Waiting List Placements May Violate ADA

Bout Time....

Being on a waiting list for community-based services may be evidence enough that an individual with developmental disabilities is at risk for institutionalization in violation of the Americans with Disabilities Act, according to the U.S. Department of Justice.

In a statement of interest filed this month, the Justice Department said that if individuals with developmental disabilities are not receiving services in the community, they may have a claim that their rights have been violated.

“Non-institutionalized individuals with disabilities who are not currently receiving state-funded home- and community-based services may bring a claim that a public entity has placed them at risk of institutionalization or segregation in violation of the ‘integration mandate’ of Title II of the Americans with Disabilities Act,” the federal filing indicates.

The Decline of Tube Feeding for Dementia Patients

The primary motivation these days for tube feeding is provider convenience......

http://goo.gl/CJRtLN

Dr. Mitchell has had a lot to do with that shift. As a young physician training in nursing homes, she wondered whether feeding tubes actually helped these bedbound elders. At the time, roughly a third of cognitively impaired nursing home residents were tube-fed.

She and a cadre of researchers, primarily from Harvard and Brown universities, have been methodically reporting their findings for 20 years, demonstrating in one article after another the drawbacks of artificial feeding for people in the final stages of dementia.

Change can come slowly in medicine, but it does come. In 2013, the American Geriatrics Society updated its recommendations against feeding tubes for older patients with advanced dementia. The Choosing Wisely campaign, which publishes lists of procedures and tests that patients and families should question, and the Alzheimer’s Association have takensimilar positions.

Now, families and physicians seem to have gotten the sorrowful message: Dementia is a terminal disease. Eating and swallowing problems eventually plague almost everyone who has it. Feeding tubes don’t help. In fact, they can make matters worse.

Hospitals Try Giving Patients a Dose of VR

People can experiment with VR themselves fairly inexpensively. See Google Cardboard......

http://goo.gl/iSrB9e

When Deona Duke woke up from a medically-induced coma to begin recovering from burns that covered almost a third of her body, one of her treatments was hurling snowballs at penguins. The 13-year-old was set on fire when a bonfire exploded on her and her friend. To prevent infection, burn victims need their bandages changed and dead skin scraped away. Sometimes, even morphine isn’t enough to make that tolerable.

At the Shriners Hospital for Children in Galveston, Duke’s doctors gave her a virtual reality headset. Slipping it on, she was immersed in “SnowWorld,” an icy landscape where she got to lob snow at snowmen and igloos. The Texas hospital is one of the few trying out virtual reality to relieve pain.

“I’d never heard of it so I was a little surprised,” she said. “When I first tried it, it distracted me from what they were doing so it helped with the pain.”

It’s still a new and experimental approach, but proponents of virtual reality say that it can be an effective treatment for everything from intense pain to Alzheimer’s disease to arachnophobia to depression. And as Facebook Inc., Sony Corp., HTC Corp. and othersrace to build a dominant VR set, the price of hardware has fallen, making the equipment a more affordable option for hospitals looking for alternatives for pain relief.

The idea is that the worst pain can be alleviated by manipulating the way the human mind works: the more you focus on pain, the worse it feels. Swamp the brain with an overload of sensory inputs—such as with the immersion in a virtual world—and its capacity to process pain, to be conscious of it, goes down.

Medicare Advantage Audit Uncovers Rampant Overcharging

http://goo.gl/gnclv3

All but two of the 37 health plans audited for 2007 were overpaid — typically several hundred thousand dollars too much.

NPR/Center For Public Integrity: Audits Of Some Medicare Advantage Plans Reveal Pervasive Overcharging
More than three dozen just-released audits reveal how some private Medicare plans overcharged the government for the majority of elderly patients they treated, often by overstating the severity of certain medical conditions, such as diabetes and depression. The Center for Public Integrity recently obtained, through a Freedom of Information Act lawsuit, the federal audits of 37 Medicare Advantage programs. These audits have never before been made public, and though they reveal overpayments from 2007 — money that has since been paid back — many plans are still appealing the findings. (Schulte, 8/29)

Integrating mental and physical health through primary care teams results in better clinical outcomes and lower costs

https://goo.gl/a2rwko

The 10-year study — which is one of the largest studies of its kind — shows the benefits of care provided by team-based providers in an integrated delivery system. The study, which was conducted by Intermountain Healthcare researchers, measured 113,452 adult patients who received care from 2003 through 2013 in 113 primary care practices at Intermountain, including 27 team-based medical practices and 75 traditional practices.

What are the results of the study (and the clinical benefits of team-based care)?

A dramatically higher rate of patients in team-based practices were screened for depression — which allowed care providers to provide medical and behavioral interventions earlier — compared to patients in traditional practices. 46.1 percent of patients in team-based practices were diagnosed with active depression compared to 24.1 percent in traditional practices.
24.6 percent of patients in team-based practices adhered to diabetes care protocols, including regular blood glucose testing, compared to 19.5 percent in traditional practices — which demonstrated how well patients engaged with care teams in working together to manage their health.
48.4 percent of patients in team-based practices had a documented self-care plan to help them manage their health conditions, compared to 8.7 percent in traditional practices.
85.0 percent of patients in team-based practices had controlled high blood pressure, compared to 97.7 percent in traditional practices (although the care teams involved in the study didn’t focus on blood pressure like they did on depression and diabetes).

