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‘Health – Continuity of Care’

Medicare Lags In Project to Expand Hospice

Despite a three-year-old order from Congress, Medicare has yet to begin an experiment to expand hospice services to allow beneficiaries to continue potentially lifesaving treatments to see if it would save money while improving the patients’ quality of life.

The demonstration project would eliminate one major reason that people are reluctant to take up Medicare’s hospice benefit: they have to first agree to forgo curative treatments such as chemotherapy.

Nurse Rachel Haenel embraces terminally ill patient Jackie Beattie, 83, at the Hospice of Saint John in 2009 in Lakewood, Colorado. A demonstration project would allow those getting hospice care under Medicare to also receive curative care at the same time (Photo by John Moore/Getty Images).

Many rapidly declining patients delay entry into hospice until their final days as they exhaust their treatment options, according to studies.

Others end up dying in hospital intensive care units, which are expensive and generally not geared to making the terminally ill as comfortable as possible.

The 2010 health law required Medicaid to pay for joint hospice and curative treatments, called concurrent care, for children. More than half the states have taken steps to implement that in the joint federal-state program for low-income residents. It also instructed the secretary of Health and Human Services to select up to 15 sites to test concurrent care for patients in Medicare, which provides health coverage to seniors and disabled people. That test is to last for three years, but Medicare has yet to take any concrete steps toward beginning it.

Read more at Kaiser Health News: Medicare Lags In Project to Expand Hospice

Nevada SMP empowers seniors to prevent Medicare Fraud

Lee Jordan

Lee Jordan, Outreach Coordinator, Nevada Senior Medicare Patrol, displays a Personal Health Care Journal. His office distributes these to Medicare recipients at no cost.

Every day consumers get ripped off by scam artists. Here is just one example: Mr. Jones has Medicare. One evening he received a phone call from a woman who identified herself as a Medicare representative. The woman told Mr. Jones that she could save him hundreds of dollars each month by signing him up for the new Medicare Prescription Drug Coverage. Because Mr. Jones spends about $300 a month in drug charges, he was anxious to join.

The woman said she could sign Mr. Jones up over the phone. She asked him for his Medicare and checking account information, and he gave them to her.

By the next morning Mr. Jones realized that he should not have given out his personal information. He contacted his local Senior Medicare Patrol (SMP) who helped him contact his bank, the local police and Medicare. Mr. Jones was almost a victim of Medicare fraud, but thanks to SMP, he was not.

Protecting your personal information is the best line of defense in the fight against healthcare fraud and abuse. You can make a difference. Fraud occurs when a person or organization deliberately deceives others to gain unauthorized benefits.

In the case of Medicare and Medicaid, fraud generally involves deliberately billing for services that were never rendered or for over-billing, such as charging a higher rate than is actually justified. The Centers for Medicare and Medicaid or CMS, estimated that in 2010, the two programs together paid more than $65 billion in improper federal payments. An April 2012 study by a RAND Corporation analyst and a former CMS administrator estimated that fraud and abuse cost Medicare and Medicaid as much as $98 billion in 2011.

In addition to the cost, Medicare fraud can jeopardize a patients’ health. Anecdotally, there was a recent case in which a woman reported that her doctor refused to see her because Medicare had flagged her for overuse. It turns out thieves had gotten hold of her Medicare number and had fraudulently billed Medicare for 40 visits in one day.

To prevent Medicare from losing valuable funds, it is incumbent on all of us to report any suspected instances of error, fraud or abuse. The Nevada SMP can provide you with a Personal Health Care Journal in which to keep your healthcare services and the dates on which they occurred. To obtain a personal use journal, call the telephone number below.

When you receive your Medicare Summary Notice or Explanation of Benefits, review it carefully. Did you receive the services and products reported? Did your doctor order the services/products listed? Were you billed more than one time for the services performed or products provided?

When you find and report abuse, you are protecting other seniors from being victims. If you are not comfortable calling your provider or if you are not comfortable with the response you get, call your local SMP at 702-486-3403 or 888-838-7305 (statewide).

Community Health Expo on April 25th


CMS softens Medicare Advantage funding changes

Medicare Advantage customers may not see the drastic benefit cuts or premium hikes next year that insurers have been warning about after all.

Health insurers had predicted big, painful changes for many of their Medicare Advantage customers after the federal government said in February that the amount it pays per person for the popular coverage could fall more than 2 percent in 2014.

