Archive for the ‘Obama’s Health Care Plan’ Category

Medicare’s 5-Star Rating System Under Fire

Medicare’s star-rating system for nursing homes, dubbed Nursing Home Compare, is no stranger to controversy. On its launch in 2008, the long-term care community was up in arms, criticizing the system’s lack of quality metrics that play a key role in resident satisfaction. And a new report by a major newspaper has brought critiques of the system back into the forefront.

New criticisms emerge pointing to flawed ratings

According to a recent article in The New York Times, “The Medicare ratings, which have become the gold standard across the industry, are based in large part on self-reported data by the nursing homes that the government does not verify.”

The article points out that only one of the metrics used to determine a nursing home’s star rating comes from independent reviewers: state inspection data. Staffing ratios and quality measures are self-reported by skilled nursing facilities (SNFs), opening the door for potential abuse of the system.

Criticisms of Nursing Home Compare are nothing new; the program has faced them since its inception. But the content of the complaints has changed course over the years.

Early criticisms of Nursing Home Compare

The American Health Care Association (AHCA) denounced Nursing Home Compare in a public statement, voicing the view that the program “is premised upon a flawed survey system that does not measure quality, lacks the inclusion of other important quality elements that help consumers make informed decisions, and includes inaccurate data.”

The general consensus was that nursing homes could be unfairly portrayed or perceived as providing a lower quality of care, based on technicalities that resulted in deficiencies on state inspections. In other words, a lower five-star rating could be assigned to a skilled nursing community that provides exceptional care, and providers were concerned that they’d lose potential residents as a result of such inaccurate ratings.

Nursing Home Compare


Ratings lack critical state complaint data

What’s more, Nursing Home Compare does not take into account complaints filed by consumers with state agencies or fines and other enforcement actions by individual states, only federal actions. The Times points to one community, Rosewood Post-Acute Rehab, a nursing home in a Sacramento suburb, which has maintained a perfect five-star rating for five years, a distinction held by just one-fifth of all nursing homes in the U.S.

But what this rating doesn’t disclose to consumers is the fact that Rosewood was fined $100,000 in 2013, the highest penalty possible, for an accidental, and unfortunately fatal, overdose in 2006. It also doesn’t tell consumers that there have been more than 100 complaints filed in California against this particular nursing home between 2009 and 2013.

California Advocates for Nursing Home Reform, an organization which also tracks complaints, has documented 164 complaints for the same time frame against Rosewood. Officials from Rosewood point out that only a small portion of those complaints have ever been validated, but according to The New York Times, experts say that merely being the subject of that number of complaints is a sign of potential trouble.

But consumers need a clear metric for comparison

While there are some changes coming that will hopefully improve the validity of the Nursing Home Compare rating, such as the requirement that Medicare use payroll data to verify reported staffing levels (required under the Affordable Care Act), a process and system for doing so hasn’t yet been finalized. Best Senior Living Awards Winner Badge

Perhaps of major concern is the idea that a standard, industry-wide rating system is such a valuable metric for consumers. It provides a single point of comparison to help families wade through what can otherwise be a confusing and overwhelming decision-making process. That’s why has created the Best Senior Living Awards, an independent, third-party rating system for assisted living, independent living, and retirement communities.

The Best Senior Living Awards rating system utilizes the opinions of independent senior living experts, along with reviews from residents, staff, and family members, and other quantifiable metrics like state inspection data, to calculate a standard score that consumers can use to easily compare their top communities. Additionally, written reviews are publicly available on, providing consumers with in-depth opinions from others with real-world experience with these communities. Visit any community’s profile on, such as Dunwoody Pines in the Greater Atlanta, Georgia metro area, and access reviews submitted by residents, family members, and staff. And, if you have experience with a senior living community and would like to share your opinion with seniors and their families searching for senior housing options, visit our Post a Senior Living Review page to search for the community and submit your review.

There’s so much information out there about senior living options, yet the choice isn’t an easy one for seniors or their families. There’s a clear need for an independent, third-party rating system that provides a clear, straightforward rating taking into account both quality and compliance, quantitative and qualitative data. And that’s precisely what aims to achieve.

Nursing Home Compare screenshot via

What the Obama Administration is Doing to Help America’s Caregivers

The Affordable Care Act, initiated by the Obama Administration in 2009, will have certain effects on in-home caregiving. Those that are interested in finding out more may want to discuss the changes with their local health care exchange or expert, as they are quite extensive.

