Aging, etc.

Medicare: Peeking Into the Database

It’s been an eventful week for Medicare: Not only did the top Medicare official resign, but he’s now publicly stating that as much as 30% of ALL Medicare spending is wasted.  This means that, in his words, as much as $250 billion per year is wasted by Medicare and Medicaid. 

Chief Dr. Donald Berwick stepped down because Senate Republicans did not confirm his recess appointment which was about to expire. In an interview with the New York Times Berwick said that between 20 percent and 30 percent of health spending is wasteful.  The five reasons for the “extremely high level of waste” include overtreatment, little coordination of care, fraud, a complex health care system and regulations that are pointless and archaic. Berwick defines waste as “activities that don’t have any value” and estimates that Medicare and Medicaid could save between $150 billion to $250 billion a year by eliminating waste.

Hopefully, Marilyn Tavenner, a top official at the agency, who has taken Berwick’s place will continue efforts to reform the system. She’s off to a good start. In a major policy shift the Department of Health and Human Services implemented a provision to make the Medicare claims database available to the public. The massive Medicare database is considered the mother lode of medical information for the U.S. health-care system. The computerized record itemizes medical bills for 48 million beneficiaries.

Nationwide, an assortment of 25 groups will be granted access to the data. These groups are working to improve health care at the local level and will be comprised of doctors, health insurers, businesses, consumers and government agencies. They will analyze, study and publish results on procedures, hospitals and doctors in order to help consumers make better-informed decisions about their care.

However, opening the $500 billion data base to 25 groups is merely the opening act of a more transparent system. The Wisconsin Collaborative for Healthcare Quality, one of the groups selected, discovered daunting challenges due to both mechanical problems as well as the sheer complexity of the information involved in a recent Medicare project.

Marilyn Tavenner says she is striving to “ensure consumers have the access they deserve to information that will help them receive the highest quality care at the best value for their dollar.” To do this she must do more than scratch the surface. She must create more opportunity for access to the data.

Reform of the Medicare system is urgent. Allowing many experts access to the data will lead to valuable insights and the most appropriate treatments. Before cutting services and benefits for older adults shouldn’t  waste be eliminated?  After all, we wouldn’t tolerate squandering 25% of our own personal resources – how is wasting Medicare tax dollars any different?

Congress is looking for solutions to control escalating Medicare costs. Ask your local advisory group to support the Grassley-Wyden DATA Act.  Go to your Senator’s page and let them know you support the Grassley-Wyden DATA legislation.

The author, Candice Rose, specializes in  aging and elder care.  She is currently serving as the Chairwoman of the Arlington County Commission on Aging in Virginia.  You can follow her on Twitter at  www.twitter.com/CandiceRose.

“Be the change you want to see in the world.” M. Gandhi

An Open Invitation to Advisory Groups on Aging Everywhere in the U.S.

Wouldn’t it be beneficial to have the opportunity to learn what peer advisory groups across the country are doing? Wouldn’t it be in the best interest of the public to inform them about the success and challenges of these groups?

Most people don’t realize that for the past 45 years 650 advisory boards across the country have been working on aging issues. Advisory Boards were created as a result of the Older Americans Act of 1965. The OAA required each state to establish a unit on aging. The state units then designated Area Agencies on Aging.  And each Area Agency on Aging is required to have an advisory board or council.

The format and structure of advisory groups varies in each jurisdiction but all share common goals. Most work, however, is done in isolation without knowledge of what peer groups are doing. State Units on Aging have a National Association. Isn’t it about time advisory groups had a forum in which to compare strategies, talk about what works and what doesn’t, to share success stories? Isn’t it about time to coordinate and leverage all the separate experiences of local groups into an integrated force? 10,000 baby boomers turn 65 everyday – it’s time to draw on the knowledge and expertise developed in local communities to find the most effective solutions to critical issues.

Many leading advocacy and service organizations are taking advantage of innovative options to create greater awareness about their work and to engage with their constituents. The Administration on Aging, AARP, n4a, The National Council on Aging, for example, goes where their audience is: Facebook and Twitter.

Advisory groups should do the same. But as of October 1, only about 10% of the 650 advisory groups are using Facebook pages to connect with their constituents. While some news may be unique to a specific organization many concerns are universal. And, on occasion, a majority of the 650 advisory groups could choose to present a unified voice on a specific issue. The opportunity to present a cohesive view directly to Congress would be powerful.

To capture these opportunities I’ve setup a Facebook page as a resource for all Advisory Groups on Aging. Come to the page by clicking on the link: National Forum for Aging Advisory Groups. Introduce yourself. “Like” the page. If your area group is not using this venue please let them know about this resource and opportunity. Let’s create greater community awareness and learn what’s happening across the country.

