AMA adopts new policies on disabled patient care

AMA supports reforms for disabled patients: The AMA passed new policy supporting Medicaid reforms that would provide disabled patients with equal access to home and community-based services so that they can live as independently as possible. The AMA supports passage of congressional legislation, the Community Choice Act of 2007, that would achieve these goals. This policy was recommended to the AMA by the American Academy of Physical Medicine and Rehabilitation and the American Association of Neuromuscular and Electrodiagnostic Medicine.

“People with disabilities who rely on Medicaid should not have to choose between the important care they need and the ability to live independently,” said AMA Board Member Rebecca J. Patchin, MD. “We support Medicaid reforms so that disabled patients, together with their physicians, can decide where the best place is to receive medical care and support based on patients’ individual needs.”

WSJ Examines Increasing Efforts To Assist Care Providers

The Wall Street Journal on Wednesday examined efforts to provide assistance to an estimated 45 million adults in the U.S. who care for a family member with a severe or long-term illness. According to the Journal, "care giving responsibilities can exact a drastic emotional, physical and financial toll" on people who look after an ill or aging relative, which can lead to "high rates of depression, stress and other physical and mental health problems."

However, the Journal notes that increasing evidence has shown that caregivers can better handle their responsibilities and the accompanying stress when they are provided with counseling and support group opportunities, in-home skills training and additional help. Some advocacy groups currently are lobbying for increased federal funding for caregiver assistance programs, and some experts are calling for formal evaluation programs that health care groups can use to determine what kind of support caregivers might need, according to the Journal. In addition, more hospitals are offering caregiver services and social worker assistance to family members when their relatives are discharged. Experienced caregivers also are "being tapped to help others new to the role," the Journal reports (Landro, Wall Street Journal, 11/28).

Long-Term Service and Supports: The Future Role and Challenges for Medicaid

This report examines the structure and impact of Medicaid’s role in long-term care. Based on a roundtable discussion of policy makers and experts and drawn from a body of health services research, the report highlights policy challenges facing the Medicaid program today and identifies issues in providing long-term care going forward. By gathering evidence to address key policy issues, such as integrating services, benefit design, quality monitoring and financing, the report can serve as a foundation for the current and ongoing policy debate regarding Medicaid’s future role as a provider of long-term care services and supports for low-income elderly and disabled Americans. Report (.pdf)

http://www.stickershockmusic.com/2007/11/27/startups-hoping-to-reach-maturity/

A year ago, I couldn’t turn around at startup events without bumping into someone launching a social-networking business.

They knew it was the next big thing and a great opportunity to connect with a young demographic sought by advertisers. Now it seems the market is maturing. Literally.

As in, everywhere I go lately, I meet someone starting a company targeting the older population.

This isn’t about more gadgets for grandma and grandpa.

The new thing is services, online and off, aimed at people entering the senior phase of life and seeking help, advice and tools to navigate the transition.

These entrepreneurs see opportunity to reduce friction and complexity in this market, just as others have done with online travel and retail, using tools and processes honed by tech companies.

Managing The Chronic Care Of Patients Is Not Being Captured In Today's Reimbursement System

Full time physicians spend an average of one full day a week providing services for patients that are not reimbursed by Medicare, according to a new study conducted by Jeffrey Farber, MD, Assistant Professor of Geriatrics at The Mount Sinai Medical Center, and published in the journal Annals of Internal Medicine.

The study results could potentially prod insurance companies and Medicare to catch up to physicians' current levels of productivity by reimbursing them for the care that is increasingly taking place outside of formal office visits.

"These services that are going un reimbursed are not unusual or luxury services," explained Dr. Farber. "These are basic elements of good patient care and include such things as talking with adult children, managing pain over the telephone, calling pharmacies, coordinating home care services like physical therapy and visiting nurses, and ordering equipment like canes and wheelchairs."...

AARP: CMS Publication of Poor Performing Nursing Homes a Good First Step

WASHINGTON— AARP Legislative Counsel David Certner made the following statement today in response to the Centers for Medicare and Medicaid (CMS) announcement regarding poor performing nursing homes in the Special Focus Facility (SFF) program:

“Residents in the poorest performing nursing homes and their families have a right to know that the care they receive may be sub-standard. Earlier this year AARP called on CMS to release this information, and we are pleased CMS has agreed. People in need of 24-hour care should not have to be concerned that their nursing home is a potentially harmful environment. This information will also be helpful to individuals and their families who are looking to choose a quality facility.

