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Community Provider News - Archived

12/12/16 – McKnight’s - MedPAC Calls For Nursing Home Pay Cuts, Revised PPS, In Final Meeting Of 2016

By Emily Mongan

The Medicare Payment Advisory Committee recommended on Thursday that market basket updates for skilled nursing facilities be eliminated for fiscal years 2018 and 2019 — restating for a second year that current payment levels for providers are “too high.”  MedPAC's final meeting of the year included a payment assessment for skilled nursing facility services, and a discussion of potential changes to the sector for the group to present to Congress.

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Click here to view the presentation slides from the meeting


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12/08/16 – McKnight’s – GAO Wants Nursing Homes’ Five-Star Ratings More Consumer-Friendly, Possibly with Resident Satisfaction Info

By Emily Mongan

Changes to providers' online ratings may be on the horizon under recommendations published Tuesday by the Government Accountability Office.

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Click here to view the GAO report


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12/01/16 – Long-Term Living – Home Health Pushes for More Thought on CMS Pre-Claim Policy

By Pamela Tabar

The home health sector is asking the Centers for Medicare and Medicaid Services for a bit more time to consider how the pre-claim rules for home health might affect seniors.

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11/23/16 – McKnight’s – Three Medicare Changes SNFs Can Expect under the New Administration

By Anne Tumlinson

Ever since the Accountable Care Act became law in March 2010, HHS has set a breakneck pace for transforming traditional Medicare fee-for-service payments into a value-based system. It has projected that nearly every fee-for-service payment the agency makes in 2018 would be tied, in some way, to value.  

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11/22/16 – LTC Ombudsman - ACL Updated FAQs about the Long-Term Care Ombudsman Program

ACL is sharing an updated frequently asked questions (FAQ) to assist State Agencies on Aging, States' Long-Term Care Ombudsman Programs, and other entities that work with Ombudsman programs with implementation of the State Long-Term Care Ombudsman Programs Rule.

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Click here to view the State Long-Term Care Ombudsman Programs Rule

Click here to view the updated FAQ for the Long-Term Care Ombudsman Program


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11/09/16 – Administration for Community Living - CMS Request for Information: Federal Government Interventions To Ensure the Provision of Timely and Quality Home and Community-Based Services

This week, the Centers for Medicare & Medicaid Services (CMS) issued a request seeking information and data on additional reforms and policy options that can be considered to accelerate the provision of home and community-based services (HCBS) to Medicaid beneficiaries, taking into account issues affecting beneficiary choice and control, program integrity, rate setting, quality infrastructure, and the homecare workforce.  The issues addressed in this request for information are highly relevant to ACL’s mission and vision. We urge our stakeholders to review and comment.  

Click here to view the Federal Register Notice


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11/04/16 – AHRQ – Nursing Home Survey on Patient Safety Culture 2016 User Comparative Database Report

The Nursing Home Survey on Patient Safety Culture is an expansion of AHRQ’s Hospital Survey on Patient Safety Culture to the nursing home setting. The nursing home survey is designed to measure the culture of resident safety in nursing homes from the perspective of providers and staff. The Nursing Home Survey on Patient Safety Culture 2016 User Comparative Database Report consists of data from 209 nursing homes and 12,395 nursing home staff respondents who completed the survey between January 2014 and April 2016.

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10/26/16 – Administration for Community Living - ACL Grants Promote Inclusion and Cultural Competency Across Disability Programs

Recently, a variety of ACL diversity programs have awarded funding to enhance the cultural and linguistic competency of the disability network and ensure that all people with disabilities can access ACL-funded programs and services.  The disability community is as diverse as the country itself. Yet many people with disabilities in underserved communities face unique barriers to accessing disability programs. A majority of ACL diversity programs are authorized by the Developmental Disabilities Act or the Rehabilitation Act. Both pieces of legislation discuss the need for programs to reach people with disabilities in underserved communities.

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10/26/16 – Administration for Community Living - ACL Releases IL Final Rule

Today, the final rule for Independent Living (IL) programs went on display in the Federal Register. The rule was developed in close coordination with the independent living network and addresses the requirements of the Rehabilitation Act of 1973, as amended by the Workforce Innovation and Opportunity Act (WIOA).

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10/25/16 – McKnight’s – Rehospitalization Measure a ‘Strong Predictor’ for Hospitals Seelking SNF Partnerships, Study Confirms

By Emily Mongan

The rehospitalization rate measure recently added to Nursing Home Compare provides valid predictions of which skilled nursing facilities are likely to have residents readmitted to the hospital, according to a study published Friday.

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10/24/16 – Star Tribune – Using Data to Track Patients, Twin Cities Clinics Save Millions While Improving Care

Medicaid in Minnesota is Running More Efficiently Thanks to a New Project

By Glenn Howsatt

Clinic staff members at Neighborhood HealthSource in Minneapolis were studying patient data not long ago when a number jumped out at them: One of their patients had visited the emergency room 73 times in the previous year.

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10/18/16 – The Commonwealth Fund - Guided Care: A Structured Approach to Providing Comprehensive Primary Care for Complex Patients

By Martha Hostetter, Sarah Klein, Douglas McCarthy, and Susan L. Hayes

An 88-year-old woman turned up in a Lahey Health emergency department every other month, struggling with the symptoms of depression, chronic pain, insomnia, and macular degeneration. The frequency of visits brought her to the attention of care managers, who reached out to enroll her in the Burlington, Mass.–based health system’s Guided Care program.  Created by Johns Hopkins University researchers in 2001 and licensed to health care systems, the Guided Care model aims to improve health outcomes and reduce spending by better managing care for the growing number of aging Americans with multiple chronic conditions. Some 37 percent of Medicare fee-for-service beneficiaries had four or more chronic conditions in 2010, and together they accounted for nearly three-quarters of total program spending.1 In many cases, they see multiple specialists and have trouble following treatment recommendations, especially as they grow frailer, leading to complications, hospitalizations, and emergency department visits that drive up costs.

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10/17/16 – McKnight’s – Education, Advocacy Key to Success Under New Quality Measures, Expert Says

By Emily Mongan

Skilled nursing providers may have to “teach” industry stakeholders how recent changes to the Five-Star Quality Rating System have impacted their ratings in order to maintain successful network partnerships, one expert stressed on Monday.

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10/17/16 – AHCA – NCQA Long-Term Services and Supports Standards Framework

By Jessica Briefer French

Long-term services and supports (LTSS) encompass a wide range of functional assistance that people with functional limitations routinely require in nursing facility settings or at home. LTSS may be provided in nursing homes or in the community, and can include adult daycare programs and transportation. Care coordination and planning services help people and their families navigate the health system and ensure that the proper services are in place in order to meet specific needs and preferences.

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10/12/16 – NAHC – Training Caregivers Pays Off

Low income elderly and disabled Californians were less likely to be hospitalized or go to the emergency room if their at-home caregivers participated in an intensive training program, according to a new report from researchers at the University of California, San Francisco (UCSF).

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10/07/16 – ACL – Two New Grants to Advance Business Acumen of State and Community-Based Organizations

Grants totaling $3.75 million over three years were awarded to the National Association of States United for Aging and Disabilities (NASUAD) and the National Association of Area Agencies on Aging (n4a) to build business capacity in the aging and disability services networks. Both projects will work together to build on the previous accomplishments of ACL’s business acumen work and to complement other publicly and privately funded technical assistance resource centers addressing this critical issue.

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10/06/16 – GAO – Skilled Nursing Facilities

CMS Should Improve Accessibility and Reliability of Expenditure Data

The Centers for Medicare & Medicaid Services (CMS)—the agency within the Department of Health and Human Services (HHS) that administers Medicare—collects and reports expenditure data from skilled nursing facilities (SNF), but it has not taken key steps to make the data readily accessible to public stakeholders or to ensure their reliability. SNFs are required to self-report their expenditures in annual financial cost reports, and CMS posts the raw data on its website. However, CMS has not provided the data in a readily accessible format and has not posted the data in a place that is easy to find on its website, according to public stakeholders and GAO’s observations. In addition, CMS does little to ensure the accuracy and completeness of the data. Federal internal control standards suggest that agencies should make data accessible to the public and ensure data reliability. Until CMS takes steps to make reliable SNF expenditure data easier to use and locate, public stakeholders will have difficulty accessing and placing confidence in the only publicly available source of financial data for many SNFs.

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10/03/16 – McKnight’s – Future Care: The Caregiver Gap Epidemic

By Matthew Gallardo

The future of healthcare and health insurance gets top billing from mass media as the primary crisis we need to contend with and resolve, especially in the U.S. But there is another epidemic looming that will affect the health and welfare of anyone in need of care in the next several decades.  

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09/30/16 – NAHC – Report: Caregivers Need Help, Too

The health and well-being of millions of older Americans is at risk unless the United States does more to help family caregivers who sacrifice their time and money to look after their loved ones, according to a new report released by the National Academies of Sciences, Engineering, and Medicine.

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Click here to view the report


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09/29/16 – McKnight’s – Providers Disappointed with Final Rule’s ‘Unnecessary’ Arbitration Ban

By Emily Mongan

The Centers for Medicare & Medicaid Services' newly released final rule for long-term care is a whopping 713 pages, but one provision in particular has earned more backlash from provider groups than any other.

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Click here to view rule


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09/29/16 – McKnight’s – CMS Surprise: New Nursing Home Survey Process to Debut in Late 2017

By Elizabeth Leis Newman

Organizers of the first national meeting of the new American Association of Directors of Nursing Services timed their event just right. On Thursday, members became the first group of long-term care providers to learn of a new survey process that will start next year as a consequence of the new federal nursing home participation rule that was released late Wednesday.

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09/28/16 – Administration for Community Living - Final Report for the National Quality Forum’s “Measuring Home and Community-Based Services Quality” Project Now Available

The final report for the National Quality Forum’s (NQF) Measuring Home and Community-Based Services Quality project is now posted on the HCBS Project Page. NQF, under a contract with the Department of Health and Human Services (HHS), convened a multi-stakeholder committee to develop recommendations for the prioritization of measurement opportunities to address gaps in home and community-based services (HCBS) quality measurement. The report represents two years of work by the HCBS Committee and contains their final set of recommendations for how to advance quality measurement in home and community-based services.

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Click here to view the report


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09/20/16 – OIG – HHS’s Office of Inspector General Levies Largest Penalty Under a Corporate Integrity Agreement Against Nation’s Biggest Provider of Post-Acute Care

Kindred Health Care, Inc., the nation's largest provider of post-acute care, including hospice and home health services, has paid a penalty of more than $3 million for failing to comply with a corporate integrity agreement (CIA) with the Federal Government, Department of Health and Human Services' Inspector General Daniel R. Levinson announced today.

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09/18/16 – GAO – Better Information Needed on Nursing Assistants, Home Health Aides, and Other Direct Care Workers

Millions of elderly individuals and persons with disabling conditions rely on LTSS to help them perform routine daily activities, such as eating and bathing. Direct care workers are among the primary providers of LTSS. Reported difficulties recruiting and retaining direct care workers and the anticipated growth in the elderly population have fueled concerns about the capacity of the paid direct care workforce to meet the demand for LTSS. Despite these concerns, policymakers lack data to help assess the size of the problem.

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09/15/16 - The Commonwealth Fund - How an Information System Can Reduce Health Risks Among the Elderly: Sweden’s Senior Alert Program

By Bradford H. Gray, Ulrika Winblad, and Dana O. Sarnak

Some health problems that cause suffering and require expensive health care services are the result of age-related risk factors that are amenable to prevention-oriented interventions. Examples include fall-related injuries, pressure ulcers in immobile patients, and malnutrition. But all too often, professionals and organizations that provide care to seniors do not address these risk factors before injury or other adverse conditions occur. In Sweden, the Senior Alert program, a national preventive care dashboard for the elderly, was developed to address these issues.

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09/15/16 – McKnight’s – Provider Groups Call for Big Changes to Value-Based Purchasing Bill

By Emily Mongan

A House bill that would establish a value-based purchasing program for post-acute care needs major revisions before it earns providers' support, several industry groups told lawmakers in a letter Thursday.

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Click here to view the letter


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09/14/16 – Avalere – What Will the Future of Home Health Look Like?

By Sally Rodriguez

Recently, Avalere partnered with the Alliance for Home Health Quality and Innovation (AHHQI) to better understand how home health care is currently being used and how it will be used in the future for older Americans and Americans with disabilities.

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Click here to view the presentation

Click here to view the infographic


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09/09/16 – ACL – ACL Awards Over $1.1 Million in Lifespan Respite Grants

ACL recently awarded grants to eight states to support lifespan respite care programs with the goal of improving the delivery and quality of respite services available to families across the age and disability spectrum.

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09/08/16 – Managed Health Care Connect – Home Care Plans: Patient Input Reduces Disability and Depression

Findings from a recent study in Health Affairs suggest that care professionals who ask for and utilize older adults’ input for care plans contribute to better health and decreased feelings of depression in their patients (2016. 35(9):1558-1563).
 

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09/08/16 – NAHC – Ways & Means Health Subcommittee Explores Value Based Purchasing in Post-Acute Care Settings, Updates Legislation

This week the Ways and Means Health Subcommittee held a hearing on the evolution of quality in Medicare Part A to examine whether existing policies are improving quality and cost-efficiency of care in hospitals and what opportunities there are to improve care delivery in post-acute care settings.  As Ways and Means Committee Chairman Kevin Brady stated, “Physician payment policies are just one piece of the puzzle. To ensure the Medicare program is truly delivering the high-quality care seniors deserve, we also need to improve the way it pays post-acute, or after hospitalization providers.”

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09/08/16 – NAHC – Home Care Issues Front and Center at House Ways and Means Hearing

A September 7th House Ways and Means Health subcommittee hearing on the evolution of quality in Medicare Part A featured an interesting series of questions and answers between Rep. Tom Price (R-GA-6) and Steve Guenthner, President of Almost Family, a home health care company with over 250 locations in 15 states. Price specifically mentioned three issues important to NAHC and its members, pre-claim review (PCR), the physician face-to-face encounter rule and withholding amounts in the value-based purchasing model.

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09/07/16 – Kaiser Health News – Study Finds Benefits When Seniors Call Shots to Help Them

By Rachel Bluth

A federally funded project that researchers say has potential to promote aging in place began by asking low-income seniors with disabilities how their lives at home could be better, according to a study released Wednesday.

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09/06/16 – McKnight’s – Group Urges Congress to Create ‘Overdue’ Definition of LTC Pharmacy

By Emily Mongan

Differing definitions of long-term care pharmacies used by government agencies may threaten seniors' care and disrupt care coordination, according to a leading long-term care pharmacy group.

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Click here to view the policy brief


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09/05/16 – Modern Heatlhcare - Another Reason Hospitals Hate Medicare's Site-Neutral Payment Plans

By Erica Teichert

The CMS' plan to eliminate Medicare payments for new off-campus outpatient departments has kicked up fierce opposition from hospitals. As the comment period comes to a close, hospitals argue it threatens not just lost revenue but also substantial and unavoidable legal risks.  The rule, proposed in July, would eliminate Medicare payments to hospitals for most services provided at off-campus departments that came into operation after Nov. 2, 2015. Instead, the payments would flow to physicians starting on Jan. 1, 2017, making it difficult for health systems to recoup capital or operational costs for the facilities, even though they are responsible for continuing to equip and maintain the off-campus offices.

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09/05/16 – Crain’s Detroit - Are physicians ready for Medicare's new payment system?

By Elizabeth Whitman

Like it or not, ready or not, MACRA is coming.  Anxiety is rippling through the health care industry as the initial reporting period for Medicare's new payment system for physicians fast approaches. Modern Healthcare's latest CEO Power Panel survey reveals leaders are bracing for uncertainties and challenges generated by the law, formally titled the Medicare Access and CHIP Reauthorization Act.  This coming phase will be extremely painful for doctors, CEOs worry, even as they applaud the overarching goal of paying for health care on the basis of quality over quantity. They are keenly aware of the near-term challenges of managing these growing pains and of successfully mitigating potential negative consequences. But they are also optimistic — even confident — that patients and physicians stand to benefit in the long run.

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09/01/16 – NAHC – Medicare Home Health Pre-claim Review Project a “Complete Mess”

Forecasts of dire consequences stemming from the recently initiated Medicare home health pre-claim review (PCR) project in Illinois are turning out to be highly accurate. Medicare Administrative Contractor (MAC) PGBA along with CMS Central Office have shown that preparation is falling far short of what is needed to handle simple tasks, such as setting up a reliable documentation submission system. Endless reports of the MAC losing documents submitted electronically led to a CMS recommendation that home health agencies (HHAs) resort to antiquated fax submissions. Those fax submissions faired no better.

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08/30/16 – NAHC – Harvard Study Shows Value of Home Care Checklist

A simple telephone-based checklist enabled caregivers to quickly identify changes in the condition of their home care patients, according to a new pilot study approved by the Harvard Medical School.

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08/29/16 – ACL – Speeches and Testimony – Remarks by Acting Assistant Secretary for Aging and ACL Administrator Edwin Walker at the HCBS Conference

Good afternoon, and thank you for inviting me to join you today.  It’s such a privilege to represent the Administration for Community Living on this stage. Although I have to tell you—it’s a bit daunting to try to follow Kathy Greenlee up here. I had the honor of being part of Kathy’s team when she, Sharon Lewis, and Henry Claypool conceived and established ACL, and it’s a tremendous honor to help carry their legacy forward into the next administration.

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08/29/16 – NAHC – CMS Open Door Forum Summary

CMS held a Home Health, Hospice and DME Open Door Forum (ODF) on August 23.  A summary of the call is below.

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08/25/16 – McKnight’s – Providers Could Face Five-Star Sanctions for Late PBJ Data

By Emily Mongan

Nursing homes that fail to submit electronic staffing data by the first required deadline may face sanctions and could see their Five-Star rating suffer as a result, Centers for Medicare & Medicaid Services officials said Thursday.

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08/23/16 – Kaiser Health News –– Geriatric ERs Reduce Stress, Medical Risks for Elderly Patients

By Anna Gorman

The Mount Sinai Hospital emergency room looks and sounds like hundreds of others across the country: Doctors rush through packed hallways; machines beep incessantly; paramedics wheel stretchers in as patients moan in pain.

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08/22/16 – The Commonwealth Fund – The Hospital at Home Model: Bringing Hospital-Level Care to the Patient

By Sarah Klein, Martha Hostetter and Douglas McCarthy

In June, 67-year-old Felimon Bailon showed up in an emergency department at Presbyterian Healthcare Services in Albuquerque, New Mexico, with a large and painful abscess on his leg. The infection had been under way for nearly two weeks, turning his leg a deep purple. Doctors feared that Bailon, who is diabetic and receives oxygen therapy, might develop sepsis. They recommended admitting him to the hospital so he could receive antibiotics intravenously but he refused, insisting the infection would go away on its own if he simply took medication.

