JFActivist

Lawmakers Questions Competitive Bidding

From The Wall Street Journal (May 6):

Lawmakers Question Medicare Bidding Plan
By ANNA WILDE MATHEWS

Members of Congress are expressing concern and scheduling hearings about a Medicare plan to use competitive bidding for products such as wheelchairs and walkers, in a sign that lobbying by medical-equipment companies is gaining traction.

Currently, companies receive a government-set fee to distribute such equipment for patients' home use. Under the competitive system, companies bid on how low a fee they would be willing to accept. Medicare then limits distribution rights for a particular geographic area to several low bidders.

An experiment with competitive bidding, mandated by a 2003 law, is starting in 10 cities this July. It is expected to expand to 70 more cities including Los Angeles and New York next year. The project involves ten categories of medical products, among them power wheelchairs...

...Read more.

Websites to Expand Ratings on Nursing Homes

From The Wall Street Journal (April 24):

Web Sites Expand Rating Information On Nursing Homes
By ANNA WILDE MATHEWS

The federal government on Thursday plans to identify some of the most troubled nursing homes in its public database, part of a trend toward giving consumers easier access to a trove of nursing-home information online.

That trend could accelerate if Congress passes a bill introduced this year that would force more nursing-home data into the public domain....

...Read more.

On Medicare and Scorned by the Docs

From The Washington Post:

On Medicare and Scorned By the Docs

April 6, 2008
By Martha M. Hamilton

When Pamela Baldwin moved from the Washington area, she never thought she would have trouble finding a doctor who would accept her as a new Medicare patient.

A former attorney with the Congressional Research Service, Baldwin was happy with her decision to relocate to a suburb of Raleigh, N.C. Housing costs were lower, and she was near one of her sons. But the move came with a distressing side effect.

When she had lived in the Washington area, she was comfortably established with all the doctors she needed.

"When I moved down here, I thought the only difficulty would be in finding good ones," she said. "But it turned out that I would call a place and say, 'I have Med -- ' and they wouldn't even let me finish."...

...Read more.

 

Medicare's Financial Woes

From The New York Times:

Medicare's Financial Woes

EDITORIAL

March 28, 2008

Warnings that Medicare spending is growing at an unsustainable rate come with mind-numbing regularity, so it was no surprise that the latest report from the Medicare trustees found that the system is still headed for a financial abyss. Medicare’s problems get scant attention on the campaign trail but will demand strong corrective action by the next president.

The latest report by the trustees, all top officials of the Bush administration, contained the same bad news as last year’s report. The trust fund that pays hospital bills is expected be exhausted by 2019, leaving Medicare to limp along with payroll tax collections that would cover only 78 percent of estimated hospital expenditures....

...Read the rest of the editorial.

The Worst Nursing Facilities - Come on CMS

From Steve Gold:

The Worst Nursing Facilities
Come On CMS - Information Bulletin #242 (3/08)

CMS issued a report on 2/13/08 identifying the 131 worst nursing facilities in the country. To make this honor role:

(1) these facilities had at least twice as many deficiencies as the average number of average deficiencies than other nursing facilities in the quality of care they provided; (2) they had more serious problems than other nursing homes ("serious problems"are those, by definition, that actually cause harm or injury to residents), AND (3) they had a pattern of these "serious problems" that persisted over approximately three years.

One would think that such nursing institutions would have been shut down well before three years! Or at least, CMS would have disallowed federal Medicaid and Medicare funds to continue to flow to them. Can one imagine how afraid older Americans and other residents with disabilities must be in these institutions? They see and know these "serious problems" pervade the nursing facility where they are, and they must live in constant fear that they will be the next "serious problem" even though many want to return to the community with appropriate services.

Can anyone imagine the CMS officials or our esteemed federally elected officials letting their mothers or brothers or children stay in these institutions for any length of time, let alone three years?

One might think that our federal Medicare and Medicaid dollars would have been stopped as soon as a nursing facility caused one "serious" harm or injury to residents. Without any question, when "serious problems" persist for more than one inspection, the dollars should have been stopped. But they continue.

What will it take to stop spending our federal dollars in nursing institutions that cause "serious" harm and injury to older Americans and people with disabilities? Maybe if CMS officials will not impose serious penalties we should ask them to spend some time in these institutions as "residents." Let them have to live in these nursing institutions and be potential victims of "serious problems." Such an experience might even push them to opt for community-based services as an entitlement.

Maybe CMS should tell us how many residents need to be seriously injured or harmed before a nursing facility loses its Medicaid and Medicare funds. Is there a magic number?

Of the 131, here are the 52 worse nursing facilities that have not improved but still receive Medicaid and Medicare funds. (Some of the 131 "improved" in one inspection but have not sustained improvement for 12 months.)  Let's remember these 52 are only the tip of the worst..

Disability and Older American advocates could check out the mortality/morbidity rates in these nursing facilities.  Do your newspapers know these esteemed nursing facilities have made the CMS "worse" list?

You could even determine what, if anything, your state Health Department (or whatever is the nursing home inspection unit in your State)  has done to monitor or impose sanctions on these dangerous institutions.