AHCA Questions for the Candidates

The entire long term care profession is concerned with the way in which long term care will be legislated and regulated in the coming years and is eager to hear how the candidates will address the care needs of an Aging America. AHCA/NCAL encourages the candidates to discuss the long term care needs of our nation and to consider the following questions.

Questions for Presidential Candidates:

1. The Medicare and Medicaid systems have come under increasing pressure at a time when the population is aging. Do you believe the U.S. can afford to cut these safety net programs as a means of balancing state and federal budgets?
   
2. Most Americans do not understand that health insurance and Medicare do not cover the cost of long term care services. Presently, nearly two-thirds of the residents in America's nursing homes rely on Medicaid. Do you believe that we need to encourage personal responsibility with the purchase of long term care insurance to take the pressure off the Medicaid program? If yes, how do we achieve this?
   
3. We all know that there are 77 million aging baby boomers rapidly nearing retirement – they have changed every aspect of our culture during their lives, and it is clear that they will also have a significant impact on our long term care system. What should the nation's long term care system look like in order to meet this population's clinical health care needs and very specific preferences?
   
4. With the recent trend to move the frail and elderly out of nursing facilities and into home- and community-based care, what sort of oversight system should be in place to ensure that those vulnerable populations are receiving the care and services they require--and that those services are of a high quality? Do you believe that all individuals who are frail and elderly can receive the around-the-clock care that they may require in the home or community?
   
5. In cases where individuals who are frail and elderly outlive their savings and are too sick to manage on their own, what do you see as the most practical way to pay for their care? Where should they be housed?....

Apathy and Insubordination in Long-Term Care Facilities

The causes of apathy and insubordination in long-term care facilities are numerous. The following article approaches some of these causes with the understanding that the medical care of the residents in these facilities is at stake, and apathy and insubordination undermines efforts to provide medical attention to these individuals. Many long-term care facilities in America today do not staff by acuity of resident needs, and this is one of the leading causes of such apathy and insubordination among staff members. Nurses and Nursing Assistants are left to work with large numbers of residents and a minimum of fellow medical staff, resulting in lack of patient/resident medical treatment.

Another issue is the ever increasing amount of paperwork...

AARP Reinvents Its Member Newsletters

ecently AARP began making over its member newsletters, which are customized and distributed in each of the fifty states, along with Washington, D.C., the Virgin Islands, and Puerto Rico. We’ve been editing and producing these newsletters for the past year and a half, and have learned our share of lessons about what works and what falls short.

The goal of the cover story, says Pete Wiley, manager for AARP state member communications, “should be to draw an uninterested member” into a newsletter “in a few seconds.”

Based on AARP’s revamped model, here are guidelines that will help any organization craft a sharper, more sophisticated publication.

• Focus on hard news, not staff picnics. Readers are eager to learn about the ways in which often complex legislation affects them. The redesigned newsletter presents concise stories with digestible facts on long-term care legislation, tax breaks, and various programs for low- and moderate-income residents. Most important, the stories conclude with calls-to-action, including Web links, e-mail addresses, and phone numbers that members can use to learn more.
• Use quotes, and conduct interviews with third-party experts—not internal staff. If Republican and Democratic legislators have cooperated on a bill to improve long-term care,.....

Bill Would Allow Tax-Exempt Long-Term Care Insurance Premium Payments

A bipartisan group of senators last Tuesday introduced a bill that would allow employees to pay long-term care insurance premiums with pre-tax dollars, CQ HealthBeat reports. Under the Long-Term Care Affordability and Security Act -- sponsored by Sens. Chuck Grassley (R-Iowa), Blanche Lincoln (D-Ark.), Olympia Snowe (R-Maine), Debbie Stabenow (D-Mich.) and Gordon Smith (R-Ore.) -- employers could offer long-term care insurance under so-called cafeteria plans, which allow employees to select from a number of tax-exempt benefits, as well as flexible spending accounts.