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08/22/16 – Long-Term Living – Illinois Signs Bill for Dementia Care Regulations

By Pamela Tabar

Illinois is the next state to mandate dementia care certification and minimum training guidelines to keep facilities honest about the quality of care they are providing. Gov. Bruce Rauner signed Senate Bill 2301, also called the Alzheimer's Disease and Related Dementias Services Act, last week.

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08/18/16 – ACL - $2.2 Million in ACL Grants to Enhance State Adult Protective Services Systems

ACL’s Administration on Aging is pleased to announce grants totaling $2.2 million to assist 13 state Adult Protective Services (APS) systems in addressing the abuse, neglect, and exploitations of older adults and people with disabilities.

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08/17/16 – Kaiser Health News – Medical Providers Try Uber, Lyft for Patients with Few Transportation Options

By Zhai Yun Tan

Edith Stowe, 83, waited patiently on a recent afternoon at the bus stop outside MedStar Washington Hospital Center in the District of Columbia. It’s become routine for her, but that doesn’t make it any easier.

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08/15/16 – McKnight’s – Why Health Data Interoperability  Matters for Long-Term Care

By Sanjay Nathwani

Health data interoperability was the big topic of discussion at this year's Health Information Management Systems Society's annual meeting – and for good reason. Healthcare providers, especially those in long-term care, need access to data from the various care providers their patients see to make more informed decisions.

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08/15/16 – Managed Health Care Connect – Care Transitions – It’s not the Transition, It’s the Care

By Richard G Stefanacci

With all of the focus on care transitions, what has been missing is the fact that the care period before the transition provides an opportunity to prepare the patient for success once they are home. Unfortunately, all too often, the inpatient care period is solely focused on dealing with acute care situations with no foresight into what will be needed for success at home. Even after years of seeing the development of many care transition programs (Table 1), patient outcomes remain lackluster. I personally experienced a transition failure several years ago, which I chronicled in the Journal of the American Geriatric Society.  As a practicing geriatrician, almost daily I witness continued failure in care transitions for my frail, older adult patients.

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08/15/16 – Managed Health Care Connect – Optimistic Transition Visits: A Model to Improve Hospital to Nursing Facility Transfers

By Arif Nazir, Kathleen T Unroe, Bryce Buente, Greg Sachs, and Greg Arling

Transitions to and from hospitals and nursing facilities (NFs) expose patients to lapses in care due to miscommunication. Potential consequences of these breakdowns in communication include medication errors, poor follow-up care after transitions, and rehospitalization. In 2012, the Centers for Medicare & Medicaid Services decided to fund an initiative made up of seven projects to re- duce potentially avoidable hospital transfers. One of these projects, the Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project, implements registered nurses and nurse practitioners to assist with and close gaps in transitions of care for NF patients. The authors provide an overview of the transition visit model and a preliminary analysis of the outcomes of their interventions.

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08/11/16 – Kaiser Health News – Teaching In-Home Caregivers Seems to Pay Off

By Anna Gorman

Low-income Californians who are elderly and disabled were less likely to go to the emergency room or be hospitalized after their in-home caregivers participated in an intensive training program, according to a report.

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08/11/16 – The Commonwealth Fund - Aging Gracefully: The PACE Approach to Caring for Frail Elders in the Community

By Martha Hostetter, Sarah Klein, and Douglas McCarthy

After a bad fall landed Dianna Boggs in a wheelchair, she needed more help than nearby family members could provide. At age 75 and living alone in rural Virginia, Boggs might have ended up in a nursing home like many others in her situation. But instead she opted to join Mountain Empire’s Program of All-Inclusive Care for the Elderly (PACE), allowing her to stay in her own home, within view of the mountains she loves.  Mountain Empire PACE staff equipped Dianna’s home so she can use the bathroom and bathe on her own. A transit service brings her to a day center five days a week for medical checkups and social activities with other elders, as well as to the grocery store and outings with friends. Since enrolling three years ago, Boggs has regained enough strength in her legs to use a cardio machine for a mile, cook most of her meals, and care for herself. “If it wasn’t for PACE, I would just sit home and dry up,” she says.

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08/09/16 – McKnight’s – Value-Based Purchasing Demo had Little Impact on Medicare Spending, Quality: Study

By Emily Mongan

The Centers for Medicare & Medicaid Services' Nursing Home Value-Based Purchasing demonstration had little effect on participating facilities' Medicare spending or quality, a new study has found.

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07/26/16 – ACL - Remarks by Assistant Secretary on Aging and ACL Administrator Kathy Greenlee at the n4a Answers on Aging Conference

Good morning. It’s great to be with you again this morning. I have been looking forward to today for many reasons. The n4a conference and my remarks have always felt to me like my own personal “State of the Union.” When I see you again, it means we’ve made “one more trip around the sun,” to quote Jimmy Buffet.  I gave Sandy a heads up several weeks ago that this would be my last speech as Assistant Secretary. I wanted to complete the cycle and I wanted a chance to see you one more time.

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07/25/16 – NAHC – 2016 FMC Highlights: Value-Based Purchasing Payment Models are Here, Now What? (Part 2 of 2)

Among the many informative and insightful education sessions at the National Association for Home Care & Hospice’s (NAHC) 2016 Financial Management Conference was a session titled, “Value-Based Purchasing Payment Models Are Here, Now What?” This is Part 2 of NAHC Report’s coverage of this session.

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Click here to view the presentation slides


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07/21/16 – NAHC – 2016 FMC Highlights: Value-Based Purchasing Payment Models are Here, Now What? (Part 1 of 2)

Among the many informative and insightful education sessions at NAHC’s 2016 Financial Management Conference was a session titled, “Value-Based Purchasing Payment Models Are Here, Now What?” The panel discussion was conducted by Mike Dordick, MBA, Executive Vice President at Principal McBee; Christine Lang, MBA, Senior Director of Product Management at ABILITY Network; Karen Vance, Managing Consultant at BKD, LLP; and Chris Attaya, Vice President of Business Intelligence with Strategic Healthcare Programs. This is Part 1 of NAHC Report’s coverage of this session; a subsequent edition will provide Part 2 of our coverage.

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Click here to view the presentation slides


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07/21/16 – OIG – Adverse Events In Rehabilitation Hospitals: National Incidence Among Medicare Beneficiaries

This report is part of a series on adverse events in healthcare settings, defined as harm resulting from medical care. Previous OIG work identified harm rates of about 30 percent in both acutecare hospitals and skilled nursing facilities (SNF), with an attendant toll on patient health and taxpayers’ costs, the latter amounting to billions of dollars annually. This report extends our work by evaluating care provided in rehabilitation (rehab) hospitals. Rehab hospitals are postacute providers that specialize in intensive rehabilitative care for patients recovering from illness, injury, or surgery. While in recent years stakeholders have paid considerable attention to patient safety in acute-care hospitals and increasingly in SNFs, less is known about adverse events in other health care settings. An increased understanding of adverse events that occur in this unique setting would better equip health care providers and other stakeholders in taking actions to improve the safety of patient care in rehab hospitals.

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07/18/16 – McKnight’s – HIPAA Audits Intensify with Document Requests for ‘Unlucky’ Providers

By Emily Mongan

More than 150 healthcare organizations received document requests last week as part of the second phase of HIPAA audits, according to the Health and Human Services Office for Civil Rights.

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07/14/16 – ACL - Celebrating 51 Years of the Older Americans Act

“The Older Americans Act clearly affirms our nation’s sense of responsibility toward the well-being of all of our older citizens. But even more, the results of this act will help us to expand our opportunities for enriching the lives of all of our citizens in this country, now and in the years to come.”  President Lyndon B. Johnson spoke these words 51 years ago today as he signed the Older Americans Act (OAA) into law. In the decades since, the OAA has indeed enriched the lives of many as the foundation for a system of services and supports that helps millions of older adults continue to work, play, and volunteer in their communities, to the great benefit of all.
 

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07/14/16 – Avalere – Leading Stakeholders Identify Need for Tools to Manage Post-Acute Network Quality

Data Shows Gap in Care Integration Across Provider Settings Following Hospital Discharges

Results from a new survey conducted by Avalere Health with the support of post-acute provider Kindred Healthcare find that while Medicare Advantage health plans unanimously report being focused on patient care following a hospital discharge, less than half (31%) have identified solutions to assess the quality of their post-acute provider network. Post-acute providers include long-term acute care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies.

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07/13/16 – McKnight’s – Drug Bill with Exemptions for LTC Pharmacies Heads to Obama

By Emily Mongan

A bill that would exempt long-term care pharmacies from a controversial “lock-in” provision received final passage from the Senate on Wednesday and now heads to the president's desk.  The Comprehensive Addiction and Recovery Act includes language that would require Medicare Part D beneficiaries to use one pharmacy for all prescriptions, in an effort to lessen opioid abuse.

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07/12/16 – Administration for Community Living - ACL Awards $1.2 Million in Grants to Increase Older Americans’ Access to Legal Services

The Administration for Community Living recently announced grant awards totaling over $1.2 million to help older adults at risk of abuse, neglect, or exploitation gain access to quality legal services.  The Model Approaches to Statewide Legal Assistance Systems (Model Approaches) demonstration grants are designed to help states expand and improve the capacity of their legal service delivery networks to effectively respond to priority legal issues impacting seniors in the most social or economic need. The awards will become effective on August 1, 2016 and will provide 8 states with funding in the amount of $1,244,154.

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07/09/16 – NAHC – CMS to Begin Field Testing Standardized Assessment Data Across PAC

The Improving Medicare Post-Acute Care Transformation Act of 2014 (The IMPACT Act of 2014) requires the submission of standardized data for specific assessment categories and quality measure domains using the assessment instruments CMS currently requires for use by Long-Term Acute Care Hospitals (LTCHs), Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs), and Inpatient Rehabilitation Facilities (IRFs). The IMPACT Act of 2014 requires the modification of these assessment instruments to enable the submission of such standardized data, and requires that the data be interoperable to allow for the exchange of data among post-acute and other providers in order to facilitate person-centered care, coordinated transitions in care, enable access to longitudinal information, and ensure high quality outcomes.

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07/07/16 – The Commonwealth Fund - Where the Money Goes: The Evolving Expenses of the U.S. Health Care System

By Sherry A. Glied, Stephanie Ma, and Claudia Solis-Roman

U.S. expenditures on hospitals, physicians’ offices, and outpatient care centers rose from $0.8 trillion in 1997 to $1.4 trillion in 2012. Half of these expenditures went toward labor costs, including physicians’ and nurses’ salaries. But the most rapidly growing category of expense was goods and services—pharmaceuticals (purchased by providers), medical devices, and other items, as well as services like accounting and engineering. By 2012, payments for such goods and services accounted for one-third of spending.

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06/28/16 – Managed Health Care Connect – Care Lacking for Nursing Home Residents with Diabetes

A recent study found that nursing home (NH) residents with diabetes were hospitalized and received rehabilitation or clinically complex care more often than those without diabetes, and neither group received the recommended frequency of preventative procedures. The findings were published online in the Journal of Post-Acute and Long-Term Care Medicine (JAMDA).

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06/27/16 – McKnight’s - CMS Data Vision Relies On Quality, Interoperability And Standardization, Experts Note

By Elizabeth Leis Newman

With skilled nursing facilities preparing for an Oct. 1 deadline for new quality measures, government officials are emphasizing their focus is to make quality the basis for value. “Quality is the foundation for all that you will see moving forward,” said Shari Ling, M.D., deputy chief medical officer, Center for Clinical Standards and Quality at the Centers for Medicare and & Medicaid Services, speaking with a panel of experts at the LTPAC HIT summit Monday in Reston, VA. The session followed a 4.5 hour presentation Sunday from CMS on the IMPACT Act and Assessment Data Element Standardization.

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06/15/16 – HHS Nondiscrimination Rule Includes New Notice Requirements for Providers

The Department of Health and Human Services (HHS) has issued a final rule implementing the prohibition of discrimination under Section 1557 of the Affordable Care Act (ACA) of 2010. The Final Rule, Nondiscrimination in Health Programs and Activities, explains consumers’ rights under the law and adds certain requirements for covered entities in order to ensure nondiscrimination on the grounds of race, color, national origin, sex, age, or disability in certain health programs and activities. Entities covered under the rule are any health program or activity which receives funding from HHS; any health program that HHS itself administers; Health Insurance Marketplaces; and issuers that participate in those Marketplaces.

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Click here to view the final rule


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06/08/16 – McKnight’s - IMPACT Act Aspects To 'Trickle Down' To Medicaid, Expert Predicts

By Emily Mongan

Skilled nursing facilities should be on the lookout for aspects of the Improving Medicare Post-Acute Care Transformation Act of 2014 to trickle into the Medicaid world, one expert advised on Wednesday. Although the IMPACT Act is still in its early stages of implementation, the evidence is there that some of its policies may be translated to Medicaid further down the road, said Julie Hamos, principal at Health Management Associates, during a policy session at the Post Acute Link Care Continuum Conference.

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06/07/16 – McKnight’s – OIG to Tackle Skilled Nursing Payments, Avoidable Hospitalizations in FY 2016

By Emily Mongan

The Department of Health and Human Services Office of Inspector General will dig into Medicare requirements for skilled nursing care coverage during the remainder of fiscal year 2016, according to a new report.

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Click here to view the full report


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06/07/16 – Long-Term Living – How Chart Audits Affect Your Reimbursement

By Krisandra Panting

Baby Boomers are 79 million strong in the United States and are turning 65 years old at a rate of 10,000 per day from now until 2030. By 2030, more than 20 percent of the population is expected to be over 65.  Boomers are making their presence in skilled nursing facilities (SNFs), whether it is for short-stay rehabilitation or as a new life-long home. Boomers expect excellent outcomes, maximum value and compassionate care. Simultaneously, medical advances are extending the lives of older adults, which impacts the type and acuity of medical care delivered in these facilities. It is not uncommon to treat residents who have more than eight chronic diseases and several acute diseases (post-knee replacement and pneumonia).

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06/03/16 – McKnight’s – Heightened Enforcement Environment for LTC

By Matt Curley

There is little doubt that the government's enforcement efforts in combatting fraud, waste, and abuse concerning the federal healthcare programs have yielded significant results. During the last five years, civil enforcement recoveries have exceeded $12.5 billion. Of that amount, the government has recovered hundreds of millions of dollars from the long-term care industry, including hospice, home health, and skilled nursing facilities, in resolving allegations arising under the civil False Claims Act.
 

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05/20/16 – Long-Term Living – New Overtime Rules Come With Hefty Price Tag

By Nicole Stempak

Salary workers who earn less than $48,000 may be eligible for overtime pay, according to the Department of Labor’s new ruling.  That could have a big impact for workers in long-term care facilities where staffing levels are set and monitored by the government, which must also balance cost of services provided with cost of Medicare and Medicaid reimbursement—and often absorb the difference.

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05/18/16 – AHRQ - Adaptation and Expansion of Existing Bundle of Inpatient Interventions Reduces Ventilator-Associated Pneumonia at Long-Term Care Facility

Coler-Goldwater Specialty Hospital and Nursing Facility modified and expanded the Institute for Healthcare Improvement's inpatient ventilator bundle for use in the long-term acute care setting. Key elements of the modified bundle include early and ongoing evaluation for weaning, pulmonary and dental evaluations, head-of-bed elevation, peptic ulcer disease and deep vein thrombosis prophylaxis, and comprehensive oral care. Pre- and post-implementation analyses suggest that the program has reduced the incidence of ventilator-associated pneumonia by 58 percent, which, in turn, has led to a decline in the overall facility pneumonia rate and use of antibiotics.

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05/15/16 – McKnight’s - OIG slams insufficient Medicare documentation, especially from nursing homes

By Elizabeth Leis Newman

The reported error rate for Medicare Fee-for-Service in fiscal year 2015 was 12.09%, well above the compliance threshold of 10%, a new government report finds.  The Office of the Inspector General report specifically called out skilled nursing facility claims last week, noting the improper payment rate increased 4.1%.  “We recommend that HHS focus on the root causes for the improper error rate percentage and evaluate critical and feasible action steps to decrease the improper error rate percentage below 10%,” the OIG recommended in “Department of Health and Human Services Met Many Requirements of the Improper Payments Information Act of 2002 But Did Not Fully Comply for Fiscal Year 2015.”

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Click here to view the full OIG report


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05/13/16 – Modern Healthcare - MACRA Struggles In Evaluating Long-Term Care

By Shannon Muchmore

Treatment for elderly patients and those with chronic conditions may not be well accounted for in the new Medicare system for reimbursing providers.  Some regulations for the Medicare Access and CHIP Reauthorization Act, which replaced the disliked sustainable growth rate formula for Medicare payment, were released this week. Most providers and advocates lauded the attempt to move toward value-based payment, but some of those who deal with patients who need long-term or end-of-life care are concerned the system won't be rewarding good performance in those fields.

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05/10/16 – McKnight’s – Cost of Private Nursing Home Rooms Grows to $7,700 per Month, Genworth Survey Shows

By Emily Mongan

The average costs of semi-private and private nursing home rooms continued to climb from last year, insurance provider Genworth Financial said in a report released Tuesday, with a private room costing almost $8,000 a month.
 
 

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05/09/16 – McKnight’s – Experts Warn of Skilled Nursing Market Changes, Researchers Offer Strategies to Avert Havoc

By James M. Berklan

Preliminary results of a survey of 36 large skilled nursing company CEOs paint a challenging picture for operators, who will either rise profitably from already strong positions, improve with proper initiatives or fail resoundingly, researchers said Monday. They discussed their findings and offered six critical strategies in a kick-off session at the LTC 100 conference in Dana Point, CA.

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05/06/16 – GAO – Medicaid Program Integrity: Improved Guidance Needed to Better Support Efforts to Screen Managed Care Providers

GAO found that the selected states and Medicaid managed care plans face significant challenges in screening providers for eligibility to participate in the Medicaid program. Based on information we received from two selected states and 16 selected plans, GAO found that the states and plans used information that was fragmented across 22 databases managed by 15 different federal agencies to screen providers. These databases included databases that the Centers for Medicare & Medicaid Services (CMS) had not identified for use in screening providers. Officials from some states noted that these additional databases provided better assurance they would not enroll ineligible providers—i.e., providers who have been barred from participating in federal health care programs.

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Click here to view the full report


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05/06/16 – Long-Term Living – SNF Care Quality Caught in the Buy-Sell Swirl

By Pamela Tabar

The whopping number of long-term care mergers and acquisitions and other market consolidations in the past 10 years isn’t helping care quality at nursing homes, say researchers from Harvard and the University of Michigan.

