Tuesday, July 18, 2017
I read this article last week in the New York Times (also published by the Kaiser Health News), the topic of which is something we should consider seriously. Poor Patient Care at Many Nursing Homes Despite Stricter Oversight discusses Medicare's Special Focus status.
While special focus status is one of the federal government’s strictest forms of oversight, nursing homes that were forced to undergo such scrutiny often slide back into providing dangerous care, according to an analysis of federal health inspection data. Of 528 nursing homes that graduated from special focus status before 2014 and are still operating, slightly more than half — 52 percent — have since harmed patients or put patients in serious jeopardy within the past three years.
The article highlights some individuals' experiences, with the basis of the article concerning the Special Focus program.
Special focus facility status is reserved for the poorest-performing facilities out of more than 15,000 skilled nursing homes. The Centers for Medicare and Medicaid Services, or C.M.S., assign each state a set number of slots, roughly based on the number of nursing homes. Then state health regulators pick which nursing homes to include.
More than 900 facilities have been placed on the watch list since 2005. But the number of nursing homes under special focus at any given time has dropped by nearly half since 2012, because of federal budget cuts. This year, the $2.6 million budget allows only 88 nursing homes to receive the designation, though regulators identified 435 as warranting scrutiny.
The article also discusses lapses by those facilities once on the watch list, how a facility earns its way off the watch list and how long it typically takes to do so and the staffing ratios in such facilities.
Background information about the special focus initiative can be found on the CMS website. You can find the list of special focus facilities on CMS website. For example, here is the one published in June of 2017.
Monday, July 17, 2017
The Medicare Trustees have also released their annual report on the health of Medicare J Medicare offers some helpful information about how to read the report
The Trustees Report is a detailed, lengthy document, containing a substantial amount of information on the past and estimated future financial operations of the Hospital Insurance and Supplementary Medical Insurance Trust Funds (see the links in the Downloads section below). We recommend that readers begin with the "Overview" section of the report. This section is fairly short, is written in "plain English," and summarizes all the key information concerning the expected financial outlook for Medicare. Substantial additional material is available in the later sections for those wishing to delve more deeply into the actuarial projections.
The report is downloadable as a pdf here. This report runs 263 pages (just a tiny bit shorter than the one from the SSA Trustees). Again, what do we want to know? We want to know whether Medicare is on sound financial footing. So let's get right to the bottom line (or pages 40-42). Here are the relevant portions of the conclusion in Section II
Total Medicare expenditures were $679 billion in 2016, and the Board projects that they will increase in most future years at a somewhat faster pace than either aggregate workers’ earnings or the economy overall. The faster increase is primarily due to the number of beneficiaries increasing more rapidly than the number of workers, coupled with a continued increase in the volume and intensity of services delivered. Based on the intermediate set of assumptions under current law, expenditures as a percentage of GDP would increase from the current 3.6 percent to a projected 5.9 percent by 2091.
The HI trust fund fails to meet the Board of Trustees’ short-range test of financial adequacy. In addition, as in past reports, the HI trust fund fails to meet the Trustees’ long-range test of close actuarial balance.
HI experienced deficits from 2008 through 2015, but annual surpluses are expected from 2016 through 2022 before deficits return for the remainder of the 75-year projection period. The projected trust fund depletion date is 2029, one year later than estimated in last year’s report. Actual HI expenditures in 2016 were slightly lower than the previous estimate. The projections are lower throughout the short-range period due to lower utilization and provider update assumptions. HI taxable payroll in 2016 was slightly higher than previously projected, and projections for HI tax income are lower after 2017 due to slower real-wage growth assumptions.
The HI actuarial deficit in this year’s report is 0.64 percent of taxable payroll, down from 0.73 percent in last year’s report. This result is due primarily to lower-than-estimated spending in 2016 and lower projected inpatient hospital utilization.
