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| Study: Complete discharge summaries improve patient safety, prevent readmissions | | Study: Complete discharge summaries improve patient safety, prevent readmissions | | Article Date: 12/22/2011 | A study by University of Wisconsin researchers found that 40 percent of patient discharge summaries sent to nursing homes failed to list the patient’s therapy and activity needs. Information on tests that would be required in the future was present on less than 10 percent of discharge summaries. "Right now, the Joint Commission standard for the creation of discharge summaries within 30 days is outdated, because this standard doesn't optimally support patients who need care right after discharge," said Amy Kind, M.D., the study’s lead author. "Our study is the first to suggest that the quality of the actual document starts getting worse the longer you wait to create a discharge summary. Important items are omitted, and because of that, patient care may suffer."
The study was published in the Journal of General Internal Medicine. | | |
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| Physician pay cut uncertainty could crash Medicare computer system, official warns | | McKnight’s Long-Term Care News & AssistedLiving | | Article Date: 12/21/2011 | The Centers for Medicare & Medicaid Services has been instructed to hold physician claims through Jan. 10 of 2012 if a doc fix measure is not passed. Medicare's deputy administrator, Jonathan Blum now says that the backlog of claims that would be created without a doc fix resolution could crash the CMS’ computer system. “We feel that (Medicare) came very close operationally to crashing our system back in 2010,” Blum told the AP. “From a stewardship perspective, that is something we feel we can never repeat again.”
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| WI: Governor Walker provides some funding—concerning potential lapses—to protect Wisconsin’s vulnerable | | BayViewCompass.com | | Article Date: 12/21/2011 | Today Governor Walker directed the Department of Administration to protect more funding for programs in reviewing potential lapse plans. Specifically, the Governor directed the Child Abuse and Neglect Prevention Board, Board on Aging and Long Term Care, and the Board for People with Developmental Disabilities to be exempt from any discretionary lapses.
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| CMS instructs contractors to hold physician payment claims as House votes down payroll tax cut bill | | McKnight’s Long-Term Care News & AssistedLiving | | Article Date: 12/20/2011 | According to an electronic advisory document, the Centers for Medicare & Medicaid Services “instruct[s] its Medicare claims administration contractors to hold claims containing 2012 services paid under the Medicare Physician Fee Schedule for the first 10 business days of January 2012.” The advisory comes in response to a failure on Congress’ part in reaching an agreement on the “doc fix.”
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| Criticism starts as House nixes Medicare 'doc fix' | Julian Pecquet | The Hill | | Article Date: 12/20/2011 | A temporary “doc fix” measure that passed the Senate over the weekend was unable to survive House Republicans who were not happy with such a short extension. AsSenate Majority Leader Harry Reid(D-NV) has said the Senateis done for the year, the move could cause issues as physicians will be hit with a 27.4 percent cut in Medicare payments starting Jan. 1. In a statement,AARP Senior Vice President Joyce Rogers said, "Today's vote calls into question whether millions of seniors in Medicare will continue to be able to get the care that they need. Unless Congress acts by the end of the year, physicians who treat Medicare beneficiaries will face a nearly 30 percent reduction in their Medicare reimbursements. And more physicians may choose to no longer take Medicare patients due to this dramatic cut to their payments."
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| A Piecemeal Approach to Health Law in States | Gardiner Harris, Reed Ableson & Robert Pear | The New York Times | | Article Date: 12/20/2011 | On Friday the Obama administration announced that each state will have the ability to pick from the benefits offered under the health care law offerings, signaling that the administration is working toward a gradualist approach in implementing the law as the 2012 election year approaches.
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| Skilled nursing groups slam MedPAC recommendations to revise payment system | | McKnight’s Long-Term Care News & AssistedLiving | | Article Date: 12/20/2011 | The Medicare Payment Advisory Commission has recommended that the Centers for Medicare and Medicaid Services completely overhaul the reimbursement rates and system for skilled nursing facilities. The Commission concluded that the CMS is paying SNFs too much. American Health Care Association and National Center for Assisted Living vice president of public affairs, Greg Crist, is disappointed with the MedPAC’s recommendation. In a Monday statement to McKnight’s, Crist said, “To examine only Medicare margins misses a more accurate, complete picture our providers face. Sixty-four percent of our residents depend on Medicaid for their care. When this program is considered in the overall reimbursement equation, skilled nursing margins are skating on a razor's edge of operating costs.”
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| 32 ‘Pioneers’ Selected To Test New Healthcare Model For Seniors | Christian Torres | 32 ‘Pioneers’ Selected To Test New Healthcare Model For Seniors | | Article Date: 12/19/2011 | Thirty-two groups were named Monday to test a new health care model, called for in the health care law, which is designed to improve care for seniors while reducing costs. The groups, which range from Boston-based Partners Healthcare, the largest health care provider in Massachusetts, to the doctor-led Healthcare Partners of southern Nevada, were selected as the first Medicare accountable care organizations(ACOs) by the Department of Health and Human Services. The networks, which begin Jan. 1, are designed to save $1 billion over five years by promoting coordination between doctors and hospitals and ensuring that people with chronic conditions such as diabetes or high blood pressure get the care they need to stay out of the hospital. While some lawmakers are calling for cuts in Medicare, HHS Secretary Kathleen Sebelius said the so-called “pioneers” would boost the quality of care for seniors, even as they reduced costs by changing the incentives to reward doctors and hospitals for better outcomes. “Many of these organizations are finding that doing care the right way can bring down the cost,” she said. The health care law attempts to use the federal government’s role as payer for Medicare to set an example of paying for quality, rather than for the number of services provided, whether they are needed or not, as is done now.
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| Feds Unveil First National Survey of ALF Facilities, Residents | Patrick Connole | Provider Magazine | | Article Date: 12/19/2011 | The “2010 National Survey of Residential Care Facilities” which was conducted by researchers at the Department of Health and Human Services, Centers for Disease Control and Prevention, and National Center for Health Statistics is providing important new data and trend information on assisted living and residential care facilities. Among the findings, 19 percent of all RCF residents receive Medicaid and 43 percent of facilities house and least one Medicaid beneficiary. | | |
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| Medical reform’s daunting task: hospital billing | J. Lester Fede | Politico | | Article Date: 12/19/2011 | New insurance regulations which will go into effect in 2014 under Obama’s health care law will help some of the billing issues patients experience after a hospitalization. Currently even insured patients are responsible for any expenses incurred from being under the care of an out-of-network doctor or service provider, but generally patients don’t think about such things at the time of an unexpected hospitalization, nor are they always given choices. New insurance regulations will to go into effect that will create more transparency, more streamlined appeals processes and clearer plan explanations for customers.
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| Tavenner To Replace Berwick At CMS Helm | Mary Agnes Carey and Phil Galewitz | Kaiser Health News | | Article Date: 11/23/2011 | Marilyn Tavenner, who has an extensive health background as a nurse, a health care official at both the state and federal level and a hospital chain executive, was tapped by President Barack Obama Wednesday to succeed Dr. Donald M. Berwick as administrator of the Centers for Medicare and Medicaid Services. Tavenner, who is the agency’s principal deputy administrator, will serve on an acting basis as administrator during the confirmation process, according to an announcement to CMS staff.
Berwick was not confirmed by the Senate and instead got a recess appointment from Obama. His appointment expires Dec. 31 and he will be stepping down Dec. 2.
Tavenner has played a key role in overseeing Medicare, Medicaid and the Children's Health Insurance Program. In remarks to the National Association of Medicaid Directors earlier this month, Tavenner shared her thoughts on how to control health care costs, themes that are very similar to ideas Berwick has expressed repeatedly throughout his tenure.
"The only way to stabilize costs without cutting benefits or provider fees is to improve care to those with the highest health care costs," she said. Tavenner also said she opposed Republican efforts to turn Medicaid into a block grant that would limit the amount of federal funding states can receive for the program. "That approach would simply dump the problem on states and force them to dump patients, benefits or make provider cuts or all the above," she said. | | |
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| Amid Budget Circus, AHCA Chair Says Organization Focused On Quality | Patrick Connole | Provider Magazine | | Article Date: 11/23/2011 | Neil Pruitt Jr., chairman and CEO of UHS-Pruitt Corp. and chairman of the American Health Care Association says that despite the failure of the deficit-reduction supercommittee and the federal and state reductions to reimbursement levels for providers, “quality” will remain the focus of the LTC industry. “I am so proud we’ve not sat back and instead are focused on our quality agenda,” said Pruitt.
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| Providers react to super-committee's failure to reach debt deal | McKnight’s Long-Term Care News & AssistedLiving | McKnight’s Long-Term Care News & AssistedLiving | | Article Date: 11/23/2011 | According to American Health Care Association president and CEO, Gov. Mark Parkinson, in the aftermath of the supercommittee’s failure, the association is pushing a proposal designed to “reduce Medicare costs for post-acute care and encourage skilled nursing facilities to reduce $5 billion worth of hospital readmissions over 10 years.” Health Facilities Association of Maryland president Joseph DeMattos, Jr. weighed in saying that the committee’s failure was a “tremendous missed opportunity.” DeMattos went on to say that other possible plans have been presented in the past by the “Gang of Six” and other groups. “However, if taken in isolation, each of these packages included provisions that would hurt the future stability of quality long-term and rehabilitative care — for instance a balanced approach cannot be reached by cost shifting federal cuts to struggling state budgets,” DeMattos said.
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| Health Programs Facing Cutbacks After Super Committee’s Failure | Marilyn Werber Serafini and Mary Agnes Carey | Kaiser Health News | | Article Date: 11/23/2011 | The failure of the congressional super committee could mean automatic budget cuts totaling billions of dollars for everything from Medicare to biomedical research, starting in 2013. But some health care interests stand to fare better than others.
Two major health entitlement programs, Medicare and Medicaid, have protections under the law that set up the super committee. Automatic cuts would not affect Medicaid, the joint federal-state health program for the poor, and Medicare spending would be cut by 2 percent – all from payments to hospitals and other care providers.
But unless Congress steps in to rework the legislation mandating the automatic cuts, a series of across-the-board reductions would kick in 2013. The House and Senate appropriations committees will have to decide how to spread the cuts among various programs. And some of the larger, better-financed lobbies may have the upper hand. | | |
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| Our nation’s veterans are a wealth of information | Angela Stringfellow | Our nation’s veterans are a wealth of information | | Article Date: 11/11/2011 |
Veterans day, a time to honor those who have served our country, is a major celebratory event in long-term care facilities across the nation today. Jessica McKay, Public Affairs Manager for Ashby Ponds in Northern Virginia, reminds us that this is a great time to listen to veterans tell of their experiences, and to recognize the contribution and sacrifice these brave individuals have made for our country. She urges us to take a few moments today to thank the special veterans in our lives and invite them to share their stories. | | |
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| Operators must embrace technology to reduce staffing costs, experts advise | | McKnight’s Long-Term Care News & AssistedLiving | | Article Date: 11/11/2011 |
According to experts speaking in a McKnight’s webinar on Thursday, facilities that make efficient use of technology to lower staffing costs will be more prepared to survive Medicare and Medicaid cuts. Jeff Amann, vice president of operations at American Baptist Homes of the Midwest said that identifying overtime hours can reap the biggest savings. "When we looked at overtime costs, we found up to 12% overtime costs in one building," said Amann. "Industry-wide it's probably less than that, but that's pretty significant."
