Category Archives: Medicare

Medicare slow to adopt telemedicine due to cost concerns

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telemedicine-5701By Phil Galewitz
KHN

Donna Miles didn’t feel like getting dressed and driving to her physician’s office or to a retailer’s health clinic near her Cincinnati home.

For several days, she had thought she had thrush, a mouth infection that made her tongue sore and discolored with raised white spots. When Miles, 68, awoke on a wintry February morning and the pain had not subsided, she decided to see a doctor.

Nearly 20 years after such videoconferencing technology has been available for health services, fewer than 1 percent of Medicare beneficiaries use it.

So she turned on her computer and logged on to www.livehealth.com, a service offered by her Medicare Advantage plan, Anthem BlueCross BlueShield of Ohio. She spoke to a physician, who used her computer’s camera to peer into her mouth and who then sent a prescription to her pharmacy.

“This was so easy,” Miles said.

For Medicare patients, it’s also incredibly rare. Continue reading

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A new focus on family caregivers

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A younger man holds an elderly man's handBy Susan Milligan
Stateline

Iraq war veteran Doug Mercer had been home in McAlester, Oklahoma, for just four days when he was in a motorcycle accident that left him broken and brain-damaged.

His wife Michelle became his caregiver after he left the hospital, but nobody there explained how to transport him safely.  A few weeks later, Michelle struggled as she tried to get Doug from the car to his wheelchair, breaking his leg.

“They’re sending you home, and you’re thinking, ‘What?’ Nobody instructs you, and says, ‘This is what’s coming home with you and how to use it,’” she said.

The Mercers’ story was a driving force behind an Oklahoma law that took effect in November that requires hospitals to train a designated family caregiver to tend to the medical needs of a released patient.

As many as 42 million Americans take care of a family member at any given time.

Since then, 12 more states (Arkansas, Colorado, Connecticut, Indiana, Mississippi, New Hampshire, New Jersey, New Mexico, Nevada, Oregon, Virginia and West Virginia) have approved similar laws. In Illinois and New York, legislation is awaiting the governor’s signature.

As many as 42 million Americans take care of a family member at any given time. Traditionally, family caregivers provide assistance with bathing, dressing and eating. They shop for groceries and manage finances.

But as the number of elderly Americans with chronic conditions has grown, family caregivers have taken on medical tasks once provided only in hospitals, nursing homes or by home care professionals.

In an AARP survey released in 2012, nearly half of family caregivers said they administered multiple medications, cared for wounds, prepared food for special diets, used monitors or operated specialized medical equipment. Continue reading

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One Nation, Under Sedation: Medicare Paid for Nearly 40 Million Tranquilizer Prescriptions in 2013

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Three red and white capsulesBy Charles Ornstein
ProPublica

This story was co-published with the Boston Globe, the Miami Herald and Health News Florida.

In 2012, Medicare’s massive prescription drug program didn’t spend a penny on popular tranquilizers such as Valium, Xanax and Ativan.

The following year, it doled out more than $377 million for the drugs.

Screen Shot 2015-06-10 at 8.59.21 AMWhile it might appear that an epidemic of anxiety swept the nation’s Medicare enrollees, the spike actually reflects a failed policy initiative by Congress.

More than a decade ago, when lawmakers created Medicare’s drug program, called Part D, they decided not to pay for anti-anxiety medications.

Some of these drugs, known as benzodiazepines, had been linked to abuse and an increased risk of falls and fractures among the elderly, who make up most of the Medicare population.

But doctors didn’t stop prescribing the drugs to Medicare enrollees. Patients just found other ways to pay for them.

When Congress later reversed the payment policy under pressure from patient groups and medical societies, it swiftly became clear that a huge swath of Medicare’s patients were already using the drugs despite the lack of coverage.

In 2013, the year Medicare started covering benzodiazepines, it paid for nearly 40 million prescriptions, a ProPublica analysis of recently released federal data shows.

Generic versions of the drugs 2014 alprazolam (which goes by the trade name of Xanax), lorazepam (Ativan) and clonazepam (Klonopin) 2014 were among the top 32 most-prescribed medications in Medicare Part D that year.

And it appears these were not new prescriptions. Continue reading

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Social Security announces new online service for replacement Medicare cards

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From the Office of the Insurance Commissioner

apple-touch-iconThe Social Security Administration introduced the expansion of online services available through its my Social Security portal.

Medicare beneficiaries can now get a replacement card if they’ve lost, damaged, or simply need to replace it using a my Social Security online account.

