OREGON — Lawmakers are hoping an ounce of prevention is worth a pound of cure for the state’s ailing Medicaid program. Additionally, its plan to push seniors’ wellness programs is being eyed as a potential reform model following the Obama administration’s $1.9 billion pledge to help it succeed.
Gov. John Kitzhaber (D), M.D., a former ER physician, hopes the plan to push preventative care would spare the state from future Medicaid cuts while preserving quality of care.
If the government makes good on its pledge, both it and the state stand to save $11 billion through 2022 through fewer duplicated treatments and avoidable hospitalizations. The Oregon plan could establish “coordinated care organizations” to manage the care of the sickest Medicaid recipients and provide caseworkers to ensure they take their medications and honor medical appointments.
Bundled pay for joints OK’d
TENNESSEE – Health systems and a major Tennessee insurer are establishing a bundled payment system for joint replacements in anticipation of payment reforms centering on coordinated care.
Under a contract announced in May, BlueCross BlueShield of Tennessee will give four orthopedic provider partners a set payment amount for the entire episode of care for total knee and hip replacements, including the surgery, post care and physical therapy, according to the insurer. The system will start Oct. 1.
The insurer said the plan is consistent with Affordable Care Act payment reforms that encourage partnerships between providers and payers to improve patient care quality and clinical outcomes. The participating practices involved are Vanderbilt Medical Group and Tennessee Orthopaedic Alliance in Nashville, Campbell Clinic in Memphis and the Knoxville Orthopedic Clinic.
Vets’ care pay recalled
GEORGIA – Servicemen and women in state-run nursing homes will have to surrender their daily federal stipend for medical care under a new state law that requires the Veterans Service Board to set a fee for such long-term care services.
Until now, Georgia was the only state to not charge veterans for nursing home care. The fee allows the state to apply the $23 daily stipends toward care costs. Even though the plan is a zero-sum game, veterans are not happy about losing their benefit. Georgia Commissioner of Veterans Service Pete Wheeler said the fee allows the state to offer more services for veterans.
Managed care eyed
WEST VIRGINIA – The latest state to consider managed care as a way to stem runaway costs for the most chronically ill Medicaid patients is West Virginia. Officials said they hope the plan will save $15 million a year in prescription and medical expenses.
Approximately 57,000 residents, mostly low-income seniors and people with disabilities, will join 170,200 Medicaid recipients already being cared for under managed care plans.
The managed care plan will be rolled out gradually, according to Commissioner Nancy Atkins of the Bureau of Medical Services. About a third of Medicaid recipients in the state are elderly, blind or disabled whose care accounts for nearly 75% of the program’s costs. The plan is the latest measure the state is employing to stem Medicaid costs. Additionally, West Virginia recently adopted the medical home concept and physician-sponsored care networks.
I.D. thefts bring arrests
FLORIDA – Law enforcement officials say they are baffled at how easily 19 people allegedly stole the identities of nearly 400 nursing home residents while pocketing almost $500,000 in fraudulent income tax refunds.
Among those charged in the scam were two certified nursing assistants who allegedly stole the personal financial information of 83 residents of one Polk County nursing home and received nearly $90,000 in tax refunds.
Police say their investigation continues and caution that the 19 arrests may be just the tip of the iceberg.
Sprinkler mandate looms
NEW YORK – An Albany County nursing home has until August 2013 to raise more than half a million dollars in state funds to upgrade its sprinkler system. Meanwhile, lawmakers are debating whether a new replacement facility should be built.
It is a quandary besetting many states struggling to shore up sagging healthcare budgets while honoring a costly federal mandate that all nursing homes install or upgrade their sprinkler systems to meet “Life Safety Code” requirements. The federal requirement, which carries stiff penalties, stems from a rash of nursing home fires that resulted in several deaths dating back to 2003. Most recently, a fire at an Indiana nursing home sent 18 people to the hospital.
A majority of lawmakers favor construction of a new $71 million, 200-bed nursing home. But state health officials have tabled the plan over budget concerns, as well as projections the new facility could lose as much as $26 million per year. Meanwhile, some industry officials have warned that a substantial percentage of nursing homes across the nation are woefully behind in plans to meet the federal mandate.
Resident’s son must pay bill
PENNSYLVANIA – With their financial backs against the wall, nursing homes nationwide are being forced to seek alternative means to stem seas of red ink. In Pennsylvania, a courtroom drama has pitted a former resident’s son against an antiquated, rarely used provision that allows facilities to recoup unpaid bills from family members.