The White House

Photo courtesy of U.S. Embassy Jakarta, Indonesia

But in general, the Affordable Care Act makes it easier to get quality health care at a lower cost, and this includes in-home caregiving and care transitions.

Less Expensive, More Benefits

Patients will no longer be able to be denied by their insurance regarding pre-existing health conditions, there will be no coverage caps and prescription costs will be far lower. This is good news for those with in-home caregivers, as many of them were previously affected by these issues.

On the health care side, more funding will be going to direct care workers and family caregivers for elderly patients. The changes made by the Affordable Care Act make it less expensive for most people, especially older adults aged 55-65, to get health care and make preventative health care largely free.

Improve Training for Care Workers

Apart from the benefits for individuals, the Affordable Care Act is projected to bolster the long-term care workforce overall, with training programs that will support these valued workers. Not only do these workers contribute to long-term care in general, but they are also invaluable resources for caregivers that need additional help. States are also encouraged by the Affordable Care Act to expand their current resource offerings under Medicaid.

Resources are being offered to help caregivers make better choices regarding the care of their patients, such as the development of aging and disability centers that will help individuals make difficult decisions regarding care.

Protecting Residents of Long-Term Care Facilities

Finally, the Affordable Care Act includes some provisions for protecting those that are currently residing in long-term care facilities. These long-term care changes include increases in reporting and compliance necessary for nursing homes, requiring abuse prevention training and changes in the way nursing home closures and transfers are currently handled. These changes meant to address issues in long-term care elder abuse that have arisen in recent years. Quality of care issues are being regulated more under the Affordable Care Act for the safety of patients.

The Affordable Care Act is undoubtedly a positive thing for many caregivers and their loved ones as it gives them a larger pool of wealth and knowledge from which to draw. Seniors will find that they have significantly more coverage and family caregivers will have a larger set of resources regarding their needs as a caregiver. Caregivers will be able to reach out to a variety of communities and departments for information and help regarding a large volume of caregiving topics.

Affordable Care Act Center of Heated Political Debate, But What Does It Mean for Seniors?

Unless you’ve been isolated from all forms of media for the last few weeks -and months, you’re probably aware of the heated debate underway regarding the Patient Portability and Affordable Care Act (PPACA), often abbreviated ACA or Affordable Care Act. With some of the provisions of the law going into effect on January 1, 2014, people started to investigate their health care options available through state and federal health insurance exchanges and learn the fate of the individual insurance policies they had previously. It’s sparked a national controversy, with members from both the far right and far left, along with many, many in between and those outside of party affiliations at all, expressing their views about the ACA.

Proponents and critics of the ACA each have strong reasons for their opinions, and there’s a lot of discussion about people from different demographic groups — one being the senior population, particularly Medicare beneficiaries. With all the speculation and opinions being reported in the news, it’s no wonder seniors are confused about what they should be doing and what to expect.  Here’s a look at the major changes impacting Medicare, as well as opinions on the potential impacts from both viewpoints.

Is Medicare Losing Funding or Cutting Provider Payments?

The ACA includes $716 billion in cuts from Medicare payments between 2013 and 2022. Critics say this could be devastating to an essential healthcare program for our elderly citizens — and one that was already on shaky ground. However, the Obama Administration says at last some of these funds are actually being reinvested into the Medicare program. For instance, the funds will be used to close the current “donut hole” that exists in the Medicare Part D prescription drug program, which has caused financial duress for many seniors since Part D was implemented. ACA impact on Medicare costs

Once a senior reaches the donut hole dollar amount in prescription drug payments, she is responsible for paying 100 percent of drug costs out-of-pocket until the upper threshold is reached. The current plan gradually closes this gap and the out-of-pocket costs for seniors, with a goal of eliminating it completely by 2020. In 2014, for instance, Medicare recipients reaching the donut hole will get a 47.5 percent discount on brand-name medications and a 21 percent discount on generic drugs. Those discounts will gradually increase until the coverage gap is minimized. However, U.S. News confirms that Medicare recipients earning more than $85,000 for an individual or $170,000 for a married couple — about 5 percent of Medicare recipients — will pay more for their Medicare Part D coverage.

Will Seniors be able to Keep Their Doctors?