The author, Candice Rose, is a specialist on the topic of aging and elder care.  She is currently serving as the Chairwoman of the Arlington County Commission on Aging in Virginia.  You can follow her on Twitter at www.twitter.com/CandiceRose.

Medicare: Check out tomorrow’s event!

Tomorrow, Wednesday, 9/28, is Medicare Call-In Day. LeadingAge, an association of 5,600 not-for-profit organizations dedicated to expanding the world of possibilities for aging, is hosting the day-long event. The purpose of the event is to urge members of Congress to preserve Medicare payments to providers of long-term services at current levels.

The Congressional Deficit Supercommittee is threatening Medicare cuts in services which jeopardize care for the most financially vulnerable older adults. Providers of long-term services and support have already absorbed substantial Medicare cuts and beginning October 1, Medicare payments will be cut again by 11%.
But before benefits are cut shouldn’t Congress act to eliminate abuse, fraud, wasteful practices, and overbilling?  The New York Times estimated that $100 Billion dollars is stolen from Medicare and Medicaid each year.  Cutting benefits, which directly affect the lives of those with annual incomes of less than $18,500 isn’t the answer.

Help protect seniors’ access to quality care. Urge your congressman to support a plan that preserves Medicare funding for long-term services. For details on how to participate check out this link:  http://www.leadingage.org/call_congress.aspx

The author, Candice Rose, is a specialist on the topic of aging and elder care.  She is currently serving as the Chairwoman of the Arlington County Commission on Aging in Virginia.  You can follow her on Twitter at www.twitter.com/CandiceRose.

“Be the change you want to see in the world.” M. Gandhi

Medicare: Cut Fraud, Not Performance

Yesterday, September 8, 2011, the American Hospital Association offered a money-saving suggestion to reduce Medicare costs: raise the eligibility age for beneficiaries from 65 to 67 years-old. Like most cost-reduction ideas, this policy will restrict access to care for a greater number of people. When patients who have delayed treatment of chronic conditions enter the Medicare system they are in poorer health and need more extensive services.

We should focus on solutions which provide the best and most efficient services for the broadest constituent group. Creating an effective system requires a focus on prevention and management of chronic diseases rather than acute care for emergencies. In addition to providing relevant value to patients, the Medicare system should operate without fraud, waste and abuse.

Previously I have discussed my 95-year-old Aunt June’s predicament in “Caught in the Medicare System.”  Like most Medicare beneficiaries, she rarely used her benefits until the last year of her life. But once she entered the hospital, she was trapped in a cycle of 7 institutional settings and Medicare footed the bill for 700 transactions. Were all the medical interventions medically necessary? Did they even happen?

For some patients, apparently not. On Wednesday, September 7, Attorney General Eric Holder and HHS Secretary Kathleen Sebelius, announced that the Medicare Fraud Strike Force charged 91 defendants, including, doctors, nurses, and other medical professionals in eight cities for their alleged participation in Medicare fraud schemes.  Defendants submitted claims to Medicare for treatments which were either not provided at all or which were medically unnecessary. Some Medicare beneficiaries received kickbacks for supplying information to providers. Investigators used data analysis techniques to uncover $295 million dollars in false billing.

These investigations are a good start in eliminating fraud so Senator Chuck Grassley (R-Iowa), ranking member of the U.S. Senate Committee on Finance, must be relieved. He has been concerned about the inadequate management and lack of oversight for federal contractors.

Last spring, Grassley and Ron Wyden (D-Oregon) introduced the Medicare Data Access for Transparency and Accountability Act to help combat fraud. The bill would require Medicare claims and payment data to be available to the public. In 2009, the federal government spent $502 billion on Medicare. Don’t taxpayers have a right to see how their hard-earned dollars are being spent?

Public accessibility may not only deter medical providers from wasteful practices and overbilling, it will give citizens a tool for community policing. Medicare data should also be reviewed and analyzed to understand changing trends and effective treatments. This will enable providers to prescribe the most appropriate and successful treatments for their patients.

Congress is looking for solutions to control escalating Medicare costs. Go to your Senator’s page and let them know you support the Grassley-Wyden DATA legislation.

The author, Candice Rose, is a specialist on the topic of aging and elder care. She is currently serving as the Chairwoman of the Arlington County Commission on Aging in Virginia.  You can follow her on Twitter  www.twitter.com/CandiceRose. 

“Be the change you want to see in the world.” M. Gandhi

Matters of Appearance

Treating people with respect doesn’t require a billing code.

