Affordable Care Act tests home care for Medicare patients

Health care reform law aims to improve care,
lower costs for seniors and people with disabilities.

House Call

The Problem

3-4 million seniors living with multiple chronic illnesses such as diabetes, lung and heart disease are too ill or disabled to easily visit their physician when they need care. Instead, they go to the ER or are hospitalized. These seniors represent about 10% of Medicare beneficiaries but account for two thirds of Medicare’s expenditures, and it’s a problem that’s not going away. The number of people with multiple chronic illnesses will grow to 6-8 million by 2025.

The Solution

House calls, directed at these highest cost patients first, are a solution to the rising Medicare costs. The average $1,500 per ER visit, for example, can more than justify the cost of 10 house calls. Savings are even greater for avoided hospitalizations. Home-based primary care programs have the potential to save 20-40% on Medicare’s most expensive patients by bringing them care in their homes. But this is a new and relatively unproven healthcare delivery model.

Testing the Solution

The Independence at Home Demonstration, authorized by the Affordable Care Act, will test the viability of a new service delivery model that utilizes physician and nurse practitioner directed primary care teams to provide services to certain Medicare beneficiaries in their homes. Up to 10,000 Medicare patients with chronic conditions will now be able to get most of the care they need at home.

“This program gives new life to the old practice of house calls, but with 21st Century technology and a team approach,” said Marilyn Tavenner, Centers for Medicare & Medicaid Services (CMS) Acting Administrator.

The new Independence at Home Demonstration greatly expands the scope of in-home services Medicare beneficiaries can receive. It’s a voluntary program for chronically ill Medicare beneficiaries that will provide them with a complete range of primary care services.  Read More …

Obamacare: What’s at Stake if it’s Repealed

Obamacare Pre-existing ConditionsBy Kathleen Sebelius, Secretary of Health and Human Services

More than three years ago, Congress passed the Affordable Care Act and President Obama signed it into law. Last year, the Supreme Court upheld it. Millions of Americans have already benefited from its provisions, and millions more are looking forward to benefits that will soon go into effect. And in November, the American people re-elected the president as an affirmation of the law’s promise that no person should go broke if they get sick.

Yet today, for nearly the 40th time since it’s been the law of the land, House Republicans staged yet another repeal vote in their latest attempt to turn back the clock on progress and deny Americans health insurance coverage they can count on.

For the 37th time, Congress is voting to repeal the health care law, the Affordable Care Act.
Learn what’s at stake for Americans if the law were repealed.

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Why High Medical Bills Are Killing Us

TIME magazine coverIn his 38-page TIME magazine special report, “Bitter Pill: Why Medical Bills are Killing Us,” Steven Brill dives into our health care system to understand why things cost so much, avoiding the more traditional question of who pays for what. What he found was both disturbing and telling. (His 3:38 min video introduction is at the end.)

His first story starts with the MD Anderson Cancer Center in Houston, a nonprofit facility of the University of Texas, as he follows a patient who had to prepay $48,900 for six days of testing just to determine his cancer treatment regimen, which could easily run half a million dollars. An analysis of the itemized list of confusing charges showed that they were inflated as much as 100 times over retail prices, even before the hospital’s leveraged buying power. Those costs were also way higher than what Medicare would pay for the same tests, procedures and drugs.

MD Anderson, with its 19,000 employees, is one of the city’s top-10 employers, and its CEO last year was paid $1,845,000. Four other hospitals in the 1,300-acre Texas Medical Center are also in the top-10. Clearly, healthcare is a big business, but who’s making the money if it’s not doctors, nurses and technicians? It’s the hospitals, insurance companies, drug companies, equipment providers, and testing companies. Read More …

Understanding Obamacare

Healthcare became a hot potato during this political season, even though the U.S. Supreme Court ruled that the Affordable Care Act is constitutional. Governor Romney wants to repeal “Obamacare,” but what’s actually in the law and why was introduced in the first place? To address these common questions, I’m reposting one of my first articles on the topic.

This article describes a great presentation by Dr. James Rohack on Health System Reform. Rohack is a practicing cardiologist and Director of Scott & White Center for Healthcare Policy. He is also a professor at Texas A&M Health Science Center and was the president of the American Medical Association from 2009 to 2010 during debates over Obama’s Healthcare Law.

The presentation was held in Sun City, a planned community north of Austin for retirees with active lifestyles. It didn’t include handouts, but I was able to find some of Rohack’s slides online and offer them below with my notes.