Transforming Hospitals: Designing for Safety and Quality

Transforming Hospitals: Designing for Safety and Quality, a DVD from the Agency for Healthcare Research and Quality (AHRQ), reviews the case for evidence-based hospital design and how it increases patient and staff satisfaction and safety, quality of care, and employee retention, and results in a positive return on investment.

This summary discusses evidence-based design, patient safety and satisfaction, quality outcomes, staff satisfaction and retention, and cost effectiveness.

Select to order the DVD.

Select for print version (PDF File, 419 KB). PDF Help.

Caring for an elder exacts financial toll

The out-of-pocket cost of caring for an aging parent, spouse or loved one averages about $5,500 a year, according to the nation’s first in-depth study of such expenses, a sum that is more than double previous estimates and more than the average American household spends annually on health care and entertainment combined.

Family members responsible for ailing loved ones provide not only “hands-on” care but often reach into their own pockets to pay for many other expenses of care recipients, including groceries, household goods, drugs, medical co-payments and transportation. That nudges the average cost of providing long-distance care to $8,728 a year.

Poll Shows Long-Term Care An Issue In Presidential Election

More than eight out of 10 people want long term care included in the agenda of presidential candidates, according to a poll by Public Opinion Strategies and the Mellman Group.

It also showed that nearly 70 percent of respondents have not prepared for the long-term care of their family or themselves. However, half of the polltakers indicated that they have known someone who has needed such care.

The poll results also suggested that Americans are willing to aid in long-term care programs at the state and national levels. More than half of the respondents agreed that payroll deductions for such programs would be allowable.

Washington Scrutinizes Nursing Homes

WASHINGTON, Nov. 15 — Lawmakers in two hearings on Thursday proposed ways to force nursing homes to provide more details about ownership and to hold those owners more accountable when problems emerge.

The hearings were prompted in part by concerns that quality at nursing homes was declining as large chains were acquired by private investment groups.

Members of the House Ways and Means Health Subcommittee and the Senate Special Committee on Aging proposed measures to require nursing homes to disclose ownership and to require regulators to release information about poorly managed homes.

Kerry N. Weems, the acting administrator of the Centers for Medicare and Medicaid Services, which regulates nursing homes, offered several initiatives to improve oversight. His suggestions included releasing the so-called special focus facility list, which identifies homes that regulators consider among the nation’s worst. That list, which will be released Dec. 1, has not been public.

Info Long-Term Care

This is a blog developed by a librarian about LTC information. Some interesting articles.

Creating The Most Comprehensive Long-Term Care Database

More than 1.4 million Americans live in nursing homes today. By 2020, an estimated 12 million will need long-term care, whether in a nursing home, assisted living facility, chronic care hospital or from an at-home health service provider.

At this time of skyrocketing demand for long-term care, the National Institute on Aging has awarded Brown University a major grant to create the first research database aimed at improving the nation's long-term care system -- and the lives of the elderly who rely on that system to eat, take medications and carry out other tasks of daily living.

Vincent Mor, chairman of the Department of Community Health at Brown and a member of the University's Center for Gerontology and Health Care Research, is principal investigator on the five-year, $10-million grant. Mor and his team will take existing federal data on Medicare reimbursement claims, patient hospitalization rates and other data and combine it with new information the team will collect on the health status of residents, reimbursement rates for long-term care services, the organization of those services, and other topics from a random sample of 2,600 nursing homes across the country. The group will also collect information on relevant policies from all 50 states.

FDA Seeks To Include Those Most Affected By Alzheimer's Disease In The Drug Review Process

The U.S. Food and Drug Administration (FDA) has expanded its Patient Consultant and Patient Representative programs to include individuals in the early stages of Alzheimer's disease and their caregivers. The FDA made the change in response to a request by the Alzheimer's Association encouraging the agency to give people directly affected by Alzheimer's a more active role in the review and approval of new Alzheimer drugs.

"People who are living with this terrible disease have much to offer to the pharmaceutical industry, researchers and government regulators, and their voices must be heard," said Harry Johns, president and CEO of the Alzheimer's Association. "We are pleased that the FDA understands the value of involving Alzheimer families in regulatory decisions that affect them and appreciate that the agency was so responsive in expanding their patient consultant program."