Medicare beneficiaries can now get a replacement card if they’ve lost, damaged, or simply need to replace it using a my Social Security online account.

Requesting a replacement card through my Social Security account is a convenient, cost-effective and secure way to ensure you have a critical piece of identification available when required by medical providers as proof of Medicare coverage.

You can access your online my Social Security account atwww.socialsecurity.gov/myaccount and select the “Replacement Documents” tab.

Then select “Mail my replacement Medicare card.” After you request a card, it will arrive in the mail in approximately 30 days.

For more information about my Social Security or to establish an account, go to: www.socialsecurity.gov/myaccount.

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A top-rated nursing home is hard to find in Texas, 10 other states

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Natalie Anne Sealy's headshot.

Natalie Sealy (Photo courtesy of Billie Pender)

LOCKHART, Texas — The call from the nursing home came just before dawn, jolting Martha Sherwood awake.

During the night, fire ants had swarmed over her 85-year-old mother, injecting their stinging venom into Natalie Sealy’s face, arms, hands and chest.

“She was just lying there being eaten alive,” said daughter Billie Pender, who said she and her sister had repeatedly complained about a broken windowsill in their mother’s room at Parkview Nursing and Rehabilitation Center.

In 11 states, 40 percent or more of nursing homes get Medicare’s lowest two lowest rating.

The Sept. 2 attack devastated Sealy, a retired bank teller with dementia. “She went steadily downhill,” dying in late March, said Sherwood, who brought a lawsuit against the home.

Their mother had chosen the for-profit facility two years earlier because it was near her adult children. The family didn’t know that Parkview scored poorly on staffing and other quality measures.

This year, Medicare rates it one star out of a possible five stars — the lowest rating possible — on Nursing Home Compare, which was designed by the federal government to help consumers choose a long-term care facility.

The problem for Sealy’s family and residents of many parts of the country is they have few, if any, higher-rated options if they want their loved ones close by.

In 11 states, 40 percent or more of nursing homes get the two lowest ratings, according to an analysis by the Kaiser Family Foundation.  (Kaiser Health News is an editorially independent program of the foundation.)

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Texas has the highest percentage of one-and two-star homes in the country: 51 percent of its nursing homes are rated “below average,” or “much below average,” on Nursing Home Compare, according to the analysis. Louisiana is close behind at 49 percent, with Oklahoma, Georgia and West Virginia tying for third at 46 percent. Continue reading

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Medicare & Medicaid at 50 – Video

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With Medicare and Medicaid turning 50 this year, the Kaiser Family Foundation produced an updated video that provides a brief history of both programs, including an examination of the health care, social and political landscapes that gave rise to them, the significant ways each program has evolved over five decades and the important roles they play in the U.S. health care system today.

The video includes archival footage, as well as commentary and perspective from policymakers, government officials and experts.

To learn more about Medicare go to the Kaiser Family Foundation Medicare webpage.

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Rural hospitals, one of the cornerstones of small town life, face increasing pressure

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Farm with red barnBy Guy Gugliotta
KHN

MOUNT VERNON, Texas — Despite residents’ concerns and a continuing need for services, the 25-bed hospital that served this small East Texas town for more than 25 years closed its doors at the end of 2014, joining the ranks of dozens of other small rural hospitals that have been unable to weather the punishment of a changing national health care environment.

For the high percentages of elderly and uninsured patients who live in rural areas, closures mean longer trips for treatment and uncertainty during times of crisis. “I came to the emergency room when I had panic attacks,” said George Taylor, 60, a retired federal government employee. “It was very soothing and the staff was great. I can’t imagine Mount Vernon without a hospital.”

Since 2010, 48 rural hospitals have closed, the majority in Southern states, and 283 are in trouble.

The Kansas-based National Rural Health Association, which represents around 2,000 small hospitals throughout the country and other rural care providers, says that 48 rural hospitals have closed since 2010, the majority in Southern states, and 283 others are in trouble. In Texas along, 10 have changed. 

“If there was one particular policy causing the trouble, it would be easy to understand,” said health economist Mark Holmes, from the University of North Carolina, whose rural health research program studies national trends in rural health care. “But there are a lot of things going on.” Continue reading

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50 years later the US Older Americans Act limps along, relying on local and state agencies to provide services

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A younger man holds an elderly man's handBy Rita Beamish
Stateline

This year marks a half-century since Congress created the Older Americans Act, the major vehicle for delivering social and nutrition services to people over 60.

But there’s little to celebrate on the golden anniversary of the law that helps people age at home.

Federal funding hasn’t kept up with the skyrocketing number of America’s seniors, now the largest elderly population in history.

