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From the category archives: healthcare

Nursing Homes Say: Hold the Meatloaf...Pass the Lo Mein, Please

There’s a growing trend among the nation’s more than 15 thousand nursing homes to break away from rigid meal schedules and standard menus to individualized meals which acknowledge their residents’ dietary, ethnic and cultural diversity.  Rather than chicken and mashed potatoes Tuesdays imagine instead a Thai-style soup with fresh ginger, vegetables and thin-sliced beef as an option.

The Associated Press reports:

“...the federal government is proposing regulations that would require facilities to create menus that reflect religious, cultural and ethnic needs and preferences, as well. Further, the proposed rules would empower nursing home residents with the "right to make personal dietary choices."

The government acknowledges that the nation's 1.4 million nursing home residents are diverse and that ‘it may be challenging’ to meet every preference. But it wants facilities to offer residents ‘meaningful choices in diets that are nutritionally adequate and satisfying to the individual.’ “

Advocates have argued for these changes for decades but cost is a challenge. 

“Janet Burns, chief executive at Sunny Vista, said the cost of fresh food is lower than prepackaged meals, but labor costs are higher. Her dietary costs were $1.08 higher than the nation's average in 2014. However, she said, higher costs are offset by things like preventing weight loss, a problem experienced by many nursing home residents. For example, she said, medication to increase a resident's appetite is more expensive than preparing a special meal. Costs aside, Burns said, ‘It's the right thing to do.’"

The benefits of more appealing and healthier food options could improve not only the quality of life but the health of residents.

“Sandra Simmons, a professor at Vanderbilt University who studies quality of care and life in institutional settings, says studies have shown that the daily caloric intake of 50 percent to 70 percent of nursing home residents is below recommended levels, she said.”

Something as simple as providing more appealing menus could make the difference. 

New Medicaid Rules Designed to Put Care Over Profit

CMS has announced tightened Medicaid rules for private insurance plans that administer most Medicaid benefits for the poor. The Obama administration says the rules will limit profits, ease enrollment, require minimum levels of participating doctors and eventually provide quality ratings.  However, those ratings would still be years away as the industry continues to fight against such measures. 

Kaiser Health News provides details on the biggest changes for Medicaid managed care in a decade.  The new rules will:

  • Require states to set rules ensuring Medicaid plans have enough physicians in the right places. The standards will include “time and distance” maximums to ensure doctors aren’t too far away from members.
  • Limit insurer profits by requiring rate setting that assumes 85 percent of revenue will be spent on medical care. Unlike a similar rule for other plans, such as insurance sold through Obamacare marketplaces, the requirement would not compel Medicaid insurers to rebate the difference if they don’t hit 85 percent. Future rates would be adjusted instead.
  • Make plans regularly update directories of doctors and hospitals. A 2014 investigation by the Department of Health and Human Services’ inspector general found that half the doctors listed in official insurer directories weren’t taking new Medicaid patients.
  • Push plans to better detect and prevent fraud by providers, including mandatory reporting of suspected abuse to the states.
  • Tighten rules for Medicaid plans and states to collect patient data and submit it to HHS.
  • Make it easier for states to offer managed-care plans incentives to improve clinical outcomes, reduce costs and share patient information among hospitals and doctors.

Nearly two-thirds of Medicaid’s 72 million member are enrolled in private managed-care plans.  Consumer advocates have pushed HHS to set stricter rules for managed-care plans, which they said too often favored profits over patients. The industry and some state Medicaid directors resisted, saying plans needed flexibility to serve different members in different states.

The rules will be phased-in over the next three years, starting next summer. 


GOP Plans for Medicare? All Slash No Strengthen

The House Ways & Means Subcommittee on Health held a hearing entitled "Preserving and Strengthening Medicare."  Unfortunately, as the ranking member Rep. Jim McDermott (D-WA) made clear, this hearing actually had virtually nothing to do with preserving and strengthening Medicare:

“This is the first Health Subcommittee hearing of the year, and it could have been an opportunity to have a fresh, constructive conversation about Medicare. Unfortunately, this won’t be the case. It looks like we should expect more of the same from my Republican colleagues this morning – bad ideas repeated incessantly in the hope that the American people eventually fall for them.

The core proposal that my Republican colleagues have offered – to end Medicare as we know it – will have devastating effects on seniors. It will shift costs onto beneficiaries, create more losers than winners, and lead to a death spiral in traditional Medicare.

We all know this.”

NCPSSM President/CEO, Max Richtman, submitted testimony to the Committee and reacted to the day’s proceedings:

“Unfortunately, today’s Congressional hearing on ‘Preserving and Strengthening Medicare’ offered no new ideas and was instead an Orwellian political exercise in which politicians say preserve when they actually mean privatize, and strengthen when they mean slash. 

Republicans in the House envision a future in which millions of seniors will lose their guaranteed Medicare benefits in favor of a privatized CouponCare system in which they receive a government coupon to try and buy private insurance. Millions of seniors in Medicaid will lose their benefits due to block-granting to states without providing the resources to pay for it.  The repeal of the Affordable Care Act will leave tens of millions without insurance and strip benefits from seniors in Medicare.  

