Healthcare Finance News reported that The Medicare Payment Advisory Commission (MedPAC) is recommending 5 percent payment cuts to home health agencies and inpatient rehabilitation facilities and no increases next year for long-term care hospitals, hospices, ambulatory surgical centers and skilled nursing facilities.

The bipartisan, 17-member commission recommends freezing skilled nursing facility payment rates for two years while the payment system is revised.

MedPAC said in its report to Congress that payment changes would ideally bring all types of post-acute care into a unified payment system.

“For years, the commission has noted that PAC (post-acute care) payment systems do not encourage efficient care and are not equitable across different patient stays,” the report said.


They also recommended requiring ambulatory surgical centers to submit cost data, eliminating therapy visits as a factor in payment, and expanding the inpatient rehabilitation facility outlier pool for high-cost enrollees.

In 2015, fee-for-service program spending on post-acute care services totaled $60 billion, according to the report.

Implementing its recommendations would reduce fee-for-service program spending by over $30 billion over the next 10 years, the report said.

If Congress had implemented the commission’s 2008 recommendations for skilled nursing facilities and home health agencies, spending would have been reduced by about $11 billion between 2009 and 2016, it said.


In 2016, MA enrollment increased by 5 percent to 17.5 million beneficiaries or 31 percent of all Medicare enrollees. The average beneficiary was able to choose from 18 Medicare Advantage plans in 2017.

The Augusta Chronicle reported the settlement between Amara Health Care, also known as Salem Nursing and Rehab, and its chief executive officer Douglas Mittleider and Norma Manning on the eve of trial.  The terms of settlements are often confidential with no admission of liability.

Manning filed the 2013 lawsuit over the death of her husband of 18 years, Patrick Manning.  Patrick Manning suffered a stroke in 2011. He remained communicative and ambulatory but needed rehab services. He was sent to Amara. Five months later, he could no longer walk to the bathroom. In 16 months, Manning was dead. He had gangrenous pressure sores, dehydration, malnutrition and severe contracture, a condition in which a person’s limbs remained clutched close to the body.

“All I can say is that it was resolved to the satisfaction of the parties,” said attorney Caleb Connor, whose firm represented Manning.

Amara, or Salem, has been sued a number of times in the past 10 years over its care of patients. It also consistently rated below average in the nursing home inspection rating system of the Centers for Medicare and Medicaid.

The 213-bed facility went into bankruptcy and was purchased at a bankruptcy auction in May by University Hospital for $3.7 million, according to an earlier report in The Augusta Chronicle.

Miami’s News7 reported the abuse of a 93 year old nursing home resident.  The victim’s family made the disturbing discovery after installing a nanny camera in her room. Loved ones were horrified to see how their great-grandmother was being treated at the Boston area facility.  The video, set up by her family in her room at Wingate at Sharon, shows two women toss the elderly resident into her wheelchair. The resident, whose family, has identified her only as Dorothy, then struggles to maintain her balance.  See video on Fox25 here.

“They actually pull her hair and her neck is catapulted back, and she can’t catch her balance,” said the victim’s granddaughter Kristin.

The video from March 5 begins with Dorothy, who has dementia, swearing at and exchanging swipes with the pair. She threatens to break one certified nursing assistant (CNA)’s nose and says she will call police.

“She can’t really hurt you. She’s 98 pounds. They were picking her up and whipping her around,” Kristen said. “It’s awful. We haven’t even slept nights with the images in our head of what was taken place, and we weren’t there to help her.”

Since the incident, officials say both employees, Domingas Teixeira and Leonide Jean Paul Bien-Aime, are now facing charges. The 93-year-old has since been removed from the home. The workers now face charges of assault and battery on a person over the age of 60.

In an effort to protect her own grandparent and others, Kristen has been sending letters to lawmakers urging them to reconsider an electronic monitoring bill that was never passed but was proposed more than 15 years ago to allow residents of nursing homes to keep a camera rolling in their room.


Dear Friend,

Next Wednesday, March 29, the House of Representatives will consider legislation that, if passed, will arbitrarily devalue human life and will make it much more difficult to hold abortionists and birth control drug manufacturers accountable in American courts.  As a friend and fellow supporter of the pro-life cause, I urge you to contact your state’s congressmen and tell them to vote NO on this offensive effort to devalue human life and undermine Americans’ right to hold abortionists and birth control drug manufacturers accountable for the harms they have caused.