That’s left states and communities struggling to provide the in-home support, meals, case management and other nonmedical services that help seniors avoid more costly nursing home care and enrolling in taxpayer-funded Medicaid.   Continue reading

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If you want to know who gets health-care handouts, look in the mirror – Opinion in The Washington Post

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cms-logo-200pxDespite all the mockery that oblivious cries of “Keep your government hands off my Medicare!” generated several years ago, older Americans still don’t seem to understand that Medicare is not only the government’s largest health-care program but also one that involves transferring lots of money away from everyone else and toward them — i.e., a subsidy.

Maybe the confusion stems from the fact that Medicare recipients have paid Medicare taxes. Every time I mention Medicare in a column, I’m inundated with irate e-mails proclaiming that seniors “paid for it fair and square” and are therefore not receiving a handout. These claims overlook the laws of arithmetic.

via If you want to know who gets health-care handouts, look in the mirror – The Washington Post.

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Adminstration to quicken pace towards quality-based Medicare payments

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cms-logo-200pxBy Jordan Rau
KHN

HHS Pledges To Quicken Pace Toward Quality-Based Medicare Payments

The Obama administration Monday announced a goal of accelerating changes to Medicare so that within four years, half of the program’s traditional spending will go to doctors, hospitals and other providers that coordinate their patient care, stressing quality and frugality.

The announcement by Health and Human Services Secretary Sylvia Burwell is intended to spur efforts to supplant Medicare’s traditional fee-for-service medicine, in which doctors, hospitals and other medical providers are paid for each case or service without regard to how the patient fares.

Within four years, half of the program’s traditional spending will go to doctors, hospitals and other providers that coordinate their patient care, stressing quality and frugality.

Since the passage of the federal health law in 2010, the administration has been designing new programs and underwriting experiments to come up with alternate payment models.

Last year, 20 percent of traditional Medicare spending, about $72 billion, went to models such as accountable care organizations, or ACOs, where doctors and others band together to care for patients with the promise of getting a piece of any savings they bring to Medicare, administration officials said.

There are now 424 ACOs, and 105 hospitals and other health care groups that accept bundled payments, where Medicare gives them a fixed sum for each patient, which is supposed to cover not only their initial treatment for a specific ailment but also all the follow-up care.

Other Medicare-funded pilot projects give doctors extra money to coordinate patient care among specialists and seek to get Medicare to work more in harmony with Medicaid, the state-federal health insurer for low-income people.

Burwell’s targets are for 30 percent, or about $113 billion, of Medicare’s traditional spending to go to these kind of endeavors by the end of President Barack Obama’s term in 2016, and 50 percent — about $215 billion — to be spent by the end of 2018. Continue reading

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Obesity Costs Evident at the State Level | Brookings Institution

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Nearly 14 percent of Washington state’s Medicaid and nearly 8 percent of its Medicare spending goes to treat conditions caused by obesity.

At the state-level, a substantial share —between 6 percent and 20 percent—of Medicaid spending goes to adult obesity-related expenditures. In 2006, Oregon (18.8 percent), Arizona (17.0 percent) and Colorado (16.2 percent) saw the highest shares, while Kansas (6.5 percent), Virginia (6.8 percent) and North Dakota (7.5 percent) devoted the smallest shares of Medicaid spending to obesity-related expenditures.

Screen Shot 2015-01-03 at 8.19.49 PM

On a state-by-state basis, Medicare spending due to obesity was substantial, too, with shares varying from 5.2 percent to 10.2 percent in 2004.

The highest percent of obesity-attributable spending was found in Ohio (10.2 percent), Michigan (10.0 percent) and West Virginia (9.9 percent), while the lowest was in Hawaii (5.2 percent), Arizona (6.2 percent), and New Mexico (6.6 percent).

via Obesity Costs Evident at the State Level | Brookings Institution.

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Medicare Cuts payments to 721 hospitals with highest rates of infections, injuries

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Physician and Nurse Pushing Gurney

By Jordan Rau
KHN

In its toughest crackdown yet on medical errors, the federal government is cutting payments to 721 hospitals for having high rates of infections and other patient injuries, records released Thursday show.

Medicare assessed these new penalties against some of the most renowned hospitals in the nation, including the Cleveland Clinic, Brigham and Women’s Hospital in Boston, the Hospital of the University of Pennsylvania in Philadelphia and Geisinger Medical Center in Danville, Pa.