The Centers for Medicare and Medicaid Services then changed course on Monday and said it now expects that the cost per person to climb more than 3 percent.

“That’s a huge positive” for the industry, said Sheryl Skolnick, an analyst who covers health insurers for CRT Capital Group.

The shares of several health insurers rose sharply in extended trading Monday following the CMS announcement. Medicare Advantage plans have become a key source of growth for insurers, which receive about $10,000 per member to provide customers with basic Medicare coverage topped with vision or dental coverage, or premiums lower than standard Medicare rates.

Insurers offer hundreds of different Medicare Advantage plans around the country, and they flood TV airwaves each fall with commercials during the annual open enrollment period for the popular plans.

More than 13 million people were enrolled in Medicare Advantage plans last year, or about 27 percent of the Medicare population, according to the Kaiser Family Foundation. That total has nearly doubled since 2006.

Read more at Yahoo News: CMS softens Medicare Advantage funding changes

Health Care Law Saves Seniors $6 Billion on Prescription Drugs

Seniors saved over $6 billion on prescription drugs as a result of the health care law

As the third anniversary of the Affordable Care Act approaches, Health and Human Services Secretary Kathleen Sebelius announced today more than 6.3 million people with Medicare saved over $6.1 billion on prescription drugs because of the health care law.

“By making prescription drugs more affordable, the Affordable Care Act is improving and promoting the best care for people with Medicare,” Secretary Sebelius said.

The Affordable Care Act makes Medicare prescription drug coverage (Part D) more affordable by gradually closing the gap in coverage where beneficiaries must pay the full cost of their prescriptions out of pocket. This gap is known as the donut hole.

People with Medicare in the donut hole now receive discounts when they purchase prescription drugs at a pharmacy or order them through the mail, until they reach the catastrophic coverage phase.  The Affordable Care Act gave those who reached the donut hole in 2010 a one-time $250 check, then began phasing in discounts and coverage for brand-name and generic prescription drugs beginning in 2011.  The law will provide additional savings each year until the coverage gap is closed in 2020.

In 2013, the health care law increases the discounts and savings to 52.5 percent of the cost of most brand name drugs and 21 percent of the cost of covered generic drugs.

Also under the Affordable Care Act, those who choose to enroll in Medicare Advantage and Part D now have access to a wider range of high-quality plan choices, with more four- and five-star plans than were previously available.  The Affordable Care Act continues to make Medicare more secure, with new tools and enhanced authority to crack down on criminals who cheat the program.

For more information on how the Affordable Care Act closes the donut hole, please visit:

For state-by-state information on savings in the donut hole, please visit:

Stop Infections from Lethal CRE Germs Now

cdc vital signa

From CDC Vital Signs March 2013:
Untreatable and hard-to-treat infections from CRE germs are on the rise among patients in medical facilities. CRE germs have become resistant to all or nearly all the antibiotics we have today. Types of CRE include KPC and NDM. By following CDC guidelines, we can halt CRE infections before they become widespread in hospitals and other medical facilities and potentially spread to otherwise healthy people outside of medical facilities.

  • About 4% of US hospitals had at least one patient with a CRE (carbapenem-resistant Enterobacteriaceae) infection during the first half of 2012. About 18% of long-term acute care hospitals had one.
  • One type of CRE infection has been reported in medical facilities in 42 states during the last 10 years.
  • CRE germs kill up to half of patients who get bloodstream infections from them.

To read more, CLICK HERE.

Who’s Going to Drive Down Costs?


Say what you will about Steven Brill’s Time magazine cover story, Bitter Pill, but it’s hard to deny that it — and his media tour that’s followed — has magnified the discussion about the cost structure and the power plays that happen within the healthcare industry.

An example of that came Wednesday when a Center for American Progress event put Brill on stage with two other opinionated personalities: Dr. Giovanni Colella, the CEO of healthcare transparency company Castlight Health, and Dr. Ezekiel Emanuel, senior fellow at the Center for American Progress and vice provost at the University of Pennsylvania.

The most colorful and thought-provoking discussion sparked when they were asked about solutions for bringing down the cost of care.

Colella, naturally, emphasized the role of price transparency and consumer education in lower healthcare costs. He likened the current approach to consumers paying for a Ferrari but getting a Toyota instead, and implied that a big part of the problem is that consumers don’t actually know what they’re buying when they receive care.