The financial outlook for SMI is fundamentally different than for HI due to the statutory differences in the methods of financing for these two components of Medicare. The Trustees project that both the Part B and Part D accounts of the SMI trust fund will remain in financial balance for all future years because beneficiary premiums and general revenue transfers are assumed to be set at a level to meet expected costs each year. However, SMI costs are projected to increase significantly as a share of GDP over the next 75 years, from 2.1 percent to 3.7 percent under current law. The projected Part B costs in this report are slightly higher over the short-range and long-range periods than the comparable projections in the previous report due to higher-than-expected actual spending for outpatient hospital services and physician-administered drugs in 2016 and a methodological change resulting in higher drug spending for patients with end-stage renal disease. The Part D short-range and long-range projections are lower than in past years’ reports, largely due to the increase in drug manufacturer rebates and lower utilization of hepatitis C drugs.
The financial projections shown for the Medicare program in this report reflect substantial, but very uncertain, cost savings deriving from provisions of the ACA and MACRA that lower increases in Medicare payment rates to most categories of health care providers. Without fundamental change in the current delivery system, these adjustments would probably not be viable indefinitely.
* * *
Policy makers should determine effective solutions to the long-range HI financial imbalance. Even assuming that the provider payment rates will be adequate, the HI program does not meet either the Trustees’ short-range test of financial adequacy or long-range test of close actuarial balance. HI revenues would cover only 88 percent of estimated expenditures in 2029 and 81 percent in 2050. By the end of the 75-year projection period, HI revenues could pay 88 percent of HI costs. Policy makers should also consider the likelihood that the price adjustments in current law may prove difficult to adhere to fully and may require even more changes to address the financial imbalance.
The projections in this year’s report continue to demonstrate the need for timely and effective action to address Medicare’s remaining financial challenges—including the projected depletion of the HI trust fund, this fund’s long-range financial imbalance, and the rapid growth in Medicare expenditures. Furthermore, if the growth in Medicare costs is comparable to growth under the illustrative alternative projections, then these further policy reforms will have to address much larger financial challenges than those assumed under current law. The Board of Trustees believes that solutions can and must be found to ensure the financial integrity of HI in the short and long term and to reduce the rate of growth in Medicare costs through viable means. Consideration of such reforms should not be delayed. The sooner the solutions are enacted, the more flexible and gradual they can be. Moreover, the early introduction of reforms increases the time available for affected individuals and organizations—including health care providers, beneficiaries, and taxpayers—to adjust their expectations and behavior. The Board recommends that Congress and the executive branch work closely together with a sense of urgency to address these challenges.
Friday, July 14, 2017
Justice in Aging has released a new issue brief for July about Medicare Savings Programs (MSP). Proposed Cuts to Medicaid Put Medicare Savings Programs At Risk explains the importance of the MSP for many Medicare beneficiaries, including paying their premiums. If the MSP program were cut or eliminated, many beneficiaries may no longer be able to afford Medicare.
Many low-income older adults are only able to participate in Medicare because Medicare Savings Programs help with their Medicare premiums, deductibles and co-pays. These critically important programs reach over 7 million people with Medicare, including 1.7 million older adults who are too poor to be able to afford Medicare but do not qualify for other Medicaid programs.1 With $772 billion in Medicaid cuts, the Better Care Reconciliation Act now being considered in the Senate could knock many older adults and people with disabilities off these programs, making Medicare unaffordable. As a result, those with the greatest needs will lose access to Medicare benefits because they will be unable to shoulder Medicare costs.
The brief explains QMBs, SLMBs, and QIs. It also explains the relationship between MSP and "Extra Help". Regardless of the Senate vote (maybe this week) on repeal and replace, the information in the brief about MSP and the other programs is really helpful. Check it out!
Thursday, July 6, 2017
NPR recently ran a story about beneficiaries enrolled in Medicare Advantage plans. As Seniors Get Sicker, They're More Likely To Drop Medicare Advantage Plans discusses a recent "GAO report, released this spring, [that] reviewed 126 Medicare Advantage plans and found that 35 of them had disproportionately high numbers of sicker people dropping out. Patients cited difficulty with access to "preferred doctors and hospitals" or other medical care as the leading reasons for leaving." The article notes the positives to MA plans, but also some concerns: "some critics argue the plans can prove risky for seniors in poor or declining health, or those ... who need to see specialists, because they often face hurdles getting access." The GAO report referenced in the story is available here.
