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  • metrics – MediCaring.org
    and the care plan that is supposed to reflect those priorities Buying on value is the right idea but buying value for each elder requires knowing what each one values A Dangerous Malfunction in the Measure of Readmission Reduction Posted by Les Morgan on August 26 2014 No Responses Tagged with Affordable Care Act CCTP CMS measurement metrics readmissions rehospitalization Aug 26 2014 By Joanne Lynn and Steve Jencks Work to reduce readmissions has started to yield remarkable improvements in integration of care for frail elderly people by prompting hospital personnel to talk with community based service providers by teaching patients and families how to manage conditions and navigate the health care system more easily and by paying more attention to trying to fill gaps in the community s services But the measure being used to track improvement is seriously misfiring in some settings and if CMS does not mitigate the adverse impacts they may become destructive to the momentum and the good that has been done This is much more than an issue of imperfect risk adjustment or inadequate identification of planned readmissions it is a punitive error that undermines program goals Since CMS mostly aims to assign responsibility for readmissions to the discharging hospital the key metric has been the risk of readmission for the average person discharged which is the number of readmissions divided by the number of live discharges Any time outcomes are monitored with a ratio one has to watch out for whether interventions that affect the numerator also affect the denominator Here that s happening enough to completely obliterate the usefulness of the metric at least in some circumstances Here s a quick hypothetical example At baseline a hospital has 1 000 Medicare fee for service FFS discharges per quarter with 200 of them back within 30 days Subsequently the hospital team and various community based providers work together and drop the readmissions to 160 per quarter Does the readmission rate go down to 16 under the metric No First they no longer have the 40 readmissions that are also admissions and in the denominator But more important the very things that are reducing the readmission rate also affect the likelihood of coming back in 45 days or 6 months or ever Patients are supported in learning to take care of themselves and to advocate for themselves in the care system they make good care plans including advance care plans and they encounter a more supportive care system in the community These things are still affecting the patient many months after the hospitalization Indeed as the care system learns how to support fragile people in the community better fewer patients will need to come to the hospital in the first place The result for our hypothetical hospital is that it ends up with 800 discharges per quarter and it has not budged its readmission rate Officially it has not improved even though the work done by the hospital by patients and families and by

    Original URL path: http://medicaring.org/tag/metrics/ (2016-04-30)
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  • patient goals – MediCaring.org
    disturbing insight arises in the list of measures under consideration for implementing the Improving Medicare Post Acute Care Transformation IMPACT Act that are meant to measure outcomes and quality in after hospital care List of Ad Hoc Measures under Consideration for the Improving Medicare Post Acute Care Transformation IMPACT Act of 2014 http www qualityforum org WorkArea linkit aspx LinkIdentifier id ItemID 78784 Given the short timeline the Centers for Medicare and Medicaid Services CMS has proposed measures that have already been 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

    Original URL path: http://medicaring.org/tag/patient-goals/ (2016-04-30)
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  • preferences – MediCaring.org
    disturbing insight arises in the list of measures under consideration for implementing the Improving Medicare Post Acute Care Transformation IMPACT Act that are meant to measure outcomes and quality in after hospital care List of Ad Hoc Measures under Consideration for the Improving Medicare Post Acute Care Transformation IMPACT Act of 2014 http www qualityforum org WorkArea linkit aspx LinkIdentifier id ItemID 78784 Given the short timeline the Centers for Medicare and Medicaid Services CMS has proposed measures that have already been 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

    Original URL path: http://medicaring.org/tag/preferences/ (2016-04-30)
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  • Senior Alert: A Swedish National Dashboard for Preventive Care for the Elderly – MediCaring.org
    health increasing disability and need of reliable care process The registry that monitors her condition and services helps ensure comprehensive care By registering Lilly for Senior Alert her doctor her family and she are assured that she will have a risk assessment by a team of professionals who will recommend and implement preventive interventions evaluate these interventions and adjust accordingly The data system combines Lilly s data with all from her geo political area and provides up to date and interactive information as to the progress of each municipality and county with regard to excellent preventive service for fragile elderly persons Senior Alert was implemented in 2010 and in the last four years all 21 counties in Sweden use the program and 288 of 290 municipalities are involved as well In addition to public programs 129 private health care providers use Senior Alert In this time patients are receiving personalized care plans along with fewer risks to the patients because of the attention to the needs of each patient As the process is followed both the patient and the doctor can see improved results and these results can be viewed publically online The data collected can be used to track prevention progress daily for individual patients in many different categories but collectively creating a reliable care process for Sweden s entire elderly population All results keep the patient confidential of course but the public can access results of various actions Want to know more Link to Senior Alert http plus lj se senioralert Link to our webinar http altarum adobeconnect com p7pyg04t14g Tweet Pin It Leave a Reply Cancel reply Your Comment You may use these HTML tags and attributes a href title abbr title acronym title b blockquote cite cite code del datetime em i q cite s strike