The contents of 95-year-old Aunt June’s closet intrigued her rehab roommate and made her look forward to meeting June.  June enjoyed a lifelong interest in fashion and never allowed her age to be a negative factor in her clothing choices.

June believed that she had a responsibility to present herself in the best way possible, and, that the whole world would be better off if everyone made the same effort. Difficult circumstances shouldn’t make a difference. But her conviction was sorely tested throughout her 7-institution, 12 month stint in the Medicare system.

During her three hospitalizations, June adjusted to a reduced wardrobe, but refused to give up wearing her jewelry despite admonitions from the staff.  The case manager warned me about a patient who had the diamond gouged out of her ring while she was sleeping.  “The family had the last laugh, though. They had already substituted a cubic zirconium.”

Though June’s friend, Wanda, insisted on doing June’s personal laundry, her clothing still disappeared into the institutional laundry system. If it reappeared it was often damaged. Theft was a recurring problem.

Hygiene and grooming were bigger issues. In every institution, scheduled bath and shower times were disrupted by conflicting appointments and staff changes.  An aide explained that when the staff was reassigned grooming tasks could slip through the cracks.  June was distressed by the erratic schedule and long periods between bathing.

In the skilled nursing and assisted living facilities June had more clothing options but little help. One morning she phoned me from Florida, “You won’t believe this. The aide came in at 5:30 and dressed me without a brassiere. She said there was no time for that.” The aides condescendingly chided June when she specified coordinated colors in her outfits.

Wanda tried to ease the situation by helping June brush her teeth, wash her face and comb her hair when aides were unavailable. Though Wanda was unsuccessful in arranging site visits for June’s hairstylist, she took June to the hair salon when June was well enough. These rare outings were a highlight for June.

In the rehab facility, where the therapists and patients were indistinguishable in their sloppy sweat attire, June stood out in her snappy outfits.  During my visits to Florida, we read fashion magazines to learn new trends and we went shopping. On one of our final outings, June spotted a rose-colored leather jacket in one of her favorite shops.  She was confined in her wheelchair, weak and unsteady. But when the sales woman informed her, that to try on the jacket, she was required to stand June suddenly was motivated.  “Well, then, I guess I will stand” she agreed.  Studying her image in the mirror she said “I will need a lipstick with a little more blue in it to go with this.”

Even when June was disappointed by the condition of her body she was not deterred from striving to maintain her best possible appearance.  Fashion was essential to June’s quality of life and it far outweighed the routine management of her medical problems.

Paying attention to a patient’s concerns is a fundamental to treating them with respect and ensuring their dignity. Respecting June’s efforts to maintain her appearance would not have cost anything but would have made a huge difference in her final year.

The author, Candice Rose, is a specialist on the topic of aging and elder care.  She is currently serving as the Chairwoman of the Arlington County Commission on Aging in Virginia.  You can follow her on Twitter at www.twitter.com/CandiceRose.

“Be the change you want to see in the world.” M. Gandhi

Medicare: This Business About “Free”

Before my 95-year-old Aunt June began her seven-institution, 12-month, stint under the Medicare system, June had considered herself extremely healthy. After all, she had never suffered from a major disease. But was her perception accurate? 

Her doctor had assured June that she would live to be 100. A former pharmacist, his only recommendation was that she begin a Lipitor regiment at the age of 93. He was inattentive to her concerns.  “He never hears a word I say” June complained to me. “I have no energy and I’m having trouble distinguishing changes in level so it’s hard for me to walk up and down stairs.”

It was obvious to everyone but June, that her mobility was impaired. Her gait gradually turned into a shuffle and she tried to hang on to people and objects when she walked. Then June began to fall.

“It’s no problem at all,” June told me. “Those EMT men are so strong and good looking – they just pick me right up! They asked if I wanted to go to the hospital and, of course, I said no. There’s nothing wrong with me.”

But after a certain number of “pick-me-up calls” to 911 the Florida authorities stepped in. After giving June a thorough assessment, she was strongly encouraged to make accommodations and begin an occupational and physical therapy program to improve her balance and walking.

This was June’s first real encounter with Medicare. June was thrilled to learn that the majority of services were “free” because of her Medicare and supplemental insurance policies. She and her friend, Wanda, began researching additional Medicare opportunities that might be available. I was startled when Wanda called me in Virginia to suggest I order a motorized scooter for June.

“She doesn’t need that” I told Wanda. I had visions of June, not especially savvy about machinery, crashing into things and falling off. It was the worst idea ever.

“But it’s free – Medicare pays for the whole thing!” Wanda told me.