Tuesday, June 20, 2017
Consider those who need home health care but say no. Kaiser Health News recently ran a story on this very topic. Some Seniors Just Want To Be Left Alone, Which Can Lead To Problems explain that the percentage of those who want to be left alone is higher than you may think. "As many as 28 percent of patients offered home health care when they’re being discharged from a hospital — mostly older adults — say “no” to those services, according to a new report." The report is from a roundtable that was sponsored by the Alliance for Home Health Quality & Innovation and United Hospital Fund. The report, I Can Take Care of Myself: Patients' Refusals of Home Health Care Services runs 23 pages.
Here are highlights of the report (found on page 1):
Medical care is moving from hospitals and other institutions into the community, which for most people means care at home, where they want to be. With shorter hospital stays and more complex post-discharge needs, the importance of home health care services, including skilled care and personal care, in discharge planning and transitional care is increasing.
Some studies show that patients who receive home health care after hospital discharge are less likely to be readmitted. Other studies show that patients who receive home health care report better quality of life.
Although data are limited, approximately 6-28 percent of patients eligible for home health care refuse these services, for a variety of reasons.
Even less is known about the process by which hospital staff identify patients for referral to home health care, how they explain these services, and how well they address the full range of patients’ and family caregivers’ transitional care needs.
Patients and their family caregivers have similar goals but may have different needs and attitudes about home health care.
Policy and system barriers to accessing services include inflexible criteria for eligibility, inadequate payment for home health care agencies’ services for patients with complex conditions, and shortages of trained workforce.
Recommendations from Roundtable participants include interventions that improve communication about care challenges and home health care services, qualitative and quantitative research on all aspects of home health care refusals, policy changes to increase access and coordination, and continuity across providers and care settings.
Monday, June 5, 2017
I'm just going to start off with my opinion on this latest action by CMS: bummer. Now I'll tell you what CMS is doing and you can decide if you agree with their course of action, or not. As you may recall, last fall CMS issued the revised nursing home regs (which we've blogged about before-you can search the archives for them, if you want). One of the regs getting a lot of attention was the reg that prohibited the use of pre-dispute arbitration clauses in nursing home admission contracts. Now CMS has announced they are reversing course. They will no longer prohibit pre-dispute arbitration clauses under the proposed amendment to the rule. Instead the proposed rule allows the use of arbitration clauses if certain notice requirements are met. The summary explains that CMS
would revise the requirements that Long-Term Care (LTC) facilities must meet to participate in the Medicare and Medicaid programs. Specifically, it would remove provisions prohibiting binding pre-dispute arbitration and strengthen requirements regarding the transparency of arbitration agreements in LTC facilities. This proposal would support the resident’s right to make informed choices about important aspects of his or her health care. In addition, this proposal is consistent with [CMS] approach to eliminating unnecessary burden on providers.
The specific amendments to 42 C.F.R. 483.70(n) appear on pages 20-21 of the notice. The notice is scheduled to be published in the Federal Register on June 8 and the comment period closes 60 days thereafter.
Wednesday, May 31, 2017
Let's start June off with some good news, shall we? Some time ago we let you know that Medicare was going to remove Social Security Numbers from beneficiaries' Medicare cards (can you say identity theft?). I saw a progress report about this. Medicare plans to replace Social Security numbers on cards reports an announcement from Medicare on May 30, 2017 that they are on schedule to have the cards revised with a randomly generated number replacing a beneficiary's SSN. Mail outs are planned to being in April of 2018. The final design of the card is still unknown, according to the article. The new numbers will be known as "MBI, which stands for Medicare Beneficiary Identifier." To read the press release from CMS, click here.