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The Waiting Room, a feature length documentary

 

The Waiting Room - Title Text

Certified Nurse Assistant Cynthia Y. Johnson at Highland Hospital in The Waiting Room

Certified Nurse Assistant Cynthia Y. Johnson at Highland Hospital in The Waiting Room

The Waiting Room is like a punch to the gut for people cast off and left out of our U.S. medical care system, what some call the best in the world. When Democrats and Republicans vie for your votes and debate healthcare reform, remember that these are not the people they are talking about. Most don’t even notice the plight of those at the bottom — this ugly underside. But our politicians, and the billionaires who set their agenda, should be made to watch this documentary, because these are the 47 percent they talk about — the people left out of the American Dream. They’re real people.

This character-driven documentary film uses unprecedented access to go behind the doors of Oakland’s Highland Hospital, a safety-net hospital fighting for survival while weathering the storm of a persistent economic downturn. Stretched to the breaking point, Highland is the primary care facility for 250,000 patients of nearly every nationality, race, and religion, with 250 patients – most of them uninsured – crowding its emergency room every day. Using a blend of cinema verité and characters’ voiceover, the film offers a raw, intimate, and often uplifting look at how patients, staff and caregivers cope with disease, bureaucracy, frustration, hope and hard choices during one typically hectic day.

The ER waiting room serves as the grounding point for the film, capturing in vivid detail what it means for millions of Americans to live without health insurance. Young victims of gun violence take their turn alongside artists and uninsured small business owners. Steel workers, cab drivers and international asylum seekers crowd the halls. (movie trailer follows)

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As Our Health Goes, So Does Our Economic Recovery

 

It’s the Health Care, Stupid:

As Our Health Goes, So Does Our Economic Recovery

As Our Health Goes, So Does Our Economic RecoveryBy Peter Abaci, M.D., Chronic pain specialist
(original on Huffington Post)

“We cannot solve our problems with the same thinking we used when we created them.”
— Albert Einstein

As we head into the final stages leading up to election day, expect the fight over whom and what is best for our economy to rage on. Debating how best to stimulate the economy has been anointed as the de facto topic of importance heading into our upcoming election, but let’s not forget that the health of Wall Street and Main Street is inextricably linked to the health of our citizens. As I have written here in the past, I am no economic expert, but I do work in the trenches every day in a profession that impacts our nation’s budget like no other.

The fact that doctors like me seem to drive the spending of tax dollars more than other occupations like teachers, governors, and generals tells you right there that health care is the elephant in the room of any debate on our economic future.

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A Disease-Creation Economy

Money, Politics and Health Care: A Disease-Creation Economy

By Mark Hyman, MD, practicing physician (original on Huffington Post)

“There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order.” —Niccolò Machiavelli, The Prince and The Discourses

Medical Economics - follow the MoneyMoney in politics is making our nation sicker, threatening our national security, and ultimately destroying the very economic prosperity the “money in politics” seeks to achieve. It is undermining our capacity to care for our citizens and threatening our global economic competitiveness in invisible, insidious ways. The links, connections and patterns that promote obesity and chronic disease are clear, though. The economic and social impacts are evident. As health care consumes an increasingly large percentage of our federal budget, the negative impacts of money in politics have become too alarming too ignore, and never more obvious than in this election cycle of 2012.

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Now the Real Work of Healthcare Reform Begins

Roberts Saves Obamacare: Now the Real Work of Reform BeginsArianna Huffington
By Arianna Huffington

The narrow survival of the Affordable Care Act last week was certainly cause for celebration. But as the jubilation subsides, it’s important to realize that having avoided what would have been a giant step backward doesn’t mean we’ve taken a giant step forward. Because the law as it now stands is only the first step toward health care reform.

On Sunday’s This Week, Vicki Kennedy (Ted Kennedy’s widow) spoke movingly of how “health care reform was the cause” of her husband’s life. “He believed that it was a moral issue,” she said, “that it defined the character of who we were as a society, who we were as a country, and that decent, quality, affordable health care should be a fundamental right and not a privilege.” She went on to say, “Families can go to sleep relaxed and happy knowing that their children who have asthma or diabetes or allergies are covered by insurance and aren’t barred because they have a pre-existing condition.” Read More …

CAPABLE means Home, not Nursing Homes, for Seniors

Source: Newswise (6/26/2012) — Nursing homes do not have to be inevitable destinations for frail older adults. Many—even those with long-term health problems—can remain at home and be independent. All it takes is a little help to change “disability” to “capability”.

A handyman with a few nails to fix a wobbly bannister can make the difference between staying at home and a nursing home stay. Visits from a nurse or occupational therapist can help simplify a bewildering medication regimen or improve the ability to get around the house and neighborhood. Simple, inexpensive steps may change the equation for thousands of seniors, but in reality, services like these are rarely available for many at greatest need—the poorest and sickest older adults receiving Medicare and Medicaid.