H.R. 1215, the “Protecting Access to Care Act,” would limit recovery for families who have lost their ability to have children due to preventable medical errors.  The bill would place a maximum value of $250,000 in non-economic damages no matter how egregious the conduct, even in cases where a doctor intentionally sterilizes a man or woman against his or her will.  Depriving someone of the ability to have children can never be adequately compensated, but capping the value of their suffering is just plain offensive.  For this reason alone, H.R. 1215 must be opposed.

The bill, however, would have other anti-life effects.  For example, H.R. 1215 devalues the life of children, mothers, and the elderly.  By imposing caps on non-economic damages, H.R. 1215 devalues human life without regard for the facts of any particular case.  Because children, the elderly, and stay at home moms usually have significantly reduced economic earning potentials (and thus economic damages), the vast majority of damages in their cases come from loss of life, pain and suffering, and other hedonic damages.  By arbitrarily capping these types of damages, Congress is devaluing the worth of our children, mothers, and grandparents’ lives.

     Furthermore, H.R. 1215 immunizes abortionists and birth control drug manufacturers.  When abortionists prescribe life-ending drugs like Mifepristone and Misoprostol to terminate healthy pregnancies, they should be held accountable when even more devastating injuries occur. H.R. 1215 would immunize the negligence of abortionists and shield defective birth control drug manufacturers from liability.  When providers and prescribers can’t be held responsible for the defects in abortifacients, they are more likely to be prescribed.

In short, this legislation seeks to attack pro-life policies by way of restricting citizens’ ability to hold bad actors accountable.  To be clear, the American citizens did not ask for this legislation – well-connected and well-funded special interests did.  It is reprehensible that this Congress is considering legislation that would promote anti-life policies through the backdoor of “civil justice reform”.  I ask that you contact your state’s congressmen and tell them to fight this arbitrary devaluation of human life, protect the rights of Americans to hold abortionists and birth control drug manufacturers accountable in court, and vote NO on this anti-life legislation.

With kindest personal regards, we remain



When CNN published a report revealing widespread sexual abuse and assault in nursing homes, many people asked the same question: Why isn’t more being done to stop it?

The multi-part investigation revealed disturbing cases of rape and sexual abuse by nursing assistants and found that more than 1,000 nursing homes had been cited for mishandling suspected cases of sexual abuse.
In response, the National Association of Health Care Assistants pledged to take action. The organization said it was “saddened and sickened by the CNN investigative report” and that it planned to immediately ramp up its education and training efforts. It said it especially wants to ensure that nursing assistants know how to spot potential abuse and report it promptly.
But federal legislation introduced two days after CNN’s investigation was published could make it far more difficult to hold problematic nursing homes accountable for abuse, according to elder abuse attorneys. The bill, submitted by Rep. Steve King, R-Iowa, would limit the legal liability of nursing homes, among a wide variety of other doctors, medical facilities and companies.

The New Yorker Magazine had an article on how and why U.S. Attorney Preet Bharara was fired because of his investigation into Secretary Price. Bharara met with Trump at Trump Tower.  When Bharara left the meeting, he informed reporters that the president-elect had asked if he were willing to remain in his post, and that he had answered in the affirmative.  Then suddenly Trump asked Bharara and 45 other U.S. Attorneys to resign. Bharara refused to tender his resignation. He was then fired.

Bharara announced his unemployment on Twitter, and then posted this enigmatic remark:

Bharara’s implication, then, was that his office was investigating something that the White House preferred to keep quiet. The former U.S. Attorney was overseeing an investigation of Health Secretary Tom Price’s stock trades prior to his firing, according to a source who spoke with ProPublica.

In December, the The Wall Street Journal reported that the former congressman had traded more than $300,000 worth of stock in health companies over a four-year period — during which he pushed legislation that could have benefited those companies.

Since then, three of Price’s trades have drawn heightened scrutiny:

(1) In March 2016, Price bought $15,000 worth of stock in Zimmer Biomet, a medical-device company. Two days later, the congressman introduced a bill that would have protected that company from a cut in its Medicare reimbursement rate. Zimmer Biomet then put money in his campaign coffers.