The man’s mother, now 66, spent six months in an Allentown nursing home recovering from injuries she sustained in a car accident.
While her unapproved Medicaid application made its way through the bureaucracy, the woman left the home, and the country, as well as a $93,000 bill. The state sued the woman’s son under its “filial responsibility statute.”
An appeals court recently upheld a decision forcing the man to pay. He argued that his mother was not indigent at the time of her stay, and that the home’s suit against him was unwarranted. The filial statutes date back 400 years to Poor Relief laws in England.
Federal law protects families from having to pay nursing home bills of family members who have been approved for Medicaid. Thirty states have filial statutes on the books, but until recently, few have resorted to using the provision to recover unpaid bills.
CO detector exemption
RHODE ISLAND – While nursing homes nationwide grapple with a looming federal mandate to install or upgrade sprinkler systems, facilities in Rhode Island are exempt from requirements to install carbon monoxide (CO) detectors.
State officials told a local television news reporter a CO detector provision was skipped for nursing homes and hospitals when the state recently updated a law requiring them in other places such as hotels and college dorms.
There is no federal provision.
While no nursing home deaths attributable to the deadly gas have been reported in the state, the absence of such relatively inexpensive life-savings devices has some fire officials worried. Ironically, Rhode Island reportedly has among the strictest fire codes in the country.
The Rhode Island Health Care Association and the Alliance for Better Long Term Care told the reporter they would support a CO law for nursing homes.
Name game irks lawyers
ILLINOIS – It could take a year or more to unravel a mind-boggling game of musical chairs that has impeded discovery of the true owner of an Oak Park nursing home where an 80-year-old dementia patient died after an alleged assault by another resident.
Attorneys for the resident’s family, who have filed a wrongful death lawsuit stemming from the incident, say it is a common practice for troubled nursing homes to change key ownership contact information in order to conceal troubled histories.
Steve Levin, the plaintiff’s attorney, said many nursing homes are family-owned businesses.
New nurses struggling
MINNESOTA – Nurses are extending their working years while hospitals and nursing homes keep staffs lean, stifling the efforts of new nursing graduates to gain full-time employment, a Minnesota Public Radio report has found.
MPR profiled the frustrations of one recent graduate, who pursued his degree largely based on the success of a relative who was offered large signing bonuses and attractive benefits when she was hired out of school a decade ago. That was when the nurse job to vacancy rate in the state was twice as high as the rest of the job market. The graduate currently works part-time in a nursing home, as he has since entering the field in 2008.
While the number of nursing positions is shrinking, colleges continue churning out graduates, leading to an unprecedented surplus of labor, the report’s authors say.
The current trend flies in the face of recent predictions. A national shortage of as many as 1 million nurses was projected by 2020. Additionally, nurses are still in high demand at many long-term care facilities.
Stricter Medicaid eligibility
WISCONSIN – Close to 17,000 residents are in jeopardy of losing benefits after the state overhauled its BadgerCare program.
The program provides family-based insurance for uninsured families who are between current Medicaid limits and 185% of the federal poverty level. While Gov. Scott Walker’s (R) original proposal would have affected up to 64,000 state residents, the Center for Medicare & Medicaid Services’ said he could proceed with only some changes. The cuts will allow the state to save $28 million a year.
State Health Department Secretary Dennis Smith said the revised eligibility rules would not affect the state’s current safety net provisions for low-income individuals.
The changes include higher premiums on a sliding scale basis, denied benefits for individuals who don’t pay their premiums and an affordability test for program participants who have access to employer-sponsored health insurance.
Many of the changes went into effect July 1. Critics of the changes say those on BadgerCare either have jobs that don’t provide health insurance, or have expensive plans with inadequate coverage.
Medical pot abandoned
COLORADO – Hundreds of nursing homes in the state are baffled by a maze of laws, regulations and patient rights provisions that confound administrators when it comes to authorizing medical marijuana in their facilities. Many are choosing to forbid its use to avoid legal problems, liability issues and potentially poor public relations, according to a Denver Post report.
Federal law allows the use of medical marijuana to treat eight medical conditions among nursing home residents, the article noted.
Many of those facilities that do allow its use treat it as any other controlled substance but require its administration in pill form or baked into food.