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| Supercommittee Dems offer $350 billion in Medicare cuts | Matt Dobias & Seung Min Kim | Politico | | Article Date: 11/10/2011 |
In response to a Republican proposal introduced earlier this week, supercommittee Democrats yesterday floated a $2.3 trillion tax-and-cut proposal that includes $400 billion in Medicare and Medicaid reductions. It also clears the way for a new physician payment formula and includes a range of new revenue proposals. | | |
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| Medicaid briefing: Cuts now would hurt economy | Meg LaPorte | Provider Magazine | | Article Date: 11/10/2011 |
Georgetown University law professor and former director of Medicaid for the CMS, Tim Westmoreland, spoke at a Thursday Hill briefing. In part, Westmoreland said that cutting Medicaid at this time would be like cutting FEMA during a disastrous storm. "Cutting Medicaid in the middle of a recession is anti-stimulus," Westmoreland told listeners. "It’s exactly the wrong plan at exactly the wrong time. If anything," Westmoreland continued, "now is the time to increase FMAP" [the federal matching rate for state Medicaid programs]. | | |
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| Experts say EHR adoption means more than technology upgrade | Patrick Connole | Provider Magazine | | Article Date: 11/8/2011 |
Creating compatibility between electronic health record programs will play a key role in making it easier for nursing homes and other care providers to switch from paper records to electronic records. Record sharing between providers will remain a challenge until a common language is agreed upon by developers of EHRs. "We have to figure out how to create a single EHR among multiple vendors; right now there is no common language," said Rebecca Armato, executive director, physician and interoperability services for Huntington Memorial Hospital and a commissioner on the Certification Commission for Health Information Technology.
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| Kansas turns to managed care to curb state health costs | Gene Meyer | The Kansas Reporter | | Article Date: 11/8/2011 |
Kansas lawmakers are proposing a reorganization of its Medicaid program into a managed care program in the hopes that doing so could reduce the growth of its Medicaid spending by $49 billion in the first year. The new plan "is a very ambitious effort to change the trajectory of Medicaid spending in Kansas," said Jerry Slaughter, executive director of the Kansas Medical Society, an advocacy group for Kansas physicians. "But the biggest change is moving the aged and disabled to a managed care system, which has not happened before," Slaughter said. | | |
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| Medicare hike to cut into Social Security increase | | The Chicago Tribune | | Article Date: 10/20/2011 | An increase to Medicare Part B premiums which will likely be announced next week could consume up to a quarter of the recently announced 3.6 percent Social Security cost of living increase.
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| MA: Massachusetts nursing homes feeling the economic pinch | Michael Morton | Metrowest Daily News | | Article Date: 10/20/2011 | Operators of Massachusetts’ nursing homes say the combination of Medicare cuts and fewer private-pay seniors choosing nursing homes over assisted living has resulted in layoffs and pay-cuts for nursing home workers. An industry spokesman and facility operators had an opportunity to speak with U.S. Rep. Jim McGovern, D-3rd, at the Beaumont Rehabilitation and Skilled Nursing Center. Massachusetts Senior Care Association Senior Vice President Scott Plumb provided a breakdown of government funding for the region’s 45 nursing homes which shows a $50 million loss in 2012. "When you put all that together, we've reached a point of great danger," Plumb told McGovern. "If there are any more cuts, we're just not going to be around."
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| Supercommittee’s lack of progress on debt reduction raises alarms on Hill | Lori Montgomery and Paul Kane | The Washington Post | | Article Date: 10/19/2011 | With only weeks to go before the set deadline, the deficit-reduction supercommittee has made limited headway in its endeavor to find at least $1.2 trillion in savings over the next 10 years. According to sources close to committee members, the committee has not yet agreed if they will aim for the $1.2 trillion target, or try to find even more savings. “The clock is ticking,” said committee member Rep. Chris Van Hollen (D-MD), Wednesday. “The next three weeks will be make-or-break for the success of this committee.”
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| Obama would pay for jobs plan with spending cuts, tax hikes and trimming Medicare and Medicaid | | The Associated Press | | Article Date: 9/8/2011 |
On Thursday night, President Obama told Congress that he plans to ask the new congressional supercommittee to find an additional $450 billion in savings to fund his new jobs plan. Obama has indicated he hopes to pay for the jobs plan by making cuts to Medicare and Medicaid, deeper spending cuts and by increasing taxes. The supercommittee was originally tasked with reducing the federal deficit by $1.5 trillion. | | |
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| Assisted living sector adds jobs | | McKnight’s Long-Term Care News & AssistedLiving | | Article Date: 9/8/2011 |
According to the Bureau of Labor Statistics, the assisted living sector created 3,900 jobs in August alone. National Center for Assisted Living executive director David Kyllo said this growth indicates a "growing need for assisted living care and services, as well as the critical role assisted living plays in a currently sluggish U.S. economy. These newly hired workers will have a positive impact on local communities, while also helping the nation's economy recover and expand." While growth was slightly less impressive, nursing care facility jobs increased by 21,800 over the past year. | | |
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| Michael Booth | The Denver Post | | Article Date: 8/9/2011 |
The Centers for Medicare and Medicaid Services’ decision to cut Medicare reimbursement rates to nursing homes by 11.1 percent means a reduction of nearly $37 million in federal funding to Colorado’s nursing homes, according to Arlene Miles of the industry group Colorado Health Care Association. The state has also made a 1.5 percent Medicaid rate cut. Shelley Hitt, the state ombudsman for nursing home residents said, "They're taking a double hit. We're very concerned about what they might mean for quality of care and operational impacts." | | |
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| The debt ‘super committee’: Who will serve on it? | Paul Kane | The Washington Post | | Article Date: 8/8/2011 |
In order to select the 12 members for the deficit-reduction "supercommittee," House Speaker John A. Boehner (R-OH), House Minority Leader Nancy Pelosi (D-CA), Senate Majority Leader Harry A. Reid (D-NV) and Senate Minority Leader Mitch McConnell (R-KY) will each pick 3 lawmakers to be on the committee. The committee will be tasked with finding a minimum of $1.2 trillion in spending cuts. | | |
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| Demonstration project seen as model for ACOs | Sam Baker | The Hill | | Article Date: 8/8/2011 |
On Monday the Medicare agency announced strong results from a test program that will serve as a model for accountable care organizations (ACOs). In a statement, Medicare administrator Don Berwick said, "As we work to help bring care coordination to a broader set of providers through accountable care organizations, the lessons learned by this demonstration provide great insight into how to use Medicare’s payment systems to improve quality while reducing costs." | | |
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| NJ: Salem County's long-term care facilities join in unique agreement for mutual aid in times of emergencies | Phil Dunn | NJ.com | | Article Date: 8/8/2011 |
In a first-of-its-kind agreement, all 7 of Salem County’s long-term care facilities signed an agreement that will allow them to assist each other in the event of an emergency or disaster. "Salem County is leading the way and setting the standard for the state in taking care of our elderly and disabled population," Freeholder Director Lee Ware said. | | |
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| CMS’ Decision to Slash $3.87 Billion of Skilled Nursing Payments Has Dire Implications | | Senior Housing | | Article Date: 8/8/2011 |
In response to the announcement that the Centers for Medicare and Medicaid Services would be reducing payments to skilled nursing facilities by 11.1% beginning in October, American Health Care Association president and CEO Mark Parkinson stated, "The CMS rule makes reductions beyond what is necessary for budget neutrality. Coupled with changes in group therapy definitions, this drastic reduction will be especially challenging for skilled nursing facilities to manage." Alan G. Rosenbloom, President of the Alliance for Quality Nursing Home Care weighed in also, saying, "The SNF sector has contributed heavily to advancing health care reform and deficit reduction, and is confronted by multiple ongoing threats to funding stability. The ill-considered nature of the Rule and its dire implications to seniors, providers and jobs are significant, immediate and dangerous. Lawmakers will now be placed in the unfortunate position of having to deal with an increased threat to local seniors’ access to care as a result of this egregious regulatory action." Rosenbloom’s statement continues, "Never in the history of the Medicare program has either CMS or Congress implemented such a large correction in one year." | | |
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| NJ: Filling budget shortfalls: Nursing, care centers prepare for $37.5M funding state budget cuts | Erin Duffy | NJ.com | | Article Date: 8/7/2011 |
Health Care Association of New Jersey president, Paul Langevin says the full impact of the funding cuts remain to be seen, but that if staffing is reduced, "Clearly [facilities are] not going to be able to provide the same level of care."
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| Health care costs seen near 20 percent of spending by 2020 | Andrew Seaman | Reuters | | Article Date: 7/28/2011 | A CMS report, published in the online edition of the journal Health Affairs, says that health care spending will account for 19.8 percent of the nation’s spending by 2020, with the government paying 49 percent of the bill.
Economist Sean Keehan, co-author of the report, said, "We are projecting a decline in the out-of-pocket share [for consumers], but that doesn't mean that the consumer's burden is going to be substantially reduced, especially since we're projecting health spending to grow at a faster rate than economic growth and disposable personal incomes."
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| Nation’s health tab to hit $4.6 trillion in 2020 | Ricardo Alonso-Zaldivar | Associated Press | | Article Date: 7/28/2011 | U.S.health care costs will soar from $2.7 trillion this year to $4.6 trillion in 2020, translating to $13,710 for every man, woman and child, according to a new Medicare report. | | |
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| Study: Medicare drug plan saves hospital costs | Carla K. Johnson | The Tennessean | | Article Date: 7/27/2011 | Harvard analysis, appearing in today’s Journal of the American Medical Association suggests that the Medicare prescription drug plan is keeping seniors out of hospitals and nursing homes, saving the federal program an estimated $12 billion a year. | | |
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| Colorado State Fair Silver Queen to be chosen Friday | | The Pueblo Chieftain | | Article Date: 7/27/2011 | Nineteen residents of area nursing homes will compete in the 2011 Colorado State Fair Silver Queen competition on Friday at the Pueblo Convention Center. | | |
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| Health care providers embracing cost-saving groups | Kelly Kennedy | USA Today | | Article Date: 7/24/2011 | Currently there are between 60 and 80 health care organizations that are using ACO models to coordinate care for patients. It is estimated that at least 100 more will set up ACOs by next year with increasing numbers through 2013. "There's broad agreement that the trajectory of the U.S. health care system is unsustainable," said Elliott Fisher, director of Dartmouth's Center for Health Policy Research. "I think that almost every provider group, every physician, recognizes that change is coming." | | |
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| Active seniors take less time, money to heal | Amy Jeter | The Virginian-Pilot | | Article Date: 6/13/2011 | The growing rehabilitation business is paying off for both patients and nursing homes. Seniors have somewhere to go while they recuperate from a stroke or joint replacement, but they keep their long-term independence. Nursing homes gain from serving more patients with higher-paying health coverage.
"The nursing homes are more and more focusing on the rehab portion of the long-term care business," said Steve Morrisette, president of the Virginia Health Care Association. "They're always looking to provide the niche for what people need."
While the over-65 population grew by nearly 25 percent in Virginia in the past decade, the demand for nursing home beds hasn't kept pace.
Seniors today stay healthier as they age, delaying the need for long-term care.
In 2010, Virginia's Medicaid paid $793 million - or 12 percent of its expenditures - to nursing homes for long-term care of the elderly and disabled.
But state legislators haven't raised Medicaid rates in four years, Morrisette said. Nursing homes lost an average of $8.35 a day per Medicaid patient in 2009, according to the Virginia Health Care Association's numbers.
Medicare's rates tend to be higher, averaging $428 a day compared with $147 for Medicaid, according to 2009 Virginia statistics from the American Health Care Association.
One reason is that Medicare pays for more, including intensive therapy and rehabilitation services, while Medicaid is generally footing the bill for chronic-disease care and help with activities of daily life.
"Many facilities are looking to increase their Medicare services and limit their Medicaid for really no other reason than the difference in reimbursement," Morrisette said.
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| ME: Health care providers pledge support of national program | Meg Haskell | Bangor Daily News | | Article Date: 6/13/2011 | BREWER, Maine — Despite widespread concern about the cost and quality of health care in the United States, the incidence of hospital-acquired infections, errors, accidents and other costly complications continues to grow. In addition, patients transitioning from hospital to home often suffer preventable relapses and are rehospitalized. On Monday, federal health officials were in Brewer to announce a new partnership aimed at reversing these trends. The “Partnership for Patients: Better Care, Lower Costs” initiative seeks the voluntary participation of all players in the health care system including doctors, hospitals, nursing homes, home-care organizations, outpatient clinics, insurance companies, state and federal agencies and patients. By identifying, sharing and adhering to practices that enhance health, improve medical care, and protect patient safety, supporters of the plan hope to create measurable savings and improve the health of individuals and populations. The Department of Health and Human Services will provide up to $1 billion over the next 10 years to help participants develop effective strategies to improve care and lower costs.