CAPABLE, short for “Community Aging in Place, Advancing Better Living for Elders,” and a $4 million Health Care Innovation Award from the U.S. Department of Health and Human Services Center for Medicare and Medicaid Services, is about to change that reality. Read More …

A Totally New Healthcare System

KingOfTheWorldFive months ago I posted a challenge on Linkedin titled, “Innovative Ideas for a Totally New Healthcare System?” and it generated a discussion that’s been active for 5 months now with over 900 responses from different perspectives worldwide.

As a fun exercise to stimulate creative, out-of-box thinking, pretend you have all been appointed to the new World Health Commission by the new King of the World (or whatever title you prefer). You have absolute power to determine health strategy, for the whole world. Think like a child, and forget the constraints you’re used to dealing with as adults. There are no financial hurdles, no political worries, no cultural barriers, no legacy to contend with, no managers looking over your shoulders, and no imposed time frames. What is it that patients, providers and society seek from healthcare? Why can’t they get that now? Starting with a completely blank canvas, what would be the objectives of the new System? Imagine potential roadblocks and how we might overcome them.

The discussion has evolved, and most participants have come in and out of it, but Clifford Thornton posted one of the longest and most thoughtful replies and gave me permission to reprint it here.

A Totally New Healthcare System

By Clifford Thornton

Wow sir, a blank sheet; this is a dynamic exercise.

I came into the healthcare field about 9 years ago from a marketing strategy business background in the cable/telecommunication industry. Let me say that I cannot think or even imagine a bigger contrast in terms of quality of service, efficiencies, level of customer satisfaction, duplication of service levels, delivery, and range/availability of services.

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Five Ways mHealth Can Decrease Hospital Readmissions

Home Healthcare cuts Costs, ReadmissionsBy David Lee Scher, MD (12/16/2011)

Patients who are discharged from the hospital after a heart attack, congestive heart failure, or pneumonia have high rates of short-term readmissions. As per a provision in the Affordable Care Act, a Medicare patient with one of these diagnoses who is readmitted within 30 days for the same will trigger a denial of reimbursement for the subsequent admission.  There are many things which need to change to limit these events, though not all readmissions can be prevented, as nothing in medicine is absolute.  Identification and intensive interventions (inpatient and post-discharge) with high risk patients, better communication/care coordination, discharge processes, and patient education have been shown to produce results.  I would make a case for mHealth to become an integral part of all these components of a multi-faceted solution. Here are a few ways that mHealth may be incorporated in the process: Read More …

It’s Fall – Time for Talking Turkey about Healthcare…

 

Medical Economics - follow the Money

We need to talk about healthcare, the role of funding, the need for healthcare teams, and core infrastructure from workplace culture to technology.  Parts of this post began as a comment in Employee Benefit News, a LinkedIn group.  Let’s start with the money.

There’s a pattern here—banks collect a 5% margin on health insurance cash flow.  This is not small potatoes.  Healthcare insurance, mostly self-insured employer costs, was about 33.5 percent of the $2.3 trillion spent on healthcare in 2008, i.e., almost 70 percent of the half of health cost not paid by Medicare and Medicaid (see National Health Expend Data). This annual $770 billion allows the 5% margin to feed some $38 billion into the banking sector’s P&L statement.  And, the annual $770 billion flow is money banks can invest in securities markets, or can lend.

 

In Snake Bit, I took a different look at annual health insurance evaluation and the danger of getting Snake Bit if we don’t dig into the details, compare plans, and consider our historical and anticipated medical costs.

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Putting Patients at the center of their Health Care

HealthITBuzz logoHere is full text of an article by by by Jodi G. Daniel / JD MPH, Director of the Office of Policy and Planning at the U.S. Department of Health & Human Services. It is provided with full attribution and a link to the original article but without copyright concerns, because I believe it’s important enough to be promoted widely and don’t expect any complaints. If, however, the Office of the National Coordinator for Health Information Technology (ONC) asks me to remove it, I will surely do so.

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In Sickness and in Health, till Death do us part

read the Pat Robertson story at MSNBC

Rev.Pat Robertson, by Clem Britt/AP

I’ve written occasionally about Medical Ethics and the misalignment of incentives that pay doctors & hospitals for treating symptoms rather than keeping us well. As we consider reforms to contain runaway deficit spending, we must come to grips with many ethical questions. Since individual choices can determine our health and well being, and therefore the cost of care, we’re less sympathetic of people still smoke, drink or eat too much of the wrong things. We know that obesity is America’s #1 health & financial risk and that it can cause heart disease, stroke, diabetes and certain cancers. Since half of our population is overweight from lifestyle choices, should they get the same level of care at taxpayer expense?

