As Medicaid budget pressures grow, more states are turning long-term care over to private managed care companies. USA Today reports that six states now require both frail elderly and younger adults with disabilities to enroll in insurance-run Medicaid managed care plans. Another 10 states are planning to either create or expand these programs, according to the story. The reason, of course: money. States pay the [...]
In the decade between 1999 and 2008, almost 3,000 nursing homes closed while the number of skilled nursing facility beds shrunk by nearly 100,000, or about 5 percent, according to a new study in the Archives of Internal Medicine. In a nation with more nursing homes than McDonald's, and at a time when long-term care can be provided in other settings, that may not be [...]
The co-chairs of President Obama's bipartisan deficit commision have proposed a far-reaching plan to reduce the nation's massive deficit. It includes big changes for both current and future seniors. Among them: higher Social Security taxes and reforms in the design of benefits, reduced payments to Medicare providers and greater cost sharing by Medicare beneficiaries, and, perhaps most dramatic, a fundamental change in federal payments for Medicaid long-term [...]
More than half of long-term care residents in skilled nursing facilities made at least one emergency room visit in 2006. A quarter had two or more. Even more troubling, 38 percent were admitted to the hospital at least once that year, and nearly half were admitted twice or more. In all, one-quarter of all hospitalizations for nursing home residents were potentially preventable. These very [...]
Instead of admitting patients, hospitals are increasingly keeping them under "observation status." This decision results in lower Medicare payments to the hospitals and more out-of- pocket costs for patients. But it also means that Medicare is no longer paying for some admissions to nursing homes, and is instead shifting those expenses to residents and their families. What's going on? It is complicated. But here is [...]
Kudos to President Obama for making a "recess appointment" of Don Berwick to run the Centers for Medicare and Medicaid Services (CMS). Berwick may be the ideal choice for the job. He is the right candidate at exactly the right time. The new health law makes possible broad reforms in the way we deliver health and long-term care. But it by no [...]
For the first time since President Bush's ill-fated effort to privatize Social Security five years ago, the future of the nation's flagship retirement program is back on the policy agenda. For example, Social Security will almost certainly be an issue for President Obama's deficit reduction commission. Unfortunately, we may be headed for the same non-productive shouting match we had over the Bush [...]
The Senate Finance Committee has begun an investigation into four big home-health agencies that, it alleges, artificially inceased their home therapy visits to take advantage of higher Medicare billing rates. A May 12 letter from committee chairman Max Baucus (D-MT) and senior Republican Charles Grassley (R-IA) asked the four for-profit agencies--Amedisys, Almost Family Inc. Gentiva Health Services, and LHC Group-- for records and [...]
A typical couple would have to save nearly $200,000 to pay for their out-of-pocket medical costs from the time they are 65 until they die, according to an important new study by the Center for Retirement Research at Boston College. Add in nursing home costs, and they are likely to need $260,000. But that's only part of the story. About 5 percent of 65-year-old couples will [...]
Mike Vitez at the Philadelphia Inquirer has done a great story on palliative care at a community hospital. Mike weaves the deeply touching story of Mary Tole, a 74-year-old woman who spent two months in the suburban Philadelphia hospital with an undiagnosed illness. She spent much of that time in an intensive care bed in a coma. Mike describes how the hospital's palliative care team [...]