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5/5/16 – McKnight’s - Michigan House Approves Plan To Send Frail Prisoners To Nursing Homes

By Emily Mongan

More than 100 frail prisoners would be released into Michigan's nursing homes annually under a bill passed by the state House on Wednesday.  The bill, sponsored by state Rep. Al Pscholka (R), is estimated to save the state's prisons as much as $5.4 million each year. Frail prisoners cost the state nearly three to five times more than healthy prisoners, according to the Associated Press.  Pscholka's bill would allow around 120 prisoners up for parole each year — roughly the same number that die in the state's prisons each year. That number is expected to rise as prisoners age and they require more complex healthcare, Pscholka said in a press release.

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05/04/16 – McKnight’s – Examiners See the Churn and Corporate SNF Operators Feel the Burn

By James M. Berklan

I imagined nursing home chain executives wincing two days ago at the sight of yet another study apparently finding that they're doing a poor job. “Corporate ownership changes linked to poor nursing home quality,” the McKnight's Daily Update headline said with a menacing overtone.

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04/25/16 – OIG – Review of Medicare Contractor Information Security Program Evaluations for Fiscal Year 2014

The Social Security Act (the Act) requires that each Medicare administrative contractor (MAC) have its information security program evaluated annually by an independent entity. These evaluations must address the eight major requirements enumerated in the Federal Information Security Management Act of 2002 (FISMA). The Act also requires evaluations of the information security controls for a subset of systems but does not specify the criteria for these evaluations. The Inspector General, Department of Health and Human Services, must submit to Congress annual reports on the results of these evaluations, to include assessments of their scope and sufficiency. This report fulfills that responsibility for fiscal year (FY) 2014.
 

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04/20/16 – NAHC – Supreme Court Hears Arguments in Health Care Fraud Case: Broad Implications for All Health Care Providers

The U.S. Supreme Court heard arguments on April 19, 2016 in a case that has broad implications for any provider doing business with Medicaid and/or Medicare.  The case, Universal Health Services v. Escobar,, concerns a lawsuit brought under the federal False Claims Act, which applies to all dealings with the federal government that involves a financial impact in some form. Most states also have their own equivalent laws. While the False Claims Act originated in the Civil War era, it has had a rebirth of sorts in recent years with whistleblower lawsuits and federal prosecutions focused on health care related transactions in Medicaid and Medicare.

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04/19/16 – Science Daily - Half Of Long-Stay Nursing Home Residents Go To Hospital ED Regardless Of Cognitive Status

A new study from the Indiana University Center for Aging Research and the Regenstrief Institute has found that almost half of all long-stay nursing home residents experience at least one transfer to an Emergency Department over the course of a year regardless of their cognitive status. While a high percentage of long-stay nursing home residents were sent to the ED, only about a third of these individuals were subsequently admitted to the hospital.

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04/19/16 – McKnight’s – Clinical Competencies Crucial to Managed Care Success, Experts Say

By Emily Mongan

Providers need to assess their clinical competencies and seek out strategic opportunities for referral partners in order to succeed in the “new” world of managed care, one industry expert advised on Tuesday.

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04/15/16 – McKnight’s – CMS Background Checks Missed Some Criminal Providers, Federal Audit Finds

By Emily Mongan

Nearly 70 providers with criminal backgrounds enrolled in Medicare prior to the program strengthening its background checks, a federal audit found.

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Click here to view the audit report


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04/15/16 – CHCS – Programs Focusing on High-Need, High-Cost Populations

The Center for Health Care Strategies(CHCS) is working with innovative programs across the country that are testing new models of care for low-income populations with complex medical, behavioral health, and social needs. These programs include an array of approaches — coordinated at the state, health plan, or provider level — to address individuals’ health issues, as well as underlying social factors, in order to improve health and cost outcomes.

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04/15/16 – McKnight’s – Minimal SNF Construction Forecasted through 2016, Report Says

By Emily Mongan

Fewer new skilled nursing developments will crop up over the coming year, and those that do will focus on short-stay, post-acute rehabilitation services, according to a new report from real estate consulting firm Integra Realty Resources.

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Click here to view coverage of the assisted living and memory care portions of the IRR report


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04/13/16 – McKnight’s – Report: OIG to Tackle Adverse Events, Therapy Payments in Nursing Homes

By Emily Mongan

Federal regulators' investigative arm has set its sight on adverse events in nursing homes, and how Medicare pays for skilled nursing therapy, according to a report released Tuesday.

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Click here to view the full report


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04/13/16 – Long-Term Living – AHCA to Congress: Rural SNFs Need Better Technology

By Pamela Tabar

Skilled nursing providers in rural areas could fall behind without better access to broadband connectivity, providers testified before the U.S. House Subcommittee on Communications and Technology. Members of the American Health Care Association urged committee members to pass the Rural Health Care Connectivity Act (S. 1916 / H.R. 4111), which would add certain skilled nursing centers to the list of providers eligible for rural telecommunications funding.

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03/22/16 – AHIP – AHIP, Partners Announce New Provider Directory Initiative to Advance Solutions for Data Accuracy, Coordination with Providers

As consumers increasingly rely on provider directories to make decisions about their health coverage and where they receive care, America's Health Insurance Plans (AHIP) is launching a new initiative to identify solutions for improving the accuracy and efficiency of data reporting with provider partners. This new pilot project builds on the industry's ongoing efforts to improve consumers' access to care and to provide the information they need to make informed health care choices.

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04/07/16 – National Center on Elder Abuse – Elder Abuse Working Groups: A Review and Comparison of 15 State Working Groups

Over the past five years, a growing number of states have convened or continued efforts to strengthen formal elder abuse working groups in response to the increase in public awareness of elder abuse. This document examines the establishment, purpose, and current status of these groups.

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Click here to view the executive summary


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4/5/16 – McKnight’s - Study: Five-Star, Consumer Rankings Agree 'Minimally' On SNF Quality

By Emily Mongan

Current government ratings for nursing homes such as Nursing Home Compare differ so much from consumers' personal rankings, they could benefit from personalization, according to a new study.  Conducted by researchers at the University of California-Irvine, the study targeted government-provided, Five-Star Ratings System-based nursing home ratings, like those found on the Centers for Medicare & Medicaid Services' Nursing Home Compare website.

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04/05/16 – McKnight’s – Managed Care Will Hit SNFs Relying on Part A Payments, Experts Say

By Elizabeth Leis Newman - Skilled nursing providers should be prepared for managed care to drill down on Medicare Part A residents, creating the potential for major financial problems, a long-term care expert warned on Tuesday.

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04/04/16 – Associated Press – New Push to Keep Seniors in Home, Community-Based Programs

By Alejandra Cancino

The federal government is pushing states to keep more low-income seniors out of nursing homes and, instead, enroll them in home and community-based programs.

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03/30/16 – U.S. Census Bureau – An Aging World: 2015 – International Population Reports

By Wan He, Daniel Goodkind and Paul Kowal

The world population continues to grow older rapidly as fertility rates have fallen to very low levels in most world regions and people tend to live longer. When the global population reached 7 billion in 2012, 562 million (or 8.0 percent) were aged 65 and over. In 2015, 3 years later, the older population rose by 55 million and the proportion of the older population reached 8.5 percent of the total population. With the post World War II baby boom generation in the United States and Europe joining the older ranks in recent years and with the accelerated growth of older populations in Asia and Latin America, the next 10 years will witness an increase of about 236 million people aged 65 and older throughout the world. Thereafter, from 2025 to 2050, the older population is projected to almost double to 1.6 billion globally, whereas the total population will grow by just 34 percent over the same period.
 
 

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03/30/16 – Department of Justice – Office of Public Affairs – Department of Justice Launches 10 Regional Elder Justice Task Forces

Today, the Department of Justice announced the launch of 10 regional Elder Justice Task Forces.  These teams will bring together federal, state and local prosecutors, law enforcement, and agencies that provide services to the elderly, to coordinate and enhance efforts to pursue nursing homes that provide grossly substandard care to their residents.

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03/18/16 – The Commonwealth Fund – Putting Doctors and Patients on the Same Page

When Doctors Share their Clinical Notes with Patients, it can Lead Both Parties to Change Their Behavior

By Martha Hostetter

Five years ago, Harvard researchers convinced 100 primary care physicians to try something novel — share the notes they made during and after office visits with their patients. Patients already had the legal right to access their records, but it involved a lot of request forms and tedious faxing, and few knew about or took advantage of their rights. Moreover, doctors were reluctant to impart their own notes, even as secure email messaging had made sharing lab test results, medication records, and other parts of the medical record easier.

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3/16/16 – Kaiser Health News - Doctors Ponder Delicate Talks As Medicare Pays For End-Of-Life Counsel

By Phil Galewitz

She didn’t want to spend the rest of her days seeing doctors, the 91-year-old woman confessed to Dr. Kevin Newfield as he treated a deep wound on her arm. “You don’t have to, but you have to tell me what you do want,” Newfield replied. “I’m not afraid of dying. I’m afraid of being 106,” she told the surgeon and her daughter, who was in the room with them. The woman’s spontaneous admission in Newfield’s south Florida office that January day triggered a 20-minute discussion about living wills, hospice and other end-of-life issues, Newfield said. An orthopedic surgeon who sometimes performs amputations, Newfield is comfortable having those conversations. Many doctors are not, but a Medicare policy, known as advance care planning, that took effect in January could help change that.
 
 

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03/16/16 – McKnight’s – House Committee Advances Bill that Would Cut Medicaid Funding

The House Energy and Commerce Committee has given the green light to a bill that has caused headaches for provider groups for its proposed cuts to Medicaid provider assessments.

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Click here to view the complete bill


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03/14/16 – Kaiser Family Foundation – States and Medicaid Provider Taxes or Fees

Medicaid is jointly financed by states and the federal government.  Provider taxes are an integral source of Medicaid financing governed by long-standing regulations.  Currently, all but one state (Alaska) reported a provider tax in FY 2015. (Figure 1) Congress is currently considering proposals to limiting the use of provider taxes.  This would restrict states’ ability on how to come up with the state share to finance Medicaid and could therefore shift additional costs to states. If states were not able to find additional funds to replace provider tax funding with other state sources, limits on provider taxes could result in program cuts with implications for Medicaid providers and beneficiaries. Since states use provider taxes differently, limits would have different effects across states. This factsheet briefly highlights the role of provider taxes in states and the possible impact of proposals to limit the use of these taxes.  Data is based on findings from the most recent survey of Medicaid programs conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates.

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03/11/16 – Kaiser Family Foundation – Streamlining Medicaid Home and Community-Based Services: Key Policy Questions

By Mary Sowers, Henry Claypool and MaryBeth Musumeci

Medicaid’s current home and community-based services (HCBS) programs represent a 35 year incremental approach to system design. Since the early 1980s, Congress has amended the law numerous times, seeking to ameliorate the program’s institutional bias by creating new authorities and incentives for states to offer HCBS. While substantially increasing beneficiary access to HCBS, these initiatives also have resulted in a patchwork of options, contributing to administrative complexity for states and confusion for individuals seeking services. Recently, policymakers have begun discussing how states and beneficiaries might be helped by a streamlined Medicaid state plan authority. This issue brief draws on features of the various existing Medicaid HCBS programs to identify key policy questions raised by initiatives to streamline Medicaid HCBS.

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03/10/16 – Long-Term Living – NIC Releases First Report in Mew SNF Data Series

The National Investment Center for Seniors Housing & Care (NIC) released its first report dedicated to skilled nursing facilities (SNFs) in a new initiative to provide better data for investors. The information analyzed includes the impact of declining length of stay on occupancy levels, data on case mix ratios and the effects of managed care, including Medicare Advantage plans, on SNF revenue.

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03/09/16 – CHCS – Community Care Teams: An Overview of State Approaches

This white paper provides information about Community Care Teams (CCTs) and includes an overview of core program features, governance structures, financing, and health informatics. The paper includes several state examples, but draws heavily on CCT models in North Carolina and Vermont.

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03/09/16 – LeadingAge – CMS Announces 6 New Quality Measures Coming Soon to Nursing Home Compare

By Kathy Pellatt

During an Open Door Forum held on March 3, The Centers for Medicare and Medicaid (CMS) announced imminent changes to Nursing Home Compare and the 5 Star Quality Rating System.
 
Next month, CMS will begin publicly reporting 6 new quality measures (QMs) to Nursing Home Compare. Four of these measures are short-stay measures (3 claims-based and 1 MDS-based) and 2 are MDS-based long-stay QMs.
 
 

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03/08/16 – The Commonwealth Fund – Adding a Measure of Patient Self-Management Capability to Risk Assessments Can Improve Prediction of High Costs

By Judith Hibbard, Jessica Greene, Rebecca M. Sacks, Valeri Overton, and Carmen D. Parrotta

Patients with the knowledge, skills, and confidence needed to manage their health conditions are sometimes referred to as “activated.” Health care systems can use patient activation scores to help predict use of costly services, like the emergency department (ED). Knowing who is most at risk for incurring high costs enables systems to tailor their outreach efforts and better manage overall health care costs.

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03/04/16 – NAHC – Continuing Access to PS&R Depends on Annual Recertification of Your EIDM Account

The Centers for Medicare & Medicaid Services (CMS) recently released information through the Medicare Administrative Contractors (MACs) indicating that to maintain access to Provider Statistical and Reimbursement (PS&R) data, providers must annually recertify their accounts in the Enterprise Identity Management (EIDM) system. CMS began sending messages about the need to recertify in EIDM to providers’ designated Security Officials in mid-February. These notices have NOT been sent to end users. Provider Security Officials must respond timely to the recertification request or lose access to the PS&R. Please alert appropriate staff to the EIDM recertification requirement.

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03/04/16 – NAHC – CMS Enters Cycle 2 for Provider Enrollment Revalidations

The Centers for Medicare & Medicaid Service (CMS) has completed the first cycle of revalidation requests for all Medicare providers and supplies and are now entering a regular cycle (Cycle 2) of provider enrollment revalidations.

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03/03/16 – Long-Term Living – CMS Pushes Interoperability for LTC

By Nicole Stempak

The Centers for Medicare & Medicaid Services announced Wednesday long-term care facilities can join the health information exchange.

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03/03/16 – LeadingAge – Nursing Homes: Prepare for Medicare Value-Based Purchasing with Improved Care Transitions

By Dr. Cheryl Phillips

Improving transitions of care between the hospital and post-acute care settings is critical to improve quality for the individual, and to reduce readmissions. As most of you know, reducing all-cause hospital readmissions is an area of important concern for all nursing home providers. Provisions of the Protecting Access to Medicare Act of 2014 put into place a Medicare value-based purchasing program for skilled nursing facilities (SNFs).

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3/2/16 – AJMC – National Estimates of Price Variation by Site of Care

By Aparna Higgins, MA; German Veselovskiy, MPP; and Jill Schinkel, MS

Recently, researchers and policy makers have demonstrated growing interest in differences in payments across sites of care for the same healthcare service, such as in a hospital outpatient department (HOPD) versus a physician office (PO). Our objective was to examine the price differential for individuals with employer-sponsored insurance by site of care for 7 commonly performed services at the national and regional level. Our analysis showed that for individuals with employer-sponsored insurance, prices for services performed at hospital outpatient departments were higher than prices for the same services at other care settings (ie, physician offices and/or ambulatory surgical centers).  

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03/01/16 – NAHC – CDC Issues Public Health Emergency Planning Guide for LTC, Home Health and Hospice Providers

This Long-Term, Home Health, and Hospice Care Planning Guide for Public Health Emergencies was developed by the Centers for Disease Control and Prevention (CDC) Healthcare Preparedness Activity (HPA), with input from stakeholders from long term care facilities and home health and hospice providers. Through stakeholder meetings, for which the National Association for Home Care & Hospice was a participant, the CDC was able to identify the gaps and issues these sectors face during a public health emergency, and to develop tools to help them address these gaps and issues.

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Click here to view the complete guide


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2/29/16 - LTC Financing Collaborative – A Consensus Framework for Long-Term Care Financing Reform

In 2012, a uniquely diverse group of policy experts and senior-level decision makers representing a wide range of interests and ideological views created The Long-Term Care Financing Collaborative. Our goal was to develop pragmatic, consensus-driven recommendations for a sustainable and affordable, public and private insurance-based financing system that better enables people of all incomes to receive high quality longterm services and supports. Our approach aims to enhance the independence and choice of those receiving care and support the family members and communities that assist them. This is the Collaborative’s final report.

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2/23/16 – McKnight’s - CMS Ramping Up Site Visits, Data Monitoring to Combat Medicare Fraud

The Centers for Medicare & Medicaid Services are beefing up their efforts against Medicare fraud with increased provider site visits, the agency announced Monday.  The increased site visits will initially target providers located in “high risk” areas that receive high Medicare reimbursements, Shantanu Agrawal, M.D., deputy administrator and director for CMS' Center for Program Integrity, wrote in a blog post.

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02/19/16 – CDC – Long-Term Care Providers and Services Users in the United States: Data From the National Study of Long-Term Care Providers, 2013-2014

By Lauren Harris-Kojetin, Ph.D., Manisha Sengupta, Ph.D., Eunice Park-Lee, Ph.D., Roberto Valverde, M.P.H., Christine Caffrey, Ph.D., Vincent Rome, M.P.H., and Jessica Lendon, Ph.D.

Long-term care services provided by paid, regulated providers are an important component of personal health care spending in the United States. This report presents the most current national descriptive results from the National Study of Long-Term Care Providers (NSLTCP), which is conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). Data presented are drawn from multiple sources, primarily NCHS surveys of adult day services centers and residential care communities (covers 2014 data year); and administrative records obtained from the Centers for Medicare & Medicare Services (CMS) on home health agencies, hospices, and nursing homes (covers 2013 and 2014 data years). This report provides information on the supply, organizational characteristics, staffing, and services offered by paid, regulated providers of long-term care services; and the demographic, health, and functional composition of users of these services. Services users include residents of nursing homes and residential care communities, patients of home health agencies and hospices, and participants of adult day services centers.

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2/19/16 – National Quality Forum - NQF Provides Recommendations to HHS for Value-Based Purchasing Programs in Hospital, Post-Acute, and Long-Term Care Settings

The National Quality Forum’s (NQF) Measure Applications Partnership (MAP) has released two reports outlining cross-cutting issues that affect the delivery of healthcare in hospitals and hospital settings (including dialysis facilities and ambulatory surgery centers) as well as post-acute care and long-term care (PAC-LTC) settings.  These reports, submitted to the U.S. Department of Health and Human Services (HHS), highlight important considerations for the federal government when selecting performance measures related to the care provided to 55 million Americans insured by Medicare in these settings.