    Original URL path: http://medicaring.org/2014/12/22/senior-alert/ (2016-04-30)
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  • The Case for Care Plans – MediCaring.org
    work can improve Ongoing communication between a well informed physician and the patient about the situation the family s values treatment preferences and care goals is crucial to a care plan Yet many physicians are reluctant to initiate these discussions citing a lack of skills training or time Or they believe that patients and families do not want or need to have these conversations and they worry about triggering a sense of hopelessness Often discussions do not happen and the care plan consists merely of medications and treatments misaligned with patients goals The required reporting for nursing homes Minimum Data Set MDS and homecare Outcome Assessment Information Set OASIS does not record care goals the possible trajectory or even the overall plan Near the end of life physicians must work more closely together than ever to help patients and families manage expectations make treatment decisions and match goals to care How can we achieve useful communication and reliable care planning First every form and document that patients must fill out or use when receiving healthcare should provide information about acquiring a basic care plan Medicare s measurement of physician quality could reflect how well they plan for care in chronic illness Second we could ensure that a negotiated care plan will be documented when patients enter and leave the hospital or nursing home upon hospice admission and every time the MDS or OASIS are filled out Third patients could demand information and clinicians could learn to provide it about the course of their illness including ambiguities a thoughtful discussion of what might improve and worsen what the personal care needs may be and what matters most to the patient and family Finally we could engineer strong decision support for clinicians and patients including feedback from prior patients about how the care plan worked We should raise our voices when care plans fall short How it is that we have come to accept widespread false hope Why have we tolerated clinicians making good incomes from unwanted tests and treatments A bit of outrage would be a good thing Chronically ill patients and their families manage increasingly complex conditions They deserve to know the medical situation and clinicians need to know the social and personal information that shapes why patients and families want certain care strategies Ongoing conversation and negotiation should engender a practical plan tailored to the individual That is the heart of reform for the last phase of life This article appeared in the November December 2011 issue of Aging Today ASA s bi monthly newspaper covering issues in aging research practice and policy nationwide key words care plans Medicaring book Joanne Lynn Tweet Pin It Leave a Reply Cancel reply Your Comment You may use these HTML tags and attributes a href title abbr title acronym title b blockquote cite cite code del datetime em i q cite s strike strong Name required E mail required URI Family Caregivers Need Care Too MediCaring is a service of the Center

    Original URL path: http://medicaring.org/2014/05/27/the-case-for-care-plans/ (2016-04-30)
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  • Janice Lynch Schuster – MediCaring.org
    on Aging Meet Medicaring Staff in Chicago American Society on Aging annual conference this week Readmissions frail elders communities So much to learn and know Going Home Costs of Care Essay Great Ideas Wanted Academy for Healthcare Improvement Wants to Hear From You Social Workers Key to Improving Medication Management in Innovative HomeMeds Program End of Life Lessons from an Unlikely Source Jumpy the Hamster Take Note and Action Improvement Standard Case Settlement Official JAMA Report Finds Community Collaboration Key to Reducing Hospitalizations and Rehospitalizations Doctors Honored for Excellent End of Life Care Readmissions Count Should CMS Revise Its Calculations January 14 deadline for comments on Meaningful Use Stage 3 End of the Improvement Standard An overview of Jimmo vs Sebelius Online resources and opportunities for caregivers Patient Activation Measure An Effective Way to Promote Self Management Effort To Curb Medicare Spending Begins With Crackdown On Hospital Readmissions MediCaring engages with Grace IHI Broadcast on Reducing Readmissions Keeping Track of Dementia Patients Would a Universal Identifier Help New CMS Physician Payment Rule includes Codes for Post Discharge Care Coordination Celebrating National Family Caregivers Month Response to Howard Gleckman s article in Forbes Online Long Term Care a Forgotten Issue in the Presidential Campaign Federal Court Settlement to Expand Medicare Coverage Dramatically Prevention Magazine Talks about Dying and Grief Workforce Development Hartford Foundation blog on direct care workers Award for Handbook for Mortals Family Caregivers Doing More Than Ever Results from New UHF AARP Study Shed Light PBS Broadcast Money and Medicine Offers Opportunity for Insight RARE Campaign Measuring Success One Pillow at a Time 2012 Hastings Center Cunniff Dixon Physician Awards Time to Comment on Care Transitions Provisions in New CMS Physician Payment Rules Reaching Rural Residents Improving Care Transitions in Western New York State The Conversation Project Encouraging People to Plan for End of Life AARP Twitter Chat Full of Intriguing News and Ideas CCTP Project in Delaware County PA Testing a Modified Transitional Care Model Four Kinds of People Mothers and Caregivers Speech at NOW Do Awards Matter Hastings Center Cuniff Dixon Physician Awards Make a Difference SAGE Bridging the Divide between Acute Medical Care and Social Services in Northeast Ohio Aging in place with in kind work Getting There From Here CMS Advises Potential CCTP Applicants on What It Takes to Win CMS Offers Tips and Pitfalls for CCTP Applications Learn How to Apply to the Community based Care Transitions Program Hospital Pharmacist Plays a Role in New York Based CCTP Program Sandwiched between an aging parent and children PEACE Trial Effective Collaboration Between Medical Services and Social Services Tips for CCTP Applicants on Writing Successful Applications Baby Boomers and the Demographic Cannonball Where I d Put the Money Quality of Life Investments for Frail and Disabled Elders Speak Up Detroit Roundtable To Focus on Aging Caregiving and End of Life Joanne Lynn Addresses Advance Care Planning Video from The Last Word Author Roundtable Now on YouTube New CMS UHF Podcasts on Medication Management Health Care Reforms