So one approach is giving consumers more transparency and letting competition among payers and providers drive down prices. “I don’t believe in a nationalized healthcare system. From a social standpoint, I like the idea, but from an economic standing, every time we’ve tried to regulate prices, it hasn’t worked,” Colella said. “If you don’t allow a market to set prices, I’m not convinced it’s going to work.” Rather, educating consumers and aligning financial incentives would drive behavior change.

A problem with that, Brill retorted, is that the nature of receiving healthcare often doesn’t allow the time or means for “shopping around.” A patient with chest pain, for example, isn’t going to compare prices on an emergency department visit before going. “There isn’t a fair market today where the individual buyer has any power in the marketplace.”

Americans Underestimate Healthcare Costs During Retirement

Counselling seniors

A new study published in the Journal of Law & Medicine finds that more than half of Americans surveyed have dramatically underestimated the amount of money they will need to cover their healthcare costs during retirement.

The retirement glass is suddenly looking half-empty.

A startling number of Americans who have either recently retired or are about to do so are badly miscalculating how much money they will need to save to cover health care costs, a new study has concluded.

Published in the latest issue of the American Journal of Law & Medicine, the study was the first of its kind to compare the expectations that retirees have about health care spending with estimates based on actual costs.

Even though 60% of current medical costs for retirees are covered by Medicare, the 40% that individuals must pay out of pocket is far above the estimates that most people are anticipating, especially over time. Of the 1,700 people surveyed, 52% said they believed their healthcare costs would be in line with what the bottom 25% of the country pay.

Read more:

Free Vision Forum At Las Vegas Senior Center March 7

vision forum

Free Vision Forum At Las Vegas Senior Center March 7
No-Cost Basic Skills Workshops For Visually Impaired

Living as a blind or visually impaired person is such a challenge! How do you find where you’re going, achieve your potential, or complete your education? Join other visually impaired individuals, their families and those who serve them for a free one-day event with workshops on basic skills and a vendor area with high- and low-technology equipment and community resources. The eighth annual Vision Forum is scheduled for Thursday, March 7, from 8 a.m. to 1:30 p.m. at the Las Vegas Senior Center, located at 451 E. Bonanza Road.  The vendor exhibit area will be open from 8 to 10 a.m. in the adjacent Dula Gym.

Workshop topics will include fitness, nutrition, technology tips, low vision resources, health advocacy, goals, Americans with Disabilities Act guidelines, blindness training, transportation, education and family discussion. The event is sponsored by Blindconnect, the city of Las Vegas, Nevada Council of the Blind and the Veterans Administration Vision Program. Those who pre-register by 5 p.m. Feb. 27 are guaranteed a free lunch, raffle ticket and expedited Paratransit service. Download the registration form and brochure, register at the senior center, or call (702) 229-6454 to register by telephone. Registration March 7 opens at 8 a.m. at the senior center.

Horizon Specialty Hospital to Open Their New Specialty Acute Care Hospital in Henderson

The Valley’s newest Long-Term Acute Care Facility to open soon

Horizon Specialty Hospital will open their new state of the art 38-bed specialty acute care hospital in Henderson at 8550 South Eastern Avenue. Horizon is hiring approximately 130 experienced healthcare workers. The new hospital will complement its existing facility which is located in the Las Vegas Medical District.

“Not only are we bringing an incredible state of the art healthcare facility to the area, we are creating jobs,” says David Tupper, CEO of Horizon Specialty Care Hospital. “Horizon Specialty Hospital culture is one of caring for patients and families with their heart and that is why we are hiring people who believe in and have the Horizon philosophy of patient care.”

Horizon Specialty Hospital is a long-term acute care facility for patients who require extended medical and rehabilitation needs. This new location will allow people who reside in Henderson and the surrounding areas to have easier access to Horizon’s services.

“We have some of the best physicians and clinical staff in Southern Nevada to continue a patient’s treatment plan to ensure full recovery in a comfortable and safe environment,” says Tupper. “We will be hiring over 100 new employees to join this dedicated group of medical professionals.”

The goal of Horizon Specialty Hospital at both campuses is to help patients improve and move to the next appropriate level of care, whether it is skilled nursing, home health services or their own home.

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