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2/17/16 – Dartmouth Atlas Project – Our Parents, Ourselves: Health Care For An Aging Population

For decades, health services researchers have studied geographic variation in the delivery of health care services. Steady progress has been made in understanding unwarranted variation and documenting underuse of effective care, misuse of preference-sensitive care, and overuse of supply-sensitive care. It is now evident that certain strategies, such as improving care continuity and instituting high-quality shared decision-making, can improve the care experience for patients.

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02/16/16 – McKnight’s – Data, Culture Change Crucial to New Payment Models, Expert Says

By Emily Mongan

Providers will need to undertake a drastic culture change and refocus on data to prepare for upcoming post-acute payment changes, an expert shared during a McKnight's Super Tuesday webinar.

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2/9/16 – McKnight’s - White House Budget Includes $4 Billion Pilot To 'Streamline' LTC

By Emily Mongan

A pilot program to improve long-term care access and quality is among the healthcare proposals in President Barack Obama's $4.1 trillion budget plan for 2017.  The pilot program would give additional federal funding to up to five states to test a “more streamlined approach” to long-term care services, according to the budget proposalreleased Tuesday. The program is expected to cost a little more than $4 billion between 2017 and 2026.

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Click here to view the proposed budget


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02/05/16 – Annals of Long-Term Care – New ADA Guidelines for Diabetes Management in Long-Term Care

New guidelines from the American Diabetes Association (ADA) address diabetes management in long-term care and skilled nursing facilities, emphasizing treatment simplification, avoidance of hypoglycemia, and reassessment of therapeutic goals for patients who are nearing the end of life. The guidelines were published in the February issue of Diabetes Care. 

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02/03/16 – MNT – ADA Presents Guidance on Managing Diabetes in Older Adults in Long-Term Care Facilities

The care of adults over age 65 with type 2 diabetes is a growing concern: the prevalence of diabetes is highest in this age group and is expected to grow as the U.S. population ages, with many needing care at long-term care (LTC) facilities. To ensure that this population receives proper care, the American Diabetes Association has issued its first position statement to address the management of diabetes in long-term care facilities, which include assisted living, skilled nursing and nursing facilities. The statement appears in the February 2016 issue of Diabetes Care.

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01/20/16 – ASPE Issue Brief – Community Health Workers: Roles and Opportunities in Health Care Delivery System Reform

By John Snyder

This report reviews select health services research findings on Community Health Worker (CHW) utilization that are relevant to U.S. policymakers and considers the key challenges to fully realizing the potential for CHWs to improve health care delivery.

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01/19/16 – Long-Term Living – JAMDA Study IDs Readmission Spike

By Nicole Stempak

Hospital discharges to post-acute care (PAC) facilities have spiked. So have hospital readmissions from PACs, or skilled nursing facilities (SNFs). And that could be deadly, according to a recent study published in the Journal of Post-Acute and Long-Term Care Medicine (JAMDA).

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01/19/16 – OIG – National Background Check Program for Long Term Care Employees: Interim Report

Long-term-care employees provide essential care to patients in settings such as nursing facilities, home health agencies, and hospices. Ensuring that these employees have undergone a minimum level of screening helps protect the safety of beneficiaries in these settings. The Patient Protection and Affordable Care Act (ACA) provides grants to States to implement background check programs for prospective long-term-care employees. The ACA also requires the Office of Inspector General (OIG) to conduct an evaluation of this grant program—known as the National Background Check Program—after its completion. This interim report describes the overall implementation status and States’ results from the first 4 years of the program, and provides the Centers for Medicare & Medicaid Services (CMS) with information that may assist its ongoing administration of this program. OIG also plans to issue a final evaluation of the grant program after its completion.

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01/14/16 – Crain’s Detroit Business - The Federation to prepare 6 Michigan nonprofit systems for new world of at-risk managed care contracting

By Jay Greene

As newly appointed CEO of The Federation, Bill Mayer, M.D., wants to help the six nonprofit health systems that have joined to form a clinically integrated network that spans most corners of Michigan to help themselves under the changing world of health care reform.  Mayer, who had been senior vice president of Kalamazoo-based Bronson Healthcare Group for managed care and community health, said participating systems had several reasons to form The Federation. Reasons include sharing best clinical practices to improve quality, learning new ways from each other to reduce costs to remain competitive and preparing for financially at-risk payment models to help prepare the systems for coming change, Mayer said.

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01/11/16 – McKnight’s – Using Telemedicine to Improve SNF Clinical Outcomes

By Paul Knight

Many skilled nursing facilities have evolved over the years by expanding post-acute care services. This evolution has required significant enhancements to the SNFs clinical processes to ensure they meet the demand of acute care partners. SNFs are also positioned to meet the regulatory changes that will impact reimbursement in the upcoming years. It's time to consider evaluating the use of telemedicine to help improve clinical outcomes.

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01/07/16 – Pride Source – Aging Study: Current LGBT Practices in Long-Term Care Facilities Lacking

By AJ Trager

An Eastern Michigan University professor conducted a study of Michigan's long term care (LTC) facilities and found that despite the existence of models, the state's LTCs have no plan on how to approach the care of LGBT older adults.

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01/06/16 – McKnights - Nursing Home Occupancy, Absorption Rates Dip Further

Rent growth was up slightly but numbers otherwise were generally dim for nursing home market indicators in the fourth quarter of 2015. The occupancy rate for skilled nursing facilities decreased 0.1% during the fourth quarter of 2015, according to data released late Wednesday by the National Investment Center for Seniors Housing & Care.

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01/04/16 – McKnight’s – New Guidelines Hone in on Pre- and Post-Surgery Care for Seniors

By Emily Mongan

Healthcare providers caring for seniors should heed new guidelines for fall prevention, care transition and nutrition, according to two industry groups. Among the recommendations is to conduct a fall risk assessment.

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Click here to view the full guide


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12/18/15 – GAO – Medicare: Increasing Hospital-Physician Consolidation Highlights Need for Payment Reform

Medicare expenditures for HOPD services have grown rapidly in recent years. Some policymakers have raised questions about whether this growth may be attributed to services that were typically performed in physician offices shifting to HOPDs. GAO was asked to examine trends in vertical consolidation and its effects on Medicare.  This report examines, for years 2007 through 2013, (1) trends in vertical consolidation between hospitals and physicians and (2) the extent to which higher levels of vertical consolidation were associated with more E/M office visits being performed in HOPDs. GAO analyzed, using various methods including regression analyses, the most recent available claims data from CMS and survey data from the American Hospital Association, in which hospitals report the types of financial arrangements they have with physicians.

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12/14/15 – The New York Times – Rising Obesity Rates Put Strain on Nursing Homes

By Sarah Varney

At 72, her gray hair closely shorn, her days occupied by sewing and television, Wanda Chism seems every bit a typical nursing home patient — but for her size.

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12/10/15 - Kaiser Health News - Medicare Penalizes 758 Hospitals For Safety Incidents

By Jordan Rau

The federal government is penalizing 758 hospitals with higher rates of patient safety incidents, and more than half of those places had also been fined last year, Medicare records released late Wednesday show. Among the hospitals getting punished for the first time are some well-known institutions, including Stanford Health Care in Northern California, Denver Health Medical Center and two satellite hospitals run by the Mayo Clinic Health System in Minnesota, according to the federal data.

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12/9/15 – NAHC – NAHC’s Medicaid Action Council to Governors: Support Nurses and Caregivers Who Support Individuals Covered by Medicaid

The Medicaid Action Council (Council), an affiliate of the National Association for Home Care & Hospice (NAHC), has sent a letter to all 50 governors and state Medicaid directors across the country encouraging support for nurses and caregivers who support individuals covered by Medicaid as a means of strengthening Medicaid programs.

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Click here to view the letter


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12/7/15 – McKnight’s – Supreme Court will Review what Counts as ‘False’ Under the False Claims Act

By Emily Mongan

The U.S. Supreme Court will review exactly what constitutes a “false” claim under the False Claims Act, due to a petition for certiorari that was granted Friday. Long-term care providers and rehab specialists are sure to take a keen interest in the outcome.

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12/4/15 – McKnight’s – What Can You Do to Achieve a Five-Star Rating?

By Deborah Nugent

If you ask people at Mirador, a Masterpiece Living Community, how we achieved a Five Star rating in Nursing Home Compare, you won't be given a 10-step plan or any detailed account of the perfect formula.

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12/2/15 – Bloomberg BNA - Medicare's Hospital Quality Efforts Saving Lives and Money: HHS

By Michael D. Williamson

Medicare's hospital quality efforts have reduced program costs by nearly $20 billion and saved 87,000 lives, according to a federal report released Dec. 1.  The draft report from the Department of Health and Human Services' Agency for Healthcare Research and Quality focused on a program designed to reduce the number of hospital-acquired conditions (HACs). Andy Slavitt, the acting Centers for Medicare & Medicaid Services administrator, announced the results of the report at the CMS Quality Conference in Baltimore.

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Click here to view the full draft report


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12/1/15 – GAO – Nursing Home Quality

CMS Should Continue to Improve Data and Oversight

In recent years, trends in four key sets of data that give insight into nursing home quality show mixed results, and data issues complicate the ability to assess quality trends. Nationally, one of the four data sets—consumer complaints— suggests that consumers’ concerns over quality have increased, while the other three data sets—deficiencies, staffing levels, and clinical quality measures— indicate potential improvement in nursing home quality. For example, the average number of consumer complaints reported per home increased by 21 percent from 2005-2014, indicating a potential decrease in quality. Conversely, the number of serious deficiencies identified per home with an on-site survey, referred to as a standard survey, decreased by 41 percent over the same period, indicating potential improvement. The Centers for Medicare & Medicaid Services’ (CMS) ability to use available data to assess nursing home quality is complicated by various issues with these data, which make it difficult to determine whether observed trends reflect actual changes in quality, data issues, or both. For example, clinical quality measures use data that are self-reported by nursing homes, and while CMS has begun auditing the self-reported data, it does not have clear plans to continue. Federal internal control standards require agencies to monitor performance data to assess the quality of performance over time.

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11/18/15 – Long-Term Living – Repurposing an Old Tool to Yield New Insights About Quality of Care

By Nicole Stempak

The National Core Indicators – Aging and Disabilities (NCI-AD) assessment tool could help compare care and quality of life for seniors and adults with physical disabilities.

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11/17/15 – Long-Term Living – Study: More Insurance Options Can Improve Long-Term Services and Supports

By Nicole Stempak

A public/private solution is needed to help aging people plan for and meet their long-term services and supports (LTSS) needs, according to a new report.

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11/11/15 – The Commonwealth Fund – Improving Care for Those Who Need It Most

By Christine Haran

"It’s too far.” That’s what Faustino Gazan, a 47-year-old man living in a walk-up apartment in the Washington Heights neighborhood of New York City, says of his journey three times a week to a dialysis center 50 blocks away. For Gazan, who uses a wheelchair, struggling down the stairs and traveling to the Central Park Dialysis Center is a part of his life with diabetes, hypertension, kidney disease, and a genetic condition called Prader-Willi syndrome that causes weak muscle tone, overeating, and developmental delays, among other problems.

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11/8/15 – McKnight’s – Budget Bill Includes CMP Increase

By Emily Mongan

A provision included in the Bipartisan Budget Act of 2015 that would double the maximum amount civil monetary penalties for providers has one leading healthcare organization crying foul.

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Click here to view the judiciary section of the bill


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11/3/15 – McKnight’s – HIPAA Being Cited Incorrectly, Expert Warns

By Elizabeth Leis Newman - Care coordination is often stymied by incorrect understanding of the Health Insurance Portability and Accountability Act (HIPAA), a former Center for Medicare & Medicaid Services official noted Tuesday.
 

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10/29/15 – The Commonwealth Fund - Models of Care for High-Need, High-Cost Patients: An Evidence Synthesis

By Douglas McCarthy, Jamie Ryan and Sarah Klein

This brief analyzes experts’ reviews of evidence about care models designed to improve outcomes and reduce costs for patients with complex needs. It finds that successful models have several common attributes: targeting patients likely to benefit from the intervention; comprehensively assessing patients’ risks and needs; relying on evidence-based care planning and patient monitoring; promoting patient and family engagement in self-care; coordinating care and communication among patients and providers; facilitating transitions from the hospital and referrals to community resources; and providing appropriate care in accordance with patients’ preferences. Overall, the evidence of impact is modest and few of these models have been widely adopted in practice because of barriers, such as a lack of supportive financial incentives under fee-for-service reimbursement arrangements. Overcoming these challenges will be essential to achieving a higher-performing health care system for this patient population.

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Click here to view Appendix A

Click here to view Appendix B


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10/29/15 – Modern Healthcare – CMS’ Proposed Discharge Changes Would Hit Home Health Agencies

By Virgil Dickson

The CMS is proposing a massive overhaul of the discharge process for hospitals, rehabilitation facilities and home health agencies. The latter would likely be hardest hit, facing an annual cost of $283 million, the agency says.

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10/29/15 – Annals of Long-Term Care – LTC GPS: Admission Criteria for Facility-Based Post-Acute Services

By Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD, Thomas Jefferson University, College of Population Health, The Access Group, and Mercy LIFE, Philadelphia, PA

Admissions to post-acute care facilities are growing as a result of the effort to decrease length of hospital stays and to reduce hospital readmissions. Rather than discharging patients directly home, hospitals are commonly transferring patients to post-acute facilities. One reason is that the transfer to an inpatient facility for post-acute services can occur more quickly than a direct discharge home—resulting in less time spent in the hospital. Another reason is that the greater oversight provided by professional caregivers in a post-acute facility decreases the likelihood of hospital readmission. To prevent the inappropriate use and potential overuse of these services, however, Medicare and other payers have rules to ensure that transfers to post-acute facilities are appropriate. Still, much of the criteria are vague and subjective.

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10/28/15 – JAMDA – Hospitalization and Mortality Rates in Long-Term Care Facilities: Does For-Profit Status Matter?

By Peter Tanuseputro MD, MHSC, Mathieu Chalifoux MSc, Carol Bennett MSc, Andrea Gruneir PhD, Susan E. Bronskill PhD, Peter Walker MD, and Douglas Manuel MD, MSc

Long-term care (LTC) facilities, also commonly known as nursing homes, deliver care to individuals unable to live in the community due to illness and/or disability. In addition to housing, LTC facilities provide personal and medical support, including 24-hour nursing care. The need for LTC facilities increases with age, and is expected to increase in aging populations. Discussions on quality of care in LTC facilities are widespread, and monitoring of performance indicators is becoming increasingly common.

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10/25/15 – McKnight’s – Final 60-day Overpayment Rule Moves to OMB

By Emily Mongan

A final rule requiring healthcare providers to return Medicare overpayments within 60 days has gone to the White House Office of Management and Budget for review.

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10/19/15 – Kaiser Family Foundation – Medicaid’s Role for People with Dementia

By Rachel Garfield, MaryBeth Musumeci, Erica L. Reaves, and Anthony Damico

Almost one-half (46%) of nursing facility residents and about one in five (21%) seniors living in the community has probable or possible dementia, a syndrome characterized by a chronic, progressive decline in memory and other cognitive functions, such as communication and judgment. People with dementia often have complex medical and behavioral health needs, and many rely on family caregivers to provide assistance with self-care and other daily activities. As dementia advances, paid care may be needed. Most people with dementia have Medicare, but due to high out-of-pocket costs and lack of long-term services and supports (LTSS) coverage, low-income people with disabilities resulting from dementia may need Medicaid to fill in the coverage gaps. Medicaid plays an important role in providing LTSS and is increasingly focused on efforts to help seniors and people with disabilities remain in the community rather than reside in institutions.

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10/16/15 – NAHC – NAHC Survey on the Role of Non-Physician Practitioners in Home Care: Preliminary Results

Survey Results Strongly Support Advocacy Efforts for Legislation Allowing NPPs to Certify Home Health Plans of Care

The National Association for Home Care & Hospice (NAHC) recently conducted a nationwide survey of the use of and impact of Non-Physician Practitioners (NPPs) in Medicare home health services. The purpose was to develop additional information that could be used in our advocacy to gain the right of NPPs to authorize Medicare-covered home health services. 
 
 

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10/8/15 – ACL – ACL “No Wrong Door” System Grants Help Streamline Access to Services and Supports

For many older adults and people with disabilities, the key to remaining independent can be something as simple as a home-delivered meal, a ramp for their homes, or a few hours of respite for a family caregiver. Unfortunately, an often disjointed maze of eligibility criteria, forms, programs, and agencies can prevent even the most determined individuals from obtaining these critical supports. The Administration for Community Living (ACL) has been helping states streamline their processes and implement systems that make it easier for people to learn about—and access—the services they need.

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10/7/15 – Long-Term Living – Mastering the New SNF Regs to Maximize Reimbursement

By Pamela Tabar

2016 begins a brave new year for skilled nursing facilities (SNFs), a year when readmission rate scores will become a direct and deliberate determiner of Medicare reimbursement amounts. A reimbursement of two percent is on the table, and facilities whose readmission scores don't compare favorably to other SNFs across the country could lose most or all of it, explained policy experts at this week's American Health Care Association/National Center for Assisted Living (AHCA/NCAL) Annual Conference and Expo in San Antonio, Texas.

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9/29/15 – OIG – The Medicare Payment System for Skilled Nursing Facilities Needs To Be Reevaluated

OIG, the Medicare Payment Advisory Commission, and other entities have raised longstanding concerns regarding Medicare's skilled nursing facility (SNF) payment system. These concerns focus on SNF billing, the method of paying for therapy, and the extent to which Medicare payments exceed SNFs' costs. Medicare pays SNFs a daily rate for nursing, therapy, and other services. The daily rate for therapy is primarily based on the amount of therapy provided, regardless of the specific beneficiary characteristics or care needs. Previously, OIG found that SNFs increasingly billed for the highest level of therapy even though key characteristics of SNF beneficiaries remained largely unchanged from 2006 to 2008. OIG also found that SNFs billed one quarter of all 2009 claims in error-primarily by billing for higher levels of therapy than they provided or were reasonable or necessary-which resulted in $1.5 billion in inappropriate Medicare payments. This study provides further evidence that supports and quantifies these concerns.
 

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9/28/15 – Health Policy Institute – Addressing the Health Needs of an Aging America

New Opportunities for Evidence-Based Policy Solutions

By a multidisciplinary team of researchers at the University of Pittsburgh, led by Dr. Sally Morton and Dr. William Dunn - By 2050, adults over the age of 65 will make up 20 percent of the U.S. population. The budgetary and policy implications of this demographic shift represent two of the greatest challenges faced by federal and state governments today. An aging population will place intense stress on our healthcare system, its funding sources, and American families. Lack of personal savings for long term-care and a fragmented and institutionally-dependent delivery system will pose significant risks to the health and quality-of-life of aging Americans. Our healthcare workforce will need to be re-tooled to manage the multiple chronic conditions prevalent in this vulnerable population. Addressing the needs of the elderly will be a top priority of policymakers at every level. 
 

