Medic Buzz http://medicbuzz.net/ Wed, 24 Nov 2021 20:24:24 +0000 en-US hourly 1 https://wordpress.org/?v=5.8 https://medicbuzz.net/wp-content/uploads/2021/06/cropped-icon-32x32.png Medic Buzz http://medicbuzz.net/ 32 32 Humana VP provides payers’ perspective on MA Hospice Carve-In, Year One https://medicbuzz.net/humana-vp-provides-payers-perspective-on-ma-hospice-carve-in-year-one/ Wed, 24 Nov 2021 17:45:56 +0000 https://medicbuzz.net/humana-vp-provides-payers-perspective-on-ma-hospice-carve-in-year-one/

Hospice News recently sat down with Kirk Allen, senior vice president of the home care segment at Humana Inc. (NYSE: HUM) to discuss the payor’s perspective on the first year of the hospice component of the demonstration of value-based assurance design (VBID).

Some hospices have reported discrepancies between the design of Medicare Advantage carve-in and its results. Humana told Hospice News the company is encouraged by the progress of the demonstration to date and that there are “many opportunities” in the evolving relationship between hospice providers and payers.

The carve-in began with a small start with 53 participating Medicare Advantage plans in 2021. The US Centers for Medicare & Medicaid Services (CMS) have indicated that participation will double next year to a total of 115 plans. MA and would expand its geographic reach to become available in 461 counties nationwide, up from 206 this year.

Humana operates most of the MA plans offering palliative care and also participates in VBID as a supplier, through its subsidiary Humana at Home. In the first year, Humana covered 145,000 eligible members in 10 plans and in five markets: Atlanta, Cleveland, Denver, Metro Louisville, Kentucky (including southern Indiana), and the Greater Montreal area. Richmond-Tidewater, Virginia.

The company’s role as both payer and provider has given Humana a unique perspective in the value-based payments space, according to Allen.

What has Humana’s experience been so far with value-based demonstration, both as a payer and as a supplier?

We have watched the creation of the hospice from the very beginning and we think it is a very well thought out plan that CMS and [the Center for Medicare & Medicaid Innovation (CMMI)] have set up for the VBID demonstration. Our experience has shown us that it delivers pretty much exactly what we thought it would deliver today in the first year.

From Humana’s point of view, we are one of the biggest suppliers, [and] due to our size and being one of the first and biggest entities in VBID, we really had a good experience. Each market is a little different in the dynamics of health care delivery. We chose not only to put a variety of markets, but also to test specific things in each market.

From a vendor engagement perspective, we’ve actually had a lot of vendors reaching out with interests in the plan, and we’ve had a lot of vendors signing up and becoming network vendors.

We’ve also had a lot of vendors who have decided they want to cooperate, but they’re going to wait a year later to participate. We have a very good interest in the program and the end of the first year is exactly where we expected it to be.

What are the most important things hospices really need to pay attention to if they are considering participating in VBID?

We are also a hospice provider, and we also had to do this plan ourselves with an understanding of the overall goals of the demonstration. Among these goals, CMMI wanted to test a Medicare Advantage organization’s ability to be truly financially responsible and accountable from the start to the end of the full continuum of care for its members. It includes palliative care, and that’s certainly one of the things they were looking at.

They are also exploring the possibility of creating a seamless continuum of care in a master’s program, especially between the coordination services of parts A and B. What struck me was the need to have care services. comprehensive palliative care outside of the palliative care provision available under the plan. When someone makes the choice of a hospice, it is clear that we have to take care of them as part of the hospice plans, but there is also a requirement that we make palliative care available upstream of the hospice. patient’s decision to elect a hospice.

Also, to understand the general objectives of the CMMI VBID demo, you really want to develop a relationship with the MA plans which have a large market share in your area. If you are interested in becoming a supplier, you want to get in early and give your opinion on how the benefits are developed. This is still a demonstration project, and it’s still in development, so it’s about being able to contribute to the scope of care that can be provided and how payment models are structured and to be a partner in AM plans.

As these plans are finalized or they become more cooked, take full advantage of the additional and additional benefits for your patients that will likely be available through a palliative care plan provided by the MA.

Can you clarify what benefits hospice providers should focus on as VBID continues to roll out?

One opportunity is to provide concurrent care and concurrent transitional care in conjunction with a Medicare Advantage plan. You can start hospice services while someone is still receiving concurrent transitional care, and this is something that under normal circumstances would have made a person ineligible for hospice care.

For example, in our model, we have advantages such as home respite in addition to hospital respite. We offer a benefit where a member can add a member or a patient can access home respite care services, and we’ve seen that play out in different ways. We have seen patients able to stay at home or give their caregiver a break in circumstances that might otherwise have turned into someone revoking palliative care benefits.

Another benefit offered by Humana as an example of the types of benefits and MA plans offered in addition to the traditional payment is a Health Care Assistance Allowance for members of the hospice. We have an additional benefit of $ 500 per year which is used to support the quality and comfort of life of our members. We can use it for home modifications, meals, transportation, caregiver support and a lot of other things as well, but it’s really to alleviate any social determinants of a patient’s health needs that can help. to make her episode of palliative care more enjoyable. .

A common concern among providers is that MA plans will pay less than the current per diem through Hospice Medicare. How do you respond to this concern? Are there factors that mitigate this financial risk?

We really approached this demo as an opportunity to learn. We are particularly interested in reducing the barriers patients face in electing a hospice and making it easier for them to stay on the hospice allowance when medical issues arise, and then helping with social determinants that can really influence negatively. their experience during the hospice. In addition to the standard hospice payment, our approach has been to pay for services that are not covered by traditional health insurance or through these additional benefits in order to reduce barriers to providing services through the additional benefits. .

