archive-org.com » ORG » M » MEDICARING.ORG

Total: 416

Choose link from "Titles, links and description words view":

Or switch to "Titles and links view".
  • Just How Dysfunctional is Frail Elder Care in the U.S.? – MediCaring.org
    a home visit yes a home visit noted that my mother could not get a good broad spectrum antibiotic except by going to the emergency room because all pharmacies near her small county seat in western Pennsylvania were closed on Saturday night and all day Sunday Feeling like a participant in a modern day Iditarod I got the antibiotic and drove 4 hours to deliver it and it actually did the trick My mother turned the corner within 12 hours and was breathing much easier by Sunday afternoon But then she was very weak and severely dehydrated which causes nausea and therefore she required some way to accomplish hydration other than just by drinking fluids I asked about home health care getting her some intravenous fluids The answer That would take 48 hours to set up I asked whether I could buy or slip away with the fluids and an IV setup after all I m a physician That would break too many rules I stumbled onward asking what would happen if my mother were in hospice Miracle delivered In hospice she could have an IV at home that day Her primary care physician agreed that without something changing her prognosis fit the hospice requirements and having an IV could hardly count as curative medicine except of course that it did put her back into her usual state of health and then she left hospice care Now let s think about this The usual course would have been an ambulance to the hospital an emergency room visit and a hospitalization perhaps followed by a few days of skilled nursing facility care to get her back on her feet And that course assumes no serious complications like a fall or an infection Hospice cost about 1 10 as much But why did her doctor and I have to figure out an end run around the rules that seemed to connive to ensure that she would have to go to the hospital if not to get the antibiotic then to get the fluids This time the priorities were set by service providers seeking their convenience and perhaps their incomes not by 93 year old women very much wanting to live out their lives at home Most of us will be relatively healthy for most of our lives We will end up spending about half our lifetime health care costs in the last years of life when we are frail needing food delivered by a friendly volunteer needing that antibiotic to be available without going to the hospital and needing some IV fluids at home today not after a lot of paperwork gets done We ll need that remarkable primary care doctor who visits at home But I sure hope that not everyone needs a physician daughter who can find one more question to ask to evade the ruthlessness of a seriously dysfunctional system and we must all insist that no elderly person will ever need to wait 6 months without being able

    Original URL path: http://medicaring.org/2015/05/19/just-how-dysfunctional-is-frail-elder-care-in-the-u-s/ (2016-04-30)
    Open archived version from archive


  • Purchasing Value – Not Yet Right for Medicare’s Frail Elders – MediCaring.org
    approved or that are in the process of approval CMS proposes four measures each applied in four care settings the rate of pressure ulcers the rate of falls with injury the existence of functional assessment and whether there is a care plan with a goal that involves function and readmissions But in setting out to talk with frail elderly people leaving the hospital for a short term stay in a nursing home before they go home what do we imagine are their highest priorities The four that Medicare proposes might make the list except that the way we measure readmissions is seriously deficient even with risk adjustment http medicaring org 2014 12 16 protecting hospitals http medicaring org 2014 12 08 lynn evidence But most people have other priorities that are equally or more important such as whether there is a workable plan to get the daily care and support needed e g housing modifications food transportation and personal care Another question elders often ask is what the effects of their disabilities on the family will be especially if family members have to provide more care Elders may also want to be sure that they will have the symptom pain control spiritual support and reliable supportive care that they will need as their conditions get worse whether they are in a care system that will maximally preserve their financial assets so that they have a lower risk of running out and whether they will have to move to a nursing home Medicare s metrics don t yet even try to address these concerns Even more troubling is the fact that Medicare does not yet have any methods to judge the match between the services given and the patient s perspective as to what matters Current metrics are all grounded in professional standards and professionals have been slow to build standards that truly take into account the very different things that individuals want in late life A high quality service delivery system must try to match the priority needs and preferences of each elder As Medicare moves toward paying its providers on the basis of value it is important to keep in mind what you value is often not what I value and this difference becomes more pronounced as we have to live with physical and financial limitations and the increasing proximity of death Here are some steps that we can take We should demand that Medicare invest in developing measures that matter for the frail phase of life before distorting the delivery system with incentives applying to everyone e g to avoid pressure ulcers falls and readmissions and to have and achieve goals concerning function CMS should be willing to be the measures steward or should fund another entity to do so since the money available for frail elder care does not spin off strong organizations that can do the developmental work and then maintain updated measures Our health information systems e g in Meaningful Use Stage 3 should at

    Original URL path: http://medicaring.org/2015/02/25/purchasing-value/ (2016-04-30)
    Open archived version from archive