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9/23/15 – McKnight’s - Study: Fall Prevention Programs Cut Costs

By Emily Morgan

Fall prevention programs may help Medicare beneficiaries save money on hospitalizations and skilled nursing facility care, a new study has found. The study analyzed data from more than 6,000 Medicare beneficiaries enrolled in the fall prevention program A Matter of Balance, an eight-week group program that helps reduce the fear of falling and help seniors change their environments to reduce fall risks.

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9/22/15 – Reuters - How Medicare’s 'Chronic Care Management' Payments Could Affect Primary Care

By Will Boggs MD

Medicare’s new “chronic care management” (CCM) payment program could make it more financially feasible for physicians to deliver services between visits. Under the new program, Medicare could reimburse primary care practices about $40 month for such things as medication management and communication with other doctors for patients who have two or more chronic medical conditions. Patients would have to agree to be enrolled and would have a 20 percent copay.

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9/13/15 – McKnight’s – MedPAC Begins Work on Post-Acute Pay Prototype

By Emily Mongan

The Medicare Payment Advisory Commission started work last week on creating a unified payment model that could change the way post-acute care providers receive Medicare reimbursements.

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9/13/15 – McKnight’s – CMS Reopens Comment Period on LTC Regulation Overhaul

By Emily Mongan

The comment period on the 403-page long-term care regulation reform rule proposed in July has been reopened for an additional 30 days, the Centers for Medicare & Medicaid Services announced Friday.

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Click here to view the Federal Register announcement


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9/9/15 – Annals of Long-Term Care – ICD-10: Why and What Matters to Long-Term Care Providers

By Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD; Thomas Jefferson University, College of Population Health; The Access Group; and Mercy Life, Philadelphia, PA

LTC providers have never had to be very knowledgeable about the International Classification of Diseases, 9th Edition—or, as it is better known, ICD-9. This is for a host of reasons, but primarily because provider reimbursement historically has not been tied to ICD coding. There was also a belief that the 10th Edition of International Classification of Diseases (ICD-10) would never happen, given that it’s been long in the making as a result of many delays. But, not only implementation of ICD-10 but also a direct link of coding to reimbursement is really coming on October 1, 2015.1 

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9/3/15 – The Commonwealth Fund – How Strong is the Primary Care Safety Net? Assessing the Ability of Federally Qualified Health Centers to Serve as Patient-Centered Medical Homes

By Jamie Ryan, Pamela Riley, M.D., Melinda K. Abrams and Robert Nocon

By expanding access to affordable insurance coverage for millions of Americans, the Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), which provide an important source of care in low-income communities. A pair of Commonwealth Fund surveys asked health center leaders about their ability to function as medical homes. Survey findings show that between 2009 and 2013, the percentage of centers exhibiting medium or high levels of medical home capability almost doubled, from 32 percent to 62 percent. The greatest improvement was reported in patient tracking and care management. Despite this increased capability, health centers reported diminished ability to coordinate care with providers outside of the practice, particularly specialists. Ongoing federal funding and technical support for medical home transformation will be needed to ensure that FQHCs can fulfill their mission of providing high-quality, comprehensive care to low-income and minority populations.

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Click here to view the Chartpack


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8/28/15 – HealthITAnalytics – Final ICD-10 End-to-End Testing Week Sees 87% Success Rate

By Jennifer Bresnick

With just over one month until the ICD-10 transition, CMS has released the latest statistics from its July ICD-10 end-to-end testing week.  Eighty-seven percent of submitted claims were accepted, mirroring results from earlier in the year.  As with previous testing events, relatively few of the claims were rejected solely based on improper ICD-10 codes.  

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Click here to view the latest statistics


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8/28/15 – Modern Healthcare – NLRB Ruling Could Shake Up Healthcare Staffing Industry

By Adam Rubenfire

A ruling Thursday by the National Labor Relations Board could complicate relations between healthcare organizations and their workers employed by staffing agencies.

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8/26/15 – Kaiser Health News – A Racial Gap in Attitudes Toward Hospice Care

By Sarah Varney

Twice already Narseary and Vernal Harris have watched a son die. The first time — Paul, at age 26 — was agonizing and frenzied, his body tethered to a machine meant to keep him alive as his incurable sickle cell disease progressed. When the same illness ravaged Solomon, at age 33, the Harrises reluctantly turned to hospice in the hope that his last days might somehow be less harrowing than his brother’s.

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8/20/15 – M Live - Michigan Hospices Test Medicare Model Allowing Patients To Get 'Curative' Care

By Sue Thoms

Medicare patients will be able to receive hospice care while also pursuing "curative" treatments under a program that will be tested by 10 Michigan hospice programs.
The new Medicare Care Choices Model marks a departure from the traditional approach to hospice care — Medicare rules do not allow a patient to receive curative and hospice care at the same time. The program, being rolled out at 141 hospices nationwide, is aimed at bringing the quality-of-life care provided by a hospice to more Medicare patients.
 

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8/20/15 – Avalere – Providers Rush to Assume Medicare Risk under Bundled Payment Program

A new Avalere analysis of Medicare’s new bundled payment program shows a strong and growing interest in alternative payment models among providers. Data show there will be 1,755 provider organizations participating in Phase 2 of the Centers for Medicare & Medicaid Services’ Bundled Payments for Care Improvement Initiative (BPCI).

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8/19/15 – The National Long-Term Care Ombudsman Resource Center – New Resources from the Consumer Voice for Consumers and Advocates on Nursing Home Transitions

The focus of these resources is to share with you the findings of a project Consumer Voice conducted on nursing home transitions. The goal of this project was to determine what could be done to improve the nursing home transition process for nursing home residents who leave the nursing home to go back into the community. Resources include a how to guide for advocates that ombudsmen can use when helping a resident transition.

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Click here to view Implementating Recommendations from Quality Care, No Matter Where: Successful Nursing Home Transitions - A How to Guide for State and Local Advocates


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8/16/15 – The Wall Street Journal – How Medicare Rewards Copious Nursing-Home Therapy

Medicare Pays Top Dollars for Patients in Heavy Rehab; The Pivotal 720-Minute Mark

By Christopher Weaver, Anna Wilde Mathews and Tom McGunty- During his 2013 California nursing-home stay, Jack Furumura became severely dehydrated and shed more than 5 pounds, partly because staff didn’t follow written plans for his nutrition or the facility’s policies, a state inspection report shows.

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An Analysis of the National Home Health Aide Survey

By Jess Wilhelm, MA, Social & Scientific Systems, Inc., Natasha Bryant, MA, LeadingAge, Janet P. Sutton, PhD, Social & Scientific Systems, Inc., and Robyn Stone, ScD, LeadingAge

After informal caregivers, home health and home care workers (referred to in this article as home health workers or home health aides [HHAs]) provide the majority of hands-on, personal care services to older adults and younger people with disabilities (Kaye, Chapman, Newcomer, & Harrington, 2006; Stone, 2004). These workers tend to have frequent, intimate contact with clients, often developing relationships with them and becoming an important source of emotional as well as physical support (Stone, 2004). The demand for home care has increased significantly over the past three decades. Elderly and younger consumers and their families prefer home and community-based services to the receipt of care in nursing homes. Four out of five elders who require long-term services and support live in the community and want to receive care in their own home (Butler, Brennan-Ing, Wardamasky, & Ashley, 2013). Federal and state policymakers have responded to this demand, as well as the potential for cost savings, by expanding home and community-based options in lieu of nursing
home placements for disabled Medicaid beneficiaries. Home health care services covered by Medicare, Medicaid and commercial insurers have also expanded to address the post-acute care needs of individuals being discharged from hospitals more quickly than in previous years, or even bypassing a hospital stay entirely. The demand for this workforce is likely to grow even more over the next 30 years as the baby boom generation ages, the number of people with disabilities increases and the availability of caregivers decreases (Redfoot, Feinberg, & Houser, 2013).
 

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8/11/15 – Aging & Adult Services Agency – State Releases Elder Abuse Prevention Request for Proposal

The Aging & Adult Services Agency (AASA), under the Michigan Department of Health and Human Services, today issued a Request for Proposal (RFP) open to Michigan’s aging network and its partners to help combat some of the fastest growing crimes in the state, crimes against older adults.

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8/11/15 – Long-Term Living – Report: Antipsychotic Drug Use in Nursing Homes Drops

By Megan Combs

Antipsychotic drug use in nursing home residents with some form of dementia has dropped from 23.9 percent in 2011 to 18.7 percent in the first quarter of 2015, according to a report from the Centers for Medicare and Medicaid Services (CMS). The National Partnership to Improve Dementia Care in Nursing Homes compiled the data. Success has varied by state, with some states and regions seeing a reduction of more than 20 percent. Maine, Arkansas and Tennessee saw the biggest drops, according to the report.

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Click here to view the National Partnership to Improve Accuracy and Quality Outcome Success


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8/10/15 – Long-Term Living – MDS Assessment Accuracy and Quality Outcome Success

By Lisa Hohlbein RN, RAC-MT, CDP, CADDCT

Nursing home Five-Star quality ratings, increasing MDS focused surveys and resident expectations puts nursing home care systems under the microscope with the MDS assessment data right in the middle of the target. It is clear our governing bodies, as well as families and loved ones, want to know which nursing homes can take the best care of those they love. This is a concept that resonates with a universal heartbeat for which all in the care continuum.

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8/6/15 – NAHC – NAHC Lawsuit Challenging the Medicare Face-to-Face Rule Presented in Court

Counsel for the National Association for Home Care & Hospice (NAHC) presented oral argument before U.S. District Court Judge Christopher Cooper on August 6, 2015, regarding NAHC’s lawsuit challenging the validity of the physician narrative requirement in the physician face-to-face encounter rule. While Medicare rescinded the narrative requirement from its rule after NAHC filed its lawsuit last year, Medicare has not provided nearly $200 million in retroactive payments to home health agencies that were wrongfully denied claims because of the now-rescinded narrative requirement. NAHC brought litigation on the validity of the narrative requirement so that home health agencies that provided care to patients in good faith are paid for their inappropriately disallowed claims.

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8/5/15 – The Commonwealth Fund – Primary Care Providers’ Views of Recent Trends in Health Care Delivery and Payment

Findings from the Commonwealth Fund/Kaiser Family Foundation 2015 National Survey of Primary Care Providers

By Jamie Ryan, Michelle M. Doty, Liz Hamel, Mira Norton, Melinda K. Abrams, and Mollyann Brodie

A new survey from The Commonwealth Fund and The Kaiser Family Foundation asked primary care providers—physicians, nurse practitioners, and physician assistants—about their experiences with and reactions to recent changes in health care delivery and payment. Providers’ views are generally positive regarding the impact of health information technology on quality of care, but they are more divided on the increased use of medical homes and accountable care organizations. Overall, providers are more negative about the increased reliance on quality metrics to assess their performance and about financial penalties. Many physicians expressed frustration with the speed and administrative burden of Medicaid and Medicare payments. An earlier brief focused on providers’ experiences under the ACA’s coverage expansions and their opinions about the law.

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Click here to view the Exhibits

Click here to view the Topline


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8/4/15 – Kaiser Family Foundation – Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2009 Through 2014

By Charlene Harrington, Helen Carrillo and Rachel Garfield

Nursing facilities are one part of the long-term care delivery system that also includes home and community based services, but their relatively high cost has led them to be the focus of much attention from policymakers. In addition, the quality of care provided in nursing facilities has been a longstanding policy challenge. Several federal and state regulations, including new regulations proposed in July 2015, aim to address longstanding quality and safety issues. As the demand for long term care continues to increase, the characteristics, capacity, and care quality of facilities remain subjects of concern among consumers and policy makers.

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Click here to view Supplemental Tables


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7/30/15 – OIG - Performance Data for the Senior Medicare Patrol Projects: July 2015 Performance Report

This memorandum report presents performance data for the Senior Medicare Patrol (SMP) projects, which receive grants from ACL to recruit and train retired professionals and other senior citizens to recognize and report instances or patterns of health care fraud. OIG has collected these performance data since 1997. In July 2010, the Administration on Aging (AoA)—now part of ACL—requested that OIG continue to collect and report these data to support AoA's efforts to evaluate and improve the SMP projects' performance. (ACL was established in 2012, bringing together AoA and two other offices.) OIG currently reports the SMP projects' performance data on an annual basis.

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7/27/15 – Department of Justice

Office of Public Affairs

Detroit-Area Home Health Care Agency Owners Convicted in $33 Million Medicare Fraud Scheme

Two home health care agency owners were convicted today of various offenses based on their roles in a $33 million Medicare fraud scheme, announced Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan, Special Agent in Charge Paul M. Abbate of the FBI’s Detroit Field Office and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services-Office of Inspector General’s (HHS-OIG) Chicago Regional Office.

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7/13/15 – Alliance for Health Reform – Long-Term Services and Supports: Changes and Challenges in Financing and Delivery

By Deanna Okrent - The aging of the baby boomers and the increase in the number of old-old persons (those 85 and older) are predictors for the increasing need for long-term services and supports (LTSS). Among persons age 65 and over, an estimated 70 percent will use LTSS. Persons age 85 and over are four times more likely to need LTSS than persons age 65 to 84.1 The number of Americans needing LTSS is projected to more than double, to 27 million by 2050,2  when one-fifth of the total U.S. population will be 65 or older. This is a significant increase from 12 percent in 2000 and 8 percent in 1950.3

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7/13/15 – Kaiser Health News – New Regulations Would Require Modernizing Nursing Home Care

By Susan Jaffe

After nearly 30 years, the Obama administration wants to modernize the rules nursing homes must follow to qualify for Medicare and Medicaid payments.

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Click here to view the Reform of Requirements for Long-Term Care Facilities


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6/16/15 – McKnight’s – Experts Say Full Staff Engagement, Training Crucial to Improve Dementia Care

By Emily Mongan

Dementia-related behavioral disturbances are one of the top five reasons nursing home residents are readmitted to hospitals, according to experts affiliated with the Centers for Medicare & Medicaid Services.

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6/2/15 – USA Today - Mental Health Spending Up, New Medicare Data Shows

By Meghan Hoyer, Laura Ungar and Jayne O’Donnell

Medicare providers got more for mental health and specialty care including sports and sleep medicine in 2013, according to new payment data released Monday that shows which healthcare providers received the most money. A USA TODAY analysis also found Medicare payments in more traditional areas of medicine -- including cardiology, general practice and geriatric medicine -- were all down. In total, more than 950,000 health care providers collectively received about $89 billion in Medicare payments in 2013, according to the Centers for Medicare and Medicaid Services.

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5/28/15 – ASPE Issue Brief – Medicare’s Hospice Benefit: Revising the Payment System to Better Reflect Visit Intensity

By Steve Sheingold, Susan Bogasky, and Sally Stearns

The Medicare hospice benefit was established in 1983 to provide palliative care and support services to terminally ill patients and their families. The benefit is intended for beneficiaries with a life expectancy of six months or less if the illness runs its normal course. Over time, utilization of the hospice benefit has grown considerably. Medicare spending for hospice increased from approximately $2.9 billion in 2000 to $15.1 billion in 2014 (MedPAC, 2015).
 

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5/27/15 – OIG – Home Health Agencies Conducted Background Checks of Varying Types

Employees of home health agencies (HHAs) provide care—usually unsupervised—to patients in their homes. Ensuring that HHA employees have undergone a minimum level of screening would help protect the safety of Medicare beneficiaries. There are no Federal laws or regulations that require HHAs to conduct background checks prior to hiring individuals or to periodically conduct background checks after individuals have been hired. State requirements for background checks vary as to what sources of information must be checked, which job positions require background checks, and what types of convictions prohibit employment. This evaluation is in response to a congressional request for the Office of Inspector General to analyze the extent to which HHAs employed individuals with criminal convictions and to explore whether these convictions should have—according to State requirements— disqualified them from HHA employment.
 

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5/22/15 – NAHC – Senators Rally Support for Legislation to Allow NPs and PAs to Certify Medicare Home Health Plans of Care

Two leading members of the U.S. Senate are urging their colleagues to cosponsor bipartisan legislation endorsed by the National Association for Home Care & Hospice (NAHC) that would allow Nurse Practitioners (NP) and Physician Assistants (PA) to certify Medicare home health plans of care.  U.S. Senators Susan M. Collins (R-ME) and Chuck E. Schumer (D-NY) sent a letter to their Senate colleagues this week encouraging them to cosponsor the Home Health Care Planning Improvement Act of 2015 (S. 578), which they introduced earlier this year.

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5/21/15 – Crain’s Detroit Business - Southeast Michigan Physician Pleads Guilty To $4.2 Million Medicare Fraud

By Jay Greene

Hicham Elhorr, M.D., a 47-year-old physician from Dearborn and former owner of Allen Park-based House Calls Physicians PLLC, has pleaded guilty to one count of conspiracy to commit health care fraud. Elhorr, who pleaded guilty for his role in $4.2 million in falsified Medicare billing before U.S. District Judge Nancy G. Edmunds of the Eastern District of Michigan, is scheduled to be sentenced Oct. 20.

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5/19/15 – MedPAC – Comments on CMS’s Skilled Nursing Facilities: Prospective Payment System, Value Based Purchased and Quality Reporting Proposed Rule

The Medicare Payment Advisory Commission (MedPAC) welcomes the opportunity to comment on the Centers for Medicare & Medicaid Services’ (CMS) proposed rule entitled Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2016, Federal Register, Vol. 80, No. 75, p. 22044 (April 20, 2015). We appreciate your staff’s ongoing efforts to administer and improve the payment system for skilled nursing facilities, particularly given the many competing demands on the agency staff’s resources.

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5/17/15 – McKnight’s – Nursing Homes Blamed for High Opt-Out Rate in Dual Eligible Demo

By John Hall

A Centers for Medicare & Medicaid Services official said late last week it's too early to assess the success of a demonstration project aimed at reforming the costly system of caring for Medicare and Medicaid dual-eligibles, even as huge numbers of them are exiting the program.

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5/14/15 – Kaiser Family Foundation – Reading the Stars: Nursing Home Quality Star Ratings, Nationally and by State

By Cristina Boccuti, Giselle Casillas and Tricia Neuman

About 1.3 million people receive care each day in over 15,500 nursing homes in the United States that are certified by either Medicaid or Medicare or both. The federal government requires nursing homes to meet minimum standards as a condition of Medicare and Medicaid payment. Over the years, serious concerns have been raised about the quality of nursing home care and the adequacy of oversight and enforcement.1 Nursing home provisions in the Omnibus Budget Reconciliation Act of 1987 (OBRA 87) were enacted to help address these concerns. Nonetheless, reports of quality problems in nursing homes persist, such as low staffing levels, new pressure ulcers (bedsores), and documented fire hazards.  These are serious issues given the frailty and vulnerability of nursing home residents.