    Original URL path: http://medicaring.org/author/janicelynchschuster/ (2016-04-30)
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  • Family Caregivers Need Care, Too – MediCaring.org
    at hand MediCaring understands that caregivers are in fact the anchor of the care team To this end MediCaring teams will assess caregivers too and understand their capacity to provide care What is the their health status like how are they doing What challenges do they face what concerns do they experience How is that information processed and addressed in the care plan Does the plan also include ways to care for the caregiver Caregivers can benefit from a partnership with health care and social service providers Existing family centered care models consider caregiver input essential for providing strategic and expert services for both the health and well being of the care recipient and the caregiver The MediCaring team will be trained to recognize the level of support that caregivers need and to provide information and resources that address those needs MediCaring teams will also recognize that caregivers these widely different needs will change over time and as an elder s condition progresses or worsens Assessing caregivers is essential as is a mechanism for offering them respite services Caregivers who feel burdened or overwhelmed experience declines in their own health By offering services that enable caregivers to become more competent and confident in providing safe and effective care to their loved ones Medicaring will reduce some burdens and stress Research indicates that such interventions must be multifaceted including both training to enhance efficacy and personal support for emotional and coping skills Caregivers who serve as health care proxies face additional stresses Making decisions for and about another adult is a difficult role to play Those caring for people with dementia repeatedly face this challenge and yet often receive little context or training to interpret the meaning or urgency of what a loved one needs Navigating the health care system is an onerous task even for healthy adults For those who are ill or vulnerable or overwhelmed it can become impossible Although a number of new programs have been developed to train caregivers caregivers remain home alone with inadequate knowledge and resources to deliver proper care PBS NewsHour released a telling infographic The 234 billion job that goes unpaid which characterizes the context of such caregiving If family caregiving were a federal agency it would be the fifth largest Would policymakers simply ignore an entire nation Or would we aim to help its citizens overcome challenges and realize opportunities Would we invite them to the table to conference rooms and negotiations Would we want them to succeed It all seems likely and yet we have not Our healthcare system and our society pay lip service to the value of such care but seldom delivers the supports and services that would make life more manageable for frail elders and their caregivers key words Joanne Lynn Janice Lynch Schuster MediCaring book frail elders family caregivers Tweet Pin It Leave a Reply Cancel reply Your Comment You may use these HTML tags and attributes a href title abbr title acronym title b blockquote cite

    Original URL path: http://medicaring.org/2014/05/27/family-caregivers-need-care-too/ (2016-04-30)
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  • Resources for Advance Care Planning include Handbook for Mortals – MediCaring.org
    your perspective without knowing your options From her profound experiences in the medical field Dr Lynn director of the Altarum Institute Center for Elder Care and Advanced Illness shares with us long developed knowhow on approaching our relationships and our medical preferences Learn where and from whom you can seek advice and channel your concerns Find cathartic ways to embrace your emotions Learn how to talk to your family and friends about your opinions and ultimately your decisions This is not a book of tips and tricks it s a book that allows you to discover your own potential and set your own rules Feeling inspired yet Get started with your own advance medical directive and start the conversation with your family and friends If there s one lesson to draw from this book it s that taking control of your medical decisions and sharing them with your loved ones is the best way to make any medical crisis a better experience for not just you but everyone involved We hope you ll read Handbook for Mortals and share with us in the comments below via Facebook and by reaching out to us on Twitter at MyDirectives what you thought of it and how it changed you key words care plans advance care planning aging Dr Joanne Lynn Tweet Pin It Leave a Reply Cancel reply Your Comment You may use these HTML tags and attributes a href title abbr title acronym title b blockquote cite cite code del datetime em i q cite s strike strong Name required E mail required URI Senate Works to Advance Care Plans Listen to Senator Mark Warner s Take IOM Supports Strengthening Social Services near EOL MediCaring is a service of the Center for Elder Care and Advanced Illness at Altarum Institute Follow

    Original URL path: http://medicaring.org/2014/03/28/resources-for-advance-care-planning-include-handbook-for-mortals/ (2016-04-30)
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