What I would say to a provider is that as you learn more about MDA plans, assess everything that is available in the payment model, basic payment and those additional benefits. and how this might influence the ability to keep patients in your department who might otherwise revoke or interrupt services. You want to let them benefit from the provision of palliative care as part of value-based care and make sure there is no disruption in care and there are no challenges that you would have had if they had benefited from the traditional service. Looking at the model as a whole would be my advice.

Providers have expressed concern that MA plans are not using their networked hospices to provide palliative care. How would you respond to this concern?

We really liked the fact that CMMI requires below the provision of palliative care services as part of the VBID demonstration, as we strongly believe in identifying end-of-life patients and ensuring they have access to all the services they need in this really vulnerable time. We went into the demo with the intention of testing different things, and we were actually really intentional about it.

We pay hospice organizations to provide hospice care in our model. We actually have markets where the hospice agencies are the hospice providers, and we have a mix in a market where it could be a dedicated hospice provider that is not a care agency. palliative. We also have whole markets where the test is [about] how effectively a hospice palliative care agency can provide hospice and palliative care once elected.

In short, we have a mix of hospice providers and hospice agencies dedicated to providing care, and this is one of the things that we specifically tested during the demonstration is to really share the results that we have.

What do you expect to happen in the long term with respect to value-based care in the palliative care space? Where is it ultimately going?

Humana has had a very good experience in providing value-based care. What we have learned is that there is a path to value that will come over time, but it requires learning in partnership with palliative care providers.

We really believe that there are many opportunities to evolve the relationship between palliative care providers and payers and to be able to test these value-based end-of-life care models. Palliative Care really strives to better integrate the end-of-life care experience for our AD members and for palliative care patients. It will be a data driven approach to really learn what works well over time and it will take time, but I think we’ll get there. We have to learn it together.

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Ian Fishback’s death highlights veterans’ mental illness crisis https://medicbuzz.net/ian-fishbacks-death-highlights-veterans-mental-illness-crisis/ Wed, 24 Nov 2021 10:00:35 +0000 https://medicbuzz.net/ian-fishbacks-death-highlights-veterans-mental-illness-crisis/

In July 2019, Major Fishback informed Mr. Garlasco in an email that the CIA was after him, he recalls. “I was like, man, call me.” Major Fishback was in Europe with a new post. “He said, ‘I’m going to give classified information to foreign governments if you don’t get rid of the CIA.’ This is where I lost track.

Work in Europe collapsed later that year.

Major Fishback returned to Michigan, but a series of fighting there led to a court-ordered treatment stay, which he violated. He was arrested after an argument during a football match with an ROTC officer in September. Then came a series of stays in low-cost group homes while friends attempted to get him into a veterans hospital in Battle Creek.

“It was horrible listening to him there,” Ms. Ford said. “He was crying. He said, ‘Can you help me? I can’t trust my family.’

His friends started a GoFundMe campaign to pay for a high-end treatment center in Massachusetts. He began to speak slowly in phone conversations, said Ms Ford, who attributed him to high levels of mind-altering drugs.

In an email, a patient coordinator for Veterans Affairs who saw him on Thursday described his appearance as “alarming,” noting that the once-fit Army major could barely walk and his “arms were outstretched. locked in a 90 degree position and he never changed his facial expression throughout our conversation.

“He had breakfast on Friday morning,” Ms. Ford said, “and later they found him dead.”

The Battle Creek Institution called its sister that day. Ms Jorgensen said she replied: “It is too late. He left.”

“We are saddened by the loss of Army veteran Ian Fishback and extend our sincere condolences to his family,” said Terrence Hayes, spokesperson for the department. “VA has been in contact with the Fishback family to offer support and all the appropriate services to help them during this time. VA remains committed to ensuring that all Veterans receive the care they need in a timely manner.

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How Precision Medicine and Genetic Testing Will Drive Value-Based Care https://medicbuzz.net/how-precision-medicine-and-genetic-testing-will-drive-value-based-care/ Tue, 23 Nov 2021 21:43:35 +0000 https://medicbuzz.net/how-precision-medicine-and-genetic-testing-will-drive-value-based-care/ The shift to value-based care in the United States has been slow in coming, in large part because providers have continued to cling to the traditional ‘fee-for-service’ model of health care that historically has worked well for them.

The shift to value-based care (VBC) in the United States has been slow in coming, in large part because providers have continued to cling to the traditional ‘fee-for-service’ (FFS) healthcare model. ) which historically has worked well for them (if not always for the patient). Plus, that’s how they’ve always done business.

But the inefficiencies and rigidity of the FFS have been exposed during the COVID-19 pandemic. Providers were suddenly faced with the shocking reality that in a fee-for-service model, no service means no fee. Revenue plummeted as patients canceled elective surgeries and clinicians’ offices restricted patient hours and volumes.

In contrast, value-based models of care reimburse providers who deliver better outcomes for patients and populations while reducing costs. The emphasis is on the quality of care, not the quantity.

Technologies that allow clinicians to tailor care plans to address each patient’s unique health risks are essential for successful BCV operation. Fortunately, huge advances are being made in genetic testing and precision medicine, which allow clinicians to use a patient’s genetic makeup and other molecular data in the delivery of care.

The BCV shows particular promise in helping providers treat patients with chronic illnesses. The Centers for Disease Control and Prevention (CDC) estimates that 90% of the country’s $ 3.8 trillion in health spending in 2019 was spent on treating people with chronic and mental illnesses.