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Click here to view the news release


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5/13/15 – The Commonwealth Fund – Mobile Health and Patient Engagement in the Safety Net: A Survey of Community Health Centers and Clinics

By Andrew Broderick and Farshid Haque

Patient-centered technologies have emerged as a way to actively engage patients in care. The reach and potential of cell phones to engage diverse patient populations is great. Evidence of their effectiveness in improving health-related outcomes is limited. Researchers conducted an online survey of community health centers and clinics to assess if and how health care providers in the safety net use cell phones to support patient engagement. The findings indicate that the use of cell phones in patient care is at an early stage of deployment across the safety net. Organizations identify chronic disease management as an area where cell phones offer considerable potential to effectively engage patients. To promote widespread adoption and use, technical assistance to support the implementation and management of interventions, evidence-based or best practice models that highlight successful implementation strategies in care delivery, and the introduction of new payment or reimbursement policies will be essential.

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Click here to view the Chartpack


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5/12/15 – NCAL – Quality Initiative for Assisted Living Renewed for Three Years

Professional Crusade Reaffirms Providers’ Commitment to Residents, Staff

By Rachel Reeves

The National Center for Assisted Living (NCAL) today announced the next phase of its national effort to demonstrate quality improvement in America’s assisted living communities. The association renewed the Quality Initiative for Assisted Living and its four measurable goals for three more years.

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5/5/15 – Long-Term Living – Experts See Two Futures for Assisted Living

By Lois A. Bowers

Two different speakers addressing attendees of two different sessions had the same prediction at the Assisted Living Federation of America annual meeting in Tampa: Assisted living may be divided into two types of providers in the future. One will include medical care in services offered, and the other will focus on the housing and hospitality aspects of the business

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5/1/15 – GAO – Advance Directives – Information on Federal Oversight, Provider Implementation, and Prevalence

The Centers for Medicare & Medicaid Services (CMS) oversees providers’ implementation of the advance directive requirement in the Patient Self Determination Act (PSDA) to maintain written policies and procedures to inform individuals about advance directives, and document information about individuals’ advance directives in the medical record by providing guidance and monitoring covered providers. Covered providers include hospitals, nursing homes, home health agencies (HHAs), hospices, and Medicare Advantage (MA) plans that receive Medicare and Medicaid payments. CMS, an agency within the Department of Health and Human Services (HHS), provides operations manuals, memoranda, and model documents to these providers to inform them about the advance directive requirement and describe how the agency will monitor providers’ implementation. Because individual states are responsible for administering contracts with and providing guidance to Medicaid managed care plans, also specified in the PSDA, CMS ensures that the contracts include the advance directive requirement, but does not issue guidance to these plans. To monitor providers’ implementation of the advance directive requirement, CMS primarily relies on other entities. CMS enters into agreements with state survey agencies to periodically survey and report data, which CMS collects, on deficiencies related to advance directives for hospitals, nursing homes, HHAs, and hospices. CMS also relies on accrediting organizations to survey providers that participate in the Medicare program through accreditation and subsequently make recommendations to CMS regarding providers’ participation in Medicare. In addition, CMS reported reviewing MA and Medicaid managed care plans’ contracts to determine that they include the advance directive requirement.
 

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4/28/15 – JAMA – Measuring Vital Signs – An IOM Report on Core Metrics for Health and Health Care Progress

By David Blumenthal, MD, MPP and Michael McGinnins, MD, MPP

Two truisms apply to the current state of performance measurement in health care. The first is that if something (eg, a process, an outcome) cannot be measured, it cannot be improved. The second is that it is possible to have too much of a good thing.
 

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4/20/15 – Long-Term Living – Congress Addresses Post-Acute Care Payment Reform

By Bob Gatty

Now that Congress has scrapped the sustainable growth rate (SGR) formula for a new and improved payment system for physicians, a House subcommittee is turning its attention to reforming how Medicare pays post-acute care (PAC) facilities for their services.

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4/6/15 – The Commonwealth Fund - Michigan’s Fee-for-Value Physician Incentive Program Reduces Spending and Improves Quality in Primary Care

By Christy Harris Lemak, Tammie A. Nahra, Genna R. Cohen, Natalie D. Erb, Michael L. Paustian, David Share, and Richard A. Hirth

An evaluation of one of the nation’s largest “fee-for-value” initiatives demonstrates that physicians can control costs while improving their performance under a traditional fee-for-service arrangement. Primary care doctors who were offered financial incentives to form patient-centered medical homes and engage in quality improvement activities reduced spending by 1.1 percent on a per-member per-month basis compared with a control group. Performance on measures of preventive care and chronic disease management also improved. Spending increased initially, but declined by the program’s second year of participation.

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4/6/15 – McKnight’s – Reinventing Rehab

By John Andrews

In recent years, nothing has helped the skilled nursing sector flex its post-acute care muscles like rehabilitation. Offering short-term rehab stays and outpatient services for discharged acute care patients has opened up a new revenue stream for long-term care facility operators while giving them the opportunity to boost their clinical care operations and forge partnerships with other providers.

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4/1/15 – McKnight’s - Sebelius: Future Payments To Operators Will Increasingly Target Care, Accountability And Savings

By John O’Connor

Providers can kiss fee-for-service payments goodbye, says Kathleen Sebelius. Most recently the nation's top healthcare official, Sebelius said Medicare and Medicaid payments will increasingly be bundled, and will mandate demonstrated value as a prerequisite. Her comments came Wednesday at the NIC 2015 Capital & Business Strategies Forum in San Diego, where she also delivered a robust defense of the five-year old Affordable Care Act — colloquially known as Obamacare.

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3/31/15 – Reuters – U.S. Top Courts Says Medical Providers Can’t Sue States Over Medicaid Funding

By Lawrence Hurley

The U.S. Supreme Court on Tuesday ruled in a case from Idaho that private medical providers that deliver residential care services cannot sue a state in try to raise Medicaid reimbursement rates to deal with rising medical costs.

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3/30/15 – McKnight’s – Numerous Medicare Funding “Extenders” at Risk for Expiration

By John Hall

While long-term care professionals have at least two more weeks to agonize over the fate of a bill that would permanently repeal the current Medicare physicians funding formula, a host of other key funding “extenders” set to expire also hang in the balance.

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3/24/15 – McKnight’s – Medicare Providers Could Face Up To 100% Late Tax Penalties

By John Hall

Praise for Congress for proposing a bill that would reset Medicare physician pay rates could be a little less hearty, after details emerged Tuesday that the measure would also include penalties as high as 100% for providers delinquent with income tax payments.

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3/21/15 – National Association for Home Care & Hospice – Hospice Self-Calculation of Aggregate Cap – Meet March 31 Deadline or Payments will be Suspended

The National Association for Home Care & Hospice (NAHC) has made a concerted effort to keep hospice providers apprised of issues related to a new Centers for Medicare & Medicaid Services (CMS) requirement for hospices to self-calculate and report their aggregate cap status to their assigned Medicare Administrative Contractor (MAC) within five months following the close of the cap year, beginning with the 2014 cap year. Hospices are also required to pay back or make payment arrangements for any liability within this same time frame. Timely implementation of the cap reporting requirement has faced several challenges; as a result there is some confusion among hospice providers about the applicability of the requirement and how to meet it on a timely basis. Due to a variety of questions and concerns fielded in recent weeks by members of NAHC’s hospice team, this article provides answers to frequently-asked questions related to the hospice cap reporting requirement and supplies information (some of which has been reported previously) on how providers can meet the requirement.

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3/19/15 – The Detroit News - Funds at Risk for Community Health Centers

By Karen Bouffard

Federally funded community health centers, a major source of doctors in Michigan's urban and rural communities, will lose up to 70 percent of their funding in September if Congress doesn't grant an extension.

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3/16/15 – National Association for Home Care & Hospice – House of Representative Leadership Working on Permanent SGR FIX: Home Health and Hospice Impact

Late last week, the leadership of the House of Representatives took significant steps towards a bipartisan bill that would replace the Medicare payment model for physician services, the Sustainable Growth Rate (SGR), with a payment system focused on value and outcomes. The SGR problem has plagued Congress for years, resulting in multiple “patches” the cost of which has been borne by providers and beneficiaries. The permanent reform package is still very fluid, but it likely will include complete SGR reforms, a series of Medicare payment extenders such as outpatient therapy limits, the so-called PIMA bill on program integrity, and the Medicaid CHIP program extension. The price tag is estimated to be from $200 to $210 billion over a ten year budget.

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3/10/15 – Kaiser Family Foundation – How Much (More) Will Seniors Pay for a Doc Fix?

By Cristina Boccuti and Tricia Neuman

Unless Congress takes action prior to April 1, 2015, Medicare will be forced to cut the amount physicians are paid by 21 percent, the result of a payment formula known as the Sustainable Growth Rate (SGR) enacted as part of the Balanced Budget Act of 1997.  In all likelihood, the new Congress won’t let this cut happen.  Lawmakers have passed stop-gap legislation 17 times to override the SGR, both to prevent physicians from seeing a drop in their Medicare payments and to guard against potential physician access problems for beneficiaries.  None of these short-term “doc fixes” replaced the SGR outright.

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2/25/15 – FBI - Detroit-Area Patient Recruiter and Physical Therapist Convicted in $1.6 Million Medicare Fraud Scheme

A federal jury in Detroit today convicted a patient recruiter and a physical therapist for their roles in a $1.6 million Medicare fraud scheme, announced Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan, Special Agent in Charge Paul M. Abbate of the FBI’s Detroit Field Office and Special Agent in Charge Lamont Pugh III of the Department of Health and Human Services Office of Inspector General (HHS-OIG) Chicago Regional Office.

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2/2015 – CHCS - Strategies for Hiring and Training Care Managers in Integrated Programs Serving Medicare-Medicaid Beneficiaries

By Brianna Ensslin and Sarah Barth

Effective care coordination and care management are essential to delivering person-centered, quality care in programs that integrate services for individuals dually eligible for Medicare and Medicaid. The health plan staff responsible for providing these services must have unique qualifications and training to meet members’ social service and medical needs. This brief, made possible through support from the California HealthCare Foundation and The SCAN Foundation, shares strategies for hiring and training care managers for health plans with integrated care programs serving Medicare-Medicaid beneficiaries. It offers lessons from five health plans with integrated care products to inform other health plans and states.

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2/18/15 – McKnight’s – CMS Delays Repayment Final Rule a Year

By John Hall

The Centers for Medicare & Medicaid Services on Tuesday made official its plan to postpone implementation of a new rule on collecting hundreds of millions of dollars in overpayments until Feb. 16, 2016 — but providers remain on the hook for returning the money before then.

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Click here to read the proposed rule


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2/12/15 – McKnight’s - Changes to Five Star Expected, Providers Fear Lower Ratings

By Elizabeth Leis Newman

The Centers for Medicare & Medicaid Services is expected to unveil major changes to Nursing Home Compare today that could cause facilities to lose rating stars, according to industry sources. CMS is believed to be changing the overall cut-off points related to achieving certain star levels. If 11 new quality measures are aggregated under a new system, it's possible that as many as 15% of facilities could lose one or two stars virtually overnight, one source said. Another said that while CMS has conveyed that “some homes” may drop one or two stars, the agency has played it close to the vest as to how many facilities it believes would actually be downgraded.

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2/10/15 – McKnight’s - Providers Complain To Feds About ACO Structure, Want More Incentives

By Jon Hall

A new rule proposing sweeping changes to the Medicare accountable care model offers few incentives and could dissuade greater participation, 34 leading healthcare organizations and industry groups said Friday in a joint letter to the Centers for Medicare & Medicaid Services. CMS proposes to change the Medicare Shared Savings Program (MSSP) by placing greater emphasis on primary care and promoting performance-based risk arrangements on transitions from one care setting to another.  But providers hit the plan hard last week, urging CMS to establish a more appropriate balance between risk and reward; to adopt payment waivers to eliminate barriers to care coordination; to modify the current benchmarking methodology; to provide better and timelier data; and to strengthen the assignment of Medicare beneficiaries, according to a published report.

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Click here to read the joint letter


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2/10/15 – Administration for Community Living - ACL issues rule to strengthen Long-Term Care Ombudsman programs

 
The Long-Term Care Ombudsman Programs final rule now can be found online in the Federal Register. A culmination of several years of collaborative work with states and other partners, this rule guides implementation of the portions of the Older Americans Act governing grants to states for operation of Long-Term Care (LTC) Ombudsman programs.  Since their establishment in the 1970s, LTC Ombudsman programs have:
Employed person-centered approaches to resolve problems with and for individuals who live in nursing facilities, assisted living, board and care, and other similar adult care facilities;
Represented consumer interests by recommending improvements in public policy;
Worked to support survivors of abuse, neglect, and financial exploitation; and
Engaged thousands of volunteers each year.
 
 

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2/3/15 – National Association for Home Care & Hospice – NAHC Opposes Proposed Home Health Copays and Inflation Update Cuts in President’s 2016 Budget

The National Association for Home Care & Hospice (NAHC) strongly opposes the Obama Administration’s proposed home health copayments and payment cuts. NAHC maintains that deficit reduction should not come in the form of a “sick tax” on the nation’s poorest, sickest, and most vulnerable individuals.

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1/29/15 – Kaiser Family Foundation - Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program

By Cristina Boccuti and Giselle Casillas

For Medicare patients, hospitalizations can be stressful; even more so when they result in subsequent readmissions to the hospital. While many readmissions cannot and should not be prevented, researchers have found wide variation in hospitals’ readmission rates, suggesting that patients admitted to certain hospitals are more likely to experience readmissions compared to other hospitals. A number of studies show that hospitals can engage in several activities to lower their rate of readmissions, such as clarifying patient discharge instructions, coordinating with post-acute care providers and patients’ primary care physicians, and reducing medical complications during patients’ initial hospital stays. 

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1/22/15 – NPR - Hospitals' Medicare Quality Bonuses Get Wiped Out By Penalties

By Jordan Rau

What Medicare gives with one hand, it's taking away with another. Most government quality bonuses to hospitals this year are being wiped out by penalties issued for other shortcomings. The government is taking performance into account when paying hospitals, one of the biggest changes in Medicare's 50-year-history and one that's required by the Affordable Care Act. This year 1,700 hospitals, 55 percent of those graded, earned higher payments for providing comparatively good care in the federal government's most comprehensive review of quality. The government measured criteria such as patient satisfaction, lower death rates and how much patients cost Medicare.

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1/16/15 – Healthcare IT News – Bill To Fix “Unmanageable” Meaningful Use Reintroduced

By Mike Miliard

"It's hard to comprehend how HHS can move forward to full-year reporting when the numbers for 90-day reporting are so low," said Congresswoman Renee Ellmers, R-N.C., as she reintroduced her Flex-IT Act earlier this week.  Originally introduced in the 113th Congress, the Flexibility in Health IT Reporting Act of 2015 gives providers the option to choose any 90-day EHR reporting period to qualify for meaningful use in 2015 – as opposed to the 365-day window currently mandated by the Centers for Medicare & Medicaid Services.

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1/14/15 - Yahoo Finance - 5 Ways Congress Can Support Seniors in 2015

2015 marks the 50th anniversary of three of the nation’s most important programs for seniors—Medicare, Medicaid, and the Older Americans Act (OAA). It is also the year when advocates and policymakers from across the country will be discussing the future of aging services at the 2015 White House Conference on Aging. “These events offer the perfect opportunity for Congress to expand and reinforce its commitment to supporting older Americans’ health and economic security,” said Howard Bedlin, Vice President of Public Policy & Advocacy for the National Council on Aging (NCOA). “The aging population is growing rapidly, and seniors want to stay independent as long as possible. Now is the time to strengthen and expand aging services to meet the needs of all seniors, especially those who are struggling.”

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1/14/15 – OIG - Medicare Hospices Have Financial Incentives To Provide Care In Assisted Living Facilities

Medicare hospice care is intended to help terminally ill beneficiaries continue life with minimal disruption and to support families and caregivers. Care may be provided in various settings, including a private home or other places of residence, such as an assisted living facility (ALF).  Pursuant to the Patient Protection and Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) must reform the hospice payment system, collect data relevant to revising  payments, and develop quality measures. This report provides information to inform those decisions and is part of the Office of Inspector General’s (OIG) larger body of work on hospice care. While the report focuses on ALFs, many of the issues identified pertain to the hospice benefit more broadly.

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1/12/15 - MedPAC - The Need to Reform Medicare’s Payments To Skilled Nursing Facilities Is As Strong As Ever

Well-documented shortcomings in the design of Medicare’s payment system for skilled nursing facilities (SNFs) have prompted CMS to make many revisions to it, including shifting payments from therapy care towards nursing care. Payments for therapy services are tied to the amount of therapy provided rather than patient need and generally overpay facilities for the costs of those services. Payments for nontherapy ancillary (NTA) services do not vary with these services’ costs or a patient’s need for the services. As a result, SNFs face incentives to shift their patient mix toward intensive therapy case-mix groups by providing unnecessary therapy services. This study compares the relationship between SNF payments and costs over time to assess whether changes CMS has made to the payment system have improved payment accuracy for therapy and NTA services. We find that between 2006 and 2014, payment accuracy for these services has steadily eroded. Payments are less able to explain differences in costs across both stays and facilities and payments are less proportional to costs. When more therapy is furnished, facility costs increase but program payments increase more quickly, to an even greater extent now than in the past. Payments for NTA services are unrelated to their costs. Current policies continue to advantage facilities that predominantly admit patients with rehabilitation care needs and poorly target payments for NTA services.

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1/11/15 - Crain’s Detroit Business - Physicians face smaller Medicaid payments – but it could have been worse

By Jay Greene

Thousands of Michigan physicians taking care of nearly 500,000 newly insured Medicaid patients under the Affordable Care Act will continue to receive slightly higher reimbursement levels this year under legislation signed by Gov. Rick Snyder. But the enhanced payments are lower than the previous two years, leading to questions as to how many Michigan primary care doctors will continue to participate in the Healthy Michigan Medicaid expansion program.  Under the Affordable Care Act, the Michigan Department of Community Health received about $175 million in enhanced payments to increase primary care physician Medicaid reimbursement about 30 percent to the equivalent of Medicare rates. So far, $147 million has been paid either directly to physicians or to Medicaid HMOs to increase reimbursements, said Tim Becker, deputy director of Community Health. Another $20 million to $30 million will be paid out over the next few months for services rendered at the end of last year, he said.