  • Comments on Payment for Advance Care Planning – MediCaring.org
    doctor on the pretext of the sacredness of life of an unborn fetus some states even extending legal personhood status to a zygote only a few moments after the possible fertilization of an egg while from the very nanosecond of birth and throughout it s entire lifetime there is no further concern for that person s physical or mental health happiness well being or anything else Funding for prenatal care neonatal care childhood nutrition 1 in 4 American children don t have enough to eat a national disgrace in such a wealthy nation childcare preschool public schools and colleges has been and continues to be ruthlessly slashed Medicaid is a perennial target for cuts and hate rhetoric the lazy the poor the illegals are wasting the tax dollars of the self righteous and hard working Medicare has barely survived the chopping block our new Speaker of the House Paul Ryan has repeatedly placed it on for almost a decade several times but that s unlikely to happen again given the complexion of the current Congress the increasingly hostile political climate and the moneyed elite and corporations behind the upcoming elections Already Speaker Ryan is resurrecting his odious plan to eliminate Medicare and replace it with block grants to states that would distribute less than a couple hundred dollars to current Medicare recipients which would purportedly allow them to purchase health insurance on the open market with the ACA s repeal it s extremely unlikely the disabled elderly could ever hope to afford even the worst health insurance especially on a fixed income without any COLA and the runaway inflation of health care costs once there are no longer any controls in place Meanwhile the disabled barely regained the 20 of their already meager EARNED SSDI income which had been arbitrarily cut by Congress as its first official act upon taking office this past January after gaining control of both Houses with today s vote on the budget extension Unfortunately the Older Americans Act was allowed to expire without a vote to extend it leaving millions of elderly and infirm citizens without adequate food or the assistance they had enjoyed for many years thanks to the Act Sadly however funding for this Act like virtually every other program intended to benefit any vulnerable population in this country had been regularly cut over and over resulting in a lengthy wait list for the vital services it provided which is certain to become even longer now Keep in mind that so far I ve been discussing programs benefitting the LIVING If this is all that s being done and grudgingly at best for people during their lifetimes is it any wonder that no one is willing to look at how we approach them in their later years and as they prepare for their last days on this Earth If this country spent just half or even one fourth of the money it devotes to waging war and dealing death on caring for PEOPLE

    Original URL path: http://medicaring.org/2015/08/25/comments-on-payment-for-advance-care-planning/ (2016-04-30)
    Open archived version from archive

  • Sixth White House Conference on Aging: Now It’s Time to Do More. A Lot More. – MediCaring.org
    or misappropriation of resident property Nursing homes will have to provide training in dementia management and resident abuse prevention training to all nurse aides http www cms handinhandtoolkit info and must promulgate clear standards for ongoing quality assurance and for establishing compliance and ethics programs designed to curb fraud The regulation further proposes to require facilities to conduct thorough competency based assessments of staffing adequacy and training in order to make thoughtful informed staffing plans and decisions that are focused on meeting resident needs including maintaining or improving resident function and quality of life When combined with adequate enforcement and the forthcoming requirements for mandatory reporting of staffing based on payroll data which will include information on staffing levels type of staff tenure and turnover this requirement could provide far more accurate and comprehensive information about what arrangements work best for varying resident populations and how these correlate with the results of health and safety inspections and quality outcomes http www cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualityInits Staffing Data Submission PBJ html President Obama and other speakers called for the reauthorization of the OAA which subsequently cleared the Senate on July 16 by unanimous consent https www congress gov bill 114th congress senate bill 192 q 7B 22search 22 3A 5B 22 5C 22s192 5C 22 22 5D 7D The law expired in 2011 and has languished in Congress for 4 years struggling to amass sufficient political support In the House of Representatives the OAA has not yet been marked up which falls within the jurisdiction of the Education and Workforce Committee While it is encouraging that a reauthorization of the OAA is moving forward the statute has not been retooled to meet the needs of millions more seniors in the 21st century possibly because doing so might require allocation of more resources By virtually any measures the law is seriously underfunded to meet on the ground needs of elders who have both chronic conditions and functional limitations For example in a growing number of cities and regions around the country access to home delivered meals is nonexistent http www mealsonwheelsamerica org theissue facts resources more than a meal In an era when tens of millions of aging boomers intend to age in place in their own homes and communities the basic long term social services and supports that they will need have gone missing services like subsidized transportation household management and personal care assistance with nutrition and access to medical services benefit programs and other fundamentals of daily life During the national conference no panel squarely addressed the glaring lack of a plan to address these gaps though there was much discussion of this topic during the regional seminars and other events leading up to the WHCOA This may be because there is as yet no political or policy consensus on how to proceed Meanwhile a recent research brief prepared by the HHS Assistant Secretary for Planning and Evaluation Long Term Services and Supports for Older

    Original URL path: http://medicaring.org/2015/07/27/sixth-white-house-conference-on-aging-now-its-time-to-do-more-a-lot-more/ (2016-04-30)
    Open archived version from archive