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| Nursing homes want IRS guidance on accountable care organization participation | | McKnight’s Long-Term Care News & AssistedLiving | | Article Date: 6/10/2011 | Nursing home and hospital provider groups have asked the Internal Revenue Service for clarification and guidance regarding the participation of nonprofit providers in accountable care organizations. Many nonprofit groups are concerned that collaborating with for-profit partners will cause them to lose their exempt status, the Bureau of National Affairs reports.
In comment letters, groups have asked the IRS to articulate scenarios in which exempt providers participating in ACOs and the Medicare Shared Savings Program will be able to contract with private payers within ACOs prior to and after they exit the program. The MSSP and ACO programs were created under the Patient Protection and Affordable Care Act.
LeadingAge, which represents non-profit nursing homes, asks the IRS in its letter to clarify the requirements for continued tax exempt treatment of 501(c)(3) organizations participating in an ACO. LeadingAge advises that not all organizations involved in ACOs are contributing capital but looking to provide better quality of care for beneficiaries.
“The IRS should make clear that the ‘economic benefits' accruing to providers participating in an ACO specifically, receiving a portion of the shared savings — need not be in proportion to their capital contribution, but rather can be distributed on the basis of, or in proportion to, relative quality performance or contributions to cost savings,” the letter recommends.
LeadingAge also advised that the IRS work closely with the Centers for Medicare & Medicaid Services and suggests enlisting more CMS staff to coordinate with the IRS.
In related ACO news, CMS announced that it has moved back to Aug. 19 the deadline for provider groups looking to qualify for the Pioneer ACO model program, giving groups an extra month to apply. CMS expects about 30 Pioneer ACOs, which it claims would save Medicare about $430 million over a three-year period. | | |
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| NJ: Coalition speaks out against Medicaid cuts | David Levinsky | Phillyburbs.com | | Article Date: 6/9/2011 | New Jersey nursing homes stand to lose as much as $140 million in government funding as a result of Medicaid cuts proposed by Republican Gov. Chris Christie, according to a coalition of health care providers and nursing home caregivers.
The coalition, United for Quality Care, contends that the reductions could force nursing homes to close or make drastic cuts that would likely affect the care they provide to senior residents.
They also worry that funding losses could prompt some homes to turn away poor residents from available beds because of reduced rates of government reimbursement.
The proposed cuts are part of the governor’s plan to save about $300 million by overhauling Medicaid, the state-run program for residents who cannot afford medical care.
According to the coalition, among the most alarming cuts proposed by the Christie administration is a 3 percent reduction in reimbursement payments that is expected to cost nursing homes an estimated $25 million in state funding as well as an additional $25 million in matching federal funds.
The administration has also proposed no increase in aid for inflation as well as cuts in the state aid awarded to special-care nursing facilities.
Workers and residents at the Cinnaminson Center said they fear the loss of funds will force the home to reduce its number of nursing aides or turn away prospective residents who need the 24-hour care a nursing home provides. | | |
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| Ark: Assisted living facility keeping families closer with new technology | Wayne Cross | Today’s THV | | Article Date: 6/9/2011 | With new technology, The Crossings at Malvern brings families together over the Internet. "Vizsit," the program The Crossings uses, is a secure video platform with multiple embedded security features that works similar to Skype. The difference is, residents don't have to log on to their computer. There is a station at the facility that family members set up a time to visit and residents are notified and brought in.
"For the residents it means a lot, because it gives them the opportunity to see grandchildren and great grandchildren," Mandy Ledbetter says. Ledbetter is the administrator for the Crossing at Malvern. | | |
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| New ACA demonstration project will coordinate care for Medicare beneficiaries | | McKnight’s Long-Term Health News & AssistedLiving | | Article Date: 6/7/2011 | A new Affordable Care Act initiative will spend $42 million over three years for a project that will coordinate care for Medicare patients, the Department of Health and Human Services announced Monday.
The demonstration project, operated by the Centers for Medicare & Medicaid Services and the Health Resources Services Administration, will give the funding to 500 Federally Qualified Health Center Advanced Care Practice facilities, known as “medical homes,” to coordinate primary care for up to 195,000 Medicare patients. The program also will enroll dual eligibles, or those individuals who qualify for both Medicare and Medicaid. The project will demonstrate how the medical home model can improve care quality, promote better health and contain costs.
To qualify for this program, FQHC facilities must implement electronic health records, help patients manage chronic conditions and actively coordinate care for these patients. The FQHC facilities will receive a monthly care management fee for each eligible Medicare beneficiary receiving primary care services. In exchange, FQHCs must agree to adopt care coordination practices that are recognized by the National Committee for Quality Assurance, CMS said.
To receive care in these facilities, Medicaid and Medicare beneficiaries cannot be enrolled in Medicare Advantage plans and must have been enrolled in the Medicare Part A and Part B fee-for-service program during the look-back period. They also may not be currently in hospice care or under treatment for end-stage renal disease, according to CMS.
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| Most states proposing FY 2012 Medicaid cuts | | McKnight’s Long-Term Care News & AssistedLiving | | Article Date: 6/7/2011 | Nearly all states are enacting Medicaid cuts for fiscal year 2012 to deal with overwhelmed budgets and a slow economic recovery, according to a new report by the National Association of State Budget Officers and the National Governors Association.
To deal with Medicaid shortfalls, 33 states have proposed lowering provider payment rates to nursing homes, hospitals and physicians; 16 states have floated provider payment freezes; and 25 states likely will introduce benefit limits, according to the report. Other Medicaid-reducing strategies include limiting spending on prescription drugs, and enacting or increasing existing copayments.
Still, it's a tough battle for budget-plagued states: Forecasts predict an 18.6% increase in Medicaid spending for states while federal funds decrease by 13%.
As states consider cuts for FY 2012, they are also weighing new regulations under the Patient Protection and Affordable Care Act. These include maintenance of effort provisions, which require maintaining the Medicaid eligibility rules in place when the Act went into effect, according to the Bureau of National Affairs.
“As states look ahead, it is not just the economy that gives them pause, but also the aging of our population and the seemingly inexorable increase in healthcare costs,” said NGA Executive Director Dan Crippen. | | |
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| Getting our CLASS Act together | | Getting our CLASS Act together | | Article Date: 6/6/2011 | The CLASS Act, a federal program created as part of national healthcare reform legislation in 2010, will make about $27,000 per year in assistance available to those who need it, taking a big chunk out of the financial obligation of long term care, according to the Private Duty Homecare Association.
According to a study from the SCAN Foundation ("Caring,” January 2010), Americans across all political views are concerned about the future of long-term care, which is critical in providing products and services to the aging population. The study found that 92 percent of people surveyed said it is important to improve coverage for services that help people remain in their homes instead of going into nursing homes; 90 percent of Republicans, 89 percent of Independents, and 97 percent of Democrats say improving coverage to help people remain in their homes is important. | | |
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| Health-care initiative draws fire | Anna Wilde Matthews | The Wall Street Journal | | Article Date: 6/3/2011 | Hospitals and doctors say they agree with the goals of the program (ACOs), and a number are moving forward in similar partnerships with private insurers. Several said they are much more likely to apply for a separate Medicare ACO initiative that is aimed at larger providers and limited to 30 groups. "There's a lot more flexibility" in that model, said Chas Roades, chief research officer of Advisory Board Co., a consulting firm that works with hospitals. For instance, he said, providers can share in more of the savings and can potentially get the money as monthly per-beneficiary payments, a format known as capitation.
Some health-care providers say the broader ACO proposal is unworkable. A letter from 10 medical groups that participated in an earlier, similar Medicare demonstration project said it would be "difficult, if not impossible" to accept the financial design. The American Medical Group Association said a survey of its members found that 93% wouldn't enroll as ACOs in the main proposed Medicare program.
Hospitals and doctors complain that the regulations are overly prescriptive, with detailed requirements such as 65 quality measures. The design could mean steep start-up costs, they say. The Medicare agency estimated average start-up and first-year operating costs at around $1.8 million for a new organization, and suggested it might help with financial advances against later shared savings. But the American Hospital Association projects the "order of magnitude is significantly different," likely more than two or three times higher, said Richard Umbdenstock, its chief executive.
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| ACO regulations should place more emphasis on nursing | | Nurse.com | | Article Date: 6/2/2011 | In written comments, the American Nurses Association has encouraged significant changes to the Centers for Medicare and Medicaid Services’ proposed rule for Accountable Care Organizations (ACOs). The ANA said its recommendations would maximize patient care and create greater efficiencies and savings by articulating professional nursing’s impact on areas of leadership, patient-centered care coordination and quality. In written comments ( www.nursingworld.org/ACOcomments), delivered Tuesday to CMS, the ANA said that the proposed rule governing ACOs does not properly identify and measure nursing services or provide sufficient incentives for care coordination, a core part of registered nursing practice. As a result, the ACO model would not achieve maximum cost savings. ANA recommended that CMS strengthen the rules regarding transitional care to ensure effective care coordination for patients who move from hospitals to community settings to home settings. ANA also suggested that ACOs be required to sufficiently fund and staff care coordination activities. The association also encouraged modification of the ACO rules to be more inclusive of nurses who provide leadership in multiple roles within a healthcare organization, from management to quality improvement to direct care. It said such a change would reflect recommendations in the 2010 Institute of Medicine/Robert Wood Johnson Foundation report, “The Future of Nursing: Leading Change, Advancing Health” that nurses participate as full partners with physicians and other healthcare professionals in redesigning the healthcare system. | | |
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| Report finds inequities in payments for Medicar | Robert Pear | The New York Times | | Article Date: 6/1/2011 | Medicare uses inaccurate, unreliable data to pay doctors and hospitals, the National Academy of Sciences said Wednesday.
The system of paying doctors has “fundamental conceptual problems,” and the method of paying hospitals is so unrealistic that almost 40 percent of them have been reclassified into higher-paying areas, the report said.
The report criticizes the current arrangement under which Medicare distributes tens of billions of dollars based on regional variations in wages, rents and other costs in 441 hospital labor markets and 89 payment zones for doctors. Of the physician payment zones, 34 cover entire states.
The panel said Medicare should recognize a single set of 441 payment areas for doctors and hospitals alike.
As a result of such a change, the panel said, “higher-cost areas would be separated from lower-cost areas,” and payments to doctors in metropolitan areas would generally increase, while payments to doctors in some rural areas could be expected to decrease.
By the end of this year, under the new health care law, the secretary of health and human services must send Congress a plan to revise the way Medicare adjusts payments to reflect regional differences in hospital wages.
Under the new health law, geographic adjustments may not increase total costs to Medicare, so that an increase in payments to one hospital or group of hospitals must generally be offset by decreases in payments to others.
Frank A. Sloan, a professor of economics at Duke University and chairman of the study panel, said Medicare needed to find a new source of data on commercial office rents. The current measure, based on rent for a two-bedroom apartment, does not accurately reflect the prices doctors face, he said. | | |
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| MN: Dayton inks nursing home bil | | Daily Globe | | Article Date: 6/1/2011 | Gov, Mark Dayton has signed into law a bill chief authored by State Representative Joe Schomacker (R-Luverne) that brings Minnesota’s nursing home classifications into conformity with federal guidelines. “This law will simplify the paperwork nurses have to complete and allow them more time for patient care, and it won’t cost the facilities a dime,” Schomacker said in a press release issued Wednesday. Currently, Minnesota nursing homes are reimbursed based on each resident’s classification in or of the 36 Resource Utilization Groups. The classification is based on a federal assessment tool called the Minimum Data Sets (or MDS). Recently, the MDS was updated after studies in 2007 and 2008 showed changes to the population and needs of our nursing home residents. Schomacker said the new system also brings a solution to a problem often complained about by private pay residents, where treatments provided during a hospital stay preceding the nursing home admission will not be reflected in the nursing home care assessment — which often raised costs.