It’s no wonder why: Recent research shows that 51.8% of adults in the United States have at least one chronic disease (such as heart disease, cancer, stroke, chronic obstructive pulmonary disease or diabetes), while 27.2% have two or more chronic conditions. Another study shows that more than half of the elderly in the United States have three or more chronic diseases.

And that’s when things get expensive. An analysis by Rand Corp. concludes that while Americans with five or more chronic diseases make up only 12% of the population, they account for 41% of total health care spending in the United States. .

As America’s population ages, the total number of people with chronic diseases – and the associated costs – will in turn increase. The PFCD predicts that the total cost of chronic disease (both in terms of medical spending and lost worker productivity) in the United States from 2016 to 2030 will reach $ 42 trillion. The PFCD also estimates that 1.1 million American lives could be saved each year through better prevention and treatment of chronic diseases, reducing health care spending by $ 418 billion each year through 2030.

However, better prevention and treatment can only be achieved through VBC payment models that reward quality care as well as the use of technologies such as precision medicine, advanced genetic testing and pharmacogenomics.

Through targeted genetic sequencing, clinicians can spot changes in an individual’s chromosomes, genes or proteins. With this information, clinicians can identify patients most at risk for developing chronic disease before the disease develops or progresses and requires more expensive long-term care. Additionally, early genetic testing may motivate at-risk patients to make lifestyle changes (such as quitting smoking or exercising more) or to take prescribed medications to control their chronic illnesses.

Let’s say that next-generation targeted sequencing (NGS) test panels from a clinical lab show that a patient is at risk for hypertension. Clinicians can use this information to work with the patient on lifestyle changes and strategies to control their blood pressure.

Additionally, providers may want to prescribe medication for this patient based on the NGS results. This is where pharmacogenomics is invaluable. Pharmacogenetic tests (PGx) can reveal genetic variations that affect a patient’s response to specific drugs. This information saves time and money, as clinicians do not have to experiment with different drugs.

Knowing precisely what medications to prescribe a patient also minimizes potential side effects of the medications. Reducing adverse drug reactions can reduce medication nonadherence, that is, when patients do not take medications prescribed by clinicians for chronic conditions, illnesses and other disorders, often for example. fear of harmful or debilitating side effects. “Medication nonadherence represents billions of dollars in preventable health care costs, millions of avoidable hospital days and thousands of avoidable emergency room visits,” writes the CDC.

In addition to enabling personalized treatment plans for individual patients based on their unique genetic makeup, precision medicine and genetic testing provide data for medical researchers to better understand chronic disease, which over time , will lead to improved prevention, diagnosis and treatment.

The American Medical Association (AMA) has advocated for several years that precision medicine and genetic testing are essential parts of value-based models of care. While barriers remain to the large-scale adoption of precision medicine and genetic testing, the benefits of these technologies – as well as of BCV models that emphasize prevention and holistic care – are growing. more and more undeniable. It will only be a matter of time before BCV, precision medicine and genetic testing enter mainstream healthcare.

Ron King is the CEO and Board Member of Tesis Biosciences. King is a seasoned healthcare executive with over 25 years of experience in the healthcare industry.

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Fight against gas prices, the United States will release 50 million barrels of oil https://medicbuzz.net/fight-against-gas-prices-the-united-states-will-release-50-million-barrels-of-oil/ Tue, 23 Nov 2021 20:24:52 +0000 https://medicbuzz.net/fight-against-gas-prices-the-united-states-will-release-50-million-barrels-of-oil/

By Josh Boak and Colleen Long, The Associated Press November 23, 2021.

President Joe Biden speaks as he announces he is appointing Jerome Powell to a second four-year term as Federal Reserve Chairman, during an event at the South Court Auditorium of the complex of the White House in Washington, Monday, November 22, 2021. Biden also named Lael Brainard as vice president, number 2 in the Federal Reserve. (AP Photo / Susan Walsh)

WASHINGTON (AP) – President Joe Biden on Tuesday ordered 50 million barrels of oil from the U.S. Strategic Reserve to help cut energy costs, in coordination with other major energy-consuming countries, including India, the UK and China.

The US action is aimed at global energy markets, but also to help Americans cope with higher inflation and rising prices before Thanksgiving and the winter holidays. Gasoline prices are around $ 3.40 per gallon, more than 50% higher than a year ago, according to the American Automobile Association.

“While our combined actions will not solve the problems of high gas prices overnight, it will make a difference”? ? Biden promised in remarks. “It will take a while, but before long you should see gas prices drop where you fill up.” ??

The government will start putting barrels on the market from mid-December to the end of December. Gasoline generally responds with a lag to changes in oil prices, and administration officials have suggested that this is one of many steps towards cutting costs.

Oil prices had fallen in the days before the announced withdrawals, a sign that investors were anticipating movements that could bring 70 to 80 million barrels of oil on world markets. But in Tuesday morning trading, prices climbed nearly 2% instead of falling.

The market was expecting the news, and traders may have been disappointed when they saw the details, said Claudio Galimberti, senior vice president of oil markets at Rystad Energy.

“The problem is that everyone knows that this measure is temporary” ?? said Galimberti. “So once it is stopped, then if the demand continues to be greater than the supply as it is now, then you are back to square one.” ??

Shortly after the US announcement, India announced that it would release 5 million barrels from its strategic reserves. The UK government has confirmed it will release up to 1.5 million barrels from its stockpile. Japan and South Korea are also participating. US officials say this is the largest coordinated release of global strategic reserves.

Prime Minister Boris Johnson’s spokesman Max Blain said it was “a sensible and measured move to support global markets” ?? during the pandemic recovery. Blain added that UK companies will be allowed but not required to participate in the publication.