One out of every seven hospitals in the nation will have their Medicare payments lowered by 1 percent over the fiscal year that began Oct. 1 and continues through September 2015. The health law mandates the reductions for the quarter of hospitals that Medicare assessed as having the highest rates of “hospital-acquired conditions,” or HACs.

These conditions include infections from catheters, blood clots, bed sores and other complications that are considered avoidable.

The penalties, which are estimated to total $373 million, are falling particularly hard on academic medical centers: Roughly half of them will be punished, according to a Kaiser Health News analysis.

Continue reading

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Seniors’ obesity-counseling benefit goes largely unused

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ScaleBy Phil Galewitz
KHN

Three years ago, the Obama administration offered hope to millions of overweight seniors when it announced Medicare would offer free weight-loss counseling.

Officials estimated that about 30 percent of seniors are obese and therefore eligible for counseling services, which studies have shown improve the odds of significant weight loss.

But less than 1 percent of Medicare’s 50 million beneficiaries have used the benefit so far. Experts blame the government’s failure to promote the program, rules that limit where and when patients can go for counseling as well as the low fees for providers.

Since November 2011, about 120,000 seniors have participated, including about 50,000 last year, according to federal data.

“It’s very disappointing,” said Dr. Scott Kahan, an obesity medicine specialist at George Washington University.

“It’s a huge lost opportunity,” said Bonnie Modugno, a registered dietician in Santa Monica, Calif., who advises doctors how to provide weight loss counseling.

By  comparison, about 250,000 seniors last year used Medicare’s tobacco cessation counseling benefit, which started in 2005 and offers greater flexibility about how providers can offer it. Nationally, 9 percent of seniors smoke, while 30 percent are obese. Continue reading

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New Medicaid rule could hinder shift away from nursing homes

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A younger man holds an elderly man's handBy Christine Vestal
Stateline

For more than 30 years, states have been finding new ways to care for aged and disabled Medicaid beneficiaries without confining them to nursing homes.

In fact, the number of people living in skilled nursing facilities has declined significantly over the last decade, despite a marked increase in the ranks of the elderly in the U.S.

Starting this year, a new federal rule will require states to ensure that long-term care alternatives to nursing homes—such as assisted living facilities, continuing care retirement communities, group homes and adult day care—work with residents and their families to develop individual care plans specifying the services and setting each resident wants.

The overarching goal is to create a “home-like” atmosphere, rather than an institutional one.

The overarching goal is to create a “home-like” atmosphere, rather than an institutional one and to give residents choices about their care.

While nearly everyone supports the concept, states, providers and even some consumer advocates are complaining that the rule could make it difficult for health care providers to fulfill increasing demand for long-term care outside of nursing homes.

Under the rule, for example, elderly people with dementia who enter assisted living facilities should not be subjected to constraints, such as locked exits, unless they are at risk for wandering.

But if they share living space with other residents with dementia who do need to be prevented from wandering, it will be difficult to allow them to leave the building whenever they want without jeopardizing the safety of others.

“The goal was completely laudable,” said Martha Roherty, director of the National Association of States United for Aging and Disabilities, which works to help elders and people with disabilities live in their communities for as long as possible.

“Unfortunately, what’s happened is that it is limiting individuals’ choice of what and where to receive (long-term care) services rather than broadening it, especially as it relates to seniors,” she said. Continue reading

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Hospitals take cues from the hospitality industry

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November 4, 2014

This KHN story also ran in The Washington Post.

Two years ago, Inova Health System recruited a top executive who was not a physician, had never worked in hospital administration and barely knew the difference between Medicare and Medicaid.

What Paul Westbrook specialized in was customer service. His background is in the hotel business – Marriott and The Ritz-Carlton, to be precise.

He is one of dozens of hospital executives around the country with a new charge. Called chief patient experience officers, their focus is on the service side of hospital care: improving communication with patients and making sure staff are attentive to their needs, whether that’s more face time with nurses or quieter hallways so they can sleep.

It’s a dimension of hospital care that has long been neglected, patient advocates say, and it was put high on hospitals’ agendas only when Medicare started tracking patient satisfaction and, in late 2012, shaving payments to hospitals that fell short.

The hospitals are judged on answers to such questions as how well their doctors and nurses communicated with them, how clean and quiet the hospital was, whether they received help when they needed it and how well providers explained the drugs they were given.

“There is a new recognition that the patient is important,” said Leah Binder, president and chief executive of the Leapfrog Group, an employer-based coalition that advocates for greater health-care quality and safety.

Hospital routines have traditionally been designed to suit employees, not customers, she said. “The patient used to be maybe 10th on the list of a hospital’s priorities.” Continue reading

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