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| Anne M. Purington, CEO, Presidential Oaks, Concord | Concord Monitor | | Article Date: 5/31/2011 | Re "Don't let employers off health care hook" (Monitor editorial, May 20):
The editorial about nursing home health insurance was a bit misleading despite its own admission that "no one tracks such statistics in New Hampshire."
Presidential Oaks is proud to be the employer of choice for nearly 200 employees. Our retirement community offers exceptional health insurance with real prescription coverage (no high deductible plans here) to full-time employees for $15 per week - along with Delta Dental benefits for only $2.50 weekly.
Twenty-five percent of our employees are "per diem" and choose to forgo benefits, work periodically and receive higher wages. Why? The majority are well-paid nurses whose spouses already have benefits. About 15 percent of our workforce consists of part-time, high school students covered by their parents' insurance, and 78 percent of the remaining employees purchase our health insurance.
While other local employers were reducing staff and freezing wages, our employees received an average 3.75 percent annual salary increase. Hourly employees, excluding managers, now make an average $14.97 per hour ($29,200 annually).
Our revenue calculations are very different than the 80 percent reported. Since Medicaid pays only about $150 a day ($6.25 per hour), that revenue is only 35 percent of the total nursing home revenue.
Nursing home workers do "deserve access to quality health care." It's fine to argue against the exemption "the industry" is requesting. However, not all nursing homes are alike.
Presidential Oaks puts its family of employees first. We take good care of them - and they take great care of our residents (please check our Star Rating on Medicare.gov). | | |
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| TX: Perry signs tort reform bill into law | Vicky Garza | San Antonio Business Journal | | Article Date: 5/31/2011 | Gov. Rick Perry on Monday signed into law a bill meant to limit frivolous lawsuits.
House Bill 274 — the so-called “loser pays” act — was deemed an emergency item by the governor at the start of the session.
The bill streamlines justice by allowing plaintiffs seeking less than $100,000 to request an expedited civil action. The new law, which goes into effect Sept. 1, also transfers risk to those filing an abusive lawsuit by requiring some losing plaintiffs to pay court costs and fees of the defendant | | |
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| FL: Nursing homes a growing industry | Doug Sword | Herald Tribune | | Article Date: 5/30/2011 | IN A REGION WHERE CONSTRUCtion has become rare, there is one part of the commercial sector that has been active. For the second time this year, ground was broken for a nursing-home facility that has skilled-nursing beds.
The Glenridge on Palmer Ranch's Carroll Center became the second company to break ground on a skilled-nursing center when it began work recently on a 28-bed expansion estimated to cost $6.4 million.
In January, Florida Living Options started construction on its $29 million Hawthorne Health and Rehab, a 120-bed skilled-nursing center on DeSoto Road.
Because Florida has a moratorium on adding skilled-nursing beds, the Carroll Center went the same route as Florida Living Options, acquiring the rights to 28 beds from a facility that was closing. Those rights cost $700,000, more than 10 percent of the project's total costs, said Charles Tirrell, Glenridge's chief executive officer.
The expansion will increase the number of beds in the Carroll Center by 75 percent, even though the expansion costs only about a quarter of what the original 34,349-square-foot center cost when it was built in 2003. | | |
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| Administration opposes challenges to Medicaid cuts | Robert Pear | The New York Times | | Article Date: 5/28/2011 | By Robert Pear, New York Times. May 28, 2011
Medicaid recipients and health care providers cannot sue state officials to challenge cuts in Medicaid payments, even if such cuts compromise access to health care for poor people, the Obama administration has told the Supreme Court.
States around the country, faced with severe budget problems, have been reducing Medicaid rates for doctors, dentists, hospitals, pharmacies, nursing homes and other providers.
Federal law says Medicaid rates must be “sufficient to enlist enough providers” so that Medicaid recipients have access to care to the same extent as the general population in an area.
In a friend-of-the court brief filed Thursday in the Supreme Court, the Justice Department said that no federal law allowed private individuals to sue states to enforce this standard.
Such lawsuits “would not be compatible” with the means of enforcement envisioned by Congress, which relies on the secretary of health and human services to make sure states comply, the administration said in the brief, by the acting solicitor general, Neal K. Katyal.
“I find it appalling that the solicitor general in a Democratic administration would assert in a Supreme Court brief that businesses can challenge state regulation under the supremacy clause, but that poor recipients of Medicaid cannot challenge state violations of federal law,” said Prof. Timothy S. Jost, an expert on health law at Washington and Lee University, who is usually sympathetic to the administration.
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| VA / TN: Remembering Veterans in nursing homes | Chris McIntosh | TriCities.com | | Article Date: 5/27/2011 | Memorial Day is Monday, a day when our nation takes the time to remember those who died in service to our country.
Each year the folks at Greystone long-term care facility, honor those men and women who live there, who spent part of their youth defending this country.
The Veterans that were honored included 27 men and 1 woman.
Each had their names read from a roll of honor, and a color guard gave them a 21-gun salute.
92-year-old Charles Roberts is the oldest veteran at today's ceremony.
He served in the Pacific in World War II, and today's ceremony makes him proud to have served his country.
"Oh it feels fine! Every year they have something here...it makes you feel good those people remember.", said Roberts.
The Veterans that live here, sometimes feel that they are forgotten, but today's celebration lets them know how grateful this nationis for their service.
It is important to remember this Memorial Day, that one-thousand World War II vets pass away each day.
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| CBO: Defunding healthcare law could end drug benefits | Sam Baker, The Hill Healthwatch Blog | The Hill | | Article Date: 5/26/2011 | Permanently defunding the healthcare reform law could lead to the end of Medicare coverage for prescription drugs, according to the Congressional Budget Office. Although the Medicare drug benefit predates healthcare reform, the new law made changes to the program — most notably eliminating the so-called “doughnut hole,” in which seniors must pay for their drugs out of pocket. If the new healthcare law is defunded, the changes to the prescription drug program could not be implemented and Medicare would be unable to offer the benefit, CBO said.
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| NC: Editorial: Long term care has some long term effects | | Richmond County Daily Journal | | Article Date: 5/26/2011 | Health care is a part of the service industry. The service industry is very labor intensive. These are local jobs that contribute directly to economic activity of our community. Rockingham Manor has over 120 employees. These individuals are your neighbors, your family, and your friends. At present, Rockingham Manor can expand its employment. That is money that goes directly into our community, with paychecks, for people who want to work.
Long Term Care is the tenth largest employer in the nation, as per a recent American Health Care Association study. Long Term Care is a larger employer than food and merchandise retail in jobs created or supported. Nationally, Long Term Care is able to generate $529 Billion in total economic activity, support and create over 5.4 million jobs, and return over $60 billion in taxes annually. For the state of North Carolina, Long Term Care facilities support an estimated $10 billion (2.5%) of the state's economic activity. Long-Term Care ranks as the eleventh largest employer for jobs in North Carolina with 139,730 employees, 2.7% of the North Carolina work force. In total taxes, Long Term Care pay almost $1.1 billion in taxes annually, just in North Carolina.
Beyond the pure economic impact of the Long Term Care facilities, there is also the benefit of the services provided. . .
Although, it still may be called "Long Term Care" the model of today's facility has changed dramatically from what it was twenty or thirty years ago. Short Term Care, or rehabilitation has become a cornerstone of today's facility. . .
The technology that is utilized in skilled facilities is much more advanced than in the past. . . .
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| Vermont governor signs universal health care bill | Dave Gram | The Associated Press | | Article Date: 5/26/2011 | Vermont still has "a few challenges" ahead to meet its goal of a universal health care system this decade, Gov. Peter Shumlin said Thursday as he signed into law the bill designed to make the state the nation's first with fully publicly funded health care.
More than 150 people, including legislators, administration officials, advocates who pushed for the bill and a handful of opponents gathered on the Statehouse steps as storm clouds threatened but gave way to humid sunshine.
"We gather here today to launch the first single-payer health care system in America, to do in Vermont what has taken too long — have a health care system that is the best in the world, that treats health care as a right and not a privilege, where health care follows the individual, isn't required by an employer — that's a huge jobs creator," Shumlin said.
Among Vermont's challenges: getting waivers from the federal government at a time when the U.S. House has come out strongly against the less ambitious federal health care bill passed last year.
The Vermont law also leaves for future debate whom the state would pay for its publicly financed health care system, what benefits would be covered and a host of other details to be figured out by a new state board in consultation with the Legislature and administration officials.
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| Parkinson: Nursing homes must be a part of ACOs | | McKnight’s Long-Term Care News & AssistedLiving | | Article Date: 4/20/2011 |
Nursing homes are "perfect partners" for accountable care organizations and don't want to be left behind in the changing healthcare landscape, the leader of the nation's biggest nursing home association said Tuesday.
In what was a recurring theme in a conversation with reporters, AHCA/NCAL President and CEO Mark Parkinson made it clear that "we want to be a part of ACOs." The system, as it exists now, does not have enough incentives to keep people from long hospital stays or return visits to healthcare facilities, he said.
"One of the understated benefits of ACOs is the potential savings in the changing of the reimbursement systems. We want to take the incentives out of treating people longer," he explained during a briefing marking his three-month anniversary on the job.
The Centers for Medicare & Medicaid Services released its long-awaited ACO guidelines on March 31, which are designed around healthcare providers banding together to provide care to 5,000 or more beneficiaries. The program, which begins in 2012, allows an ACO to partake in shared savings resulting from high-quality efficient treatment. CMS is accepting comments on the guidelines until May 31.
Whether ACOs gain traction or not, there is "a logic to episodic bundled payments. It makes sense from the cost side," Parkinson said.
But Medicaid block grants to states, which have been proposed under House Budget Committee Chairman Paul Ryan's plan, are far less ideal as a cost-cutting measure, he said.
"Block grants could potentially be very, very bad for nursing homes," Parkinson said. "A block granting program that is unrestricted doesn't solve the healthcare cost problem; it just passes it off. It doesn't provide a solution; it just means someone else doesn't get care."
ACHA/NCAL is working internally on block grant proposals that could work, he said, but it "is very, very hard."
Parkinson also touched on a general lack of technology in most nursing homes, the need for site-neutral payments for Medicare, ACHA/NCAL's commitment to quality care, and the association's support of the CLASS Act. | | |
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| Nursing home industry leader worries about cuts to Medicare, Medicaid | Phil Galewitz | Kaiser Health News | | Article Date: 4/19/2011 |
Mark Parkinson, who heads the nation’s largest nursing home lobby, finds it hard to celebrate government estimates predicting an explosion in the number of Americans aged 85 and older during the next few decades.
"This would be terrific news, but the challenge is that at a time when we have this enormous demand on resources to take care of older people, this country has never been in a worse position to do it," Parkinson, president and CEO of the American Health Care Association, said Tuesday at a briefing with reporters. The association represents about 11,000 nursing homes and assisted living facilities.
Parkinson, a former governor of Kansas who came to the organization in January, said his group realizes the pressure on Congress and the states to find ways to slow the growth of Medicare and Medicaid, which together pay for most nursing home care. "We understand the budget situation is so dramatic that the status quo can’t continue," he said. "We want to be part of the solutions to the long-term deficit."
But Parkinson is critical of a key feature of the new health law that aims to slow growth of Medicare — the creation of an independent panel that will have broad authority to recommend ways to curb Medicare spending. Starting in 2015, the Independent Payment Advisory Board -- a 15 member independent panel, to be appointed by the president and confirmed by the Senate—would make its recommendations if spending passed certain benchmarks. Congress would be required to accept those or offer others that would achieve the same effect.
Like a number of other provider groups that oppose the new board, Parkinson said Congress should not give up its authority to a panel that is not directly accountable to the public. "IPAB further erodes our ability to advocate on behalf of older people," he said.