Monday, May 15, 2017
The Commonwealth Fund has released a new issue brief regarding Medicare out of pocket costs. Medicare Beneficiaries’ High Out-of-Pocket Costs: Cost Burdens by Income and Health Status examines the out of pocket costs faced by Medicare beneficiaries" "Fifty-six million people—17 percent of the U.S. population—rely on Medicare. Yet, its benefits exclude dental, vision, hearing, and long-term services, and it contains no ceiling on out-of-pocket costs for covered services, exposing beneficiaries to high costs." The issue brief concludes that
More than one-fourth of all Medicare beneficiaries—15 million people—spend 20 percent or more of their incomes on premiums plus medical care, including cost-sharing and uncovered services. Beneficiaries with incomes below 200 percent of the poverty level (just under $24,000 for a single person) and those with multiple chronic conditions or functional limitations are at significant financial risk. Overall, beneficiaries spent an average of $3,024 per year on out-of-pocket costs. Financial burdens and access gaps highlight the need to approach reform with caution. Already-high burdens suggest restructuring cost-sharing to ensure affordability and to provide relief for low-income beneficiaries.
The Commonwealth Fund used 2 "indicators" in doing the research, the "High total cost burden" and "underinsurance". The issue brief notes that lower-income beneficiaries may have significant out of pocket costs. "When premiums, cost-sharing, and spending on uncovered services are included, more than one-fourth of all beneficiaries (27%)—an estimated 15 million people—and two of five beneficiaries with incomes below 200 percent of the federal poverty level spent 20 percent or more of their income on health care and premium costs in 2016." As far as the other indicator, the Commonwealth Fund found "that one-fourth of beneficiaries are underinsured—that is, they spend at least 10 percent of their total annual incomes on medical care services, excluding premiums. Of beneficiaries with incomes below the poverty level, one-third spent 10 percent or more... Despite having Medicare or supplemental coverage, these people are effectively underinsured." (citations omitted).
The brief concludes with these observations:
Despite the substantial set of benefits that Medicare provides, many beneficiaries are left vulnerable because of financial burdens and unmet needs. As Medicare enters its sixth decade and the baby boom population becomes eligible, the costs of the program will increase, likely placing it on the policy agenda. Despite Medicare’s notable recent success in controlling costs per beneficiary, total spending will increase as the program covers more people.
The high financial burdens documented in this brief illustrate the need for caution. Half of Medicare beneficiaries have low incomes; one-third have modest incomes (200% to 399% of poverty). Any potential policy should first consider the impact on beneficiaries.
Access and affordability remain key concerns. In any discussions of potential Medicare reform, it will be important to pay particular attention to consequences for those vulnerable because of poor health or low income. Indeed, the findings point to the need to limit out-of-pocket costs and enhance protection for low-income or sicker beneficiaries.
As the single largest purchaser of health care in the country, Medicare policies directly influence insurance and care systems across the country. With a projected one-fifth of the population on Medicare by 2024, keeping beneficiaries healthy and financially independent is important to beneficiaries, their families, and the nation. (citations omitted).
Monday, May 8, 2017
Justice in Aging, the Center for Medicare Advocacy and the National Consumer Voice for Quality Long-Term Care have issued another in the series of issue briefs about the revised nursing home regulations. Return to Facility After Hospitalization covers several important topics including notice, bed holds, right to return and appeal rights. Here is the executive summary:
Bed hold rights are set by state law. Federal law complements state law by requiring facilities to notify residents of those rights. Notice of bed hold rights must be provided at two separate times: in advance of a hospitalization, and at the time of transfer to a hospital. The advance notification must include the resident’s right to a bed hold, whether the state’s Medicaid program pays for a bed hold, and the facility’s bed hold policies (which must be consistent with state and federal law). The time-of-transfer notification must describe the resident’s bed hold rights under the facility’s policy.
Federal law also establishes a resident’s right to return to the facility even if a bed hold period has been exceeded, or if the resident did not have a bed hold. The resident can return to her previous room if available, or to the next available room if the previous room is not available. The regulations specify that the resident can request a transfer/discharge hearing if the facility refuses to accept her back.
Wednesday, May 3, 2017
Justice in Aging announced the release of two additional issue briefs concerning the revised nursing home regs. One brief concerns quality of care and the other, grievances and resident/family councils.