(2) That same month, Price purchased thousands of dollars worth of stock in six pharmaceutical companies — and then led a legislative and public-relations effort to defeat regulations that would have (almost certainly) hurt those companies’s profits.

(3) Last summer, Price made a bulk purchase of discounted shares in Innate Immuno, an Australian biotechnology company. Shortly thereafter, he helped push through legislation that expedites the FDA’s approval process — a reform that directly benefits Innate Immuno, which is working to get its wares onto the U.S. market. Price has already enjoyed a 400 percent paper gain on his investment in the company.

The Wall Street Journal found that “the cabinet nominee was one of fewer than 20 U.S. investors who were invited last year to buy discounted shares of the company — an opportunity that, for Mr. Price, arose from an invitation from a company director and fellow congressman.”

In January, Democratic Representative Louise Slaughter asked the SEC to investigate Price’s trades, arguing that there was reason to suspect that he had violated the STOCK Act — a 2012 law that bars members of Congress from using nonpublic information for personal profit.

Bharara’s office was also reportedly investigating Fox News for an array of potential crimes, including whether the network’s executives committed wire fraud by allegedly hiding financial settlements paid to women who had accused Roger Ailes of sexual harassment.

Margaret Hartmann wrote an excellent article in New Yorker Magazine about the search for a scapegoat for Trumpcare now that the Congressional Budget Office states that 24 million people will lose health coverage by 2026 under the Republican health-care. More and more Republicans are coming out against the current version of the legislation — and pointing fingers at each other.  The Wall Street Journal reported Tuesday that at least a dozen Senate Republicans, “including some who had previously kept a low profile in the health debate,” have expressed serious doubts about the legislation making its way through the House. The report poured cold water on the theory that passage in the House would build enough momentum to get the AHCA though the Senate.

The most obvious target is the man behind the bill; Breitbart’s escalating attacks on House Speaker Paul Ryan have added fuel to suspicions that chief strategist Steve Bannon hasn’t given up on his goal of ending Ryan’s career.

Breitbart is far from the only conservative outlet bashing “Ryancare.” Newsmax chief executive Christopher Ruddy even published a piece urging President Trump to abandon the current bill.

According to the Huffington Post, Republicans may already be giving up on getting AHCA passed in the Senate.

“The focus of House leadership has been more about getting a bill out of the House that is unchanged and in keeping with the Better Way plan, instead of truly seeing to potential roadblocks that exist in the House and Senate,” said a Republican House member.

“The question people should be looking at is whether Republican senators like Tom Cotton and Rand Paul are actually interested in repealing Obamacare, or whether they’re sabotaging this to preserve the Medicaid expansion in their states,” said the aide. “These senators masquerading with conservative objections are too afraid to admit they want to keep Obamacare.”

Of course, as President Trump has stated several times, the Republicans’ preferred “Plan B” is to keep blaming Senate Democrats. As the Huffington Post notes, there’s a major flaw in that strategy:

If Trump and some Republicans now think their best course of action is to do nothing and continue blaming problems with the health-care system on Democrats, then perhaps the best cover they can offer their members is to move a GOP bill out of the House, watch it die in the Senate, and then spend the next two years blaming Senate Democrats in states that Trump won.

In that scenario, voters fail to recognize that Republicans have the power to pass this bill without a single Democratic vote, and the ire over Obamacare doesn’t dissipate even though voters have seen the GOP alternative.

Will voters remember that Trump promised an Obamacare replacement “that’s going to be better health care for more people at a lesser cost,” then failed to put much energy into crafting that plan? Maybe, but blaming other people for his mistakes happens to be one of his strong suits.

A new poll released yesterday brought more bad news for GOP leaders trying to garner enough Republican support to pass the American Health Care Act.

Just 17% of voters support the AHCA, according to the Quinnipiac University poll, while 56% disapprove of the proposal.

White voters without college degrees disapprove of the AHCA by a stunning 26-point margin. Just 22% of those voters support the bill, compared to 48% who oppose the legislation.

The AHCA doesn’t even garner a majority support from Republican voters, with just 41% saying they support the law.

Overall, nearly two-thirds of voters — or 61% — disapprove of the way Trump is handling health care, according to the poll.

46% of voters said they’d be less likely to vote for a representative who supported the AHCA.