Parkinson also opposes efforts by Republicans to turn Medicaid, the federal-state health program for low-income people, into a block grant program that would give states more flexibility. "It potentially could be very bad for nursing homes," he said, citing the likelihood that providers would see additional cuts in reimbursements.
The typical nursing home counts on Medicaid to cover about seven out of 10 residents. Many states are already curbing reimbursements.
In addition, nursing homes receive money from Medicare. Those payments will be cut by $14.6 billion over the next decade under the health law to help finance the coverage for 32 million Americans who currently are uninsured. The first of those cuts begin in October. Parkinson said the industry agreed to the cuts partly because it feared an even bigger one. But reducing the number of uninsured Americans by 32 million under the law by 2018 will do little for nursing homes because nearly all of their residents already have coverage.
The association wants Congress to consider paying nursing homes and other providers a single fee for a patient’s illness episode rather than a per day fee. That way if a patient needs a hip replacement, providers would determine how to split up the money and would be rewarded only if the patients did well.
Another priority of the association is making sure nursing homes can be included in the new accountable care organizations that will start next year in the Medicare program and are expected to also be offered in the private sector.
ACOs, which would be formed most likely by hospitals and doctors, would get paid by Medicare and other insurers a lump sum each year to care for a population and would share in any savings if they can hold down cost while meeting quality targets. "We don’t want nursing home to get left behind," Parkinson said. | | |
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| Obama panel to curb Medicare finds foes in both parties | Robert Pear | The New York Times | | Article Date: 4/19/2011 |
Democrats and Republicans are joining to oppose one of the most important features of President Obama’s new deficit reduction plan, a powerful independent board that could make sweeping cuts in the growth of Medicare spending.
Mr. Obama wants to expand the power of the 15-member panel, which was created by the new health care law, to rein in Medicare costs.
But not only do Republicans and some Democrats oppose increasing the power of the board, they also want to eliminate it altogether. Opponents fear that the panel, known as the Independent Payment Advisory Board, would usurp Congressional spending power over one of the government’s most important and expensive social programs.
Under the law, spending cuts recommended by the presidentially appointed panel would take effect automatically unless Congress voted to block or change them. In general, federal courts could not review actions to carry out the board’s recommendations. The impact of the board’s decisions could be magnified because private insurers often use Medicare rates as a guide or a benchmark in paying doctors, hospitals and other providers.
Senator John Cornyn, a Texas Republican who introduced a bill last month to repeal the Medicare board, said the president’s proposal "punts difficult decisions on health spending to an unelected, unaccountable board of bureaucrats."
Mark Parkinson, president of the American Health Care Association, which represents nursing homes, said his members disliked the board because it would allow Congress and the president to "subcontract out difficult decisions." | | |
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| Keeping the promise to America’s seniors | Governor Mark Parkinson | The Hill | | Article Date: 4/19/2011 |
It’s only the second day of spring recess, but at AHCA/NCAL, we’re already thinking about Congress’ first day back. With the budget debate only beginning, we want to ensure that long term care for America’s seniors remains a top priority for lawmakers during the decision making process.
Today I held a media roundtable with reporters who cover Capitol Hill and the health care industry to discuss this very issue. It was a great opportunity for me to actually meet many of these reporters, since I only joined AHCA/NCAL a few months ago after serving as Governor of Kansas.
I had the chance to talk about my background and passion for developing quality long term and assisted living facilities. But mainly, we focused our discussion on how the current budget debate will potentially impact the long term care profession.
As everyone around the Hill is fully aware, leaders in Washington are closely examining our large entitlement programs – specifically Medicaid and Medicare – in order to find more substantial savings in the federal budget. Both of these programs play a critical role in the success of long term and post-acute care facilities.
Currently, 64 percent of nursing facility patients depend on Medicaid to pay for the care they need, including 24-hour nursing care, housing and meals. Meanwhile, 1.9 million Medicare beneficiaries receive skilled nursing and rehabilitative care.
Already, we’re keeping a close eye on the proposals that are coming out of Washington, such as Medicaid block grants, changes to the provider tax, and a premium-support version of Medicare. We continue to advocate that any changes to Medicaid and Medicare cannot result in America turning its back on the promise we’ve made to our nation’s seniors.
I also used this roundtable to talk about how investments in Medicaid and Medicare to long term and post-acute care are paying off tenfold for America’s economy. While we keep seeing discouraging news from Detroit with the manufacturing industry, or even from my hometown of Wichita, Kansas where the aviation industry has been hit hard, the long term care profession is a beacon of light.
Last year, we created 69,000 jobs and generated $529 billion in total economic activity. We also returned over $60 billion in tax revenues to federal and state governments.
And our economic potential is just beginning. Remember those Baby Boomers? Well, 2011 marks the first year that this age group will hit the age of 65. And by 2050, 27 million more Americans will require our services. What other profession out there today can you guarantee will double over the next 40 years?
That’s why Medicaid and Medicare are so important to ensure our continued success. Over 70 percent of a facility’s costs go towards labor – employing nurses, therapists, dieticians, activity directors, medical directors and more. Cuts to these federal health programs could have a direct impact on the economic benefit these 3.1 million American jobs provide.
However, we also know that we can’t just be another organization among a town full of political interests demanding our own. AHCA/NCAL want to be a part of the solution to our budget crisis, and we will be offering solutions to Medicaid and Medicare that will save the system money, but still take care of our elder population.
I thoroughly enjoyed the opportunity to discuss these issues and more with the media today. It is my hope that by bringing long term care issues to the forefront – whether in news articles, blogs or anything else – our nation’s lawmakers will return with a resolve to maintain the commitment we’ve made to current and future generations.
This commitment to ensure America’s seniors live out the remainder of their years in dignity cannot waver in the face of political discourse. And AHCA/NCAL stands ready to reiterate this message to Members of Congress throughout the budget debate.
Former Governor Mark Parkinson (D-Kan.) is the President and CEO of the American Health Care Association. | | |
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| Obama deficit-cutting speech cites nursing home care | McKnight’s Long-Term Care News & AssistedLiving | McKnight’s Long-Term Care News & AssistedLiving | | Article Date: 4/14/2011 |
President Obama outlined his plan Wednesday to cut the nation's deficit by $4 trillion in 12 years but also vowed to preserve entitlement programs, including Medicare, Medicaid and Social Security.
In his address, Obama mentioned plans for improving Medicare, including expanding the power of the Independent Payment Advisory Board created under the Affordable Care Act. The board would advise Congress on policy issues, such as streamlining funding formulas for Medicaid and the Children's Health Insurance Program, the Bureau of National Affairs reported. The board also would hold oversight on prescription drug costs. The Medicaid and Medicare programs are the source of about four-fifths of all payments to nursing homes.
Obama's proposals run counter to a Republican-led plan, which he said would turn Medicare into a voucher program and provide states with block grants to fund Medicaid.
"It's a vision that says up to 50 million Americans have to lose their health insurance in order for us to reduce the deficit," Obama said. "Who are these 50 million Americans? Many are somebody's grandparents, maybe one of yours, who wouldn't be able afford nursing home care without Medicaid."
Republicans have vowed to fight the proposals, saying that Obama's plans, which include tax increases, would stymie economic recovery. Obama said his Medicare reform would save $340 billion by 2021, $480 billion by 2023 and an additional $1 trillion in the next decade.
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| GA: House approves assisted living bill | Carrie Teegardin | Atlanta Journal-Constitution | | Article Date: 4/13/2011 |
The state House voted 172-1 Tuesday to approve a bill that will help seniors stay in assisted living facilities instead of being forced into nursing homes simply because they need help taking medications or getting around in an emergency.
Senate bill 178 will return to the Senate, which already passed a slightly different version of the bill.
The nursing home lobby in previous years argued that assisted living facilities could not adequately care for frail seniors. But this year a compromise was reached between the nursing home industry, assisted living facilities and personal care home operators, allowing the bill to win widespread support. | | |
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| Pending legislation would end therapy caps | | McKnight’s Long-Term Care News & AssistedLiving | | Article Date: 4/13/2011 |
A measure to terminate Medicare therapy caps will soon be introduced in Congress, a top association official said during a McKnight's Super Tuesday webcast yesterday.
But Cynthia Morton, executive vice president for the National Association for the Support of Long Term Care (NASL), acknowledged lawmakers already understand the issue, and cautioned the bill faces long odds.
"We hear a lot of, ‘Yes, okay, I get it," she said of members of Congress. "We may be headed toward ‘therapy cap fatigue.'"
President Obama signed the Medicare and Medicaid Extenders Act of 2019 last year. This new law directs the Centers for Medicare & Medicaid Services to continue exceptions to therapy caps for certain medically necessary services provided through 2011. Most skilled nursing residents are covered by the exceptions process. For physical therapy and speech language pathology services combined, the limit was $1,860 in 2010 and $1,870 in 2011. Those are also the limits for occupational therapy services.
Morton also discussed the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) competitive bidding program. She also addressed accountable care organizations, which will be incentivized to provide high-quality care and keep patients out of emergency rooms. Skilled nursing facilities need to weigh their options when it comes to participation in these organizations, she noted.
"There may be no size difference for nursing homes in terms of getting ready for ACOs," she said. One issue, however, is whether rural areas or smaller groups would attract the needed number of beneficiaries. Current guidelines would require 5,000 beneficiaries, and Morton said providers might actually have to cover more people if they hope to be financially viable.
The next McKnight's Super Tuesday webcast will address reimbursement issues. That event will be held on May 3. | | |
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| Nursing homes provide valuable services to older people | Column: Dr. John Morley | STLToday.com | | Article Date: 4/13/2011 |
John Morley, director of geriatrics, St. Louis University and geriatrician, St. Louis VA Medical Center; St. Louis Post-Dispatch. April 13, 2011
In recognition of the importance of nursing homes, the International Association of Gerontology and Geriatrics and the World Health Organization have collaborated on a white paper that highlights the critical role nursing home staff plays in the lives of patients. As a nursing home medical director, I applaud the paper as a blueprint for the future of nursing homes as a venue to enhance the quality of life of older people.
The white paper calls for increasing research in nursing homes to focus on improving the ability of residents to function. It provides an ethical framework for the care of older people in nursing homes and mandates "meaningful activities" should be available to all residents.
The paper addresses medications for nursing home residents. Physical restraints are no longer needed, and facilities are urged to carefully monitor the use of antipsychotic medications. Finally, because many new drugs are first given to older people, the paper suggests that clinical trials that meet strict ethical controls be conducted in nursing homes before these medications are approved by regulatory agencies.
It is time to recognize the tremendous quality of nursing home care provided in the United States and appreciate the wonderful people who care for our loved ones. | | |
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| TX: Elderly could lose big in Medicaid | Mary Ann Rosner | Austin American Statesman | | Article Date: 4/12/2011 |
Today, about 56,000 Texas nursing home residents out of about 90,000 are on Medicaid, according to Tim Graves, president of the Texas Health Care Association, which represents the state’s nursing home industry.
About 550 of the state’s 1,100 nursing homes have 70 percent or more of their residents on Medicaid.
The state House just approved legislation that would cut Medicaid payments to health care providers by 33 percent. That could potentially put hundreds of nursing homes out of business, Graves said. The Senate is considering legislation that would cut far less, and Graves is hoping to come out of the session with the smallest cut possible.
If nursing homes did close, where would fragile elderly people go? Maybe some could live with family members, but what about the ones who have no one to take care of them?
Hospitals can’t fill the burden. They also are facing big Medicaid cuts. And home health care for the elderly and disabled would go away, according to the Statesman article. "All 700 of the state’s private attendant care companies would be forced to close under the House bill, which cuts almost $900 million in state and matching federal money — or 28 to 37 percent — from three home care programs, said Anita Bradberry, director of the Texas Association for Home Care & Hospice," it says.
As Graves, who was at the Capitol today said, "It’s a very nervous waiting game."