Stark Announces Hearing on Trends in Nursing Home Ownership and Quality

House Ways and Means Health Subcommittee Chairman Pete Stark (D-CA) announced today that the Subcommittee will hold a hearing to examine the effect of nursing home ownership trends on nursing home quality and accountability. The hearing will take place at 10:00 a.m. on Thursday, November 15, 2007, in Room 1100, Longworth House Office Building.

In view of the limited time available to hear witnesses, oral testimony at this hearing will be from invited witnesses only. However, any individual or organization not scheduled for an oral appearance may submit a written statement for consideration by the Subcommittee and for inclusion in the printed record of the hearing.

AMA Adopts New Policies On Disabled Patient Care

AMA supports reforms for disabled patients: The AMA passed new policy supporting Medicaid reforms that would provide disabled patients with equal access to home and community-based services so that they can live as independently as possible. The AMA supports passage of congressional legislation, the Community Choice Act of 2007, that would achieve these goals. This policy was recommended to the AMA by the American Academy of Physical Medicine and Rehabilitation and the American Association of Neuromuscular and Electrodiagnostic Medicine.

"People with disabilities who rely on Medicaid should not have to choose between the important care they need and the ability to live independently," said AMA Board Member Rebecca J. Patchin, MD. "We support Medicaid reforms so that disabled patients, together with their physicians, can decide where the best place is to receive medical care and support based on patients' individual needs."

Choice Cuts Costs in Medicaid Programs

States are finding choice is one way to cut costs as America ages.

Policymakers are learning citizens want choice when it comes to long-term care of the graying population.

Marc Gold, director of the Promoting Independence Initiative in the Texas Department of Aging and Disability Services, said the cost of nursing home care is about twice the cost of similar services in community-based care.

“Community care is not only about human choice, not only about individual choice, not only about quality of life, or quality of care,” he said. “Not only is it the preferred model. It’s about saving money.”

Dirty Dealings

With that brief background of Antitrust law in mind, what do you folks think about this little deal between Omnicare and Manor Care?
Omnicare and Manor Care formed a partnership on February 16, 1994, called Heartland Healthcare Services. The partnership is still in place, and is operated through a management committee consisting of three Manor Care Executives and three Omnicare Executives (Manor Care 2006 10K).
In its short history, Heartland has established an institutional pharmacy in Toledo, Ohio supporting Ohio and Michigan HCR facilities and two institutional pharmacies in Florida serving HCR and other long-term facilities.
This cozy partnership also includes the Heartland Repack Services, which they recently shut down after a fire, a massive recall (119 pages of recalled drug NDCs), and a damning FDA Warning Letter. - Related Article: Repackager's Recall Could Lead to FDA Visit.
Omnicare contracted with Cardinal to handle Heartland's Repackaging.
Earlier this year, Manor Care agreed to be acquired by private-equity giant Carlyle Group in a $6.3 billion deal (Manor Care Finds a Buyer). In this deal Manor Care will be absorbed by a Carlyle Group entity, ManorCare Health Services, Inc. ("MCHS") (Special Meeting Demand).
But now,what seemed to be a done deal, is coming under increased scrutiny - Florida lawmakers and a union are questioning a private equity firm's pending purchase of the nation's largest nursing home chain.
We learned recently that UnitedHealth received a Subpoena regarding Omnicare patient steering. You don't suppose that subpoena has anything to do with the Heartland partnership?
Do you suppose this Heartland partnership violates anti-trust laws? Do you think that the Long term Care Facilities which make up this partnership might be more than happy to pay inflated prices for drugs which are provided through this little off-the-books joint venture?

American Association For Homecare Disputes Validity Of Internet Power Wheelchair Prices

The American Association for Homecare vigorously disputed the validity of using Internet prices for power wheelchairs as a basis for setting reimbursement rates for power wheelchairs provided to seniors and disabled beneficiaries in Medicare.

The Association outlined its concerns in letters sent to Daniel Levinson, Inspector General for the U.S. Department of Health and Human Services Office of Inspector General (OIG), and to Congressman Pete Stark (D-Calif.), who chairs the House Ways and Means Subcommittee on Health.

On October 30, the OIG issued a report titled, "A Comparison of Medicare Program and Consumer Internet Prices for Power Wheelchairs," which concluded that, "Medicare and its beneficiaries could have achieved savings during the first quarter of 2007 had Medicare reimbursements more closely resembled prices available to consumers over the Internet." AAHomecare strongly questions the appropriateness of the OIG comparison and its policy implications for Medicare reimbursement rates.

