Health and Disability

Last month, ProPublica and NPR detailed how one nonprofit hospital in Missouri sued thousands of lower income workers who couldn't pay their bills, then seized their wages, all while enjoying a big break on its taxes.

Since then, the IRS has released long-awaited rules designed to address such aggressive debt collection against the poor. Largely because these new rules fill a void — there were hardly any rules at all — patient advocates agree they are a major step forward.

Even so, they have easily exploitable gaps. It remains up to each hospital, for example, to decide which patients the new rules should apply to. And because the rules only apply to hospitals that have been granted tax-exempt status by the IRS, they don't apply to for-profit hospitals or most public hospitals. ProPublica reported last month that public hospitals can be even more aggressive in collecting debt than nonprofits.

Most hospitals in the U.S. are charitable organizations. They don't pay taxes because they are supposed to be a key part of the safety net for the nation's poor patients. In theory, patients who aren't covered by Medicaid and can't afford insurance — or who are underinsured and can't afford their out-of-pocket costs — can receive necessary care from a nonprofit hospital without facing financial ruin. Each hospital is required to offer services to lower-income patients at a reduced cost and to have a financial assistance policy that states who qualifies for aid, known as "charity care."

Bipartisan legislation, introduced today by Representatives Tiberi (R-Ohio) and Larson (D-Conn.) and Senators Portman (R-Ohio) and Cardin (D-Md.) would help stop the speculative bidding that has marred the Medicare competitive bidding program for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). The American Association for Homecare (AAHomecare) applauds these leaders for their determination to put the patients first by bringing prudence to the flawed bidding process.

H.R. 284 and S. 148 would ban non-binding bids, one of the biggest problems with the bidding program. 244 economic experts from around the world, a group that includes Nobel Prize laureates, agree that the current Medicare bidding scheme is unsustainable, citing the lack of binding bids as a primary shortcoming of the program.

Officials from Centers for Medicare and Medicaid Services (CMS) have repeatedly said that CMS does not have the statutory authority to require binding bids, and that Congress must authorize CMS to require binding bids. With the next cycle of competitive bidding opening in less than two weeks, Congress must act now to protect Medicare beneficiary access to critical medical equipment.

Since CMS began implementing the bidding program in 2011, bidders have been allowed to submit suicide low-ball bids with no obligation to accept the contract at the price they bid at.

The Florida case is the latest effort to get federal judges to force states to increase Medicaid provider payment rates for the state and federal program that covers about 70 million low-income Americans. In the past two decades, similar cases have been filed in numerous states, including California, Illinois, Massachusetts, Oklahoma, Texas and the District of Columbia– with many resulting in higher pay.

But while providers and patient advocates nationwide hailed the Florida decision, they are deeply worried about a U.S. Supreme Court case  that they say could restrict their ability across the country to seek judicial relief from low Medicaid reimbursement rates.

Throughout the four-year OPTIMISTIC project, nurses are stationed at the participating nursing facilities to provide direct support to long-stay residents and their families as well as education and training to the staff. OPTIMISTIC nurses lead care management reviews to optimize chronic disease management, reduce unnecessary medications and clarify goals of care.

"Long-stay nursing home residents - whose numbers are growing as our population ages - need more attention from both researchers and clinicians," said Regenstrief investigator Greg A. Sachs, M.D., OPTIMISTIC project director and director of the IU School of Medicine's Division of General Internal Medicine and Geriatrics. Dr. Sachs is also a professor of medicine and an IU Center for Aging Research center scientist. "With OPTIMISTIC, we are working with the residents where they live to improve many aspects of their lives including chronic disease management - especially for dementia, which affects more than half of long-stay residents -- as well as to improve the care they receive during the transition process to and from a hospital, when that transfer is necessary."

Starting this month, Medicare will pay primary care doctors a monthly fee to better coordinate care for the most vulnerable seniors – those with multiple chronic illnesses – even if they don’t have a face-to-face exam.

The goal is to help patients stay healthier between doctor visits, and avoid pricey hospitals and nursing homes.

“We all need care coordination. Medicare patients need it more than ever,” said Sean Cavanaugh, deputy administrator at the Centers for Medicare and Medicaid Services.

About two-thirds of Medicare beneficiaries have two or more chronic conditions, such as diabetes, heart disease or kidney disease. Their care is infamously fragmented. They tend to visit numerous doctors for different illnesses.

Too often, no one oversees their overall health – making sure multiple treatments don’t mix badly, that X-rays and other tests aren’t repeated just because one doctor didn’t know another already had ordered them, and that nothing falls between the cracks.

Of course, many people with hearing problems can use hearing aids or, for serious cases, cochlear implants. But the implants require surgery and many people do not like or use hearing aids, so drugs could be an alternative.

“Glasses can usually return you to 20/20 while hearing aids don’t return you to normal hearing, not even close,” said Kathleen C.M. Campbell, a professor at Southern Illinois University School of Medicine.

But challenges remain. Efforts in the past to develop ear drugs, to the extent they were made, largely failed. The inner ear, which is crucial to both hearing and balance, is almost impenetrable, making it difficult to study or for drugs to enter.

“It’s a teeny organ encased in a really, really hard bone,” said Dr. Hinrich Staecker, professor of otolaryngology at the University of Kansas School of Medicine. “The whole inner ear fits inside the tip of your pinkie.”

Buried in the new rules that the House Republican majority plans to adopt for the 114thCongress is a provision that could threaten Disability Insurance (DI) beneficiaries — a group of severely impaired and vulnerable Americans — with a sudden, one-fifth cut in their benefits by late 2016. The provision bars the House from replenishing the DI trust fund simply by shifting some payroll tax revenues from Social Security’s retirement trust fund.

ust about everything you think you know about Alzheimer’s disease and other dementias is wrong. And because the conventional wisdom is so off-track, so are the ways we—both family members and professionals—respond to those with dementia.

That’s Dr. G. Allen Power’s provocative message. He wants us to stop thinking that people with dementia are victims of a terrible debilitating disease that destroys their memory and perception. Instead, Power argues, dementia is “a shift in the way a person experiences the world.”

In his new book Dementia Beyond Disease, Power argues that people with dementia are not psychotic or delusional. Rather, they see the world differently than others. Power’s goal is not to treat a disease. It is to improve the well-being of those who have it. And unlike drug therapies, which have been high-cost failures, Power identifies dozens of ways that may enhance the lives of those with dementia.

The Obama administration announced new rules under Obamacare on Monday that target nonprofit hospitals’ efforts to get paid by their patients.

Nonprofit hospitals, which serve a charitable purpose and are often religiously affiliated, will now be subject to strict rules on when and how they can collect payments from customers, thanks to regulations included in the health-care law. As a condition of their tax-exempt status, these hospitals must “take an active role in improving the health of the communities they serve,” Treasury Department deputy assistant secretary for tax policy Emily McMahon wrote in a blog post Monday.

Under the new IRS rules, the penalty for failing to meet the new standards could even lead hospitals’ tax-exempt status to be revoked entirely.

“Reports that some charitable hospitals have used aggressive debt collection practices, including allowing debt collectors to pursue collections in emergency rooms, have highlighted the need for clear rules to protect patients,” McMahon wrote. “For hospitals to be tax-exempt, they should be held to a higher standard.”