The actions of the United States and others are also likely to counter the measures taken by the Gulf countries, especially Saudi Arabia, and Russia. Saudi Arabia and other Gulf countries have made it clear that they intend to control supply to keep prices high for now.

As word has spread in recent days of an upcoming joint release of reserves by the United States and other countries, OPEC interests have warned those countries may respond in turn, reneging on their promises. to increase supplies in the coming months.

Wyoming Senator John Barrasso was among Republicans who criticized Biden’s announcement. Senate Republican No.3 said the underlying problem was restrictions on domestic production by the Biden administration.

“Asking OPEC and Russia to increase production and now use the strategic oil reserve are desperate attempts to deal with a disaster caused by Biden”? ? Barrasso said. “They do not replace American energy production. “??

Biden was quick to reshape much of his economic agenda around the issue of inflation, saying his recently passed $ 1 trillion infrastructure package will reduce pricing pressures by making freight transportation more efficient and less expensive.

Republican lawmakers hammered the administration so that inflation peaked in 31 years in October. The Consumer Price Index climbed 6.2% from a year ago – the biggest 12-month jump since 1990.

The Strategic Oil Reserve is an emergency stockpile to preserve access to oil in the event of natural disasters, national security concerns and other events. Maintained by the Department of Energy, the reserves are stored in caves created in salt domes along the Gulf coasts of Texas and Louisiana. There are approximately 605 million barrels of oil in the reserve.

The Biden administration maintains that the reserve is the right tool to help alleviate the supply problem. Americans used an average of 20.7 million barrels per day in September, according to the Energy Information Administration. This means that the release almost equates to about two and a half days of additional supply.

“For now, I will do what needs to be done to lower the price you pay at the pump,” Biden said. “Middle class and working families spending way too much and it’s a strain… you are the reason I was sent here to watch over you. “??

Biden said the White House is investigating a possible price hike by gas companies that are squeezing customers while making money from falling oil costs.

The coronavirus pandemic has shaken energy markets. When the closures began in April 2020, demand collapsed and oil futures prices turned negative. Energy traders didn’t want to end up with crude they couldn’t store. But as the economy recovered, prices hit a seven-year high in October.

American production has not recovered. Figures from the Energy Information Administration indicate that national production averages around 11 million barrels per day, up from 12.8 million before the start of the pandemic.

Republicans have also taken advantage of Biden’s efforts to minimize drilling and support renewables as the reason for the decline in production, although there are multiple market dynamics at play as fossil fuel prices are higher in the world. world.

Biden and administration officials insist that drawing more oil from the reserve does not conflict with the president’s long-term climate goals, as this short-term solution addresses a specific problem, while climate policies are a long-term response spanning decades.

They argue that the administration’s push to boost renewables will ultimately mean less dependence in the United States on fossil fuels. But it’s a politically convenient argument – put simply, higher prices reduce usage, and significantly higher gasoline prices could force Americans to rely less on fossil fuels.

“The only long-term solution to rising gas prices is to continue our march to eliminate our dependence on fossil fuels and create a robust green energy economy”? ? Democratic Senate Leader Chuck Schumer said he was in favor of the release.

The White House decision comes after weeks of diplomatic negotiations. Biden and Chinese President Xi Jinping discussed measures to address limited oil supplies at their virtual meeting earlier this month and “discussed the importance of taking action to meet global energy supplies.” ?? according to the White House.

The Department of Energy will make oil available from the Strategic Oil Reserve in two ways; 32 million barrels will be released in the coming months and will return to the reserve in the years to come, the White House said. An additional 18 million barrels will be part of an oil sale authorized by Congress.

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Contributed AP writers Cathy Bussewitz and Charles Sheehan from New York, Jill Lawless from London, and Matthew Daly and Ellen Knickmeyer from Washington.

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Ann Arbor’s anesthesiologist convicted of stealing opioids from VA medical center https://medicbuzz.net/ann-arbors-anesthesiologist-convicted-of-stealing-opioids-from-va-medical-center/ Mon, 22 Nov 2021 19:48:53 +0000 https://medicbuzz.net/ann-arbors-anesthesiologist-convicted-of-stealing-opioids-from-va-medical-center/

A former certified nurse anesthetist at Ann Arbor VA Medical Center was sentenced on Nov. 9 to three years probation for stealing controlled substances, including several types of opioids, from hospital dispensers, the acting prosecutor said of the United States, Saima S. Mohsin, in a statement. Press release.

While Elizabeth Prophitt, 39, of Saline, Michigan, was initially charged with 25 counts of obtaining controlled substances by fraud, misrepresentation or deception, she pleaded guilty to just five counts of ‘obtaining controlled substances through fraud, misrepresentation or deception, according to the plea deal she signed on July 8.

Prophitt also agreed to pay the VA $ 1,482.90 in restitution, according to court documents.

Prophitt used his position from July 2018 to February 2019 as a surgical nurse to steal over 2,200 vials of Schedule II and IV controlled substances – drugs classified by the Drug Enforcement Administration as having highly addictive properties that are susceptible to abuse. These controlled substances included fentanyl, hydromorphone and morphine.

In order to access drugs for his own use, Prophitt falsified patient records, misusing patients’ personal information. Prophitt went to the hospital on off-schedule or after-hours days, often stealing the vials directly from the hospital’s substance distribution systems.

“We will not tolerate medical professionals stealing controlled substances intended for the care of our country’s veterans,” said Acting Special Agent in Charge Gavin McClaren of the Inspector’s Central Office for Veterans Affairs. general.