The executive summary for the quality of care issue brief explains
The substantive requirements for quality of care are retained in the revised regulations, and the Centers for Medicare & Medicaid Services (CMS) affirms the regulations’ overriding goals: supporting person-centered care and enabling each resident to attain or maintain his or her highest level of well-being. Finding all of the requirements presents a challenge, however. CMS has significantly reorganized the quality of care provisions, moving some provisions to other regulatory sections, expanding the standards of the prior regulations, and adding several entirely new requirements.
The executive summary for the grievances and resident/family councils issue brief explains:
Residents have the right to file grievances and the facility must work to resolve those concerns promptly. A grievance official at the facility is responsible for complaint handling. Each facility must have a grievance policy and provide residents with information about how to file a grievance, how to contact the grievance official, a time frame for complaint review, a written decision, and information about other entities with which grievances can be filed. Written decisions must include, but are not limited to, the steps the facility took to investigate the complaint, the findings, whether the complaint was confirmed or not, and the action the facility has taken or will take to correct the problem.
The resident has a right to: form and participate in a resident council; have family member(s) or other resident representative(s) meet in the facility with the families or resident representative(s) of other residents; and participate in the family council. There must be a staff person assigned to assist both resident and family councils and the council, along with the facility, must approve this person. The councils must be given a private space in which to meet and no one outside of a resident or family member can attend without invitation. The facility must act upon council concerns and recommendations and provide a reason for its decision, although it does not have to implement all that the councils request.
All of the issue briefs are available here.
Monday, May 1, 2017
Late last week I learned that CMS may be reversing course on prohibiting pre-dispute arbitration clauses in nursing home admission contracts. I couldn't decide if my response should be "say it isn't so" or "you have got to be kidding me". Nevertheless, Justice in Aging reported in their weekly newsletter, This Week in Health Care Defense that:
CMS Backtracks on Nursing Home Arbitration Prohibition
As part of last year’s revision of nursing facility regulations, CMS prohibited federally-certified nursing facilities from obtaining arbitration agreements at the time of admission. CMS concluded that it was unfair to have residents and families waive legal rights during such a difficult and chaotic time. Now, however, CMS has reversed course and has filed language that would revise the regulation to allow facilities to obtain arbitration agreements at admission. For more on the revised regulations, see the series of issue briefs developed by Justice in Aging in partnership with the Center for Medicare Advocacy and the National Consumer Voice for Quality Long Term Care.
Wednesday, March 22, 2017
Justice in Aging has released a new brief on the revised nursing home regulations this one focusing on admissions, A Closer Look at the Revised Nursing Facility Regulations Admission. Here's the executive summary:
The revised regulations broadly prohibit facilities from using admission agreements or other documents that waive a resident’s rights. A resident cannot waive the protections of federal nursing facility law, or protections derived from any state or local nursing facility law. A resident also cannot waive his or her right to Medicare or Medicaid coverage, or any responsibility that the facility may have for the resident’s personal property. A facility cannot obligate a family member or friend to become liable for the nursing facility bill, although the facility can require the resident’s agent to agree to pay the resident’s money for the nursing facility expenses. The revised regulations prohibit pre-dispute arbitration agreements, but this consumer protection currently is blocked by a court order. Prior to admission, a facility must give notice of any special characteristics or service limitations.
The brief concludes with 4 suggestions for advocates and residents: careful review of the contract, sign the contract after residency in the SNF has begun, contest contract paragraphs that are improper and get a lawyer.
Tuesday, March 21, 2017
It's not final, it's not been passed, and changes are likely, but the current health care bill, known as the American Health Care Act, has a significant impact on elders. Last week's CBO report engendered a lot of discussion about the impact of this new health care proposal. The New York Times ran an article last week discussing it, No Magic in How G.O.P. Plan Lowers Premiums: It Pushes Out Older People. The article explains that lower premiums are on the way for some under this proposal. But, the way the lower premiums are achieved? "[T]he way the bill achieves those lower average premiums has little to do with increased choice and competition. It depends, rather, on penalizing older patients and rewarding younger ones. According to the C.B.O. report, the bill would make health insurance so unaffordable for many older Americans that they would simply leave the market and join the ranks of the uninsured."