Tyler J. Wilson, president of the American Association for Homecare, commented, "This study and the inappropriate comparison of Medicare and Internet pricing will be used by some members of Congress to justify further cuts to power wheelchair Medicare reimbursement rates and defend the new competitive bidding program. We urge Congress to evaluate Medicare reimbursement for power wheelchairs in the correct context."

In today's letters to both Inspector General Levinson and Congressman Stark, the Association made several points:....

LTC reform bill introduced in House

The level of discourse about improving the quality of long-term care rose to a new level Tuesday, when three members of the U.S. House introduced the Long Term Care Quality & Modernization Act of 2007 (H.R. 4082). Although there are no illusions in the provider community about quick passage for the sweeping reform measure, its unveiling had been anxiously anticipated since a companion bill was unveiled in the Senate in early August.

Advocates praised H.R. 4082 for its wide array of provider-friendly provisions. They say it would promote investment in health information technology and capital improvements. It also would encourage collaboration between nursing home providers and surveyors...

Nursing Home Residents Who Receive Eyeglasses For Correcting Poor Vision Experience Less Depression

A nursing home resident who gets eyeglasses for uncorrected refractive error is less likely to suffer from depression than one with refractive error who did not receive eyeglasses, according to an article in Archives of Ophthalmology (JAMA/Archives), November edition.

Refractive error results in blurred vision - the back of the eye does not get the right amount of light.

The authors explain "Nursing home residents in the United States and other industrialized countries have high rates of vision impairment, with estimates ranging from three to 15 times higher than corresponding rates for community-dwelling older adults. Studies suggest that vision impairment in about one-third of nursing home residents could largely be reversed by treatment of uncorrected refractive error (myopia [nearsightedness], hyperopia [farsightedness], presbyopia [loss of focus])."

Cynthia Owsley, Ph.D., M.S.P.H., University of Alabama at Birmingham, and team carried out a trial involving 142 nursing home residents, aged 55 or more. 78 residents were randomly assigned to a group that would get eyeglasses one week after check-up, while 64 received eyeglasses two months after check up (at follow-up). At two months vision-related quality of life and depressive symptoms were measured at baseline.

At baseline the two groups had similar demographic and medical characteristics - they also had similar visual acuteness and refractive error uncorrected by eyeglasses. Two months later, distance and near visual acuity for both left and right eyes improved in the group that had been given eyeglasses, while the other group had no improvement in visual acuity.

During the two-month follow-up, the eyeglass group had better scores for general vision, reading, activities/hobbies and social interaction - they also displayed fewer depressive symptoms.

Future LTC Costs of the War

The link goes to a pdf file from Physicians for Social Responsibility. It focuses on the LTC costs of TBI and PTSD in soldiers returning from Iraq.

no succor for vets once they're out of the suck

..[A]fter a string of damning reports and stinging congressional hearings, there is a rush to help these wounded warriors. A massive mobilization across the Defense and Veterans Affairs departments – with crucial assistance from veteran advocacy groups and nonprofit organizations – is under way to help veterans transition from combat to civilian life.

The result is a cornucopia of services that remains extraordinarily difficult to navigate, even with perseverance and the help of others who know how to work the system.
..
Better medical technology, improved treatment techniques and beefed-up armament means soldiers survive wounds that would have killed them in past wars. Using a narrow definition, the Defense Department reports that more than 28,000 troops have been wounded in Iraq, while just over 3,100 died from combat wounds.
For good order, the DoD numbers are bullshit. According to a Harvard study (pdf), as of January 2007, 152,669 servicemen had applied for disability benefits - far more than the DoD's 28,000 wounded figure, even if half of the applicants were pure PTSD claims (which they're not: "Some 20% have suffered brain trauma, spinal injuries or amputations; another 20% have suffered other major injuries such as amputations, blindness, partial blindness or deafness, and serious burns.").

Elder Caregiving Site Wins WebAward for Outstanding Online Community

The ShirleyBOARD website, has been recognized by the Web Marketing Association (WMA) for Outstanding Achievement in Website Development by being honored with the Online Community Standard of Excellence WebAward Designation.