The Medicare payment cuts impact payments to providers under the Medicare Advantage program, a program that has been experiencing steady enrollment growth for the past several years. Insurers providing these plans say that funding cuts have forced them to tighten networks, reduce benefits and increase the out-of-pocket costs for beneficiaries. This is one of the primary concerns noted by those who oppose further cuts to the Medicare program — that more providers will withdraw from the program.

Opinions are split on whether doctors will pull out of the Medicare program. While reduced payments could certainly push some in that direction, the ACA includes other provisions as provider incentives. For instance, new programs will be implemented to help reduce hospital re-admissions through coordinated transitional care, as well as bonus payments to primary care physicians for certain services that will improve the quality of care. So while the ACA doesn’t intentionally force physicians out of Medicare provider networks, some providers may make that choice on their own.

Will Medicare Premiums Increase?

A central point of the current heated debate is the cost of health insurance policies under the Affordable Care Act. When the ACA was introduced, one of the main motivators to implementing the law was to reduce healthcare costs while expanding coverage to millions of additional Americans. Now that the healthcare exchanges are open, some are finding the new plans to be more affordable while others have been hit with significantly higher out-of-pocket costs. The National Committee to Preserve Social Security and Medicare says Medicare recipients will actually save an average of $4,200 over the next 10 years in the form of lower prescription costs, free preventative care and reductions in healthcare spending across the board.

Since the ACA was implemented in 2010, premiums for Medicare Advantage plans have actually decreased by an average of 9.8 percent, according to the NCPSSM. But the Henry J. Kaiser Family Foundation paints a different picture, with 2014 premium projections showing a 14 percent increase over the 2013 rates.

Medicare Now Includes ACA Required Minimum Coverage

One of the most-discussed features of the ACA is that it requires everyone in the U.S. to have the same minimum amount of covered services, including those on Medicare plans. Seniors on Medicare will now have health insurance covergambling with Medicare coverageage for preventative care, such as wellness visits, without the former Medicare Part B co-payment. With open enrollment for the health insurance exchanges and Medicare happening around the same time, many Medicare beneficiaries were confused about whether they were required to choose a new health insurance plan.

All existing Medicare Part A beneficiaries are considered to meet the ACA’s minimum coverage requirements, meaning they didn’t have to select a new plan. In fact, Medicare beneficiaries shouldn’t use the ACA healthcare exchange website at all. Instead, they should use the Medicare Plan Finder. Through February 14, 2014, Medicare Advantage beneficiaries may review their current plans, prescription drug coverage, premiums and deductibles and opt to switch to Original Medicare coverage. Anyone choosing to do so must select a Medicare Prescription Drug Plan by February 14th in order to receive Medicare Part D prescription drug benefits.

Medicare beneficiaries will now receive an annual wellness exam, most standard health screenings, such as those for diabetes and high cholesterol, as well as mammograms and colonoscopies, with no out-of-pocket costs. However, the free preventative coverage under Medicare Advantage plans may vary from plan to plan, as these are private plans sold from health insurance companies as alternatives to the original Medicare benefit.

Medicare Advantage Faces Most Uncertainty

There’s a lot of information floating around the web about the ACA, littered with opinions, speculation, data and a mix of myths and facts. Even the same statistics and figures from the same study can look vastly different when analyzed from different views. But there is one thing the majority seems to agree on, and that is that among the senior population, those on Medicare Advantage plans face the most uncertainty. With no clear answer on how things will really shake out in terms of increased out-of-pocket costs, coverage and provider networks, Medicare Advantage beneficiaries could land on either end of the scale.

Much of these changes will depend on how the individual insurance company interprets the law and makes changes to those plans. Seniors on Medicare Advantage plans should review their benefits and costs carefully, and seek expert help if needed. No one wants to receive a surprise health care bill for thousands of dollars, especially seniors who are already on limited incomes.

President Obama is set to deliver his State of the Union Address tomorrow evening. His advisors have indicated that he’ll focus on issues like income inequality, gun control and immigration. Some political commentators tend to think health care reform will be minimized in the President’s speech this year due to the rocky rollout and ongoing controversy. Others, however, think he’d be ignoring the elephant in the room and must devote at least some time to discussing his signature legislative achievement and what Americans can expect in the coming months.

Do you think seniors will be heavily impacted by the Affordable Care Act? Share your opinions with us in the comments below.