Eastview Health Care Center,        Birmingham, AL
Medi-Home Inc,              Fort Smith AR
Infinia At Show Low,                Show Low, AZ
Evergreen Foothills Health & Rehab,     Phoenix, AZ
Ember Health Care - Pomona,     Pomona, CA
Pleasant Care Rehab & Nursing Center, Santa Cruz, CA
Eagle Ridge at Grand Valley,            Grand Junction, CO
Kindred Healthcare & Rehab,     Northgleen, CP
Apollo Health & Rehab,          St. Petersburg, FL
Key West Conv Center,           Key West, FL
Polk City Nurisng & Rehab,          Polk City, IA
Cedar Falls Health care,             Cedar Falls, IA
International Village,              Chicago, IL
Berkshire Nursing & Rehab Center,       Forest Park, IL
Hillcrest Center for Heath & Rehab,     Jeffersonville, IN
St. Jospeh Care Center - west,       South bend, IN
Valparaiso Care & Rehab center,       Valparaiso, IN
Deseret Nursing & Rehab,             Colby, KS
Highlands Nursing,                Louisville, KY
Cambridge Place,             Lexington, KY
Cedar Hill Health Care,          Randolph, MA
Harborside Healthare,                Wakefield, MA
Fairlane Senior Care,                Detroit, MI
Imperial Healthcare,             Dearborn Heights, MI
Metron of Big Rapids,                Big Rapids, MI
West Village Manor,              Columbia, MO
Senior Estates,                   Kansas City, MO
St. Elizabeth Healthcare,             Florissant, MO
Evergreen Missoula,              Missoula, MT
Infinia Att Florence Heights,            Omaha, NE
Victoria Health Care Center,          Matawan, NJ
Fort Bayard Med Center,          Fort Bayard, NM
Northwoods Rehab ECC Hilltop,        Niskayuna, NY
Geriatric Center of Mansfield,       Mansfield, OH
Woodlawn Health Care,             Pawhuska, OK
Northwest Nursing Center,             Oklahoma City, OK
Hometown Nursing,                Tamqua, PA
Ashton Hall,                 Phila, PA
Brighten at Broomall,                Broomall, PA
Unihealth Post Acute (formerly     Manolia Manor),          Moncks Corner, SC
Bennett Co. Hosp & Nursing,       Martin, SC
Overton Park Health care,             Memphis, TN
Taylor Care,                 Taylor, TX
Renaissance at Kessler Park,          Dallas, TX
Bennner Healthcare,              Houston, TX
San Saba Nursing Home,           San Saba, TX
Ruston Health of Woodbridge,     Woodbridge, VA
Frontier Rehab & Ext Care,           Longview, WA
Franklin Hills Health & Rehab,        Spokane, WA
Willows Nursing and Rehab,           Sun Prairie, WI
Middleton Village Nursing Rehab,     Middleton, WI

Medicare Package Addresses Disability Rights Priorities

From the Coalition to Preserve Rehabilitation, of which AAPD is a Steering Committee Member:

 
After months of debate, Congress approved a Medicare "extenders" package just before the holidays which is expected to be signed by the President shortly and addresses three top disability rights priorities.

Medicare's 75% Rule:  The legislation approved by the House and Senate will permanently freeze implementation of the 75% Rule at the 60% level as well as allow comorbid conditions to continue to count toward meeting the rule's threshold. Additionally, the bill requires that HHS study beneficiary access to inpatient rehabilitation services and make recommendations for classifying inpatient rehabilitation hospitals and units. These provisions constitute a huge victory for disability advocates!
 
Medicare's Outpatient Therapy Caps:  The Medicare extenders package will extend the current exceptions process for Medicare's cap on outpatient rehabilitation therapy services through June 30, 2008.  While this is not the longer-term fix the Coalition advocated for this year, it does allow continued access to outpatient rehabilitation therapy for individuals who need it most, and Congress is likely to address this issue again before this extension expires in six months.

Medicaid Rehabilitative Services Option:  The bill places a six-month moratorium on issuance of final regulations to restrict allowable services under the Medicaid Rehabilitative Services Option. Again, while this is not the longer-term moratorium the Coalition had promoted, it does allow advocates additional time to work with Congress to prevent final implementation of this harmful regulation. 

Tell the Senate to Stop Medicare's Quota-Based Inpatient Rehab Rule!

******ACTION ALERT*******

Tell the Senate to stop Medicare's quota-based inpatient rehab rule!

Medicare is phasing in a rule (the "75% Rule") that restricts access to inpatient rehab services for people with disabilities, injuries, or chronic conditions who need these services.

Without access to an appropriate rehab, many of these people wind up in nursing homes where they receive a lesser level of care, which often impedes or prevents independence and a return to home and community!

This week, the Senate has an opportunity to fix this damaging rule, and we need your help to send a strong message!

BACKGROUND:

Medicare's "75% Rule" is restricting access to inpatient rehabilitation by requiring inpatient rehab hospitals or units to maintain a particular percentage of patients with one or more of 13 arbitrary conditions.

Even if a doctor finds it medically necessary for someone to receive inpatient rehab, an inpatient hospital or unit may have to deny that person access if he/she does not have the "right" diagnosis.

This could mean the difference between returning to the community and being forced into institutional care.

Stopgap legislation has been introduced in the Senate (S. 543) that would prevent this rule from causing even greater access problems.

ACTION:

Check this list for the current cosponsors of S. 543.   If your Senator is a cosponsor, please call the Capitol switchboard at 1-888-281-0661 and thank them for cosponsoring and ask them to push for the bill's inclusion in the Senator Finance Committee's Medicare bill.

Tell them that the 75% Rule restricts access to necessary inpatient rehab based solely on diagnosis rather than on total rehabilitative need.

Tell them that people with disabilities don't want to be shuffled into nursing homes because of Medicare's quota system for inpatient rehab.