The case was continued by Assistant United States Attorney Brandy R. McMillion, Deputy Head of the Department of Justice’s Healthcare Fraud Enforcement Unit.

The investigation into Prophitt was conducted by special agents from the VA’s OIG and the Drug Enforcement Administration.

Rachel is a Marine Corps veteran, Penn State alumnus, and a New York University master’s degree candidate for business and economics reports.

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Quality of care decreases with private ownership of nursing homes, study finds https://medicbuzz.net/quality-of-care-decreases-with-private-ownership-of-nursing-homes-study-finds/ Mon, 22 Nov 2021 03:38:00 +0000 https://medicbuzz.net/quality-of-care-decreases-with-private-ownership-of-nursing-homes-study-finds/

Retirement homes acquired by private equity firms have seen an increase in emergency room visits and hospitalizations among long-term residents and rising Medicare costs, according to a new study from investigators at Weill Cornell Medicine. The results, published Nov. 19 in the JAMA Health Forum, suggest that the quality of care declined when private equity firms took over the facilities.

Our results indicate that facilities owned by private equity firms provide lower quality long-term care. These residents are among the most vulnerable in our healthcare system, and a lack of transparency in ownership makes it difficult to identify facilities with private holdings, which consumers may be interested in knowing. “

Dr Mark Unruh, Associate Professor of Population Health Sciences, Weill Cornell Medicine

Private equity investments in nursing homes have skyrocketed in recent years, under $ 750 billion in healthcare deals between 2010 and 2019. According to the research team, 5% of Nursing homes in the United States are owned by private equity firms. which included Dr Lawrence Casalino, Dr Hye-Young Jung, Dr Robert Tyler Braun and Weill Cornell Medical College alumnus Dr Zachary Myslinski ’21.

The pressure to generate high profits in the short term could lead privately owned nursing homes to cut staff, services, supplies or equipment, which may have a negative association with the quality of care, said. Dr Unruh, adding that these companies are looking for returns of 20 percent or more.

Using a new national database developed by Dr Braun for the study, investigators at Weill Cornell identified 302 nursing homes acquired by private equity firms between 2013 and 2017, with a total of 9,632 long-stay residents. Investigators compared the results of residents in privately owned facilities with the results of residents of 9,562 other for-profit nursing homes, which included 249,771 long-stay residents during the study period.

For quality of care indicators, the team looked at emergency room visits for outpatient care (ACS) and hospitalizations. These episodes, such as complications from diabetes or heart failure, can be largely avoided with good management of the disorders.

Investigators found that residents of privately owned facilities were 11% more likely to have an ACS emergency visit and 8.7% more likely to be hospitalized. As a result, they had Medicare costs (Medicare covers emergency room visits and hospitalizations) that were 3.9% higher, or $ 1,080 more per year, per patient than the residents of for-profit nursing homes without private participation.

“The majority of revenues that fund care in nursing homes come from public sources,” Dr Unruh said. “After acquiring equity, the quality of care declines and Medicare spending increases for residents, and this should be a concern for policy makers.”

The study deserves further discussion not only on the implications of the growth of private equity firm acquisitions, Dr Unruh said, but also on the importance of making property information available on enabling websites. for the public to compare nursing home providers.

Source:

Journal reference:

Braun, RT, et al. (2021) Association of Private Equity Investment in US Nursing Homes with quality and cost of care for long-term residents. JAMA Health Forum. doi.org/10.1001/jamahealthforum.2021.3817.

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Senior informed: Does Medicare cover scooters or wheelchairs? https://medicbuzz.net/senior-informed-does-medicare-cover-scooters-or-wheelchairs/ Sun, 21 Nov 2021 11:00:09 +0000 https://medicbuzz.net/senior-informed-does-medicare-cover-scooters-or-wheelchairs/

Dear wise elder,
I have arthritis in my hips and knees and have difficulty moving around. How do I get a scooter or electric wheelchair covered by Medicare?
Need a ride

Dear need,

If you are registered with the original Medicare, obtaining a scooter or electric wheelchair covered by Medicare begins with a visit to your doctor’s office.

If you are eligible, Medicare will pay 80 percent of the cost once you reach your Part B deductible ($ 203 in 2021). You will be responsible for the remaining 20 percent, unless you have additional insurance. Here’s a breakdown of how it works.

Schedule a meeting

Your first step is to call your doctor or primary care provider and schedule a Medicare-required face-to-face mobility assessment to determine your need for an electric scooter or wheelchair. To be eligible, you must meet all of the following conditions:

  • Your medical condition makes it very difficult to move around your home, even with the help of a cane, crutch, walker or manual wheelchair.
  • You have significant problems with activities of daily living such as bathing, dressing, getting in or out of a bed or chair, or using the bathroom.
  • You can drive safely, get on and off the scooter or wheelchair, or have someone with you who is always available to help you use the device safely.

If you are eligible, your doctor will determine the type of mobility equipment you will need based on your medical condition, its ease of use in your home, and your ability to use it.

It’s also important to know that Medicare coverage depends on your need for a scooter or a wheelchair in your home. If your request is based on needing it outside of your home, it will be refused as not medically necessary as the wheelchair or scooter will be considered a leisure item.

Or buy

If your doctor determines that you need an electric scooter or wheelchair, they will fill out a prescription or written prescription. Once you receive it, you will need to take it to a Medicare-approved provider within 45 days. To find Medicare approved providers in your area, visit Medicare.gov/medical-equipment-suppliers or call (800) 633-4227.

There are, however, circumstances in which you may need “prior authorization” for certain types of power wheelchairs. In this case, you will need Medicare clearance before you can get one.