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11/24/14 – McKnight’s - Draft Bill Proposes Counting Observation Stays For SNF Coverage, Limiting RAC Oversight 

By Tim Mullaney 

Hospital observation stays would count toward establishing Medicare eligibility for post-acute services, under comprehensive reforms in a new draft bill from the House Committee on Ways and Means. The Hospitals Improvements for Payment (HIP) Act of 2014 proposes a new hospital prospective payment system to be in place by fiscal year 2020. Its goal is to address problems with how short stays are reimbursed. Medicare auditors have aggressively challenged claims for short inpatient stays in recent years, leading to a surge in appeals and a huge backlog, as well as a spike in hospitals categorizing people as outpatients under observation, rather than as inpatients. Under the proposed system, observation stays that stretch overnight would be categorized as Part A inpatient hospital services. These stays also would count toward the three days that people need to spend as an inpatient to qualify for Medicare coverage of follow-up skilled nursing services.
 

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11/12/14 The Center for Public Integrity - Analysis Shows Widespread Discrepancies In Staffing Levels Reported By Nursing Homes

Data Compiled For Medicare Shows Lower Levels Of Care Than Website For Consumers

By Jeff Kelly Lowenstein 

Edna Irvin enjoyed caring for other people so much that, even while she was in the grips of dementia and confined to a wheelchair, she'd wheel over to try to help other residents in the Chenal Heights Health and Rehabilitation Center in Little Rock. Irvin had been placed there by Lisa Sanders, her youngest daughter, after a family friend found the then-80-year-old lying on the floor of her home in Magnolia, Arkansas, on January 18, 2012. Irvin, a former certified nursing assistant who won awards for perfect attendance, had been lying there overnight. Sanders agreed with her mother's doctor that Irvin could no longer take care of herself. She decided to move her mother to Little Rock and, after a couple of months, into the Chenal Heights home. The daughter assumed that the staffing levels and care her mother was to receive there would match the neighborhood’s attractiveness.
 

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10/27/14 – Forbes - Want To Fix The "Doc Fix"? Experiment!

By Yevgeniy Feyman

For health policy wonks, the end of the year isn’t just the holiday season. With the falling temperatures will come a renewed “doc fix” debate, as Congress deliberates on ways to avoid a scheduled double-digit (24 percent last year) cut in Medicare’s physician payments. And avoid it they will. As health economist Austin Frakt put bluntly: “Good luck getting physicians to keep Medicare patients if the payments are suddenly cut 24 percent.” The problem, as anyone who follows health policy will tell you, is Medicare’s “Sustainable Growth Rate,” or SGR. The SGR is a formula created under the 1997 Balanced Budget Act, with a noble goal: keep Medicare physician spending under control. Under the formula, when spending per beneficiary grows faster than GDP, a payment cut is required. Because policymakers haven’t been thrilled about cutting physician payments as the SGR would have required over the past 11 years, the required cuts have accumulated over the years, resulting in the 24 percent cut that Congress worked to avoid last year.
 

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10/8/14 – FBI - Michigan Home Health Agency Owner Pleads Guilty in $22 Million Medicare Fraud Conspiracy

A former owner and manager of two Detroit-area home health care agencies has pleaded guilty in federal court for his role in a $22 million Medicare fraud conspiracy. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan, Special Agent in Charge Paul M. Abbate of the FBI’s Detroit Field Office, Special Agent in Charge Lamont Pugh III of the Department of Health and Human Services Office of Inspector General (HHS-OIG), Chicago Regional Office and Acting Special Agent in Charge Jarod Koopman of Internal Revenue Service, Criminal Investigation (IRS-CI) made the announcement. Usman Butt, 40, of Shelby Township, Michigan, pleaded guilty before U.S. District Judge Bernard A. Friedman in the Eastern District of Michigan to conspiracy to commit health care fraud and aiding or assisting in preparing a fraudulent tax return on Aug. 27, 2014, and the case was unsealed today. Sentencing has been scheduled for Jan. 13, 2015. His plea follows that of his former business partner and co-conspirator, Muhammad Aamir, who pleaded guilty on Aug. 20, 2014.
 

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9/25/14 – NPR - To Prevent Repeat Hospitalizations, Talk To Patients

By Sarah McCammon 

Kevin Wiehrs is a nurse in Savannah, Ga. But instead of giving patients shots or taking blood pressure readings, his job is mostly talking with patients like Susan Johnson. Johnson, 63, is a retired restaurant cook who receives Medicare and Medicaid. She has diabetes, and has already met with her doctor. Afterward, Wiehrs spends another half-hour with Johnson, talking through her medication, exercise and diet. "So it sounds like you cut back on your sweets, things that have a lot of sugars in them. What about vegetables, your portions of food?" Wiehrs asks Johnson. "Have you made any changes with that?" "A little bit," Johnson says. "Ain't gonna lie — a little bit." Wierhs, 51, was a hospice nurse for 15 years and a social worker before that. Now he is one of five new care coordinators at Memorial Health, a medical system based in Savannah. He was hired to pay special attention to patients with poorly controlled chronic conditions like diabetes and heart disease.
 

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9/2/14 – Crain’s Detroit Business - DMC Gets $10M From Medicare To Improve Primary Care At Detroit ERs 

By Jay Greene

The Detroit Medical Center has been awarded a $10 million grant by the Centers for Medicare and Medicaid Services to test a primary care and preventive health care program at four of its hospital emergency departments. Under “Gateway to Health: An Innovative Model for Primary Care Expansion in Detroit,” the DMC will identify certain patients who don’t have primary care physicians and offer them coordinated care services. Types of patients include those with diabetes, asthma, hypertension, heart failure, chronic lung disease, depression and HIV, primarily those patients on Medicaid, Medicare and the Children’s Health Insurance Program. Another target group will be those patients who use the emergency department 10 or more times each year. Hospital emergency departments that will be part of the Medicare grant will be DMC Harper University Hospital, DMC Detroit Receiving Hospital, DMC Sinai-Grace Hospital and DMC Children’s Hospital of Michigan.
 

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8/25/14 – The New York Times - Medicare Ratings Let Nursing Homes Game the System

By Katie Thomas

The lobby of Rosewood Post-Acute Rehab, a nursing home in this Sacramento suburb, bears all the touches of a luxury hotel, including high ceilings, leather club chairs and paintings of bucolic landscapes. What really sets Rosewood apart, however, is its five-star rating from Medicare, which has been assigning hotel-style ratings to nearly every nursing home in the country for the last five years. Rosewood's five-star status — the best possible — places it in rarefied company: Only one-fifth of more than 15,000 nursing homes nationwide hold such a distinction. But an examination of the rating system by The New York Times has found that Rosewood and many other top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes. The Medicare ratings, which have become the gold standard across the industry, are based in large part on self-reported data by the nursing homes that the government does not verify. Only one of the three criteria used to determine the star ratings — the results of annual health inspections — relies on assessments from independent reviewers. The other measures — staff levels and quality statistics — are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value.
 

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8/7/14 – McKnight’s - Medicare Advantage Organizations Are Unresponsive To Provider Questions, Long-Term Care Professionals Tell CMS

By Tim Mullaney

Several skilled nursing facility workers expressed frustration regarding communications with Medicare Advantage organizations during a public call with government officials Wednesday. Centers for Medicare & Medicaid Services representatives acknowledged that provider frustration in this area has been an ongoing issue, but they said that their hands essentially are tied. John Kane, a CMS skilled nursing facility program analyst, began the Open Door Forum call by stating that the agency has continued to receive provider questions regarding residents paying for nursing home care through Medicare Advantage. He reminded providers on the call that CMS is not able to address these questions, which must be directed to Medicare Advantage organizations directly. Under Medicare Advantage, health maintenance organizations or similar entities contract with the government to provide managed care services to beneficiaries enrolled in this system rather than traditional fee-for-service.
 

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7/21/14 – Forbes - Medicare Eases Rule For Hospice Patients

By Bob Rosenblatt

Medicare eased significantly on Friday, July 18, 2014 its rules for insurance coverage of medications for many thousands of hospice patients, responding to intense criticism from patient advocates and members of Congress. The new policy should eliminate 95% of the cases in which hospice patients need prior approval from an insurance company to get coverage for their drugs, according to participants in a Medicare briefing. The move applies to coverage of drugs for conditions unrelated to the terminal illness. For example, a hospice patient who is dying from cancer also might be taking drugs to deal with his arthritis and congestive heart failure. The policy in effect since May required patients to get prior approval from their Medicare Part D insurer before filling a prescription for these medications for conditions other than the terminal illness. This became a tedious process, and many prescriptions went unfilled because it took a long time to get prior approval and the families might not be able to afford the drugs without insurance coverage.
 

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7/7/14 – McKnight’s - CMS Announces Medicare Appeals Without Administrative Law Judges

By Tim Mullaney

Long-term care providers will be able to appeal certain Medicare claims decisions without utilizing an administrative law judge, the Centers for Medicare & Medicaid Services announced Thursday. Settlement Conference Facilitation is an alternate dispute resolution process that would bring providers and CMS representatives together to negotiate and settle Medicare disputes with the help of a third party. This “settlement conference facilitator” would be an employee of the Office of Medicare Hearings and Appeals, which is a separate agency from CMS, according to a fact sheet on the pilot program. “The facilitator does not make official determinations on the merits of the claims at issue and does not serve as a fact finder, but may help the appellant and CMS see the relative strengths and weaknesses of their positions,” the fact sheet states. The pilot program is meant for Medicare Part B claims appealed to the administrative law judge level. There currently is a huge backlog of claims at this level, which healthcare providers have attributed to overzealous Medicare auditors, particular recovery audit contractors. An association of RACs supports the new pilot program. 
 

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6/25/14 - McKnight's - Technology Is Helping Prevent Readmissions, But Integration Across The Care Continuum Remains A Pressing Goal, Experts Say

By Elizabeth Leis Newman

As data sets increase for post-acute care, so will the need for standardization and the push for skilled nursing facilities to be connected with other health entities, experts said at a health information technology summit Tuesday. For example, skilled nursing facilities seeking greater connectivity might want to hire community health coaches to reduce hospital readmissions, and empower employees with mobile technology, one physician said during the 2014 Long-Term and Post-Acute Care Health IT Summit in Baltimore. His Care at Hand model involves non-clinical healthcare workers, such as a community coach, using technology at the point of care, with an application that is directed at a nurse care manager, explained Andrey Ostrovsky, M.D., Care at Hand co-founder and chief executive officer.
 

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6/23/14 – NPR - Hospitals To Pay Big Fines For Infections, Avoidable Injuries

By Jordan Rau

Medicare is preparing to penalize about 750 hospitals that have the highest rates of infections and patient injuries. The sanctions, estimated to total $330 million over a year, will kick in at a time when most infections and accidents in hospitals are on the decline, but still too common.
In 2012, 1 out of every 8 patients nationally suffered a potentially avoidable complication during a hospital stay, the government estimates. Even infections that are waning are not decreasing fast enough to meet targets set by federal health officials. Meanwhile, new strains of antibiotic-resistant bacteria are making infections much harder to cure. Dr. Clifford McDonald, a senior adviser at the federal Centers for Disease Control and Prevention, says the worst performers "still have a lot of room to move in a positive direction."
 

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6/4/14 – The Oakland Press - Medicare Dollars For Pontiac’s Doctors’ Hospital At Risk

By Dave Phillips and Dustin Blitchok

Medicare funding for Doctors’ Hospital of Michigan is in jeopardy of being terminated June 18 if an inspection this month finds that dozens of problems identified by the federal agency at the hospital have not been fixed. The hospital’s plan of correction has been accepted by Medicare for violations in the following areas: Patient rights, quality assurance and performance improvement, physical environment, infection control and organ, tissue and eye procurement. The numerous underlying violations found after an Oct. 2013 inspection include citations for holding a patient against their will, issues with the hospital’s physical condition, procedures in dealing with patient injuries and more.
 
 

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5/29/14 – McKnight’s - 20% Of Medicare Patients Harmed Due To Improper Care; Nursing Homes Among Areas Needing More Attention, Researcher Says

By John Hall

Nearly one in five Medicare patients fall prey to medically related injuries unrelated to their underlying disease or condition, according to new research. In the May 27 issue of Injury Prevention online, Towson University researcher Mary Carter notes that the adverse events included wrong medication, allergic reactions to medications, and receiving treatments leading to complications over and above an existing medical problem. A lot of effort has been spent in hospitals trying to understand medical injury, but not as much in nursing homes and outpatient settings such as doctors' offices, surgery centers and emergency rooms, noted Carter, the school's gerontology program director.
 

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5/23/14 – McKnight’s - '2-Midnight Rule' Is Increasing Observation Stays, Not Decreasing Them As Hoped, Johns Hopkins Director Tells Congressional Panel

By Tim Mullaney

A Medicare policy change meant to reduce the number of hospital observation stays actually is having the opposite effect, a senior Johns Hopkins Medical System executive told a Congressional panel this week. The so-called two-midnight rule directed hospitals to admit patients expected to stay for at least two midnights, rather than place them in observation status. A drastic increase in observation stays has created an outcry among seniors and long-term care providers, because a beneficiary needs to be classified as an inpatient for three days to qualify for Medicare coverage of post-acute services. The two-midnight rule actually has exacerbated this problem by making doctors more hesitant to classify someone as an inpatient right off the bat, said Amy Deutschendorf, senior director of clinical resource management at the Johns Hopkins Medical System, during an appearance Tuesday before the House Committee on Ways and Means Subcommittee on Health.
 

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5/20/14 – AHCA – Long Term Care Advocates Gather on Capitol Hill

Skilled Nursing And Assisted Living Professionals Share Priorities With Members Of Congress

More than 400 long term and post-acute care professionals from across the country will meet with Members of Congress this week to talk about significant gains in quality of care, observations stays and other priorities for the skilled nursing sector. The meetings are part of the annual Congressional Briefing hosted by the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL). “Our members are on Capitol Hill today to ensure that seniors and individuals with disabilities continue to have access to the quality care they deserve,” said AHCA/NCAL President and CEO Mark Parkinson. “It is important for Congress to work toward policies that will support our efforts to continue improving quality of care while also containing health care costs.”
 

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5/19/14 – Annals of Long-Term Care - Determining the Future of Long-Term Care

How will long-term care (LTC) be financed and delivered in the future? This important question was presented to the Commission on Long-Term Care upon its establishment under Section 643 of the American Taxpayer Relief Act of 2012, which was signed into law on January 2, 2013.1 The Commission was tasked with developing a plan for the establishment, implementation, and financing of a system to ensure the availability of long-term services and supports (LTSS) for individuals such as elderly persons, those with substantial cognitive or functional limitations, those who require assistance to perform activities of daily living, and those who wish to plan for future LTC needs. The Commission on Long-Term Care, which comprises 15 members appointed by the President of the United States, the majority leader of the Senate, the minority leader of the Senate, the Speaker of the House of Representatives, and the minority leader of the House of Representatives, was given only months to answer this vital question for frail older adults and all of us involved in the delivery and funding of LTC. The Commission submitted its final report to Congress on September 30, 2013, which highlights its recommendations for addressing the challenges with delivering and financing LTSS.
 

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5/12/14 – McKnight’s Long-Term Care News & Assisted Living - Providers Could Be Removed From Medicare And Medicaid For Obstructing Audits Under Newly Proposed Rule

Long-term care providers who obstruct audits soon could have their Medicare and Medicaid certifications revoked, according to a newly proposed rule from a top federal watchdog. Currently, individuals and organizations can be booted from Medicare or Medicaid if they are convicted of obstructing a criminal investigation. The Affordable Care Act empowered the government to also kick out those who are found guilty of obstructing audits. The Department of Health and Human Services Office of Inspector General has created a rule to implement this ACA provision, which was published Friday in the Federal Register.
 

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4/21/14 – CNN Money - Medicare Vs. Private Insurance: Which Costs Less

By Tami Luhby

Wonder why some doctors grumble when a Medicare patient walks in the door? It's likely because the government program typically pays only 80% of what private insurers do. Medicare has the bad rap of being a big, bloated government program, but it's not because it's overpaying doctors. CNN Money analyzed the "allowed charges" for five common procedures, using data provided the Centers for Medicare and Medicaid Services and Truven Health Analytics, a research firm. The differences can be stark. Private insurers allow an average of $1,226 for low-back disc surgery, while Medicare will only permit $654, for instance. And the gap can grow wider depending on where the patient is. In New York, insurers allow $1,352 for a gall bladder removal, compared to $580 for Medicare.
 

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4/17/14 – The Commonwealth Fund - Grand Rapids and West Central Michigan: Pursuing Health Care Value Through Regional Planning, Cooperation, and Investment

By Sarah Klein, Douglas McCarthy, M.B.A., and Alexander Cohen, M.P.H., M.S.W.

The region of West Central Michigan encompassing Grand Rapids and surrounding communities ranks in the top quartile among 306 U.S. regions evaluated by The Commonwealth Fund’s Scorecard on Local Health System Performance, 2012, performing especially well on measures of prevention and treatment quality, avoidable hospital use, and costs of care. This relatively higher performance may stem from the area’s conservative medical practice style and local stakeholders’ stewardship of community health and health care, as illustrated by a long history of regional planning and accountability for promoting the efficient use of resources. Complementary efforts and incentives to improve quality of care, community outreach programs, and a commitment to strengthening the safety net also may influence regional performance. However, more recently, rising costs and increasingly competitive market dynamics appear to be challenging the social contract that has long guided community cooperation.
 

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4/15/14 – Modern Healthcare – AHA Lawsuit Over “Two-Midnight” Rule Called Uphill Battle

By Joe Carlson

No matter how strong their legal arguments, hospitals will have a tough time convincing judges to overturn Medicare's controversial new rules on classifying inpatients, some legal experts say. The CMS' so-called “two-midnight” rule was intended to clarify which patients are sick enough to be admitted to the hospital by requiring doctors to certify they have good reason to expect patients to need two nights in the hospital. Only then will Medicare pay inpatient hospital rates for the patients' care. On Monday, the American Hospital Association and a coalition of members filed two federal lawsuits challenging the rule and its reduction in payments to hospitals. At least three other lawsuits challenging Medicare's inpatient rules are pending. One is a class action filed on behalf of Medicare beneficiaries by the Center for Medicare Advocacy that currently is on appeal.
 

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4/7/14 – Associated Press - Medical Assn Won’t Stop Medicare Doc Data Release 

The nation’s largest doctors’ group said Monday it won’t try to block Medicare’s release of billing records for 880,000 physicians, although it continues to oppose the government’s recent decision to open up the massive data trove. An official of the American Medical Association told The Associated Press that the group won’t go to court ahead of Wednesday’s scheduled release. The official spoke on condition of anonymity because the organization’s policies allow only certain designated representatives to make on-the-record comments.