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| Govt announces plan to reduce health disparities | Lauran Neergaard | The Associated Press | | Article Date: 4/8/2011 |
From cradle to grave, minority populations tend to suffer poorer health and get poorer health care than white Americans. In a first-of-its-kind report, the government is recommending steps to reduce those disparities.
The plan being released Friday runs the gamut from improving dental care for poor children to tapping "promotoras," savvy community health workers who can help guide their Spanish-speaking neighbors in seeking treatment.
But it acknowledges that giving everyone an equal shot at living a healthy life depends on far more than what happens inside a doctor's office — or steps that federal health officials can take.
"It's also a product of where people live, labor, learn, play and pray," Dr. Howard Koh, assistant secretary of Health and Human Services, told The Associated Press. "We really need a full commitment from the country to achieve these goals."
HHS wouldn't put a dollar figure on its own pending projects, but said it plans to pay for them with money already in hand and not subject to Congress' ongoing budget battle. | | |
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| States rush to settle Medicaid bills | Dennis Cauchon | USA Today | | Article Date: 3/21/2011 |
State governments are rushing to pay billions of dollars of medical bills before special federal assistance for Medicaid expires July 1. The hurry-up-and-pay effort will put an
extra $1 billion or more into the pockets of financially struggling states — and increase
the federal deficit by a similar amount.
"States are paying bills as fast as they can," says Debra Miller, health care expert at the
Council of State Governments. To beat deadlines for reduced federal aid, states are writing checks swiftly, paying off backlogs of bills and asking hospitals and doctors to send in bills as fast as they can.
The federal stimulus law and a later extension provided states an extra $80 billion in 2009 and 2010 for Medicaid, the nation's health care program for the poor. This was done by reducing the state's share of the program from a national average of 40% to 28%.
This bargain rate declines slightly April 1 and expires completely July 1. That means
the average state responsibility on a $1,000 Medicaid bill will rise from $280 today to
$400 July 1 — a 43% increase.
The bonus federal matching rate depends on when the bill is paid, not when the service is provided or the bill is received. Because states run the $400 billion a year program — while the federal government reimburses them — states can time payments to maximize the federal share. | | |
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| Rule allows proactive nursing homes to reduce inspection-related fines | McKnight’s Long-Term Care News & AssistedLiving | McKnight’s Long-Term Care News & AssistedLiving | | Article Date: 3/21/2011 |
Nursing homes that self-report compliance violations and quickly address them will see their fines cut in half, under a new final rule released Thursday by the Centers for Medicare & Medicaid Services.
Facilities must report the violation before it is identified by CMS or by state inspectors in order to qualify for reduced civil monetary penalties. Operators are required to forego administrative hearings to remain eligible. The reduction does not apply when immediate jeopardy or patient harm is possible. If a nursing home decides to appeal violations, the CMP would be held in an escrow account, and returned to the home with interest if the appeal succeeds.
The rule was created through a section of the Patient Protection and Affordable Care Act, and was originally proposed in July 2010. ( McKnight's, 7/13/10) CMPs currently range from $50 to $10,000 per day of noncompliance, according to CMS. The rule will take effect Jan. 1. | | |
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| IA: Nurses in care homes in a noble profession | Julie Kennedy, CNA, Dubuque, vice president, Iowa Chapter, National Association of Health Care Assistants | Des Moines Register | | Article Date: 3/20/2011 |
Unfortunately, media attention to the wonderful care provided every day to the nearly 50,000 elderly in long term care across the state isn't news.
In the battle to stop Medicare cuts to skilled nursing care that would threaten frontline caregivers jobs, a Certified Nursing Assistant from Iowa sat in her senator's office on Capitol Hill and explained to his aide, "I held the hand of one of my resident's as she passed away last night. If I'm not there, who will hold their hands?"
Oversight is necessary. Negatively characterizing a noble profession is not. | | |
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| MN: Services for seniors deserve more money | Karie Simpson, COO, Northland Assisted Living | The Duluth News Tribune | | Article Date: 3/20/2011 |
The demographic data doesn’t lie. According to the state’s own numbers, the senior population will grow by 40 percent in the next decade, while the population under age 65 will only grow by 4 percent. The number of seniors in our state will surpass the number of school kids by 2025. Given the magnitude of the demographic shifts ahead, the budget priority should be clear: Fund care for seniors.
Gov. Mark Dayton and the Legislature need to prioritize seniors in their budget negotiations by fully restoring proposed cuts to nursing homes and
assisted-living providers. What’s more, the state should ensure the surcharge it imposes on seniors is earmarked to help pay for older-adult services. If the surcharge is sent into the general fund to be used for other budget priorities it would return no value to those who pay it. It would be a true "granny tax."
Where will seniors turn if the governor and Legislature continue to cut health-care services? In many rural communities nursing homes don’t have capacity to take on an increased demand.
It’s time for the state to prioritize seniors and fully restore the cuts to older adult services. | | |
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| House GOP questions CLASS Act startup funds | Jason Millman | The Hill Healthwatch | | Article Date: 3/17/2011 |
House Republicans on Thursday questioned why the White House is requesting millions of dollars to implement a long-term health insurance program that the administration admits is unsustainable.
The Department of Health and Human Services (HHS) is seeking $120 million in the 2012 budget to ramp up implementation of the Community Living Assistance Services and Support (CLASS) Act, a voluntary program included in the healthcare reform law enacted nearly a year ago.
But Republicans on the House Energy and Commerce Committee's Health subpanel want to know why HHS is moving forward on a program that HHS Secretary Kathleen Sebelius acknowledges is deeply flawed. They are particularly agitated that more than three-quarters of the funding would go toward an education and outreach campaign for a program the department is in the midst of transforming.
"If we have a program that everyone acknowledges is broken, why do we want to waste money educating people on something that might not work in its present form?" asked Rep. Bob Latta (R-Ohio) during a hearing on the program. | | |
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| IL: Program to improve nursing home care deemed a success | Paul Sweich | The Bloomington Pentagraph | | Article Date: 3/17/2011 |
A five-year effort to improve care of older adults in Central Illinois nursing homes by increasing the number of student nurses specializing in geriatrics was hailed Thursday as a success.
Even though the Expanding Teaching Nursing Home Project of the Mennonite College of Nursing at Illinois State University and Heritage Enterprises will end Monday, the collaboration that helped the program to succeed will continue, organizers said.
"We think the program was a remarkable success bringing more students to long-term care, where there is a critical need," said Steve Wannemacher, chief executive officer of Bloomington-based Heritage, which owns long-term care facilities.
The project was celebrated at a reception at the home of Rose Stadel, a member of the project’s advisory council and Heritage vice president of operations.
The project began with a one-year U.S. Department of Education grant as the Joe Warner Teaching Nursing Home Project, named for the former Heritage CEO who died in 2002. A year later, Illinois Department of Public Health awarded a five-year, $1.48 million grant, which will end Monday.
In the past five years, 500 students have participated in clinical experiences and projects at several Heritage nursing homes, said Charlene Aaron, a Mennonite assistant professor and project coordinator. They learned how to communicate with residents and care for them, assess their conditions, administer medicine and solve problems by working in interdisciplinary teams, Aaron said. | | |
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| Why federal funding for nursing-care information technology would be a good investment | Ken Terry | McKnight’s Long-Term Care News & AssistedLiving | | Article Date: 3/2/2011 |
Long-term care is the stepchild of the healthcare industry. So it's not surprising that none of the $27 billion extended by the federal government for health information technology is available to nursing homes and other LTC facilities.
According to the Centers for Medicare and Medicaid Services (CMS), in 2009 the U.S. spent $137 billion on healthcare in "nursing care facilities and continuing care retirement communities." The Congressional Budget Office projects that long-term care will cost $207 billion a year by 2020 and $346 billion a year by 2040. And that's just for the actual cost of caring for seniors in these facilities.
The cost of not having accurate, timely data on the health status of LTC patients will be much higher. That's because sick, elderly patients often bounce back and forth between nursing homes and hospitals. That's one reason why the government is investigating the idea of "bundled payments" that would cover the cost of a hospital stay, the attendant physician care, and 30 days of post-discharge care, which might well be in a nursing home.
Similarly, if "accountable care organizations" are going to be responsible for the cost and quality of care for Medicare patients, they'll have to monitor what's going on with those patients in nursing homes. Moreover, there will have to be close coordination between doctors caring for patients in hospitals and post-acute-care facilities.
So perhaps Congress should take another look at the health IT subsidy program and authorize some more funds for long-term care. In the long run, it's a great investment in more ways than one. | | |
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| AZ: Nursing home impact in Arizona: $1.99B | | Phoenix Business Journal | | Article Date: 3/2/2011 |
Arizona sees nearly $2 billion annually in economic activity generated from nursing facilities, according to the Alliance for Quality Nursing Home CareHYPERLINK "" \l "bizWatch-infoPopup" bizWatch-infoPopup.
That sector brings in $1.99 billion annually and employs 11,946 people in the state with wages totaling $374 million, according to the group’s report.
Nationally, the alliance’s Care Context series of health policy studies found the skilled nursing sector accounts for 1.7 million jobs, with a total economic impact of more than $201 billion annually. New York has the most economic activity and jobs at $21.3 billion and 141,151 jobs. California and Ohio follow.
In figuring out the total economic impact, the group used U.S. Bureau of Economic Analysis multipliers and industry data for 2009. Using those multipliers the industry is responsible for 17,778 jobs in Arizona and wages of $604 million. Total expenditures annually in the state were pegged at $974 million. | | |
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| IL: Home-delivered meals, other Illinois programs for the elderly face deep cuts | By Janice Neumann, , March 2, 2011 | The Chicago Tribune | | Article Date: 3/2/2011 |
Senior advocates say threatened programs help keep frail seniors out of nursing homes. Proposed cuts would take effect July 1.
Helen Russell might have landed in a nursing home were it not for the tasty and nutritious home-delivered meals she receives courtesy of Aging Care Connections, a La Grange-based nonprofit that helps older individuals. "I don't even share any with the dog," said Russell, 98, joking about some of her favorite dishes. Russell, of North Riverside, is too frail to cook and doesn't want to burden her children. She also enjoys frequent camaraderie with the friendly drivers who deliver the meals. But some of Illinois' 49,948 homebound seniors who receive the meals will lose this lifeline to independence under the state's plan to slash the program's budget by 11 percent. Gov. Pat Quinn recently unveiled a fiscal 2012 budget proposal that includes the cut to the meal program and other senior services. | | |
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| Governors seek help on Medicaid costs | Robert Pear | The New York Times | | Article Date: 3/1/2011 |
Governors told Congress on Tuesday that President Obama had not gone far enough in proposing to let states opt out of major provisions of the new health care law in 2014, and they said they needed more immediate relief from the growing financial burden of Medicaid.
"It sounds good, but it provides very, very little actual help," Gov. Haley Barbour of Mississippi, a Republican, said of Mr. Obama’s proposal.
Gov. Gary R. Herbert of Utah, a Republican, said Medicaid had been a large and growing part of his state’s budget even before the federal law was passed.
"In this recession," Mr. Herbert said, "Medicaid enrollment has skyrocketed. In December 2007, enrollment in Utah stood at 158,267 individuals. In December 2010, enrollment stood at 230,812 individuals, a 46 percent increase in three years."
Representative Joe Pitts, Republican of Pennsylvania and chairman of the Subcommittee on Health, said Congress might need to give states more latitude. "If states cannot change their eligibility criteria," Mr. Pitts said, "governors are left with few choices but to cut payments to providers or cut other parts of the state budget, such as education and transportation."
The governors testified at a hearing of the House Energy and Commerce Committee. | | |
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| | GoLocal Providence | | Article Date: 3/1/2011 |
Dr. David Gifford, the recently departed director of the Rhode Island Department of Health, has take a position with the American Health Care Association and National Center for Assisted Living, the group announced today.