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Post by Angela Stringfellow

Top 10 Health Technology Blogs

Technology is re-shaping the healthcare industry. With HIPAA and other regulations getting stricter by the day while technology becomes more prevalent for things like maintaining patient records, staying compliant becomes challenging. At the same time, new technology is streamlining the delivery of patient care, reducing medical errors and saving lives. Leading experts in health technology are taking to the blogosphere to keep both providers and consumers up-to-date on the latest technologies impacting the industry. Here’s a look at a few, listed in no particular order of importance.

1. HealthIT Buzz – Where else to turn for the latest regulatory information than the federal government? Run by the U.S. Department of Health and Human Services Office of the National Coordinator for Health Information Technology (ONC), HealthIT Buzz shares information on the ongoing transition of the healthcare industry to electronic health records. Regulations like the HIPAA Security Rule weigh heavily on Covered Entities, so this blog is an excellent resource for keeping tabs on changes to the rules and guidelines.

2. Personal Health Tech Blog – Ira Brodsky blogs about health technology from a personal perspective in an easy-to-understand format. While this blog is relatively new, we’ve included it in this list thanks to the easily digestible news on health technology that’s relevant to patients and caregivers. Definitely one to watch.

3. iHealthTran – The Institute for Health Technology Transformation “is the leading organization committed to bringing together private and public sector leaders fostering the growth and effective use of technology across the healthcare industry.” The Institute offers programming spanning a wide range of healthcare industry entities, including providers, medical device manufacturers, consumer and patient groups, and much more. The blog is engaging and highly informative — discussing the use of Twitter for customer service, new innovations that shape patient care, and more.

4. Kevin MD – Kevin Pho, MD, is “social media’s leading physician voice,” providing physician insights on the latest breaking medical news. Trust us, this blog is anything but dry. Pho sheds some light on the new voice of the physician world–the patient-empowering, thoughtful, and engaged practitioners that thrive on saving and improving lives, and aren’t afraid of trying the next great technology to make it happen.

5. Health Tech Hatch – This blog covers mobile technology — including a recent call-out to mobile app developers to come up with something to ease the process of self-care, along with news on progress with the move to electronic health records, cost savings and tons of other useful tidbits.

6. CNET One of the web’s leading news publications, CNET has an impressive section devoted solely to health technology. Recent posts include coverage of a children’s cancer wing transformed into a “superhero” wing and other heartwarming and informative news on the cutting edge of health tech.

7. My Health Tech Blog – The great thing about this list of health tech blogs is that there are so many different perspectives represented. Deborah Leyva, author of My Health Tech Blog, spent 17 years in the technology industry and is now a Registered Nurse and Health Informatics Specialist. She offers an abundance of insightful expertise on everything from HIPAA (including some valuable HIPAA checklists and tools), to healthcare analytics, awards, and EHR.

8. eHealth Focusing on all things electronic health technology, eHealth is managed by John Sharp, a medical center IT manager in Ohio. Sharp is active in a number of premier healthcare and technology associations and brings his expertise forward on e-health, personal health records, Web 2.0 and more.

9. Health Plan Innovation Health practitioners aren’t the only entities impacted by the technology wave. Health Plan Innovation focuses on ways to use innovation to “solve health care access, quality and funding issues.” We don’t think there’s anyone out there who would disagree that this is exactly the kind of thought leadership we need to solve the nation’s healthcare crisis.

10. Meaningful HIT News Neil Versel is a professional healthcare journalist, bringing yet another point of view to this blog roundup. Versel has written on healthcare technology for a wide range of publications and brings his investigative journalism experience to the blogosphere, sharing both light-hearted looks at the challenges in the industry as well as a serious approach to covering some of the biggest changes impacting practitioners, quality, mobile health and other pertinent facets of the industry.

What are your favorite reads on the intersection between health and technology? Any favorite bloggers who share insights from the changing world of health IT in an engaging way? Tell us what health IT blogs you love in the comments below.

Image via Flickr by tedeytan
Post by Angela Stringfellow

The Looming Fiscal Cliff: Should Seniors Be Worried?

Everyone’s talking about the looming fiscal cliff, otherwise known as the between-a-rock-and-a-hard-place position the U.S. Government will find itself in if a new budget agreement isn’t reached before the end of 2012. Yikes. Sounds scary, right?

The biggest problem is that the conditions of the Budget Control Act of 2011 are scheduled to take effect at that time. And that means — in a nutshell — more taxes.

How will seniors be affected?