ShirleyBOARD is a free online community with tools and features to help those caring for aging loved ones stay organized and communicate with one another. The site allows caregivers to centrally store important information, keep a log of daily activities for family and friends to view, and network with other caregivers for support and inspiration.

Some of the tools include: Online Journal to keep a record of caregiving activities; Photo Keeper for sharing photos; The PillBox to record prescription information, including names of medicines, dose sizes, etc; Document Keeper for uploading wills, power of attorney forms and other documents that you need to keep track of; and, Be a Peer/Find a Peer for users to search for fellow caregivers to get assistance or just connect to ask questions and share tips and stories.

Boomers Not Planning for Parents’ Care

Nov. 8, 2007 -- Baby boomer women are concerned about how to care for their aging parents, but few are planning for it, according to a survey released Thursday by AARP.

The telephone survey included 629 women aged 45 and older with at least one living parent. It was conducted in October 2007.

Almost seven in 10 women surveyed by AARP said they were somewhat concerned or very concerned about their parents' ability to live independently as they age. But just four in 10 said they or their parents had begun to plan living arrangements, whether that means living at home, in a new place, or in a care facility.

"These are difficult conversations, but they are very important conversations," Elinda Ginzler, AARP's director of livable communities, told reporters.

Union, lawmakers challenge sale of Manor Care nursing homes

TALLAHASSEE, Fla. (AP) -- Some Florida lawmakers and a union are questioning a private equity firm's pending purchase of the nation's largest nursing home chain, demanding answers about how it will affect the 3,000-plus residents in the chain's 29 homes in this state.

The lawmakers and the Service Employees International Union are asking that state regulators closely examine Carlyle Group's plan to take over Manor Care Inc. The $4.9 billion buyout, which has already been approved by Manor Care shareholders, is also being examined by officials and lawmakers in other states.

New Survey Finds One In Four Baby Boomers Erroneously Believe They Have Coverage For Long-Term Care Expenses

One in four Baby Boomers erroneously believe they have coverage for long-term care expenses, according to new survey data released by America's Health Insurance Plans (AHIP). The survey found that many Baby Boomers have misconceptions about who pays for long-term care services and have not thought about long-term care insurance.

"This should be a wake-up call to Baby Boomers. They aren't factoring expenses for long-term care into their retirement planning and are missing an opportunity to protect themselves," said Karen Ignagni, President and CEO of AHIP.

Creating an Ethical Workplace

AAHSA members have moral responsibilities as caregivers, employers and members of the community. More specifically,
the AAHSA mission, vision and ideals suggest that its members have at least a tri-fold responsibility to provide
high-quality services to those in need, meaningful work and an ethical workplace for employees. These expectations
spring from AAHSA’s central value of respect for all persons; therefore, it is appropriate that the Association and the
Commission pay considerable attention to workforce issues. The increasing number, diversity and significance of issues
related to our workforce underscores workplace ethics as a compelling priority.
Issues related to our staff have moral significance. The term “workforce” considers all talent within our housing, care
and service system—encompassing direct-care workers, service coordinators, housekeeping staff, geriatricians, nurses,
pharmacists, therapists and administrators. We believe that all staff members are truly the heart and soul of homes and
services for the aging.
We begin our exploration of.....

H.R. 3582 The Fair Home Health Care Act: An Analysis

H.R. 3582 offers Congress an historic opportunity to send three important economic and
social signals:
1. Homecare workers should be on an equal footing with respect to all other low‐wage
occupations.
2. Within long‐term care, the homecare labor market should not have second‐class status
with respect to compensation and, therefore, with respect to its ability to attract and
retain workers.
3. Federal lawmakers can work together to coordinate, rather than send conflicting
messages about, the direction of our nation’s long‐term care policy.

Employer Support For Long Term Care Insurance Grows

More than 90 percent of employers offering long term care insurance at the workplace are willing to help pay for the benefit, Unum (NYSE: UNM) reveals in its second annual Landscape of Long Term Care. This is a dramatic shift from the 100-percent employee-paid coverage that represented most of the market in earlier years.

"The increasing awareness and need for long term care services is propelling the sales momentum in the workplace," says John Noble, director of long term care products for Unum, the leading provider of this benefit. "Unum's sales premium is up 26 percent in the first half of the year. Even more dramatic is that we saw a 54 percent increase in new enrollees."