"Dr. Gifford will be a valuable asset to both our Association and profession as a whole," said Governor Mark Parkinson, President & CEO of AHCA/NCAL. "We are making remarkable strides in quality – unquestionably the most important focus of long term care. Dr. Gifford will help us further those strides and brings with him decades of experience and a commitment to the future of quality care that cannot be matched."
Gifford will serve as the senior vice president of quality and regulatory affairs. As part of his job, he will lead the internal quality department and spearhead initiatives on improving the quality of long-term care.
"I am very excited to join Mark Parkinson and the AHCA/NCAL team to help make sure that the elderly, who are our parents or grandparents, receive the highest quality of care when they need care in a nursing home or assisted living facility," said Dr. Gifford. "AHCA/NCAL is a leader in advocating for quality, which was one of the reasons I wanted to join this organization and work with its members." | | |
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| TX: Cuts would devastate older Texans | Ollie Besteiro, president of AARP Texas | The Houston Chronicle | | Article Date: 2/7/2011 |
What does it say about the value that Texas places on its older citizens when we pay fast-food restaurant workers more than those who provide care for our elders?
Under consideration at the Texas Capitol is a 10 percent cut in payments to Medicaid providers — including community-based services and nursing homes - on top of a recent 2 percent rate cut that's already gone into effect for nursing homes.
Texas currently pays the second lowest Medicaid reimbursement rates for nursing homes in the country. Further cuts would have a direct impact on the quality of care received by residents, leaving nursing homes with no option but to reduce staffing. There are volumes of research documenting the relationship between staffing levels and the quality of care. Reduced payments to nursing homes will place our most vulnerable seniors in a highly dangerous situation.
At the same time, the Legislature is proposing to reduce oversight of nursing homes by reducing the number of staff responsible for their monitoring. This would only add insult to injury when it comes to ensuring our seniors are safe.
In a nutshell, the Legislature's approach is seriously misguided. Lowering payment rates would put the lives of nursing home residents at risk by reducing the number of facility staff. Reducing oversight of these facilities by state personnel will degrade the quality of care received by patients, potentially putting their health at risk. At the same time, reducing rates for community-based care would have the effect of pushing more people into nursing homes, which are more expensive for the state.
Wages for workers who care for clients either in the community or in a nursing home have not kept pace with the cost of living. It's essential that direct-care workers be paid a living wage in order to ensure quality care.
Rather than saving money, the proposed state budget is dangerous for our seniors as well as costly for taxpayers. Both in terms of money and human lives, it is a plan we just can't afford. | | |
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| Letter to the Editor: Medicaid and Medicare | | The New York Times | | Article Date: 2/6/2011 |
''For Governors of Both Parties, Medicaid Looks Ripe to Slash'' (front page, Jan. 29) concisely reports on the quandary facing our nation's chief executives as they are forced to detail budgetary priorities amid state fiscal chaos.
But when it comes to actually helping governors safeguard seniors' access to quality care, no policy discussion is complete until acknowledging the critical relationship between adequate Medicare financing from Washington and improved Medicaid financing stability in our state capitals.
In senior care settings throughout the nation, Medicaid is increasingly reliant upon Medicare to supplement the widening, dangerous gap between the growing costs of providing quality care versus the amount state Medicaid programs actually pay to reimburse embattled facilities.
As America's long-term and post-acute-care providers are also the nation's second largest health care employer, robust federal Medicare financing in the face of historic state Medicaid financing volatility is essential to preserving quality care for seniors, and good jobs for American workers. | | |
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| SD: Medicaid cut amounts to elderly tax, official says | Ross Dolan | The Daily Republic | | Article Date: 2/5/2011 |
Mark Deak , executive director for the South Dakota Health Care Association, a nursing-home trade association that represents both for-profit and not-for-profit nursing care providers, said the gap between the costs of care and what Medicaid pays providers is widening.
The association claims the state's Medicaid program already underfunds the cost of skilled nursing care by more than $20 million a year. Deak said further cuts would be "catastrophic."
A December report developed by the Eljay Corporation on behalf of the American Health Care Association claims South Dakota was projected to be underfunded by $15.39 per Medicaid patient per day.
Deak said Medicaid funding has been frozen for the past two years, and a 10 percent cut would only increase provider costs for skilled nursing and rehabilitation care. Nursing homes in South Dakota employ an estimated 7,432 people. According to Deak's association, the total and indirect economic impact resulting from those jobs is an estimated $830.8 million.
"The drying up of federal dollars is increasing demands on the state's matching side of Medicaid," Deak said. | | |
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| In a graying population, business opportunity | Natasha Singer | The New York Times | | Article Date: 2/5/2011 |
The M.I.T. AgeLab, like a handful of other research centers at universities and companies around the country, develops technologies to help older adults maintain their health, independence and quality of life. Companies come here to understand their target audience or to have their products, policies and services studied.
Often, visitors learn hard truths at AgeLab: many older adults don’t like products, like big-button phones, that telegraph agedness. "The reality is such that you can’t build an old man’s product, because a young man won’t buy it and an old man won’t buy it," Professor Coughlin says.
The idea is to help companies design and sell age-friendly products — with customizable font size, say, or sound speed — much the way they did with environmentally friendly products. That means offering enticing features and packaging to appeal to a certain demographic without alienating other consumer groups. Baked potato chips are just one example of products that appeal to everybody but skew toward older people. Toothpastes that promise whitening or gum health are another.
Professor Coughlin started AgeLab in 1999 to address what he calls "the longevity paradox" — the idea that, while people in many developed countries now live several decades longer than those born a century ago, very few policy makers, institutions and industries are dedicated to helping people make those extra decades healthy and productive. | | |
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| Governors get advice for saving on Medicaid | Robert Pear | The New York Times | | Article Date: 2/3/2011 |
Fearing wholesale cuts in Medicaid by states with severe budget problems, the Obama administration told governors on Thursday how they could save money by selectively and judiciously reducing benefits, curbing overuse of costly prescription drugs and attacking fraud.
However, the administration refused to say whether it would allow states to adopt stricter eligibility standards that would, in effect, throw low-income people off the Medicaid rolls and eliminate their insurance coverage.
Kathleen Sebelius, the secretary of health and human services, said she was still studying that question.
Governors said the ideas, though constructive, were not nearly enough. They said they wanted waivers of some federal requirements and relief from Congress, and they noted that the new health care law would greatly increase Medicaid rolls in 2014.
In a letter to governors on Thursday, Ms. Sebelius said, “I have heard the urgency of your state budget concerns.” Ms. Sebelius emphasized that states already had substantial discretion to alter benefits and establish or increase co-payments. | | |
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| Out-of-pocket costs by Medicare patients significantly dings incomes | Patty Henetz | The Salt Lake Tribune | | Article Date: 2/3/2011 |
Out-of-pocket spending by Medicare beneficiaries is eating significant holes in elders’ incomes even as the federal government has denied cost-of-living increases in Social Security benefits for two years in a row.
An AARP Public Policy Institute report released this week shows median out-of-pocket Medicare spending reached $3,103 a year in 2006. The report says researchers at the University of Maryland School of Pharmacy based findings on data from the most recent Medicare Current Beneficiary Survey.
The research concluded that 10 percent — more than 4 million people — of those receiving Medicare benefits spent more than $8,300 of their own money on health care per year. That translates to about 25 percent of income for the oldest and poorest Medicare patients.
Three-quarters of the out-of-pocket spending in 2006 were for nursing home costs, prescription drugs and care providers. The figures do not include spending on prescription drugs or Medicare Part D drug premiums, which have been available only since 2006.
Median out-of-pocket spending for long-term health care facilities was $7,611 annually, with 10 percent of beneficiaries spending at least $41,900 for room-and-board or long-term care, most likely because they were spending down assets in order to qualify for Medicaid, the study found. | | |
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| The rule that rankles | Julie Williamson, | McKnight’s Long Term Care News & Assisted Living | | Article Date: 2/1/2011 |
For months, long-term care operators and therapy providers have been wringing their hands and gritting their teeth about the impact the Multiple Procedure Payment Reduction rule will have on their therapy programs—and on the Medicare beneficiaries whose wellness hinges on access to therapy services.
The fact that the MPPR policy excludes data from the institutional setting, which is where roughly 65% of outpatient therapy occurs, is particularly irksome for skilled nursing operators. Even more troubling, though, is the impact it could have on the level of therapy service provided to residents.
“MPPR does not take into account that patients may receive different therapies during a day and may undergo multiple therapy sessions multiple times a day, with little or no duplication,” reasons Greg Crist, vice president of public affairs for the American Health Care Association. A possible result, he explains, could be a cut in speech therapy for millions of individuals who may desperately need it.
“Due to the existing Medicare payment policy, payments may be cut for services for speech therapy because that same patient receives physical or occupational therapy services on that same day,” Crist explains. “This policy that arbitrarily cuts one therapy from a patient's care plan is not in [that individual's] best interest.”
“Providers should not focus solely on Part B therapy services, but should rather take a more holistic approach to evaluate the provision of Part B therapy services as part of a review of goals and opportunities for the delivery of therapy services overall.”
“We are confident that our members will survive this,” assures Crist, pointing to the fact that a significant win for the institutional setting was having the practice expense component of the fee reduced from 50% to 25%. “No financial cut is welcomed, but this is survivable.”
Still, there is a much larger therapy payment issue that continues to plague the skilled nursing environment—and it reaches far beyond MPPR.
“The bigger issue is the overall attack on therapy payments,” Crist notes. “When you add up the therapy cap and the concurrent therapy issue and you realize that CMS is just getting started on MPPR, it's pretty daunting.” | | |
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| States still implementing health care reform | Sarah Kliff | Politico | | Article Date: 1/31/2011 |
All told, each of the 26 states that are party to the federal lawsuit in Florida against health reform have received some level of funding to implement provisions of the Affordable Care Act. Observers on both sides of the aisle expect implementation to move forward largely despite Monday’s ruling.
“I think you have a number of states who say, I may not like this law, but I sure as heck would rather design the exchange myself than leave it to the federal government,” said Dean Rosen, a health lobbyist with Mehlman Vogel Castagnetti, Inc. and former health policy advisor to former Senate Majority Leader Bill Frist (R-Tenn.). “You have the states in this position of, we are on the hook and going about implementation, even though they may be philosophically opposed.” | | |
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| Long-term care providers say health care reform necessitates cost management, possible hospital partnerships | Nathan Bomey | AnnArbor.com | | Article Date: 1/30/2011 |
Ray Rabidoux, CEO of Ann Arbor-based Glacier Hills Retirement Community, which has about 620 employees, said his organization is having discussions with St. Joseph Mercy Health System and the University of Michigan Health System about ways to collaborate better.
The discussions, he said, center on how to reduce “hospital readmissions and some of those things that cost the health care systems extra dollars, to try to make sure that patients that move from one setting to another are being moved efficiently and only when necessary.”
Federal health care reform will provide “bundled payments” to hospitals, which would turn around and distribute funds to their partners - in this case, long-term care organizations.
That means hospitals may be on the hunt to partner or acquire nursing homes, assisted living centers and memory care centers. “The ties are going to continue to be stronger and more integrated as time goes on,” Rabidoux said. “These organizations need to work together, we have to share information, we have to share access to information, we have to increase each other’s understanding of the full continuum of care when we’re serving older adults.” | | |
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| Cuts may test how PA handles care for the elderly | CNBC | CNBC | | Article Date: 12/29/2010 |
Increasingly, states have pursued what some say is a cheaper alternative to nursing homes, and begun trying to deliver nursing care, therapy and meals at home or in small group settings to more of the elderly on Medicaid. The cost is about $25,000 a year per person, versus the $60,000 annual cost of a person's nursing home care in Pennsylvania, the state Department of Aging says.
Currently, about 50,000 nursing home residents in Pennsylvania are Medicaid enrollees, while another 35,000 elderly Medicaid enrollees are served in alternative settings, the Department of Aging says.