  • Petition the White House for a MediCaringCommunities demo! – MediCaring.org
    administrations change in a little more than a year Getting a set of demonstration communities underway before the disruption of personnel change would be prudent Waiting even a few more years until lines of authority are reestablished means that the period of major increase in the numbers of frail elders is that much closer and teams eager to be underway are blocked and will lose momentum and commitment Second many communities note the challenges that they will have as the number of persons living with serious chronic conditions grows the financial and workforce resources needed are not available and the inherited service delivery system is overwhelmed Fully half of retirees now have no savings yet the average duration of self care disability in old age is more than 2½ years The mismatch is ominous How are we to ensure food and housing for so many frail elderly people who have no assets Furthermore we are paying for medical services that are often unreliable undesired and ineffective The examples are rife Someone once told me that if we paid ministers by the prayer there would be a lot of prayers said We do pay doctors for each service and there are a lot of services provided That is changing but some questionable medical services have been substituting for serious shortcomings in supportive services There needs to be a way to take some of the savings from more prudent medical care to fund better supportive services still aiming to reduce the overall cost but with a more balanced approach The MediCaring Communities model is a comprehensive approach that makes better medical care better supportive services and lower costs all come together But communities cannot implement it fully without CMMI providing some flexibility in current rules Communities could use an Accountable Care Organization framework for example but then they would need exemption from the restrictions that bar all enrollment enrollment of only a targeted set of elders or geographic service delivery If the community used a Program of All Inclusive Care for the Elderly PACE or Medicare Advantage framework then they would need to be able to spend on nonmedical items and enroll only the targeted frail elders In short we can t fully implement MediCaring Communities without some partnership with CMMI Let s encourage CMMI to move ahead Sign the White House petition as an individual today Go to https petitions whitehouse gov petition allow counties and communities manage elder care using savings more efficient medicare spending It takes only a few seconds Send this along to others as well We need a few hundred citizens and leaders to sign on in order to help CMMI take notice If you have a community that would want to be among the first let us know at email protected Let s build the future together Tweet Pin It One Response to Petition the White House for a MediCaringCommunities demo Norman McRae says December 2 2015 at 10 52 am Great article I support Reply

    Original URL path: http://medicaring.org/2015/06/23/petition-the-white-house-for-a-medicaringcommunities-demo/ (2016-04-30)
    Open archived version from archive

  • Introducing the Family Caregiver Platform Project – MediCaring.org
    provide a forum for building strong advocates and amplify their voices in their localities In many cases attending the local meetings that lead up to a state convention is perfectly possible CECAI looked into four states Iowa Massachusetts South Dakota and California and found out how the process works Usually meetings on party platforms and approval of candidates are open to every resident in the state who is registered with the party making it easy to get involved at a community level where you can have the most impact CECAI s goal is simple to get family caregiver issues into as many state party platforms as possible before the national election on November 8 2016 To do that we need your help We are looking for volunteer advocates across the country to move the conversation on caregiving forward in their home towns counties or states If you want to volunteer to get caregiver issues on state party platforms in your state here are some things you can do to get involved To find out more visit our website at the link below We need to tap into volunteer energy and expertise in many states Sign up for our mailing list by going to http caregivercorps org Research what supports exist or don t exist for family caregivers in your area Find out whether there is a local political club in your community that holds regular meetings If so attend as many as you can Talk to people and tell stories about the caregivers in your life Find out how the platform committee works for your state and whether you can attend their working meetings Raise awareness of caregiver issues You can use our planks to get started http caregivercorps org about us planks Regardless of whether CECAI manages to get family caregiver issues incorporated into multiple party platforms the many meetings that we attend and people to whom we talk are first rate opportunities to raise awareness of how to help neighbors and friends and to start conversations that will reverberate outward into county council meetings and state legislatures Remember Each person s voice matters in the political process Now is the time to start making the case Will you volunteer in your state Tweet Pin It 6 Responses to Introducing the Family Caregiver Platform Project Peg Graham says May 27 2015 at 10 03 am Yes I will volunteer in NYS Reply Davis Baird says July 2 2015 at 10 45 am Hi Peg Apologies for the delayed response but thank you so much for expressing interest in The Family Caregiver Platform Project FCPP My name is Davis and I am a staff member working on the FCPP I would love to discuss with you further how you can get involved with our efforts in NY Please email me at email protected if you are interested in finding out more about the project and ways you can contribute to this exciting work Best Davis Reply Jackie Siminitus says June

    Original URL path: http://medicaring.org/2015/05/27/introducing-the-family-caregiver-platform-project/ (2016-04-30)
    Open archived version from archive

