For decades, seniors and others with chronic illness have had to scale a seemingly insurmountable barrier built by the health care system, aided and abetted by Medicare and Medicaid. On one side of the wall was medical care, mostly controlled by doctors, hospitals, drug companies, and skilled nursing facilities. Medicare paid them to do as many medical procedures as possible, and [...]
The loud debate over how many people have gotten health insurance under the Affordable Care Act misses the point. Yes, reducing the number of uninsured was one goal of the ACA. But only one. The law’s most enduring legacy will come from its historical—but largely unnoticed—changes in the way health care is delivered. Unlike the insurance expansion, which largely excludes Medicare, many [...]
The other day, I wrote about a troubling report on the high likelihood of falls or medication errors in skilled nursing facilities. The problem is real and serious, but at least we can measure it-- which is a first step towards fixing it. In contrast, there is home care. More than eight of every 10 people who need long-term supports [...]
Earlier this month, the federal department of Health & Human Services concluded that more than one of every five skilled nursing facility (SNF) patients suffered serious harm from events such as medication errors, falls, or infections in 2011. Half were sent to the hospital as a result of these events. Six percent died. And 60 percent of these adverse events [...]
Federal senior services programs are in for another very difficult year. In the 2015 budget he released yesterday, President Obama proposed freezing or even cutting spending for many key programs. And Obama’s blueprint may be the highwater mark for many initiatives, which are likely to see even deeper cuts as the budget works its way through Congress. Key House Republicans have [...]
The most important trend in care for the frail elderly and younger people with disabilities may be what’s called managed long-term supports and services, or MLTSS. This effort to combine medical care with long-term care would replace today’s disorganized, ineffective, and even dangerous system with one that can bring together complex care that’s being delivered by many different providers. Done [...]
For years, it has been an article of faith that Medicare would not pay for services such as skilled nursing or physical therapy unless that care improved a patient’s health status. I cannot tell you how many times I’ve heard doctors, nursing homes administrators, and even case workers say Medicare would stop paying once a patient was no longer getting better. [...]
A new Medicare payment model would encourage health systems to provide fully-integrated medical care for people with chronic disease, according new bipartisan legislation sponsored by senators Ron Wyden (D-OR) and Johnny Isakson (R-GA), and congressmen Erik Paulsen (R-MN) and Peter Welch (D-VT). The measure would allow, but not require, participating providers to offer long-term services and supports as well as medical [...]
The Washington Post published an extensive investigative story on hospice the other day. The take away: Hospices (mostly for-profits) are making big bucks by manipulating their case loads to maximize Medicare payments. In short, they are taking on many patients who are frail but not dying and thus staying on hospice care for a very long time. But the Post [...]
Despite widespread claims that doctors are fleeing Medicare, more than 9 in 10 still accept new Medicare patients and fewer than 1 percent have quit the program. The vast majority of seniors have regular access to a doctor and can find a physician when they need one. And Medicare patients are no more likely than others to have to wait [...]