Costco, Unum's largest group long term care customer, was a pioneer in recognizing the value of employer-sponsored long term care insurance. Costco added the coverage eight years ago and currently enrolls 23,000 employees in the plan.

Independent Consumer Group Launches Free Interactive Resource To Help Older And Disabled South Carolina Residents Navigate Medicare

Medicare Interactive Counselor, an online educational tool now includes health information and resources specific to South Carolina. This web-based resource provides easy-to-understand answers to questions posed by the millions of older adults and people with disabilities who rely on Medicare for health insurance. For the first time, older adults and people with disabilities across the state, as well as caregivers and professionals, can access expert, unbiased guidance that is tailored to residents of South Carolina at no charge.

Medicare Interactive Counselor is designed to help people with Medicare navigate the health coverage maze. A service of the Medicare Rights Center-a nonprofit organization that is the largest independent source of health care information and assistance in the United States for people with Medicare-Medicare Interactive Counselor draws from the experience and best practices of real-life counselors.

http://www.medicarerights.org/help.html

Congress Called On To Replace 'Devastating' Cuts In Medicare Reimbursements

The American College of Physicians (ACP) renewed its call on Congress to replace the 10.1 percent devastating cuts in Medicare reimbursements set to take effect Jan. 1 with at least two years of positive updates that are paid for in a way that does not make the problem worse in future years. The organization of 124,000 internal medicine physicians, related subspecialists and medical students reacted to the final physician fee schedule published late last Thurs. by the Centers for Medicare & Medicaid Services (CMS).

"The cuts will accelerate the collapse of primary care, create access problems and manufacture obstacles to fundamental reform of physician policies," emphasized ACP President David C. Dale, MD, FACP. "It is essential that lawmakers agree on an immediate fix that will provide positive and stable updates, support patient-centered care coordinated by a personal physician, and create the building blocks for long-term reform of a flawed payment system."

House Hearing Focuses On Bush Administration Cuts To Medicaid

A House Oversight and Government Reform Committee hearing on Thursday examined six rules proposed by HHS that would affect matching funds for state Medicaid programs, CQ HealthBeat reports. According to committee Chair Henry Waxman (D-Calif.), the six proposals would restrict coverage of rehabilitation services for those who have disabilities and are eligible for Medicaid; eliminate the ability of schools to help enroll eligible children in Medicaid; eliminate Medicaid funding for schools that provide Medicaid services to severely disabled children; limit the services states can cover under Medicaid outpatient programs; eliminate Medicaid payments for graduate medical education; and limit how states can raise money to pay their portion of Medicaid costs.

Waxman said the rules are part of a "thinly disguised assault of the health care safety net," also calling them "lawless regulation, not anchored in statute" (Reichard, CQ HealthBeat, 11/1). Bush administration officials say the regulations are needed to keep the states from overbilling the federal government. Congress has passed a one-year moratorium on one of the regulations, and legislation proposed by Rep. Eliot Engel (D-N.Y.) would extend the moratorium. Witnesses at the hearing urged Congress to work to prevent the rules from being implemented (CongressDaily, 11/1). Comments
Dennis Parella, chair of the National Association of State Medicaid Directors, said a "retrenchment by Medicaid will only make ... struggles more difficult for millions of Americans at a time when no comprehensive health care system is even on the horizon," adding that "it is surprising that this philosophy" of fiscal conservatism "should come when most experts in the field would say that the nation's health care system is in a state of crisis." Many local officials testified about the impact the rules would have (CQ HealthBeat, 11/1).

Caring For Aging Parents: 10 Things To Know For An Emergency

Aging parents may not be able to provide vital information to health care providers caring for them during a medical emergency. Mayoclinic.com provides caregivers with a helpful list of 10 things they need to know about caring for aging parents' health, and discusses some signs that warn of a health problem in aging parents.

"Sometimes a parent isn't able to give medical information when an emergency arises, so emergency medical personnel must rely on the adult children or a spouse for that information," says Paul Takahashi, M.D., a specialist in geriatrics at Mayo Clinic in Rochester. "These are things you should know. Just as you fill out those emergency cards for your kids in school, you should have similar information available about your parents or for whomever you are the caregiver."