And while advocates of that approach say it saves taxpayer money and that elderly Medicaid enrollees much prefer it, others question whether it is even necessary, and suggest that it is simply bloating the state's Medicaid rolls.
What if it didn't exist?
Family and friends would care for most of these people — not on federal and state dollars — and a tiny percentage of them would likely need nursing home care," said Stuart H. Shapiro, president and CEO of the Pennsylvania Health Care Association, a group that advocates on behalf of nursing homes and variety of other care providers.
Shapiro stressed that he is not advocating throwing people off home- and community-care services, but he said the state should stop adding new Medicaid enrollees. | | |
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| Congress puts off cuts to doctor Medicare payments | | The Associated Press | | Article Date: 11/29/2010 | Congress agreed Monday to a one-month delay in Medicare payment cuts to doctors, giving a short-term reprieve to a looming crisis over treatment of the nation's elderly.
The House, in approving by voice vote the bill passed by the Senate earlier this month, postponed a 23 percent cut in doctors' pay scheduled to take effect Dec. 1. That gives lawmakers a month to come up with a longer-term plan to overhaul a system that in recent years has bedeviled Congress, angered doctors and jeopardized health care for 46 million elderly and disabled.
"This bill is a stopgap measure to make sure that seniors and military families can continue to see their doctors during December while we work on the solution for the next year," said Rep. Frank Pallone, R-N.J., chairman of the Energy and Commerce health subcommittee.
Health care payment formulas for military service members and veterans are tied to Medicare.
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| Steep rise in H.M.O. costs | Reed Abelson | The New York Times | | Article Date: 11/29/2010 | When employers first introduced H.M.O. plans to their workers in the early 1990s, the plans were considered bargains.
Companies paid much less for these plans because patients were sharply limited in where they could go for care, and medical expenses were tightly managed. Today, these plans are no longer a best buy, according to an analysis released Monday by consultants Aon Hewitt.
The analysis of rates paid by 160 large companies, representing one million participants, show that H.M.O. plans have become increasingly expensive. The average increase for 2011 was 9.8 percent, the highest in five years, putting the average cost of the plan at $10,254. By way of contrast, a P.P.O. plan, where you pay more if you go outside the selected network, cost just $9,408 per person, on average.
Over the years, H.M.O.’s have changed from a health plan that sharply limited a patient’s choice to one that now offers much more generous coverage than other plans that might require large upfront deductibles or significant co-payments for a doctor’s visit.
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| Medicare Advantage provision going smoothly | Amy Goldstein | The Washington Post | | Article Date: 11/29/2010 | One of the most significant savings envisioned in the new health care law - limiting payments to the private health plans that cover 11 million older Americans under Medicare - is, so far, bringing little of the turbulence that the insurance industry and many Republicans predicted.
The law, which sets in motion the broadest changes to the U.S. health care system in decades, will hold down the amount of money the government gives to so-called Medicare Advantage plans, which are available to patients who prefer a managed-care version of the program. The savings is forecast to amount to $145 billion by the end of the decade.
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| | The Associated Press, KSWT | | Article Date: 11/29/2010 | Gov. Jan Brewer says Arizona needs flexibility under both state and federal law to stop providing Medicaid coverage for hundreds of thousands of people and that it might requiring holding a special election.
Brewer says holding a special election to ask state voters to roll back a 2000 eligibility expansion for the Arizona Health Care Cost Containment System is an option being considered.
But Brewer says the state also needs relief from the federal health care overhaul's prohibition against rollbacks of eligibility for Medicaid programs.
Brewer says Arizona's budget troubles mean the state cannot afford to continue paying its share of the expense for providing care for the more than 300,000 people covered by the 2000 expansion.
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| Illinois State Senate Special Committee discusses Medicaid reform | Alex de Leon | My Stateline.com | | Article Date: 11/29/2010 | Springfield - The newly formed Illinois State Senate Special Committee met today for the first time to discuss Medicaid reform.
It's a bi-partisan committee charged with finding ways to cut costs and reduce waste and fraud claims.
Medicaid costs the state nearly $10 billion a year.
That money comes from the state's general fund, forcing cuts all across the board. One way being considered is requiring a means test for all public assistance programs. Many of those programs have no income limit and lawmakers say they're abused. They also say a cap would save the state hundreds of millions of dollars.
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| GOP lawmakers under pressure to decline government health plan | Mike Lillis | Healthwatch Blog, The Hill | | Article Date: 11/23/2010 | Congressional Republicans who assailed the Democrats’ healthcare law in the run-up to the midterm elections are facing pressure to decline government-provided coverage when they take office.
GOP Reps.-elect Bobby Schilling (Ill.) and Mike Kelly (Pa.), both opponents of the law, have already vowed to refuse government-backed health insurance when they come to Capitol Hill next year.
Other freshman lawmakers who ran on a promise to “repeal and replace” the healthcare law could be pressed to follow suit.
A survey released Tuesday found that the majority of voters want congressional opponents of the new healthcare law to decline government-provided healthcare coverage when they take office.
Fifty-three percent of voters in a survey from Public Policy Polling said lawmakers who ran against the reforms should stay true to their rhetoric and refuse government coverage. Among Republican voters in the survey, that figure jumped to 58 percent.
On Tuesday, Rep. Joseph Crowley (D-N.Y.) sent a letter to GOP leaders signed by 60 Democrats arguing that critics of a government-backed coverage expansion should "walk that walk" and also refuse their federally subsidized coverage.
"If your conference wants to deny millions of Americans affordable health care, your members should walk that walk," Crowley wrote in a letter to Boehner and Senate Minority Leader Mitch McConnell (R-Ky.). "You cannot enroll in the very kind of coverage that you want for yourselves, and then turn around and deny it to Americans who don't happen to be Members of Congress."
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| NIST names three healthcare companies as 2010 Baldrige Award winners | Maureen McKinney | Modern Healthcare | | Article Date: 11/23/2010 | A hospital and two healthcare sector businesses are among the seven recipients of the 2010 Malcolm Baldrige National Quality Awards, which honor performance excellence, innovation and leadership.
Advocate Good Samaritan Hospital, Downers Grove, Ill.; Medrad, a medical device manufacture based in Warrendale, Pa.; and Studer Group, a healthcare consulting and coaching company based in Gulf Breeze, Fla., received the award.
"This award is unique in that it honors the collective effort of an entire organization that has systematically strived to achieve excellence in all aspects of its work," U.S. Commerce Secretary Gary Locke said in a news release. "Today's honorees demonstrate how teamwork and a shared vision can lead not only to organizational success but also to nationwide advancements in innovation and economic competitiveness."
The Baldrige Performance Excellence Program is overseen by the Commerce Department's National Institute of Standards and Technology.
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| Experts on aging ponder best way to reduce disabilities | Janice Lloyd | Janice Lloyd | | Article Date: 11/18/2010 | How to make that wish a reality for aging Baby Boomers will be one of dozens of health issues that aging experts will address at the 65th annual meeting of the Gerontological Society of America beginning Friday in New Orleans.
Disabilities — expected to reach record numbers as the nation's 77 million baby boomers begin to grow old — could cut into their quality of life and put a huge burden on caregivers. The size of the older population is expected to swell to 90 million by 2050, nearly triple the current number.
Remaining active and strong — even as the body starts losing strength through the natural aging process — has long been regarded as one of the keys to longevity and to maintaining quality of life.
New research consistent with that philosophy is being presented at the conference by Michelle Gray and other exercise physiologists at the University of Central Oklahoma. Their research on high-intensity resistance training in women in their 80s shows two days a week of training improved lean tissue mass during a 24-week training period, gains that can help maintain independence.
Other research about the benefits of exercise is being presented by Duke, Peking and Shanghai universities.
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| Letter: Nursing home trade association CEO responds to Medicaid opt out proposal | Bruce Yarwood, President & CEO | Kaiser Health News | | Article Date: 11/17/2010 | The 11/12 New York Times news article produced in partnership with Kaiser Health News, "Battle Lines Drawn Over Medicaid in Texas" reflects the post-election reality faced by vulnerable populations and the providers who care for them, on a variety of significant levels. But while the debate is now clearly underway in terms of how state and federal lawmakers will actively seek to significantly alter federal health care reform, we must avoid any type of hatchet approach that places the burden on the backs of our frail and elderly. Withdrawing from Medicaid in the manner reported would have a tremendously negative ripple effect throughout state economies in general, and to elderly Medicaid beneficiaries in particular. As local nursing facilities are a mainstay of local economies – especially in rural areas – some would inevitably be forced to close. Access to quality care would be decimated, facility job losses would be rampant, and already low state Medicaid rates could not possibly support the ongoing care needs of a rapidly aging population. This is not to say cost savings are not needed. They are. Facilities in Texas and throughout America have invested heavily in recent years to increase capabilities to admit, treat and return home growing numbers of patients requiring intensive rehabilitative care. This is a clear benefit to both seniors as well as taxpayers. A greater focus in state capitols and in Washington on helping facilities improve their capacity to return patients home more quickly -- thereby boosting cost-efficiency – is a more realistic, forward-thinking and workable approach compared to simply opting out of Medicaid. | | |
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| CMS launches Medicare, Medicaid Innovation Center | Nicole Lewis | InformationWeek | | Article Date: 11/17/2010 | The Centers for Medicare & Medicaid Services (CMS) said the center, which was created by the Affordable Care Act, will consult a diverse group of healthcare stakeholders including hospitals, doctors, consumers, payers, states, employers, advocates and relevant federal agencies, to discuss ways in which healthcare providers can coordinate their efforts, supported by technology, to drive greater efficiency into healthcare delivery. | | |
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| MetLife steps back from long-term care market | Erik Holm and Anne Tergesen | The Wall Street Journal | | Article Date: 11/12/2010 | MetLife Inc. said it will halt sales of long-term-care insurance, a type of coverage that repeatedly has flummoxed insurers and forced some to pay significantly more in claims than they expected.
MetLife is among the bigger sellers of the coverage, with about 600,000 policyholders, or about 8%, among the eight million who have long-term-care insurance in the U.S., according to the company and an industry trade association.
MetLife joins a parade of insurers that have exited the business rather than try to fight for customers in the small market. Many life insurers, having suffered losses in the financial crisis, have been rethinking product lines from long-term care to retirement offerings to reduce their exposure to volatile markets.
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| OH: New technology at local nursing home | WDTN (Dayton) | WDTN (Dayton) | | Article Date: 11/12/2010 | Nursing home care goes hi-tech, with a system that could make the clipboard a thing of the past.
In fact, you won't see caretakers taking notes with a pencil and paper at the Wright Nursing Rehab Center in Fairborn.
Instead, the nurses will soon be equipped with a headset. The microphone can record and store care plans and medical records as the nurse speaks them.
It makes documenting the care they're given much faster and easier, and the records can be quickly accessed and played back.
The headsets also allow employees to communicate with and page each other.
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| Veterans are missing out on benefits they've earned | Rita Files | Philadelphia Inquirer | | Article Date: 11/11/2010 | This Veterans Day, show up at a parade, applaud those who served, and remember those who have made the ultimate sacrifice. But there is something else you can do to honor veterans: become informed about veterans' benefits. Too often, veterans go without services they need simply because they are unaware of benefits they earned through their service.
Consider the Aid and Attendance benefit, which is meant to help aging veterans and their surviving spouses pay for care at home, in a nursing home, or in an assisted-living facility. Millions of veterans and their families are failing to take advantage of it.
According to a recent report, about 105,000 veterans were using the benefit last year. Yet the pool of potential recipients could be much bigger. There are 2.3 million World War II vets still living, along with 2.6 million Korean War vets and 7.7 million Vietnam vets.
The Aid and Attendance benefit is significant. It pays up to $1,949 per month to provide care for single or married veterans or their surviving spouses. Applicants must meet certain medical and financial thresholds, but eligibility does not depend on service-related injuries or even overseas service. Too many veterans and their families are simply unaware of this benefit or assume they are ineligible for it.
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