Like nearly everything involving the Government, the fiscal cliff carries some significant impacts for seniors. Programs like Medicare are slated for deep cuts in funding, to the tune of $11 billion in 2013 based on an across-the-board two percent cut in payments. There’s already a 27 percent cut to physician payments set to kick in in January 2013; the two percent is on top of that already-drastic cut. Imagine the number of physicians who will cut back on accepting Medicare patients.

Fiscal cliff looms; impacts seniors

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Based on the details of an emerging but tentative agreement between President Obama and House Speaker John Boehner, seniors could receive smaller Social Security cost-of-living adjustments due to a new method for calculating inflation.

According to The Huffington Post, here’s how this would work: The new technique used to calculate inflation would be based on the chained CPI (consumer price index), which accounts for consumer substitutions in response to price increases. If pork prices were to increase while beef prices remained flat, consumers may shift their spending habits — buying more pork and less beef. It essentially takes the law of supply and demand in relation to price changes and applies it to calculating inflation.

The bottom line of chained CPI calculations

The result? After three years, the average Social Security beneficiary would receive $258 less in cumulative benefits. Over the long-term, the effect is much more significant. “If the chained CPI had been in place all along, today an 88-year-old who’d started drawing benefits at age 62 would receive 7.32 percent less in benefits this year, according to the group,” HuffPo explains, referencing calculations released by Social Security Works, an advocacy group based in Washington.

In some cases, the cumulative effect could mean at least $1,000 less in annual benefits and $15,000 over the long-term, 16-year period used in the example above.

What else is on the table?

All of these effects are dependent on the specific deal reached by Congress. And other effects may be possible depending on the terms of the agreement, such as raising the Medicare-eligibility age to 67 or asking higher-income beneficiaries to pay more for their coverage.

Other agencies, such as the National Institutes of Health and the Centers for Disease Control and Prevention could face cuts reaching hundreds of millions, or billions, of dollars, reports Medscape. This could mean cuts to valuable services or halts to medical research.

Unfortunately, there’s no easy solution to any of this. Cuts must be made, taxes raised or some other method found to balance the budget. With a Republican-led House and a Democratic President and Senate, these agreements are tougher to reach because of drastically differing party views — although it will hopefully mean a more balanced solution overall. Stay tuned for January 1, 2013.


Are the Presidential Candidates Supporting Caregivers?

The campaign trail is on fire these days, and the presidential and vice-presidential debates drew much attention from right and left-wingers alike, as well as those who haven’t yet made up their minds about how to cast their vote next month. But one criticism hitting both candidates from all sides is the lack of attention placed on caregiving.

No policies for caregivers

Both President Barack Obama and Governor Mitt Romney have heavily discussed support for modern families. Yet neither party has come forward with solid policies that would help working women or members of the Sandwich Generation.

Vote 2012

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The Guardian points out that “neither Romney nor Obama has offered a single policy idea on the campaign trail that would ease the burden of working families who are juggling demanding work schedules with care for children and elderly parents.” Both candidates’ wives have discussed a focus on family life — but what about public support to help these families get the services they need?

What do caregivers need?

Caregivers need more public support that can help them balance the challenges of juggling work and caring for an elderly parent, and in many cases, caring for young children simultaneously. Neither candidate has mentioned policies that would provide tax breaks for working caregivers or anti-discrimination laws that would protect working adults who also have duties at home to care for aging loved ones.

Seniors face an uncertain future

It’s already unclear how the proposed plans of both sides will directly impact the nation’s seniors. Educated predictions and estimates aside, no one knows for certain how the plans of either side will affect seniors’ ability to obtain necessary medical care. One thing, however, is for certain: Medicare and Medicaid will be undergoing major changes over the next few years.

According to The Huffington Post, Romney is under fire among disabled Americans for proposed cuts to Medicaid. Obama, on the other hand, has received constant criticism for Obamacare and his future plans for both Medicare and Medicaid, which critics say won’t save seniors money in the long run. Many protesters don’t support either candidate, saying neither are truly tuned in to the needs of the elderly and disabled.

But the current state of affairs doesn’t look promising either. Cash-strapped states have already made cuts in the past few years due to the recession. And even if Romney’s block grant plan isn’t implemented, states will continue to seek ways to cut their own costs, likely affecting these programs.

