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Friday, 13 December 2013 13:01

How to Age with Dignity and Independence

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Aging with dignity and independence is the ability to live life to its fullest in the place you call home, regardless of age, illness, or disability. This ideal is important because many Americans have loved ones who are aging.  A little-known reality is that 70 percent of people over 65 will need long-term care at some point in their lives. To better prepare, here some things to know, and steps to take, for both you and your loved one:

10 Valuable Resources

Wednesday, 11 December 2013 14:44

Strategies For Containing Acute Care Costs

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The acute care system reflects the best and worst in American medicine. The system, which includes urgent care and retail clinics, emergency departments, hospitals, and doctors’ offices, delivers 24/7 care for life-threatening conditions and is a key part of the safety net for the under- and uninsured. At the same time, it is fragmented, disconnected, and costly. We describe strategies to contain acute care costs. Reducing demands for acute care may be achieved through public health measures and educational initiatives; in contrast, delivery system reform has shown mixed results. Changing providers’ behavior will require the development of care pathways, assessments of goals of care, and practice feedback. Creating alternatives to hospitalization and enhancing the interoperability of electronic health records will be key levers in cost containment. Finally, we contend that fee-for-service with modified payments based on quality and resource measures is the only feasible acute care payment model; others might be so disruptive that they could threaten the system’s effectiveness and the safety net.

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Tuesday, 10 December 2013 11:23

Who Pays For The Ambulance Transport?

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When you're calling for an ambulance, chances are good that you won't think to ask for one that's in your health plan's provider network. And in most cases, you wouldn't have much control over who it is anyway. That could leave you with hassles and extra charges for an out-of-network ride.

This spring, Blue Cross Blue Shield of Massachusetts launched a policy aimed at getting more emergency medical services providers to join its network: It began sending checks for out-of-network private ambulance rides directly to plan members rather than to the EMS providers. The move forces these providers to pursue consumers individually for payment — a more complicated process than getting the money straight from BCBS. (Government ambulance services are exempt from the new policy.)

This is another wrinkle in the complicated process of providing and paying for ambulance services. Systems vary widely around the country, as does funding, which may be a mix of tax subsidies, fee-for-service payments and donations. In many places, municipal EMS providers respond to 911 calls, while private companies handle non-emergency transport, such as between hospitals and nursing homes.
Monday, 09 December 2013 16:39

Impact of the Affordable Care Act on Palliative Care

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 Diane Meier and Amy Kelley write:  “Because of its focus on quality of care, the Affordable Care Act is poised to expand access to palliative care services for the sickest, most vulnerable, and therefore most costly, 5 percent of patients, who drive about 50 percent of all healthcare spending.  Palliative care is specialized medical care for people with serious illnesses that focuses on providing relief from symptoms, pain, and stress, whatever the diagnosis or stage of illness.  Patients (and family caregivers) receiving palliative care experience improved quality of life, better symptom management, lower rates of depression and anxiety, and improved survival.  Because patient and family needs are met, crises are prevented, thereby directly reducing need for emergency department and hospital use and their associated costs.”

Currently, most formal palliative care programs operate in clinic and hospital settings, where there is evidence that these programs enhance the quality of care, increase patient and family satisfaction, and decrease health care costs. The failure of palliative care to take hold in nursing homes stems from several factors:  regulations that favor rehabilitation over palliative care; inadequate staff knowledge and skill in palliative care; financial disincentives (e.g., higher reimbursement for skilled nursing care and invasive therapies); misconceptions about palliative care; and lack of reimbursement for specialized palliative care.

Hospice agency/nursing home partnerships.  There are three models for delivering palliative care in nursing homes. The first model involves partnerships between hospice agencies and nursing homes. This approach has grown substantially since the late 1980s, when CMS determined that eligible nursing home residents could access the Medicare hospice benefit. Around a third of all nursing home decedents now use the Medicare hospice benefit before death.  Hospice supplements the resources available at nursing homes, introducing services such as expert symptom management, additional personal care, spiritual counseling, social work services, and volunteer and bereavement services. Although some authors have raised questions of the fit between Medicare’s configuration of the hospice benefit and the nursing home setting, hospice use in NHs is associated with decreased unnecessary therapies, fewer hospitalizations, improved pain and symptom management, and higher family satisfaction with care.

Source: Health Affairs Blog

Thursday, 05 December 2013 17:59

New Method For Predicting Alzheimer's?

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I just came across a fantastic article from David Surico writing for McKnight's

New method predicts Alzheimer's in two-year window

A new study has led to a breakthrough in the process to identify people who will fall victim to Alzheimer's disease.

The research predicted with 90% accuracy which mild cognitive impairment sufferers would develop Alzheimer's disease within two years. Findings were published in the current issue of the Journal of Alzheimer's Disease.