Financial aid

If you have a Medicare Supplemental Policy (Medigap), it may cover some or all of the 20% of the cost of the scooter or wheelchair that is not covered by Medicare. If, however, you don’t have supplemental insurance and can’t afford the 20 percent, you may be able to get help through Medicare savings programs. Call your local Medicaid office for information on eligibility.

Or, if you find that you aren’t eligible for a Medicare-covered scooter or wheelchair and can’t afford to buy one, renting may be a much cheaper short-term solution. Talk to a provider about this option.

For more information on electric mobility devices, call Medicare at (800) 633-4227 or visit Medicare.gov/coverage/wheelchairs-scooters.

Advantage of Medicare

If you have a Medicare Advantage plan (such as an HMO or PPO), you will need to call your plan to find out the specific steps for getting a power wheelchair or scooter. Many Advantage plans have specific providers within the plan’s network that they will require you to use.

Send your senior questions to: Savvy Senior, PO Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is an NBC contributor Today show and author of “The wise elder” delivered.

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East Washington Walla Walla Veterans Struggle to Find the Right Mental Health Care | Mental Health https://medicbuzz.net/east-washington-walla-walla-veterans-struggle-to-find-the-right-mental-health-care-mental-health/ Sun, 21 Nov 2021 00:00:00 +0000 https://medicbuzz.net/east-washington-walla-walla-veterans-struggle-to-find-the-right-mental-health-care-mental-health/

Veteran care is a topic very familiar to Cathy McMorris Rodgers.

Along with United States Senator Patty Murray, United States Representative for the 5th District of Washington State has made health care for those who have served in the military a focal point of her campaigns and career in Congress. , with special attention to veterans in eastern Washington.

This includes a long history of keeping tabs on what the Jonathan M. Wainwright Memorial VA Medical Center in Walla Walla is doing to fulfill its mission.

Earlier this month, McMorris Rodgers hosted a panel discussion with veterans from across the region in Spokane. And as a senior Republican on the Federal Energy and Trade Committee – which has jurisdiction over some of the issues surrounding mental health care across the country – she participated in a discussion on women’s mental health and suicide. last week, according to his staff.

During the current session of Congress, McMorris Rodgers helped develop several pieces of legislation addressing the continuing rise in suicide deaths in the veteran population.

These include the following:

  • The Veterans Support and Awareness Commitment Act provides funding to ensure that there is at least one Veterans Support Officer in every county across the country. These officers help veterans with a variety of issues, including obtaining physical and mental health care, as well as the benefits of IL.
  • The PFC Joseph P. Dwyer Peer Support Program Act to require the VA to establish a grant program to support peer-to-peer mental health programs for veterans.
  • Puppies Helping Members of the Injured Service, or PAWS, for Veterans Therapy Act, provide canine companions for veterans diagnosed with post-traumatic stress disorder as part of their treatment plan.
  • The PAWS Act of 2021 establishes a grant program to fund organizations to provide therapy dogs, supplies, veterinary care, and more to the military and their therapy dogs.





Jonathan M. Wainwright VA Medical Center with the Veterans Home in the lower left corner, October 16, 2021.



Staff at McMorris Rodgers’ office in Washington, DC, said the congressman had received a number of complaints about the Walla Walla VA in the past five months regarding services and care. Most related to long wait times and the difficulty of making appointments.

The veterans affairs social worker for McMorris Rodgers has been told by a local VA representative that the medical center is not currently monitoring any concerns about delays in care. His office is awaiting an update on more specific mental health care, staff noted.

Kyle VonEnde, communications director for the congressman’s office in Washington, DC, said in an email that her boss is working to resolve ongoing issues within the federal VA.

Complaints filed at McMorris Rodgers’ offices in Spokane and Colville typically cite the same issues, VonEnde said, including veterans who don’t get prescriptions when needed or get it wrong. In one case, a veteran’s medication was delayed long enough for that person to withdraw.

In another situation, a veteran was supposed to be given two drugs and ended up taking 15 bad ones instead. Part of this is attributed to the confusion over the VA’s online patient portal system; the latest version is not only unknown but less functional than the previous one, VonEnde said.






Suicide Series

Representative Cathy McMorris Rodgers visits the Gold Star Families Memorial near Fort Walla Walla on August 11, 2021.



Not only does this system create dangerous situations for patients, it punishes VA employees who struggle to provide excellent care, he said.

In March, McMorris Rodgers called for a review of the electronic health records system after more complaints came from veterans in eastern Washington, a request that was immediately accepted by the federal VA. At the end of June, the review revealed issues that now need to be addressed before this system is used at other AV sites.

The challenges big and small to receiving health care add to the additional mental health burden veterans can carry, experts say.

McMorris Rodgers sees it again and again.

“I keep hearing from veterans in eastern Washington who feel like they don’t matter or don’t have a voice. They are desperate and feel lonely. Some struggle with PTSD and other mental health battles. Others are grieved by the failure of the US withdrawal from Afghanistan, ”she said.

“Still more are simply overcome by the burden of returning to civilian life. “

Veterans need the help they’ve earned, and it is America’s responsibility to provide that care, McMorris Rodgers said, adding that Congress must reaffirm its support and redouble its efforts to ensure the best care and benefits for those who have served their country.

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Grateful? Remember to thank these organizations with your donation https://medicbuzz.net/grateful-remember-to-thank-these-organizations-with-your-donation/ Sat, 20 Nov 2021 15:30:00 +0000 https://medicbuzz.net/grateful-remember-to-thank-these-organizations-with-your-donation/

When the sun goes down and the holiday lights sparkle, the peninsula is a place of celebration. But the holiday can mask a very real need that some families in the region face for basic services. With a local poverty rate of 12.6% according to Data USA, affected residents have created charities to help their neighbors.