Medicaid cuts mean more dependence on unpaid family caregivers

It’s not just vulnerable seniors and disabled persons standing to lose valuable benefits under both the current and proposed systems. Those providing unpaid family care to loved ones — a group already experiencing the impact of doing more advanced nursing tasks — will be faced with picking up the slack. A decreased ability to seek professional medical care could worsen the health of many individuals, exacerbating the effects on already stressed caregivers and other loved ones.

What’s the answer? Unfortunately, there’s no clear cut solution. And seniors, disabled persons and their caregivers and loved ones have little impact on what’s to come unless they take to the polls and vote on Election Day. But it extends beyond merely voting: Get out, stand up and let your voice be heard. Let our government know what the caregiving population needs in terms of support. Your voice matters.


Medicare Part D Premiums to Remain Steady, But Cuts to Nursing Homes Could Reach $65 Billion

With the healthcare system in a state of flux, seniors are left to wonder how their coverage may change under Medicare over the next few years. The good news, according to Reuters, is that seniors enrolled in the Medicare Part D prescription drug program can expect their premiums to remain steady over the next year. But that doesn’t mean there many not be major changes coming down the line. It appears the nursing home industry is taking the most hits, with cuts projected to reach $65 billion over the next 10 years.

Skilled Nursing industry slapped with $4 billion in cuts by 2014

Affordable Care Act aims to close the doughnut hole

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Long Term Living magazine reports that new budget-reducing regulations from the Centers for Medicare and Medicaid Services (CMS) are overlapping with federal regulations, resulting in $4 billion in reductions to nursing homes between 2013-2014. Further cuts coming down the line could result in a total loss of $65 billion in funding for the skilled nursing industry over the next decade.

The data was compiled by Avalere and reflects the impact of the Affordable Care Act, case mix adjustments made by CMS and legislative cost-reduction efforts. These steep financial impacts will make it increasingly difficult for the skilled nursing sector to compete with other health providers in terms of hiring qualified staff, which will eventually impact the quality of care.

Affordable Care Act takes a bite out of the “doughnut hole”

The Affordable Care Act seems to be working in favor of seniors, at least in terms of out-of-pocket costs. Because the government subsidizes the difference between the premiums participants are required to pay and the actual cost of a program’s premium, seniors and other Medicare Part D participants won’t be subject to an out-of-pocket premium increase in 2013. Largely, premiums actually paid by participants have remained relatively stable over the past several years; the premiums averaged $30.76 monthly in 2011, and estimates project $30 premiums for 2013.

The aim of the healthcare reform law is to close the “doughnut hole,” or the gap in drug coverage that creates significant out-of-pocket expenses for seniors if utilization reaches a certain level during the year. The goal is to fully close this coverage gap by 2020, and measures to date have resulted in a savings of about $3.9 billion for Part D participants.

Future remains uncertain for seniors, skilled nursing industry

Still, political agendas have been taking center stage in terms of U.S. healthcare for a number of years, and that’s not likely to change anytime soon. Efforts to reduce costs inevitably result in cuts somewhere, and seniors will be impacted in one way or another no matter how the cuts are broken down. The good news is that for now, seniors are benefiting from stable out-of-pocket costs for the most part. Fortunately, more and more seniors are already opting for alternative long-term care options, such as assisted living and home care, which may not be as severely impacted by drastic cuts as the skilled nursing industry.


Medicare Bundled Payments a New Money-Saving Tactic

The Centers for Medicare and Medicaid Services (CMS) is implementing a new bundled payment structure for medical providers as part of the Affordable Care Act, a tactic which could save Medicare money. The strategy incentivizes providers to work together, shifting the focus from payments based on the quantity of care to one focused on quality. Currently, physicians have no financial incentive to help patients to quick recovery; in fact, the more office visits a patient makes, the more money the physician earns. CMS introduces bundled payments

Bundled payments will also force providers to work collaboratively to effectively manage patient care. Instead of a per-visit sum, a predetermined fee will be paid for, say, heart attack care, and nurses, specialists and various care settings must coordinate their care across settings to treat the patient. Electronic health records management will become essential in the success of this initiative, according to an article on

Called “Bundled Payments for Care Improvement Initiative,” the program could potentially revamp the way patients are cared for. Currently, each provider, such as the physician, hospital, skilled nursing facility and surgeon, sends a separate bill to Medicare. In essence, this is a really inefficient and scattered method, but it’s the one providers are accustomed to. Because only a set fee will be paid for an “episode of care,” providers will earn more by treating patients quickly and more effectively. An episode of care is a specific illness requiring a period of care, such as a hip replacement, and would include the initial evaluation, hospital stay, treatment and any post-operative care.

