growing the fastest.

The Washington Post had an enlightening article on how Medicaid forces people to remain poor to receive any benefits.  The article discusses a bipartisian fix co-sponsored by seventy senators and by 359 members of the House called The Achieving a Better Life Experience (ABLE) Act of 2013.

Medicaid does have one huge flaw, which hurts millions of people living with disabilities, injuries, or chronic illness. You have to live, officially at least, as a pauper. With important variations across the states, most recipients are forbidden from having more than two or three thousand dollars in the bank.

The ABLE Act was introduced last year to fix this problem.  The Act will allow people living with disabilities to establish accounts that can be used for educational expenses, housing, transportation, assistive technologies, and other basic needs.  For many people, this reduces the need for complicated record-keeping and paperwork. It’s cheaper and easier than the complicated special needs trusts many of us have spent thousands of dollars to create and manage. It provides tax advantages. It legitimates what families are often already doing in less transparent and efficient ways.

“Although more remains to be done, the ABLE Act promises to be a humane and valuable contribution to public policy. In an era disfigured by mean-spirited and polarized gridlock politics, this is no little thing.”

The Pittsburg Post Gazette had an interesting article from Kaiser on how the federal government is trying to lower Medicare spending at hospitals and nursing homes. “Researchers have discovered huge discrepancies in how much is spent on these services in different areas around the country. In Connecticut, Medicare beneficiaries are more than twice as likely to end up in a nursing home as they are in Arizona. Medicare spends $8,800 on each Louisiana patient getting home health care, $5,000 more than it spends on the average New Jersey senior. In Chicago, 1 out of 4 Medicare beneficiaries receives additional services after leaving the hospital — three times the rate in Phoenix.”

Medicare per capita spending on these services, collectively known as post-acute or post-hospital care, has grown at 5 percent a year or faster in 34 of the nation’s 50 most populous hospital markets in recent years.  In 2012, $62 billion — 1 out of every 6 dollars Medicare spent in the traditional fee-for-service program — went to nursing and therapy for patients in rehabilitation facilities, nursing homes, long-term care hospitals and in their own homes, according to a congressional advisory panel.

Many providers earn double-digit profits from Medicare through a hodgepodge of payment methods that experts say promotes disjointed care, wastes taxpayer money and makes fraud easier.  Medicare is experimenting with new payment methods in which hospitals and post-acute providers would be given a lump sum to take care of a patient, forcing them to become more efficient if they want to make money.

The vagueness of the term “post-acute” reflects the wide array of ways Medicare patients can be treated after they leave the hospital. Those robust enough to return home can receive intermittent visits from nurses, physical therapists and aides who monitor their condition and assist in basic tasks. These services are known as home health.

Medicare pays each type of facility different rates — even when they are treating the same kinds of patients.  These varying payment rates were created under the assumption that many sicker patients would need to be in facilities that could provide more intensive care. But researchers have found evidence that the same types of patients can end up in different types of facilities, for no obvious medical reason.

An Institute of Medicine study released in July concluded that post-hospital services are the primary reason that Medicare spends much more in some parts of the nation than elsewhere. Uneven spending on post-acute care around the country accounts for 73 percent of the variation in Medicare spending.

For many companies, these patients translate into substantial profits. Nursing homes are expected to earn between 12 and 14 percent this year on their Medicare patients, MedPAC estimates. Home health margins are expected to average 12 percent, and intensive rehabilitation facilities margins are around 8.5 percent, MedPAC estimates. Long-term care hospitals, the laggard of the post-acute groups in profits, are earning almost 6 percent.

Policy experts say providers tailor their approaches to wring the most money out of Medicare’s payment methods. Nursing homes, for instance, are paid per day, encouraging homes to keep patients for as long as possible up to the 100-day limit Medicare set. Medicare picks up the entire tab for the first 20 days.