  • Initial CMS Evaluations of Readmissions Have Serious Flaws – MediCaring.org
    evaluation not address these central issues Further there is no reason why a 20 reduction in the now thoroughly discredited readmissions discharges ratio is the best target A more informative target would clearly focus on providing a reliable well characterized set of services that work to the advantage of patients and families and that also reduces total costs The CCTP program and other efforts to improve care transitions have already met that criterion so the question now needs to be What are the next prudent steps for health care managers and policymakers To answer that question it makes sense to look to the other recently released evaluation of readmissions work developed for the Partnership for Patients http innovation cms gov Files reports PFPEvalProgRpt pdf This report claims that readmissions reductions may have saved Medicare 2 8 billion out of 3 1 billion saved by all of the hospital acquired conditions reductions Table 3 in the report but this presentation only attributes improvement to the Partnership for Patients PfP and its Hospital Engagement Networks HENs The CCTP the hospital penalties under the Hospital Readmissions Reduction Program and the QIO s extensive work in supporting community efforts are not mentioned let alone cited as possible parts of the causal chain The metrics supporting the claim of gains pages 3 2 and 3 3 are similarly inconsistent One figure uses 30 day readmissions discharges in Medicare one uses the QIOs readmissions 1 000 beneficiaries per quarter but does not report any statistical tests and one uses the hospital reported 30 day all cause all payer readmissions discharges The report aims to have the reader believe that the PfP and the HENS generated a number of positive results including saving money On closer inspection however it becomes clear that the authors are counting the reductions in admissions as well as the reductions in readmissions in estimating the savings a tacit admission that at least some people at CMS recognize that good practices in transitions and in longer term community support reduce both the numerator and the denominator in the readmissions discharges metric There are other evaluations to come with some presumably already in the works Many site visits have been made and much data are available Let s hope that the next round of evaluation reports starts to answer serious policy questions about how to proceed Now that we have come this far what combinations of services should become standard and expected by beneficiaries and family caregivers and which ones tend to be useful only in particular settings Which specific interventions should be used for targeted patients and which should become part of the ordinary operations of high quality health care delivery What have we learned about care planning interoperability feedback loops community action and useful measures Recently the Patient Centered Outcomes Research Institute PCORI has announced a multi million dollar multiyear contract focusing on care transitions Maybe that work will start identifying better measures of quality care during transitions and leading to better

    Original URL path: http://medicaring.org/2015/01/26/evaluation-flaws/ (2016-04-30)
    Open archived version from archive

  • Protecting Hospitals That Improve Population Health – MediCaring.org
    to increase a hospital s risk We also do yet fully understand what specific changes produce these decreases in the population based discharge rate but the most parsimonious explanation is that the causes are pretty much the causes of reduced readmissions Provide urgent care with support for keeping the patient in the community and you are likely to reduce all admissions not just readmissions Enroll more patients in medical homes and the benefits will not disappear 30 days after hospital discharge Improve nursing home communications with emergency rooms and the benefits will not be limited to patients within 30 days after hospital discharge What we can foresee is that hospitals already wary of readmissions reduction because it directly reduces revenue will become doubly wary if they conclude that reducing discharges may also cause or increase the MRRP penalty If CMS is penalizing hospitals and communities for succeeding at improving care and reducing costs the reaction may threaten a very successful set of initiatives The examples we report are for community based efforts to reduce readmissions Hospital level calculations are generally beyond our capability CMS can however easily determine whether all else being equal penalties are more likely or larger in areas where the population based hospital discharge rate is declining substantially than elsewhere That information is urgently needed What to do The purpose of the MRRP is to reduce the burden of readmissions on Medicare beneficiaries and the Medicare trust funds so the important indicator of progress is the number of readmissions not the percentage of discharged patients that are readmitted Healthcare quality measurement needs to catch up with the National Quality Strategy and add measures of the impact of care on the health of the population that will complement measures of the quality of individual episodes of care such as hospitalizations In the case of readmission measurement for the MRRP this need is substantially more urgent because there is good reason to fear that a hospital that engages with its community and does exactly what the MRRP hopes for is more liable to financial penalties under the current discharge based measure than it would be under a population based measure The first step is to assess the degree of urgency by examining national evidence on actual penalties If unreasonable penalties are at all frequent then the problem is far more urgent This will be complex because Epstein has already shown in cross sectional studies that population based hospitalization rates and readmission rates are positively correlated 2 At the same time it will be important to develop population based measures of readmissions and compare their impact on penalties with the impact of discharge based measures The obstacles are bureaucratic technical and political Bureaucratically the most important obstacle has been a widespread belief that the Patient Protection and Affordable Care Act requires calculating discharge based rates In fact the Act says only that penalties are to be determined from the ratio of observed to expected numbers of readmissions and is silent

    Original URL path: http://medicaring.org/2014/12/16/protecting-hospitals/ (2016-04-30)
    Open archived version from archive



  •