Bundled payments will most certainly force providers to offer a better continuum of care and reduce unnecessary duplication of services, such as repeat tests in different settings. In order to ease the transition, CMS has opened an application process for providers willing to participate in a testing phase. Participating providers will be able to choose from four broad bundled payment structures and will have input into what classifies as an episode of care and what services are included, which will help customize the program for providers of different sizes and capabilities. reports on a demonstration project which showed the potential for bundled payments to save money: “For example, a Medicare heart bypass surgery bundled payment demonstration saved the program $42.3 million, or about 10 percent of expected costs, and saved patients $7.9 million in co-insurance payments while improving care and lowering hospital mortality.”

The approach makes a lot of sense for patients and will result in a smoother transition across settings. Patients will have greater confidence that their providers are well informed of their condition, prior testing and treatment. Providers may struggle with the increased coordination required and the initial shift in thinking from a quantity-based to a quality-based approach as a financial incentive, but it’s precisely this financial incentive that will force practitioners to act in ways that make the most sense for the patient.

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Nursing Homes Face Uncertain Economic Future

Nursing homes in nearly all 50 states are looking into their future with uncertainty, as Medicare and Medicaid cuts seem certain. Further, skilled nursing facilities are required to comply with the Affordable Care Act, which mandates that employers with 50 or more employees provide health insurance or pay a shared responsibility fee. According to a White House brief, 96 percent of all employers with more than 50 employees already provide ample coverage. Many nursing homes, however, do not offer health insurance to hourly employees. Many nursing home and home care workers are uninsured

The New York Times recently reported on the growing concern of many nursing homes and home care agencies who are petitioning for exclusion from the new law. Twenty-five percent of nursing facility staff and 33 percent of home care workers are uninsured. Low wage-earners who work for organizations that do offer coverage often can’t afford premiums.

Mark Parkinson, president of the American Health Care Association, is active in lobbying efforts to exclude nursing homes and home care providers from the requirement. According to Parkinson, Medicare and Medicaid reimbursement rates are too low to allow health providers to cover the cost of insurance for workers. Potential cuts to these reimbursement rates only further complicate the issue. Skilled nursing facilities who opt out of providing coverage will face a penalty, which The Times estimates could exceed $200,000 per year for a mid-size facility.

Charlene A. Harrington, professor at the School of Nursing at the University of California in San Francisco, has a different take on the situation. She feels that nursing homes and other healthcare providers should not be exempt from the requirements, pointing out that direct care workers with adequate health care coverage are more likely to be treated for illness and, therefore, less likely to pass dangerous infections to residents.

Parkinson has suggested a number of alternative solutions, such as exempting only those organizations who enter financial distress as a result of compliance or allowing penalties to be used as a tax write-off.

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States Restructure Senior Care in Wake of Recession

Many states have made cuts to aging and disability services budgets, according to a recent report conducted by the AARP Public Policy Institute; yet, demand for such services hasn’t slowed — in fact, demand for senior care and disability services continues to grow at an alarming rate. The report surveyed programs and funding in all 50 U.S. states, finding that 31 states cut aging and disability budgets (non-Medicare) in the 2010 fiscal year, and 28 states expected to make cuts in the 2011 fiscal year. Balancing state aging and disability services budgets

The report, Weathering the Storm: The Impact of the Great Recession on Long-Term Services and Supports, finds that state incomes are expected to be below pre-recession levels in 2011, as funding from major sources is still down, including personal income, sales and corporate taxes. Increasing demands for services are forcing states to place restrictions on non-Medicaid long-term services and supports (LTSS), although these programs are currently bolstered through funds from the American Recovery and Reinvestment Act (ARRA). ARRA funds are set to expire in June 2011, when states will be faced with more difficult decisions.

Most Medicaid cuts focused on cuts to provider payments, although a few states implemented service cuts, particularly personal care services. This is a concern because during a recession, demand for payment assistance increases as more families facing financial hardship qualify for assistance.

One bright spot in the midst of this funding crisis is the Affordable Care Act, which aids states in expanding efforts for home and community-based services; however, many states are hesitant to embrace such programs until government initiatives provide ample guidance.

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