A new question arose this week about medical ethics and marriage when religious leader Pat Robertson told his 700 Club television audience that divorcing a spouse with Alzheimer’s disease is justifiable. He was taking questions from the audience when Robertson was asked how to advise a man who began seeing another woman after his wife started showing symptoms of Alzheimer’s.

“I know it sounds cruel,” he said, “but if he’s going to do something, he should divorce her and start all over again, but make sure she has custodial care and somebody looking after her.” After all, it’s “a kind of death.”

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ONC: Helping Consumers Be Partners in Their Own Health

HealthITBuzz logoHere is full text of an article by Lygeia Ricciardi, Senior Policy Advisor for Consumer e-Health at the U.S. Department of Health & Human Services. It is provided with full attribution and a link to the original article but without copyright concerns, because I believe it’s important enough to be promoted widely and don’t expect any complaints. If, however, the ONC asks me to remove it, I will surely do so.

Helping Consumers Be Partners in Their Own Health

by Lygeia Ricciardi, Senior Policy Advisor for Consumer e-Health

We at the Office of the National Coordinator for Health Information Technology (ONC) know that patients are asking themselves, “How do I manage my health information?” We are working to bring the U.S. health care system into the 21st century through technology to address that concern. We understand that it’s not all about health care providers and hospitals—it’s also about you: the patient, the individual, the person who should be the focus of the health care system.

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States Slash Home Health Care & Services for the Neediest

Senior with Home Care Bound for Adult Day Care States Slash Home Health Care & Adult Day Care Services for the Neediest; Likely to Increase Costs

Republished with permission from HelpingYouCare.com.

Several reports recently have noted that across the nation, U.S. states are slashing Medicaid dollars for home health care services and adult day care services that help keep the elderly and disabled out of nursing homes. State lawmakers cite budget shortfalls, yet these cuts may end up costing Medicaid and taxpayers more in forced nursing home costs, authorities say.

According to a July 16 report by the Associated Press, “Aging and disability services in three out of four states have been reduced over the last two years or face cuts, even though demand is increasing.”

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AARP Finds Toll On Family Caregivers Is ‘Huge’

AARP: Join the Fight for Medicare and Social SecurityValuing the Invaluable: The Growing Contributions and Costs of Family Caregiving is a new study by the AARP that estimates a value of $450 billion a year for work done by more than 40 million Americans caring for an elderly or disabled loved one. That may be a bargain for society, but it’s a “huge” burden on the family members.

Cymando Henley’s mom was diagnosed with Multiple Sclerosis as he started college. Now she’s in a wheelchair, and Henley has been taking care of her ever since – for nearly twenty years now – helping her in and out of bed and onto the toilet, and even rolling her over in the middle of the night if she gets uncomfortable. Social programs help pay for about 35 hours a week of in-home health care, but Henley puts in at least that much himself for free, on top of working at a full-time job. Such non-medical care from a professional can cost tens of thousands of dollars a year.

Listen to the story or read about it at NPR.org.

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When Healthcare Hits Home

illustration of gall bladder with stonesGuest article by Jessica Wapner (www.jessicawapner.com, @jessicawapner), from WorkInProgress blog.

Jessica gained a new perspective of our healthcare system when a relative needed emergency surgery in a small village in Cyprus to remove gall stones and her gall bladder. Her story is included because it relates to Health Concerns for Oversees Travel. If you’d rather not see this type of story, reply below.

Over the course of the decade-plus that I’ve been writing and editing material on healthcare (cancer research and treatment, in particular), people have asked from time to time whether my interest is driven by some personal stake in the matter. Read More …

Does Medicare Cover Home Health Care?

By Shannon Martin (reprinted with permission)

Nothing is more discomforting than not knowing if you or a loved one will receive the adequate care for a full and safe recovery after hospitalization.  Neither Medicare nor traditional medical insurance cover many of the home care services that can help reduce otherwise preventable injuries and hospital re-admissions. These services, usually referred to as long term care, or “custodial care,” include companion services, general supervision for health and safety and long term home help with personal care and hygiene, meal preparation, transportation and errands.

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You Really Are Paying a lot More For Health Care

Julie Rovner posted this article on the NPR Health blog, but she didn’t include my reader comments, so I’m summarizing key points here and adding my comments afterwards.

  • The good news – Health costs rose 7.3% last year, which was the slowest rate in more than a decade but still nearly 5 times faster than the Consumer Price Index.
  • The bad news – Since 2002, the annual health care cost for American families has more than doubled from about $9,000 to over $19,000.

So what’s driving the increases? It’s not Obama Care, the new federal health law.

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