We know that insurers want to have a broad pool to spread the risk. Typically, "older customers cost substantially more to cover than younger ones because they have more health needs and use their insurance more. By discouraging older people from buying insurance, the plan will lower the average sticker price of care." Ready for some sticker shock? Under the proposal, according to the story, the plan "increases the amount that insurers can charge older customers, and it awards flat subsidies by age, up to an income of $75,000. ... On premiums alone, prices would rise by more than 20 percent for the oldest group of customers. By 2026, the budget office projected, 'premiums in the nongroup market would be 20 percent to 25 percent lower for a 21-year-old and 8 percent to 10 percent lower for a 40-year-old — but 20 percent to 25 percent higher for a 64-year-old.'"
The story explains that it's not just the premiums that give the whole picture. Tax credits factor into this as well. Here is where the real sticker shock comes in. "[T]he change in tax credits matters more. The combined difference in how much extra the older customer would have to pay for health insurance is enormous. The C.B.O. estimates that the price an average 64-year-old earning $26,500 would need to pay after using a subsidy would increase from $1,700 under Obamacare to $14,600 under the Republican plan." Did you see that-an increase from $1,700 to $14,600...
The semester is quickly drawing to a close, but the bill could be a basis for an interesting class discussion on social policy, if you have time.
Monday, March 20, 2017
Wonder what is in the new health care bill? New Health Plan Broken Down appears in the Centre Daily Times on March 12, 2017. The article is written by Amos Goodall, a prominent elder law attorney (and graduate of Stetson's LL.M. in Elder Law). The article explains changes to the individual mandate (penalty repealed and replaced), preexisting conditions protection (none), age-based premiums (5:1 ratio & will be up to states which ration), cost-sharing subsidies (will be eliminated), over the counter drugs (adding reimbursement from HSA, FSA or Archer MSA), Medicaid expansion (changes financing) and per capita caps.
To read more about these and other proposed changes, click here.
Thanks to Amos for sending me the link to the story.
Thursday, March 16, 2017
Today is Call Congress About Medicaid day. Here is the information from the Medicare Rights Center:
Tell Congress to protect our care by joining today’s national call-in day. Urge your representative to vote “no” on the American Health Care Act... Call 866-426-2631 to contact your member of Congress.
The message is to vote no for changes to Medicaid and Medicare. The Medicare Rights Center also offers a one page issue brief on the proposed changes to Medicare, available here.
Regardless of your views, it is always important to make your voice heard.
Thanks to Kim Dayton, the elderlawprof blog founder, for sending me a note on this.
Friday, March 10, 2017
NBC Nightly News ran a story on March 8 about Medicare Observation Status and the Notice Act. Law Aims to Protect Medicare Patients from Surprise Hospital Bill explains the hospital's disclosure requirement for patients and notes that a bill has been introduced to once and for all solve the problems caused when patients are on observation status. "A bill reintroduced Wednesday by Congressman Joe Courtney, D-Connecticut, would make days spent "under observation" count towards qualification for Medicare coverage." The story featured comments from Judy Stein, executive director of the Center for Medicare Advocacy and former NAELA President (full disclosure, I serve of the Center's board).
Monday, March 6, 2017
The New York Times recently reported the death of Dorothy Rice whose work affected so many elder Americans. Dorothy Rice, Pioneering Economist Who Made Case for Medicare, Dies at 94 explains "Mrs. Rice was an analyst at the Social Security Administration when its study on aging highlighted how about half the population 65 and over had no health insurance — and that those who needed it most were the least likely to be able to afford it."
She wrote a Social Security bulletin in 1964 that described the need for Medicare, how the number of older Americans who were not covered by health insurance "'include disproportionate numbers of the very old — particularly women — those in poor health, and those no longer engaged in full-time employment.... The high cost of hospital and nursing home care, she added, 'presents special problems for the aged because of their large and often unexpected bills.'"
She was instrumental in estimating costs and learning about the requirements of elder Americans for health care.. Thank you Mrs. Rice.
