Health and Disability

MYTH #1: Medicare overpays for home medical equipment and services, and the bidding system improves the method for setting reimbursement rates for that equipment and service.

REALITY: Proponents of the bidding system use out-of-date reimbursement rates and false comparisons of retail costs versus Medicare costs to argue their case. For many years, CMS has set reimbursement rates for home medical equipment through a fee schedule. Over the past decade, those reimbursement rates have dropped nearly 50 percent because of cuts mandated by Congress or imposed by CMS.

The costs of delivering, setting up, maintaining, and servicing medically required equipment in the home are obviously greater than the cost of merely acquiring the equipment. But Medicare does not recognize the costs of these services. So comparing the cost of the equipment to the larger cost of furnishing the full array of required equipment, supplies, and services is false and misleading.

Hospitals could reduce health care costs arising from pressure ulcers, commonly known as bedsores, by investing in pressure-reduction mattresses for elderly patients in emergency departments, according to new research from the University of Toronto.

In emergency departments (EDs), elderly patients are at high risk for pressure ulcers in part because they spend hours lying on hard surfaces. The researchers found that while the average cost of upgrading from standard to pressure-redistribution mattresses would be 30 cents per patient, the corresponding reduction in pressure-ulcer incidence would produce savings of $32 per patient.

ADAPT, a national grassroots disability rights organization, is outraged by a Dear State Medicaid Director letter issued by the Centers for Medicare and Medicaid Services (CMS) on Friday, August 5th.  That letter explained how states

can cut Medicaid home and community based services, which provide alternatives to institutionalization, and not run afoul of the maintenance of effort requirement in the Affordable Care Act. The organization is particularly upset because Secretary Sebelius spoke before national disability rights groups in July, highlighting how the Affordable Care Act benefits people with disabilities, including the potential to improve access to home and community based services.  While the Secretary gave rousing speeches and was applauded by our community, her staff were crafting guidance to states on cutting our services, said Rahnee Patrick, an ADAPT Organizer from Chicago, IL.  This is reprehensible.

• A Quality Care Finder - Medicare beneficiaries can go online and access all Medicare's Compare tools, with information on nursing homes, hospitals and plans.
• Hospital Compare Website - now updated with information on how hospitals rate for outpatient care, surgical infections.

  Also tells you how each outpatient is treated for suspected heart attack, whether proven therapies that reduce mortality are used. Also includes 30-day mortality rates and 30-day readmission rates for inpatients with heart attack, pneumonia and heart failure. Three full years of claims data are compared.

  Also includes 10 measures related to patient experience with hospital care.

The antidepressants most often prescribed to treat depression in dementia patients provide no appreciable relief, and may raise the risk for serious side effects, new British research suggests.

"The two classes of antidepressants most likely to be prescribed for depression in Alzheimer's disease are no more effective than placebo," the study authors said.

The drugs in question are Zoloft (sertraline), and Remeron (mirtazapine).

"In our study, there were more adverse reactions in individuals treated with antidepressants than there were with placebo," the research team added. "Clinicians and investigators need to reframe the way they think about the treatment of people with Alzheimer's disease who are depressed, and reconsider routine prescription of antidepressants."

On June 17^th, 2011, the Centers for Medicare and Medicaid Services (“CMS”) released Survey and Certification Memorandum 11-30-NH (the “Memorandum”) (for a copy click: S&C 11-30-NH) that provides guidance to State Survey Agencies (“SSA") regarding the reporting of reasonable suspicions of crimes in long term care facilities (“LTC”), also known as the “Section 1150B requirements.”  The requirement for covered individuals to report suspicions of crimes in LTCs to the SSA and at least one law enforcement agency, as well as requirements on LTCs to notify covered individuals of their duty to report, all stem from the Elder Justice Act that was part of the Patient Protection and Affordable Care Act ("PPACA").

The Memorandum has been long expected by the LTC industry and by SSAs and serves as the only official guidance from CMS on the suspicion of crimes reporting requirement.  CMS acknowledges that there are “no CMS regulations that apply specifically to section 1150B [the "reporting requirements]” and the Memorandum serves to explain the requirements of the new law so that it is implemented without any delay that may be caused due to the rule-making process.  CMS notes further guidance will be released that addresses implementation of the Civil Monetary Penalty component of the Section 1150B requirements.

The British and Norwegian study, published on the BMJ website, found painkillers significantly cut agitation in dementia patients.

Agitation, a common dementia symptom, is often treated with antipsychotic drugs, which have risky side effects.

The Alzheimer's Society wants doctors to consider other types of treatment.

Experts say that each year about 150,000 patients in the UK are unnecessarily prescribed antipsychotics, which have a powerful sedative effect, and can worsen dementia symptoms, and increase the risk of stroke or even death

Maybe they are FEELING PAIN!!

Nursing homes in the United States are shrinking and their residents are becoming proportionately more black, more Hispanic, more Asian, and less white, according to a new study by Brown University researchers. The nationwide trend, reflected in metropolitan areas from New York to Los Angeles, results from changing demographics and disparities in what people can afford. The study is published in the July edition of Health Affairs.

In the last decade, minorities have poured into nursing homes at a time when whites have left in even greater numbers, according to a new Brown University study that suggests a racial disparity in elder care options in the United States.

A recent study on privatization of nursing homes concluded that when a government-run home is taken over by a for-profit company, violations of quality care tend to increase. When a nonprofit assumes control, violations don’t increase, but fewer Medicaid patients are admitted. Anne Amirkhanyan, who conducted the study, notes, “It’s different priorities. There are wealthier, happier clients at nonprofits. For- profit companies have residents who are quite poor, but they don’t have the (care-oriented) mission.

Well it seems that The Obama Administration is getting some aspects of expanded healthcare right as new information released proves that low income adults' access to Medicaid substantially increases health care use, reduces financial strain on covered individuals, and improves their self-reported health and well-being. This is the first study to evaluate the impact of insuring the uninsured in the U.S. using a randomized controlled trial.