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.

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.