The combination of brain imaging analysis and a neuropsychological assessment allowed the team to uncover which subjects would develop Alzheimer's and those who would not. Sylvie Belleville, Ph.D., Director of Research at the Institut universitaire de gériatrie de Montréal, an institution affiliated with Université de Montréal, led the study.

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Tuesday, 03 December 2013 14:05

Does Medicaid Breed Dependency?

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With more and more Americans going on Medicaid, this has become a real issue.

The question is, does Medicaid breed Dependency? Obviously, for those who would otherwise be ineligible for coverage, the question is more practical than philosophical.

In fact, the refusal of 25 states to expand their Medicaid programs is a tragedy for the 5.2 million people who won't get health coverage. At the same time, it's also an excellent opportunity to test a long-held conservative view: that Medicaid and other government programs lull able-bodied Americans into a state of dependency.

Your reaction to that concept is about as good a litmus test as you can get for where you fall on the ideological scale.

Bloomberg certainly has much to say on this topic.

Monday, 02 December 2013 15:48

Charity Care Documented by NJ Hospitals On The Rise

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I must say, I have seen an increase in the amount of charity case referrals we received from the local hospitals in the past year.

It is always extremely unfortunate when I see elderly people who are sick and compromised and have no health insurance.

It should never come to that. People owe it to themselves (and their families owe it to them) to secure proper insurance, especially elderly people who are at greater risk for hospitalizations and skilled nursing placement. 

Take a look at this recent article from the New Jersey Department of Health.

Friday, 29 November 2013 09:32

Growth of Medicaid Enrollment Creates Doctor Shortage

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For some time now, the Healthcare industry has been dealing with this growing problem.

We are seeing more and more doctors who are reluctant to keep patients as they transition from Medicare to Medicaid, or to accept residents who are already enrolled in Medicaid.

The fact is, doctors who accept Medicaid patients are forced to make due with a significantly lower reimbursement rate and over the top red tape.

This situation is likely to get worse with the high expansion anticipated once the President's healthcare law goes into full effect.

In just 5 weeks millions of additional Americans will be covered under Medicaid, many of them older people with a myriad of health problems.

The Congressional Budget Office predicts that an additional 9 million people will gain coverage through Medicaid in the next year alone.

How this will continue to impact the Skilled Nursing Community is left to be seen.

Thursday, 28 November 2013 13:35

Senior Healthcare Technology Demand Is Growing

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As Boomers Become Seniors, Healthcare Technology Demand Grows

With baby boomers all grown up, a new generation of tech-savvy seniors is emerging.

Tech-savvy seniors will begin to enter the healthcare market in the coming years, so the industry needs to prepare for this new type of aging patient. An estimated 3.5 million US citizens a year are expected to reach 65-years-old through 2023, according to an Accenture study. Internet use from 2000 to 2012 tripled for those 65 and older, and doubled among those 50 to 64-years-old, as documented by the Pew Internet and American Life Project.

A different study found 73 percent of baby boomers and Generation Xers want to age in their own home, and 95 percent don't think today's technology will allow them to do so. Georgetown University's Global Social Enterprise Initiative and Philips surveyed current and future seniors' attitudes on technology, finding most boomers and Gen Xers skeptical of the technology that awaits them as they enter their senior years.

Information Week: Healthcare

Wednesday, 27 November 2013 17:00

Long Term Care and the Rehospitalization Issue

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Government inspectors say there’s not enough attention being paid to the readmissions problem in long-term care settings, specifically nursing homes. 

A recent study by the Office of the Inspector General (OIG) found that of the 825,765 Medicare residents who stayed in nursing homes for at least one day in fiscal year 2011, 24.8% experienced hospitalizations.

As this population cost Medicare $14.3 billion during that year—33% more per stay than for the average Medicare hospitalization—OIG’s study stresses the need for improved quality measures that detail hospitalization rates within these care settings.

The most common illnesses that drew nursing home residents back to the hospital were for septicemia (13.4%), pneumonia (7%) and congestive heart failure (5.8%).

Septicemia alone accounted for 21% of Medicare spending on nursing home resident hospitalizations, amounting to almost $3 billion in FY 2011, according to OIG’s findings.

Nursing homes routinely collect resident assessment data during a nursing home stay and the Centers for Medicare & Medicaid Services (CMS) converts this data into 18 quality measures.

Examples of quality measures indicate how well a nursing home provides care to its residents, including the percentages of residents who report moderate to severe pain, residents who were appropriately given the seasonal influenza vaccine, and the percentage of residents who have lost significant amounts of weight.

While nursing homes routinely collect resident assessment data when reporting quality measures to CMS, there is not a measure of how often nursing homes hospitalize their residents.

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