These organizations work quietly throughout the year to put food on tables, dress residents, heat homes, feed school children, house veterans, keep pets alive, deliver free medical supplies. and providing a long list of goods and services otherwise out of reach for more than one in eight people living here.

In addition to the charities listed below, other nonprofits in the area would welcome a donation or your time and effort to help them in their work.

Many organizations accept donations through their websites. And if you want to donate throughout the year, consider signing up for Amazon Smile, which donates a portion of your Amazon spending to the charity of your choice. Find more information on https://www.aboutamazon.com/news/community/how-to-sign-up-for-amazonsmile

Boothbay region pantry

Provides a week of food for families in need. Donations of non-perishable food accepted, complemented by contributions from Hannaford Super Markets, local schools, YMCA and other local organizations. Open every Friday from 11 a.m. to 1 p.m. Accessible from the parking lot behind Boothbay Harbor Congregational Church, Townsend Avenue. Contact 350-2962. Send your donations to: PO Box 63, East Boothbay, ME 04544.

Boothbay VETS Inc. (Temporary Emergency Shelter for Veterans)

Provides safe and secure short-term shelters for homeless veterans who do not have immediate access to shelter. Each trailer is equipped with a bed, microwave and refrigerator. Contact 252-9310. To donate: PO Box 402, East Boothbay, ME 04544. https://boothbayvets.weebly.com/contact.html

Veterans in Need of Maine (MVN)

Assistance to the homeless and other veterans in need when official organizations cannot be contacted or cannot provide assistance. MVN can quickly provide a hotel room, Hannaford food cards, Irving gas cards, Trac phone cards, and other temporary aids. Relies only on donations. Contact David Patch 751-5672. To donate: Send a check for MVN to PO Box 264, Brunswick 04011

Meals on Wheels from the Boothbay region

Volunteers deliver meals between 9 a.m. and noon Monday through Friday for in-home clients unable to provide for their own nutritional needs. A volunteer run operation not affiliated with the Federal program, Meals on Wheels charges $ 5 per meal and $ 2.50 for those who cannot afford the full price. Contact Pat Wheeler at 350-6754. To Donate: Send Boothbay area Meals on Wheels checks to Peggy Peters, 82 Oak St., Boothbay Harbor, ME 04538.

Sustainable medical equipment program (the community center)

This program provides durable medical equipment free of charge to area residents. The equipment includes canes, wheelchairs, hospital beds, Hoyer and other elevators and much more. Equipment can be obtained from the Community Center or the Nathan Pharmacy, both located in the Meadow Mall. Contact Shawn Lewin at 478-5874 to donate used medical equipment.

Action for animals

Help people in desperate need of financial assistance pay for their pets’ medical care. Also provides pet food for emergencies. Contact 350-1312. To donate: PO Box 238, Boothbay Harbor, ME 04538. https://www.actionforanimalsmaine.com/

Rebuild together

Volunteers work together to help homeowners make repairs they are unable to financially or physically in order to keep their homes safe and warm and to enable them to live independently. Skilled and unqualified volunteers are needed. Contact 380-5719. To donate: PO Box 22, Boothbay Harbor, ME 04538. https://www.rebuildingtogether-lc.org

Free clothes closet

A program of the Boothbay Area Co-operative Parish, the free clothing closet is located behind the First United Methodist Church in Boothbay Harbor and is open to those in need Wednesdays and Saturdays between 10 a.m. and 4 p.m. Clothing can be left in the container behind the church at 81 Townsend Contact avenue: 633-2131. Donations can be sent to: PO Box 641, Boothbay Harbor, ME 04538.

Boothbay Area District Nurses Association

Since 1952, the District Nurse has provided residents of the area with one-on-one nursing support that is not usually covered by health insurance, so patients can stay safely in their homes. These services are coordinated with the doctor and include the management of medications, blood pressure tests, lab work and more. Fee of $ 10 per visit unless patients are unable to pay. Contact 633-5533. To donate: PO Box 554, Boothbay, ME 04537.

Boothbay area health care

Provides a range of health and wellness programs to area residents and visitors six days a week at its Meadow Mall facilities. Boothbay Area Health Care offers family medicine, acute care, preventive care, pediatric care and women’s health care services, among others. Contact 633-1075. Donations can be sent to: 185 Townsend Ave., Boothbay Harbor, ME 04538. https://boothbayhealthcare.org/

Community Resource Council

Provides information, referrals and resources to local people in need through its Community Browser and other programs, including:

The Combustible Fund – Support and referral for domestic heating needs from November 15 to April 15.

Groundhogs – A “wood bank” that provides inexpensive or even free firewood to low-income individuals and families who depend on firewood for their fuel.

Food for Thought – Healthy, nutritious snacks that are kid-friendly and easily accessible for families in need are delivered by volunteers to homes across the region every Friday.

Contact 633-6272. Donations can be sent to: PO Box 43, Boothbay Harbor, ME 04538

Community browser

A free and confidential service designed to help families on the peninsula meet basic needs by connecting community members with available resources. Contact 350-1743 or email: hannah.corkum@crcboothbay.org. Learn more about https://youtu.be/WJKA1V58Nbk

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How can we improve health care for the homeless? https://medicbuzz.net/how-can-we-improve-health-care-for-the-homeless/ Fri, 19 Nov 2021 23:00:59 +0000 https://medicbuzz.net/how-can-we-improve-health-care-for-the-homeless/

Building trust, ensuring continuity of care and doing no harm are key principles for improving health care for homeless or “homeless” people, experts said at an online briefing hosted by the Alliance for Health Policy Wednesday.