Thursday, March 2, 2017
Kaiser Health News ran a story about specialized 911 responders for those under hospice care. For Some Hospice Patients, A 911 Call Saves A Trip To The ER explains a project in Fort Worth where
Fort Worth paramedics [are] trained for this type of hospice support — part of a local partnership with VITAS Healthcare, the country’s largest hospice organization — is to spend a longer stretch of time on the scene to determine if the symptoms that triggered the 911 call can be addressed without a trip to the emergency room. MedStar Mobile Healthcare, a governmental agency created to provide ambulance services for Fort Worth and 14 nearby cities, is one of several ambulance providers nationwide that have teamed up with local hospice agencies. The paramedic backup, enthusiasts argue, not only helps more hospice patients remain at home, but also reduces the potential for costlier and likely unnecessary care.
The article reports that almost 20% of hospice patients make a trip to the ER and this specialized paramedic may help the patient to avoid that trip. The article explains that these specialized paramedics are known as "community paramedics [and] they can offer a range of in-home care and support for home health patients, frequent 911 callers and others to reduce unnecessary ambulance trips."
The article explains how this works, noting that the community paramedic is dispatched along with other paramedics. The community paramedic provides many patients with an alternative to a trip to the ER.
Patients or their family members can still insist on going to the emergency room, and sometimes they do. Of the 287 patients enrolled in Fort Worth’s program for the first five years — all of whom had been prescreened as highly likely to go to the hospital — just 20 percent, or about 58 patients, were transported, according to MedStar data. In Ventura, ambulance transports for hospice patients calling 911 also have declined — from 80 percent shortly before the program’s start to 37 percent from August 2015 through December 2016 .....
Wednesday, February 8, 2017
Justice in Aging has released two new issue briefs concerning the new nursing home regs. One is on involuntary transfers and discharges and is available here. The other is on unnecessary medications and antipsychotic meds, and is available here. The briefs were done with the Center for Medicare Advocacy and the National Consumer Voice for Quality Long-Term Care.
Here's the executives summary for the transfer/discharge brief
The involuntary transfer/discharge regulations have changed, but not dramatically. Facilities still can force a transfer/discharge only under one of six specified circumstances, and a resident continues to have the right to contest a proposed transfer/discharge in an administrative hearing. The revised regulations narrow the facility’s ability to base a transfer/discharge on a supposed inability to meet the resident’s needs, by requiring increased documentation by the resident’s physician. The regulations also limit transfer/discharge for nonpayment, by stating that nonpayment has not occurred as long as Medicaid or another third-party payor is considering a claim for the time period in question. All transfer/discharge notices must be sent to the resident, resident representative(s), and (in a new requirement) the Long-Term Care Ombudsman program. The revised regulations now explicitly state that a facility cannot discharge a resident while an appeal is pending.
Here's the executive summary for the medications brief:
Regulations about unnecessary drugs and antipsychotic drugs have been moved from the quality of care section to the pharmacy services section. Some provisions have been moved but not otherwise changed: these include protection from unnecessary medications, requirements for gradual dose reductions, and the use of behavioral interventions in order to discontinue drugs, "unless clinically contraindicated." In addition, the pharmacy services regulation includes a new discussion of a broader category of psychotropic drugs, along with new controls over "as needed" (PRN) psychotropic drugs. The revised regulations also expand requirements for drug regimen reviews.
These and the first brief in the series are available here.
Sunday, February 5, 2017
As mentioned in a recent post, the observation status case was headed back to court. The February 2, 2017 opinion resulted in a favorable decision requiring corrective action. The Center for Medicare Advocacy released the following Court Orders Corrective Action Plan for Government's Noncompliance with Settlement in Jimmo v. Burwell explaining that the judge has "ordered the Secretary of Health & Human Services to carry out a Corrective Action Plan to remedy the Department’s noncompliance with the Settlement." What's included in this corrective action plan?
The judge ruled that the Corrective Action Plan will include a new CMS webpage dedicated to Jimmo, a published Corrective Statement disavowing the improvement standard, a posting of Frequently Asked Questions (FAQs), and new training for contractors making coverage decisions. In addition, and significantly, the Court largely adopted the Corrective Statement drafted by plaintiffs, and ordered the Secretary to conduct a new National Call to explain the correct policy.
The opinion is available here. Great job CMA! (in the interest of full disclosure, I'm on the CMA board)