The Republican leadership has offered no plans to improve benefits in Medicare or make reforms to reign in the skyrocketing price of drugs and healthcare costs system wide.  Instead, the GOP vision for seniors in Medicare is they must just do more with less. Stagnant wages are grinding away at the middle class’s ability to save for retirement.  Many employers have significantly scaled back or eliminated the traditional retirement benefits offered to their employees.  As a result, current and future retirees simply cannot afford proposals to cut benefits, raise the eligibility age or privatize the program.”...Max Richtman, NCPSSM President/CEO

While the House Ways and Means Health Subcommittee promoted destroying traditional Medicare in favor of a fully privatized system during today’s Congressional hearing, their GOP colleagues are moving a budget through Congress that would make that plan reality.

The House budget would cut Social Security and Medicare by $463 billion over 10 years, while cutting Medicaid and other health programs by $1.028 trillion, not including the Affordable Care Act.  The GOP budget protects the wealthiest Americans and big corporations from any tax increases while imposing massive spending cuts on average Americans and their families.

Max Richtman’s full testimony as submitted to the House Ways and Means Health Subcommittee is here.  

CMS Caves to Political Pressure from the Insurance Industry, Again

The Centers for Medicare & Medicaid Services (CMS) has quietly scrapped a policy that required private Medicare Advantage insurance companies facing sanctions to face a reduction in the star ratings consumers use when picking their private health insurance plans.  Unbelievably, CMS (caving to political pressure from the insurance lobby) will allow sanctioned companies to keep their violations hidden from consumers by protecting their star ratings.  Modern Healthcare reports:

The move, which was quietly released by the CMS in a memo (PDF) and shocked many in the industry, will immediately protect hundreds of millions of dollars at Cigna Corp., which had its Medicare Advantage plans sanctioned in January.

“It does seem pretty unusual to make this kind of dramatic change in a memo,” said Tom Kornfield, a vice president at consulting firm Avalere Health and former CMS official. “It sort of comes out of nowhere.”

Richard Lieberman, a Medicare Advantage data consultant at Mile High Healthcare Analytics, said the CMS' decision could be characterized as “a huge gift or even corporate welfare” even though it could help insurers that quickly resolve problems.

“CMS' actions definitely send a mixed message to plans,” he said.

Clearly, there are huge financial rewards for the insurance industry if companies are allowed to violate CMS’ rules and seniors are left in the dark about a company’s sanctions.  CMS is allowing companies like Cigna which has been found guilty of “egregious instances of noncompliance,” including blocking the appeals process for its customers, to continue to reap the rewards of government subsidized bonuses and over payments.

“Star ratings carry clinical and financial impact. The CMS ties bonus payments to Medicare Advantage plans that have at least four stars. Highly rated plans that get sanctioned and thereby lose their high ratings stand to lose millions of dollars in extra payments. But the goal is motivate more insurers to improve their Medicare Advantage operations.” Modern Healthcare

It’s impossible to imagine how -- in this political environment where cutting Medicare benefits has become the “go-to” solution for Members of Congress who claim we can’t afford the program – allowing the nation’s multi-billion dollar insurance industry to keep taxpayer funded bonuses while they are violating federal standards is acceptable policy. 

This decision didn’t happen in a vacuum.  If follows another political cave by CMS last month when it bowed to industry lobbying pressure and decided to raise reimbursement rates for insurance companies rather than trimming back the billions of federal overpayments as required in the Affordable Care Act.  Wall Street and the insurance industry loved the news that taxpayers will continue to overpay Medicare Advantage plans.  They’ll surely love it now that these massive companies will keep their taxpayer-funded overpayments while not being held accountable to serving the seniors who’ve signed up for medical coverage, blissfully unaware that anything is amiss. 

Medicare End of Life Counseling – Do You Have a Plan? Many African Americans Do Not

For many years, patients, families and health care advocates have urged that doctors in Medicare be reimbursed for end of life counseling.  Unfortunately in 2008, the GOP’s Vice Presidential candidate, Sarah Palin, derailed any hope of a reasonable debate by claiming such conversations would lead to “death panels.”  Thankfully, time and truth have put an end to the political posturing and Medicare will now reimburse doctors for conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves.

According to Kaiser Family Foundation polling, public support for the move is huge; however, many Americans haven’t had end of life counseling with their doctor.

“Even though 89 percent of respondents said doctors should have this conversation with patients -- and just 9 percent said they shouldn't -- only 17 percent of people reported having done so. And 4 in 10 of those who haven't yet had the discussion said they didn't want to. That's despite the survey also showing that 84 percent of people would be comfortable talking to their doctors about the topic.”

Additionally, Kaiser found that communities of color are even less likely to have dealt with end of life issues:

“Studies have found that about 4 in 10 Americans ages 65 and older do not have advanced directives or have not written down their own wishes for end-of-life medical treatment. Additionally, demographic differences appear to play a role in the likelihood of having advanced directives. Specifically, African Americans and Hispanics have advance directives at lower rates compared to whites, as do people with lower incomes and lower levels of completed education. Researchers have identified several factors that contribute to these differences, including cultural and religious differences, communication challenges between patients and medical staff, distrust of medical care systems, and awareness of advance directive options.”

Research on how to reverse the trend of less end of life engagement in the African American and Hispanic community is limited.  However, as of January 1 this year, Medicare will cover advance care planning as a separate service provided by physicians and other health professionals.  Advocates hope the new provisions will open the door to increased usage of the new benefit across the nation. 

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