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4/7/14 – Kaiser Family Foundation - Paying a Visit to the Doctor: Current Financial Protections for Medicare Patients When Receiving Physician 

By Cristina Boccuti 

With the recent decision to enact a 17th short-term “fix” to avert deep cuts in Medicare payments to physicians, Congress will likely return within the year to the question of whether and how to replace the widely-criticized formula that Medicare uses to calculate payments for physician services, called the Sustainable Growth Rate (SGR) system.1 For the most part, recent proposals on reforming the physician payment system leave intact current financial protections that shield beneficiaries from unexpected and confusing charges when they see physicians and practitioners. These protections include the participating provider program, limitations on balance billing, and conditions on private contracting. This issue brief describes these three protections, explains why they were enacted, and analyzes the implications of modifying them for beneficiaries, providers, and the Medicare program.

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4/3/14 – Healthcare IT News - ICD-10 Delay Dismays Prepared Vendors 

By John Andrews 

Healthcare industry response to yet another postponement of ICD-10 coding ranges from relief to resentment. Those who haven’t prepared for the radical format transition are exhaling contentedly, while those who have worked furiously to make the deadline are understandably indignant about the delay. With a stroke of his pen, President Obama authorized yet another implementation deferment to the ICD-10 coding system after the Senate approved the measure as part of the Sustainable Growth Rate “doc fix” legislation on April 1. The ICD-10 delay is a late add-on item to HR 4302, initially drafted to stall a 24 percent Medicare reimbursement cut to physicians for one year. While there is really no way of knowing how many providers are in a position to make the ICD-10 conversion, forwarding the Oct. 1, 2014 implementation date to next year after several false starts has caught many off guard, including Mike Lovett, executive vice president and general manager of Horsham, Pa.-based NextGen. “It definitely came as a surprise – everyone I’ve spoken to has said another delay would not happen,” he said. “I’m not sure what happened or how it even got on [legislators'] radar.” Lovett acknowledges that some providers are behind in gearing up for the ICD-10 shift, but also exudes frustration that his clients now have to hurry up and wait. “This rewards those who weren’t organized,” he said. “It lets them off the hook."
 

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3/27/14 – Bloomberg - House Speeds Medicare ‘Doc Fix’ as Support Was Collapsing 

By Derek Wallbank and James Rowley 

The U.S. House passed a one-year delay of a 24 percent payment cut to physicians who accept Medicare patients, with Republican leaders pushing the bill through in a move that masked trouble finding the votes for it. They solved the problem by simply not counting the votes. The House approved the measure with untallied voice votes - - ayes first, then nays -- and the presiding officer, Representative Steve Womack of Arkansas, declared the votes sufficient. The bill now goes to the Senate. The move sidestepped the opposition fueled by doctors’ groups, who were seeking a longer-term agreement instead. “It was a take-it-or-leave-it deal” worked out by House Speaker John Boehner and Senate Majority Leader Harry Reid, Louisiana Republican John Fleming told reporters.
 

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3/25/14 – The New York Times - A Quiet ‘Sea Change’ in Medicare 

By Susan Jaffee 

Ever since Cindy Hasz opened her geriatric care management business in San Diego 13 years ago, she has been fighting a losing battle for clients unable to get Medicare coverage for physical therapy because they “plateaued” and were not getting better. “It has been standard operating procedure that patients will be discontinued from therapy services because they are not improving,” she said. No more. In January, Medicare officials updated the agency’s policy manual — the rule book for everything Medicare does — to erase any notion that improvement is necessary to receive coverage for skilled care. That means Medicare now will pay for physical therapy, nursing care and other services for beneficiaries with chronic diseases like multiple sclerosis, Parkinson’s or Alzheimer’s disease in order to maintain their condition and prevent deterioration.
 

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3/19/14 – McKnight’s Long-Term Care News & Assisted Living - Dual Eligibles In Nursing Homes Have Fewer Hospitalizations Than Those In Home- And Community-Based Care, Researchers Find 

By Tim Mullaney 

Elderly, frail people are more likely to be hospitalized if they are receiving home- or community-based services than if they live in a nursing home, according to newly published research. Recent Medicaid reforms have aimed to increase use of HCBS because it is believed to be less costly than institutional long-term care, investigators noted. They said their findings suggest that more frequent hospitalizations are a “hidden cost” of home- and community-based care. The analysis looked at seniors dually eligible for Medicare and Medicaid, who were receiving home health or personal care or residing in a nursing home during the 2003 to 2005 period. Investigators calculated how many hospitalizations these people experienced per quarter by analyzing data from the Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, and the Medicaid offices of Arkansas, Florida, Minnesota, New Mexico, Texas, Vermont and Washington.
 

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3/5/14 – NCOA - President’s Budget a Mixed Bag for Senior Programs 

President Obama’s FY15 budget proposal, released March 4, includes a variety of program cuts plus investments intended to promote opportunity and growth. The request rejects earlier proposals to limit Social Security cost-of-living adjustments (COLAs) and advocates for additional funding for elder justice, Alzheimer’s research, and senior housing. Yet, the Administration continues to call for shifting costs onto Medicare beneficiaries, as well as cuts rejected by Congress in job training, energy assistance, community service, and other social services for disadvantaged seniors.
 

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2/28/14 – McKnight’s Long-Term Care News & Assisted Living - With ICD-10 Transition Date Firm And Testing Imminent, Medicare Agency Releases New Provider Resources

By Tim Mullaney

Long-term care providers can refer to newly released materials about looming ICD-10 testing and the overall transition to the new coding system, but they should not expect any delay in the Oct. 1 transition date, according to the head of the Centers for Medicare & Medicaid Services. The 10th edition of the International Classification of Diseases codes greatly expands the current set, and providers have said they need more time to prepare. CMS Administrator Marilyn Tavenner said Thursday that the date is firm. “Let's face it, guys, we've delayed this several times and it's time to move on,” she said at the annual Healthcare Information and Management Systems Society convention in Orlando, according to news reports.
 

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2/19/14 – Annals Of Long-Term Care - Weighing In On Changes Affecting Medicare Advantage And Prescription Drug Benefits

By Richard Stefanacci, DO, MGH, MBA, AGSF, CMD

On January 6, 2014, the Centers for Medicare & Medicaid Services (CMS) proposed making changes to the Medicare Advantage plans and the prescription drug benefit program that if approved, could go into effect as early as January 1, 2015. Among the major provisions proposed, the one causing the most commotion among patients and healthcare providers is the proposal to change the criteria defining protected drug classes. If approved, these new criteria could affect Part D beneficiaries’ access to some antipsychotic, antidepressant, and immunosuppressant medications. This article gives an overview of these major provisions and the impact they could have on geriatric care providers. CMS is accepting comments from the public on these proposed changes through March 7, 2014. At the end of this article, please follow the instructions for submitting a comment to Annals of Long-Term Care: Clinical Care and Aging®. All comments will be submitted online to the CMS before the deadline.
 
 

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2/18/14 – Science Daily - Medicare Beneficiaries Return To Emergency Rooms After Nursing Home Discharge

Nursing homes are widely used by Medicare beneficiaries who require rehabilitation after hospital stays. But according to a recent study led by a researcher at the University of North Carolina at Chapel Hill School of Nursing, a high percentage of Medicare patients who are discharged from nursing homes will return to the hospital or the emergency room within 30 days. "Nearly two million older adults use this benefit every year," said assistant professor Mark Toles, the first author of the study. "Before this study, we didn't recognize the large number of older adults who require additional acute care after they're discharged from a nursing home." The study included more than 50,000 Medicare beneficiaries who were treated at skilled nursing facilities in North and South Carolina. Analyses conducted in collaboration with the Carolinas Center for Medical Excellence and investigators at Duke University revealed that approximately 22 percent of beneficiaries required emergency care within 30 days of discharge and 37.5 percent required acute care within 90 days.
 

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2/11/14 – McKnight’s Long-Term Care News & Assisted Living - CMS Clarifies Rules Regarding Vaccines, Respite Care For Hospice Patients 

By Tim Mullaney 

The Centers for Medicare & Medicaid Services has loosened regulatory language regarding which providers can furnish vaccines to hospice patients, and has tightened enforcement of a five-day payment limit for respite care. Medicare systems currently prevent non-hospice providers from furnishing vaccines to hospice patients, to enforce the Medicare manual provision that vaccines “may be covered when furnished by the hospice.” CMS stated in a Feb. 6 transmittal. Because the manual does not say that vaccines can be covered “only” when provided by a hospice, CMS determined the current enforcement is “too restrictive,” according to the notification. Therefore, CMS is removing previous changes to Medicare systems, the notification stated. After the implementation date of April 7, “any provider” will be able to furnish vaccines, such as the influenza vaccine, to hospice beneficiaries, according to the document. In a separate transmittal, CMS addressed the five-day limit for respite care under the hospice benefit.
 

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1/21/14 – McKnight’s Long-Term Care News & Assisted Living - MedPAC Endorses Readmissions Penalties For Home Health, Hospice Benefit For Medicare Advantage 

By Tim Mullaney 

Home health providers should be subject to Medicare reimbursement penalties based on hospital readmission rates, according to the Medicare Payment Advisory Commission. The proposed penalties would be structured similarly to those currently levied against hospitals and proposed for skilled nursing facilities, according to reports on MedPAC's Jan. 16 meeting. About one-third of patients who go from a hospital to a home health stay are subsequently readmitted to the hospital, an analyst told the panel, which advises Congress on Medicare policy. The Secretary of Health and Human Services would determine the readmissions rate that would trigger penalties.
 

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1/20/14 – Crain’s Detroit Business - Merger Of 2 Health Information Exchanges Could Create One Of Nation's Largest 

By Jay Greene 

Michigan Health Connect, Grand Rapids, and Great Lakes Health Information Exchange, East Lansing, have signed a letter of intent to merge operations. The result could be one of the largest health information exchanges in the nation, officials said. The agreement is expected to be finalized by March 31. Last year, the two organizations agreed to share electronic patient medical record information in a secure exchange. Michigan Health and Great Lakes are the largest of six similar organizations in Michigan. More than 2,000 physician provider offices and 100 of the state's approximate 117 hospitals are members. "Millions of Michigan residents will receive better care and achieve greater levels of personal health as a result of this merger," said Patrick O'Hare, board chair of Michigan Health Connect, in a statement. "Combining the talent and resources of these two organizations makes perfect sense for Michigan at this time," he said.
 

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11/18/13 – Crain’s Detroit Business - Detroit Mental Health Organization To Create Integrated Care Center In Midtown

By Jay Greene

Detroit Central City Community Mental Health Inc. has received $793,000 in federal funding to create Southeast Michigan's sixth federally qualified health center. But Detroit Central City's Midtown health center at 10 Peterboro St. will be quite different than the other five centers. It will provide integrated primary medical, dental and mental health services along with housing and support services to clients, said Irva Faber-Bermudez, DCC's CEO. "This is what we wanted. We are the first community mental health center to be able to do this on our own," Faber-Bermudez said. "Almost half the people who come to DCC are homeless. It is difficult to coordinate care for them because of transportation problems and other challenges." Faber-Bermudez said DCC has 120 days to begin operations as a health center and expects to treat about 3,500 people its first year. She said DCC plans to continue its mission of providing assistance to about 4,400 homeless and public housing residents.
 

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11/15/13 – NPR - Medicare Penalizes Nearly 1,500 Hospitals For Poor Quality Scores

By Jordan Rau

While the health law's insurance markets are still struggling to get off the ground, the Obama administration is moving ahead with its second year of meting out bonuses and penalties to hospitals based on the quality of their care. This year, there are more losers than winners. Medicare has raised payment rates to 1,231 hospitals based on two-dozen quality measurements, including surveys of patient satisfaction and — for the first time — death rates. Another 1,451 hospitals are being paid less for each Medicare patient they treat for the year that began Oct. 1. For half the hospitals, the financial changes are negligible: they are gaining or losing less a fraction of a percent of what Medicare otherwise would have paid. Others are experiencing greater swings.

Read More


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11/6/13 – The Commonwealth Fund - Clinical Management Apps: Creating Partnerships Between Providers and Patients

By Sharon Silow-Carroll, M.B.A., M.S.W., and Barbara Smith, J.D., Health Management Associates

The market for health applications, or apps, on mobile devices is growing rapidly, with over 40,000 currently in use. One type of app technology—clinical management apps—enable patients and providers to work together to manage chronic conditions, particularly diabetes and asthma. These apps are mostly used by health plans and large health care organizations with an interest in improving outcomes and controlling costs. Challenges to broader adoption of apps include the lack of objective research to evaluate outcomes, uncertainty about how to pay for and encourage the use of cost-effective apps, and the absence of a regulatory framework that standardizes development to ensure performance. If this infrastructure is developed, apps may serve as a catalyst to stimulate the transformation of health care generally and target low-income populations to expand access to care and help reduce health disparities.

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10/31/13 – Bloomberg - Lawmakers Want to Stop Fee-for-Service Medicare Payments

By James Rowley

The chairmen of the U.S. House Ways and Means and the Senate Finance committees want to phase out the way Medicare pays doctors for their services. They’re proposing a gradual change to a new system along with a pay freeze and incentives to give up fee-for-service billing. “Enough with the quick fixes. Our proposal is for a new physician payment system that rewards value over volume,” Senator Max Baucus of Montana said in a statement. “It will go a long way in improving the efficiency and quality of care for America’s seniors.” The proposal by Democrat Baucus and his Republican counterpart, Representative Dave Camp of Michigan, would freeze physician payment rates for 10 years and give doctors bonuses for agreeing to accept certain percentages of Medicare revenue through the alternative payment methods.
 

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10/29/13 – The New York Times - Two Kinds Of Hospital Patients: Admitted, And Not

By Paula Span

Judith Stein got a call from her mother recently, reporting that a friend was in the hospital. “Be sure she’s admitted,” Ms. Stein said. As executive director of the Center for Medicare Advocacy, she has gotten all too savvy about this stuff. “Of course she’s admitted,” her mother said. “Didn’t I just tell you she was in the hospital?” But like a sharply growing number of Medicare beneficiaries, her mother’s friend would soon learn that she could spend a day or three in a hospital bed, could be monitored and treated by doctors and nurses — and never be formally admitted to the hospital. She was on observation status and therefore an outpatient. As I wrote last year, the distinction can have serious consequences.
 

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10/9/13 – Kaiser Family Foundation - A Look at Section 1115 Medicaid Demonstration Waivers Under the ACA: A Focus on Childless Adults

By Robin Rudowitz, Samantha Artiga and Rachel Arguello

Prior to the Affordable Care Act (ACA), adults without dependent children were excluded from Medicaid coverage, unless states used Section 1115 waivers to extend coverage to this population. Since the enactment of the ACA, additional states have obtained these waivers to get an early start on the ACA’s Medicaid expansion that will take effect in January 2014. As of September 2013, nearly half of states (24) have a Medicaid Section 1115 waiver in place that expands coverage to childless adults. This brief provides an overview of Section 1115 waiver authority, describes major provisions of waivers that extend coverage to childless adults, and identifies key issues and implications of these waivers looking forward to the ACA and beyond.
 

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5/8/13 – CBS News - Medicare Fraud Allegations: National Nursing Home Chain Accused Of Billing For Excess Care Main Header


By Ben Eisler and Jeff Glor
 


(CBS News) Each year, Americans spend hundreds of billions of dollars on unnecessary medical tests and treatments. It's one reason why health care costs are so high.


In recent months, "CBS This Morning" has been looking into the rehab practices of Life Care Centers of America. It is the third largest nursing home chain in the country, with more than 30,000 beds in 28 states.


Half-a-dozen former employees tell "CTM" that the company is giving patients rehab they don't need, and billing the government for money they're not entitled to.

"The mission statement that they have is no longer true, which is to serve their residents in a Christian based atmosphere," says Helen Toomey, a former assistant manager and speech therapist at the company's Plymouth, Mass., facility.


Among other services, Life Care provides speech and physical therapy. But Toomey, who worked at multiple Life Care locations between 1998 and 2012, says by the time she left, 40 percent of the work she was being told to administer was not reasonable or necessary. "They felt that no one was watching them and so every patient that came through the building they could charge the highest rate of reimbursement, regardless of their diagnosis or need."


Toomey says it got so bad that she resigned. But on her way out, she took some patient notes with her. She says they show how Life Care would not let patients leave, so the company could continue to bill Medicare. On Dec. 30, 2011, for example, they indicate that Toomey tried to discharge four patients. All four of those requests were denied. She provided a copy of the notes to "CTM."


The day after Toomey resigned, she got a phone call. It was a Life Care supervisor. She let it go to voicemail, and saved the message: "I was calling to see if you might have by mistake taken the communication book, the spiral book. They had it in the office at noon time and thought you may have just grabbed it by mistake when you were leaving."


Toomey says the supervisor knew exactly what was in the notebook. And now the FBI does, too. She has spoken with federal agents. And the Justice Department is currently suing Life Care centers nationwide, for Medicare fraud.


According to court documents, investigators found that from 2006 to 2011, Medicare paid Life Care $4.2 billion. In 2008, it "...billed nearly 68 percent of its Medicare rehabilitation days at the [highest] level," almost double the "nationwide...average of 35 percent."


Read the court documents


The documents also reveal stories of patients, like a "92 year old...dying of metastatic cancer...Two days before [his] death, he was spitting out blood. Life Care therapists, however, still recorded 48 minutes of physical therapy, 47 minutes of Occupational therapy, and 30 minutes of speech therapy that very day."


At another facility, Life Care Center of Estero in Florida, the entire rehab staff signed a letter to their boss. It reads in part, "we have been encouraged to maximize reimbursement even when clinically inappropriate..."


And the Justice Department wrote as evidence in the case that all of this comes from the top. "Cathy Murray, Life Care's former Chief Operating Officer...frequently told her employees, their job was to make money for Forrest Preston, the founder, sole shareholder, and Chairman of the Board of Life Care."


The company would not make Preston available for an interview, but sent a statement: "Life Care strongly disagrees with the allegations and will vigorously defend its therapy programs...[Our own analysis] indicates that Life Care's practices have resulted in significant savings to the Medicare program...This lawsuit's allegations second guess, after-the-fact, the trained medical professionals who prescribed the level of care provided to Medicare beneficiaries."


This isn't just about one company, though. The latest report from the inspector general found industry-wide, a quarter of all Medicare payments to nursing homes are made in error, costing taxpayers $1.5 billion a year. The problem is Medicare rarely checks if the care is necessary.


Jodi Nudelman, regional inspector general at the U.S. Department of Health and Human Services, has been sounding the alarm on this for years. She says it is a growing and serious problem, and Medicare has yet to take significant action. "All of us are paying the cost," she told "CTM." "Until you create incentives to bill for the right care, and not for the most care, the problem will continue."


For its part, Medicare says fraud is unacceptable and that it's constantly ramping up efforts to stop it. As for the Life Care case, the Justice Department is currently sorting through hundreds of patient records to estimate the total that taxpayers are owed.


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