“Trust is a big issue” among the homeless, said David Peery, JD, co-chair of the National Consumer Advisory Council and the National Homeless Health Care Council, who himself spent time to live in the street.

People who have lived on the streets are both emotionally and physically traumatized by the experience, and they often see the institutions and professionals upon which others inherently depend – including the police and doctors – as predators, Peery said.

One of the reasons for this mistrust may be the criminalization of homelessness or the interference with the “life activities” that homeless people engage in – sleeping, eating, camping, asking for money – through activities such as “sweeping” of camps and prohibiting begging.

Peery illustrated with examples from Miami how the criminalization of homelessness can have a significant impact on health.

“We documented cases of a woman having seizures in the street because her medicine had been thrown away by city workers hours earlier, and… of people with disabilities, who had their own walkers and wheelchairs. … Thrown… away, ”he said.

In other parts of the country, decades of outreach and a patient-centered approach have helped build trust with the homeless.

Street medicine

About 75% of people living on the streets of Boston have been vaccinated against COVID-19, said Jim O’Connell, MD, president and founder of the Boston Health Care for the Homeless Program (BHCHP) and assistant professor of medicine at Harvard Medical School. .

He said there was nothing magical about Boston’s radiance; vaccines were accepted by people living on the streets simply because they were given by people who had known them for years.

In the early 1980s, the city of Boston obtained a grant from the Robert Wood Johnson Foundation to set up a health care program for the homeless. A stipulation of the grant was that the homeless should be included as stakeholders in the planning of the program.

Patients living on the streets stressed the importance of continuity of care, telling doctors at the time, “We want you to do this as your profession and not as something you do just as a temporary thing that you do. move on. [from]”said O’Connell.

Of the approximately 40 physicians currently working at BHCHP, most started out as residents or medical students and have stayed there. O’Connell, who himself had planned to work for a year and then move on to an oncology fellowship, also stayed.

Each doctor works alongside a nurse practitioner or medical assistant, and today also with psychiatrists and recovery coaches, all serving the same panel of patients. All providers who encounter patients on the street must be accredited at one of the two main hospitals – another level helping to promote continuity of patient care, as this reduces the need for a referral to another clinician in the hospital. hospital.

Additionally, because consumers asked for care teams who met them where they were, the delivery model involved doctors running a clinic in the hospital during the day – as shelters are typically closed during the day. – then in shelters and streets in the afternoon. and evenings.

For O’Connell and other doctors, meeting patients where they were also meant going on night rides with peers (people with lived experience of homelessness) in a van giving homeless people soup, sandwiches and blankets. Handing out these articles, O’Connell was casually saying to anyone he met, “By the way, if you need anything, I’m a doctor.”

This “backdoor” tended to function both as a way to provide care and to build confidence, he said.

Medical respites

One of the challenges hospitals across the country face on a daily basis is getting homeless patients out after their care is complete.

“We have documented cases in which someone who was sent back to the street has died, several cases… literally, right across the street or right next to the hospital,” Peery said.

He noted that laws and regulations advise against, and in some cases penalize, hospitals for discharging homeless people who “are not sick enough to be kept in acute short-term care, but are far too sick. to take care of themselves on the streets. “Despite all the efforts of case managers and discharge planners to find transitional care sites, homeless people are still being released with nowhere where to go.

One solution has been medical respites, which go beyond a simple transitional space and offer a number of benefits, explained Barbara DiPietro, PhD, senior director of policy at the National Health Care for the Homeless Council.

O’Connell had launched the first medical respite in the early 1990s. The first programs functioned primarily as AIDS units during the height of the HIV epidemic, he noted.

Today, medical respites provide a gateway for patients to primary care and behavioral health resources, giving clinicians time to develop a care plan and learn how to better manage patient medications for any chronic illness. .

As a result, these facilities have been associated with better patient outcomes, shorter hospitalizations and lower readmission rates, leading to lower costs across the healthcare system, DiPietro said.

Peery noted that Miami medical professionals were looking to replicate this pattern.

Expanding access to care, reducing harm, housing

Panelists presented the expansion of Medicaid as another way to support and improve care for the homeless.

“The failure to expand Medicaid is not just a moral failure, I would say, but also a public health failure,” said Peery, who lives in Florida, one of 12 states that have no further extended Medicaid eligibility to adults under age 65 whose income is at or below 138% of the federal poverty line.

In addition to consistent continuing care, relationship building and Medicaid eligibility, harm reduction is essential to help provide effective care to people living on the streets, the panelists said.

Through programs aimed at reducing the risk of drug overdose or contracting HIV and hepatitis C, harm reduction may involve providing homeless people with needle exchange services, fentanyl test strips and naloxone (Narcan).

There are also other innovations such as safe consumption sites or safe injection sites that “reduce harmful behavior and keep people alive so that we have another day when we can do the awareness needed to do this.” connect them to care, ”said DiPietro.

One principle that can be lost but which perhaps transcends all other models is the simple idea that “stable housing is important for stable health,” said DiPietro.

Research suggests that the homeless have much higher rates of diabetes, high blood pressure, and other chronic conditions than the general public. In addition, poor health can lead to homelessness, as medical debts can cause a person to lose their housing and access to health care.

“So when we say ‘housing is health’, that’s where we come from,” said DiPietro. “Nothing we do with health care providers works as well if someone returns to the shelter or under the bridge or to the camp. “

  • Shannon Firth has worked on health policy as a correspondent for MedPage Today in Washington since 2014. She is also a member of the site’s Enterprise & Investigative Reporting team. To follow

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