MayoClinic.com also provides a downloadable emergency medical information form to use for unexpected emergencies, and the Senior Health Center on MayoClinic.com provides a host of other information on wellness, lifestyle, and health.

Info on Employer based LTC insurance

IMPACT5 OF BENEFIT PORTING ON LTC COSTS

For an employer self-funding long-term care (LTC) employee benefits, cost is typically the biggest concern. There are several cost-saving features that can be implemented such as waiting and vesting periods, cost sharing and underwriting, to name a few. However, there is another implicit element that could have a large impact on program costs.

In a program where the employer is paying for the benefit and employees have a choice of continuing to participate in the program upon termination,(what we refer to as "porting" coverage), the porting rate has a critical impact on plan costs. If all departing employees decide to port the benefits upon termination, this is significantly more expensive for the employer than if no one ports the coverage.

If employees are paying for the program, we would expect porting rates (and therefore cost) to be high among participants, although participation rates would most likely be lower.

What is a Porting Rate?
Porting rates represent the probability that an individual will choose to continue to participate in the LTC coverage upon employment termination. This also implies that the employee will be financially responsible for part or all of the premium from then on. This is the main reason why porting rates are generally very low for employer-paid coverage.

Why Port?
The following issues may impact employees' decision on whether to port their LTC coverage upon termination:
* employee education on the subject of long-term care,
* cost of the coverage for separating employees,
* convenience of making the transition to ported coverage, and
* health status and age at the time of departure.

At termination, an employee in an employer-paid LTC program has to make a decision on whether to drop or pay for LTC coverage. For employees not porting their LTC coverage, obtaining new coverage on the market would be priced based on the older age at which the coverage is now sought. Note also that full underwriting would be required, resulting in some applicants being denied coverage. Waiting until the need is imminent will generally result in coverage becoming unavailable as applicants can not pass underwriting. Despite this, due to the lack of financial commitment to the benefit, many employees drop the coverage.

The Never Ending Tradeoff
Porting rates tend to increase with employment longevity and age due to the greater value of the benefit priced at younger ages, as well as greater awareness of the importance of long-term care coverage. Additionally, an increase in porting rates indicates that the benefit will have greater value to the employees. Porting rates represent the most sensitive assumption in estimating the financial needs of an employer sponsored LTC program, and is the most critical distinguishing element between a voluntary product and an employer-paid benefit. Correctly reflecting low levels of future benefit porting can reduce plan costs significantly as compared to pricing that does not account for this. Incorrectly reflecting higher levels of porting, however, is a risk in setting the contribution rates. Careful monitoring of this experience is critical.

Since there is a fine balance between providing meaningful benefits and paying a reasonable cost, one compromise is for employers who self-fund to explore ways to encourage longer-term employees to port the coverage more than shorter-term employees. "Concentrating" the benefits this way can keep the costs down some, but still encourage the most valued employees to make the best use of the benefit since this coverage becomes truly useful after retirement age.

Note! For an essential perspective about true group long-term care, please refer to the book True Group Long-Term Care by Milliman's consulting actuaries Jon Shreve and Jill Van Den Bos (published by the International Foundation of Employee Benefit Plans). We also provide a variety of resources for true group long-term care, such as informative white papers and articles, on our website at www.milliman.com/denver.

Medicare Bidding For Durable Medical Equipment Will Harm Small Businesses And Seniors' Access To Care

The Medicare bidding program for durable medical equipment will hurt small providers and "undermine the nation's homecare infrastructure" unless Congress modifies the program. This is the key message that will be presented to a congressional subcommittee today by the American Association for Homecare. The Association believes the bidding program will "jeopardize patients' standard of care, choice of provider, and access to the medical equipment and services they need."

Georgie Blackburn, vice president at Blackburn's, a homecare provider in Pittsburgh, Pa. and a board director at the American Association for Homecare, will testify on behalf of the Association on October 31 before the U.S. House Small Business Subcommittee on Investigations and Oversight.

Blackburn will testify that under the bidding program, "Those who are not selected as winning bidders will not be able to provide competitively bid equipment or services to Medicare beneficiaries. Since Medicare payments typically comprise 35 to 50 percent of a small provider's revenue, losing the ability to provide competitively bid items for a three-year contract period is essentially a death knell."