Patients in team-based medical practices also used fewer healthcare services and had lower total costs, according to the study. Data showed that per 100 person years:

The rate of emergency room visits was 18.1 for patients in team-based practices versus 23.5 visits for patients in traditional practices, which is a reduction of 23.0 percent.
The rate of hospital admissions was 9.5 for patients in team-based practices versus 10.6 in traditional practices, which is a reduction of 10.6 percent.
The number of primary care physician encounters was 232.8 for patients in team-based practices versus 250.4 for patients in traditional practices, which is a reduction of 7.0 percent.
Payments to providers were $3,400 for patients in team-based practices versus $3,515 for patients in traditional practices, which is a savings of 3.3 percent. The payments were less than the investment costs Intermountain incurred in creating the team-based practice model.

Figuring Out A Strategy For Eating Well For Dementia Patients

http://goo.gl/eKxkQk

Your physician was wise to recommend a consultation with a nutrition expert, especially one who is experienced working with geriatric patients, such as Barbie Lazar MS, RD, CDN, Clinical Nutrition Manager at Miami Jewish Health Systems. She told me in an email that weight loss is a common challenge for people with dementia and the main culprit is usually undereating. She offered this advice:

“The mealtime environment plays a very important role in promoting adequate intake.Reducing distractions, maintaining adequate lighting, and using appropriate utensils can assist in maximizing how much he eats. Try interacting with him at mealtime. Provide encouragement and reminders for him to complete his meal. Also, observe if he has difficulties chewing or swallowing. If so, consider softer or pureed foods.”

She also added that your husband may prefer smaller meals with snacks in between rather than large meals.

“ Consider high calorie snacks such as pudding, ice cream,” she added. “A better and more natural option that any artificial supplements would be homemade smoothies. High calorie, high-protein ingredients can include avocado, bananas, yogurt, silken tofu and protein powder.”

Lazar added that “Food First” is the best approach to solving your husband’s under-eating.

"Doing what you can to increase his caloric intake — hopefully with more healthful foods than sweets — will likely improve your husband’s energy level and disposition. And if testing shows that your husband has nutritional or absorption deficiencies, a nutrition expert will know how to rectify these issues through diet and/or supplements."

To find a registered dietitian and nutritionist who specializes in geriatric nutrition, use the referral service offered by EatRight.org which allows you to search by zipcode and specialty.

CareLinx

Interesting model-includes apps...

https://www.carelinx.com/

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The National Academy for State health Policy

http://goo.gl/4krYS

Putting the Evidence to Work for States

Evidence reviews are powerful tools that allow health policymakers to direct resources to certain options that outperform others. Evidence-informed approaches can optimize coverage decisions, increase performance on quality improvement measures, and drive effective responses to major challenges. One way states are utilizing these evidence-informed approaches is in addressing the opioid crisis.

Data for Change: How States Have Used APCDs to Drive Innovation

State-run all-payer claims databases (APCDs) are a critical public resource and serve a unique function in the current era of health care reform. APCDs, which are operating in 18 states, provide fair and equal access to independently validated data that can both support evidence-based policymaking as well as help patients navigate the health care system. These databases are also the only publicly accessible, independent resources available to analyze the billions of dollars spent on health care through private health insurance markets.

APCDs saw a setback earlier this year in Gobeille v. Liberty Mutual ,when the Supreme Court held that ERISA prohibits state mandated reporting by self-insured plans. Without claims data from self-funded sources, APCDs will be unable to provide a comprehensive picture of health care spending and use,[1] and as a result these databases will be considerably less valuable to the leaders and consumers that have come to rely on them.

Before Gobeille, states were making important strides in collecting and validating claims data from payers and beginning to leverage this information to drive health care reform efforts. Below are just a few examples of the ways states have been able to use APCD data to improve care and lower costs.

ACOs Save $466 Million

http://goo.gl/bHSvJE

This week, the Centers for Medicare & Medicaid Services (CMS) announced Medicare Accountable Care Organizations saved more than $466 million in 2015, surpassing shared savings in 2014.

Other highlights of the week include a Harvard pilot study that utilized a checklist for caregivers, enabling them to track changes in patients’ conditions and potentially monitor and reduce the likelihood of a future hospitalization. Home care also had a small win in an overtime case in New York. Here in the newsroom, we keep our readers informed on how the industry is advocating against home health copayment proposals.

New Clues in the Mystery of Women’s Lagging Life Expectancy

http://goo.gl/ky0fUf

Using new state-by-state data collected by the federal government, researchers found that a state’s economic and social environment — from its welfare policy and tobacco tax rate, to the strength of social ties through sports clubs and churchgoing, to the level of economic inequality — had a significant effect on women’s life spans.

Health and Disability

All the Churn in Health Policy