This wasn’t the first time the issue of Medicare fees had come up. “I don’t want to hear that phrase again. Nothing is free. Every Medicare service costs money - even if you are not the one paying for it. This is not medical Christmas” I told Wanda.

June is not alone in her perception that Medicare services are “free.” Unlike patients outside the Medicare system, beneficiaries, especially those with comprehensive supplemental insurance, are often unaware of cost.

Now, even Medicare itself is advertising “Free Services.”  As of January 1, 2011, a number of tests and treatments, such as colonoscopies, mammograms and pelvic exams, became available to beneficiaries at no charge. Medicare beneficiaries can also now get an annual no-charge “wellness visit” with a health-care provider that is supposed to provide a baseline health assessment.

I applaud preventive healthcare and hope it will lead to fewer crises. It’s important to make the most effective medical management available at a reasonable fee. But I object to insulating beneficiaries, who are also medical consumers, to the cost of care. Medicare is being exploited on many fronts and consumers must be informed in order to make responsible choices.

Especially in an era of economic crisis, everyone needs to be stewards of our common resources. We have the responsibility to use them wisely and preserve resources for all. There is no free lunch.

The author, Candice Rose, is a specialist on the topic of aging and elder care.  She is currently serving as the Chairwoman of the Arlington County Commission on Aging in Virginia.  You can follow her on Twitter at  www.twitter.com/CandiceRose

“Be the change you want to see in the world.” M. Gandhi

Medicare: Changes Beyond the Vocabulary ?

A paradigm shift in health care is happening at every level from medical providers to patients. Dave deBronkart refers to the “Year of Patients Rising” during his recent TED talk. He states that “patient is not a third-person word. Patients must take control of their cases and define the terms of their success.” Dave became part of the E-Patients Movement, a group of patients who are equipped, engaged, empowered and enabled.

deBronkart, aka “e-Patient Dave,” stresses that “the patient is the most underutilized resource in heath care.  If all patients could talk with one another and know their own health data they could make health care better one e-Patient at a time.  If patients are allowed access to their raw data and could share it with others great strides could be made in medicine.” Patients would not only have the opportunity to improve their own health status – they would contribute to overall medical knowledge benefitting the community.

E-patient Dave is focused on acute care but what about managing chronic disease? At the June 27, 2nd Innovative Communities Summit held on the Georgetown University campus, Kathy Greenlee, posed the rhetorical question “Is health reform about the acute care-medical model?” She answered “YES. What we need now is integration of all services.”

At the summit we learned that “Person-Centered Living” will replace “Person-Centered Care.” Patients in this system will learn how to accomplish their own medical management. The new vocabulary is designed to encourage best outcomes. For example, PT will no longer mean physical therapy but personal trainer.

And how will health care reforms apply to Medicare? A new model “The Care Support Model” will replace the “Medical Model.” Medicare was established in 1965 to cover acute care after a patient was sick. Now, due to medical advances over the past 46 years, patients can learn to avoid and manage chronic conditions with the proper support. The Care Support Model integrates long-term health care and social services at the community level and will eliminate fragmented health care.  An essential difference is a focus on the quality of an individual’s life vs. his health status.

Hopefully, proactive preventive management will lead to fewer crises and will delay institutionalization. But what happens when institutionalization is unavoidable? Care between hospitals, medical providers, nursing homes, long-term care facilities and residences will be integrated. “Care Transitions” including community resources will enable seamless care between institutions and community.

Let’s hope that the changes don’t start and stop with the vocabulary and are merely the reflection of the changes in the underlying systems.


The author, Candice Rose, is a specialist on the topic of aging and elder care.  She is currently serving as the Chairwoman of the Arlington County Commission on Aging in Virginia.  You can follow her on Twitter at www.twitter.com/CandiceRose.

“Be the change you want to see in the world.” M.Ghandi

Medicare Reform: What Kind of Change Is Needed?

Navigating the Medicare system was a challenge to both 95-year-old Aunt June and to me, as her caregiver. Though I suspected her treatment problems were not unusual, it was impossible to know if her case was an extraordinary example, completely typical, or somewhere in-between. Recently I learned that the hazards she confronted are happening to many patients throughout the medical system.

The 2nd Innovative Communities Summit convened at the Georgetown University campus on June 27, to raise awareness about resources which reduce avoidable rehospitalizations and improve care transitions. I’m glad that experts are working on solutions but I’m sorry we’re still in the talking phase on this objective.

Participants at the summit agree that our current system is incentivized in all the wrong ways and that patient experience is considered dead last. Everyone also agrees that health care delivery must be changed to reduce all harm done to patients. In particular, this means that:

* Hospital-acquired infections must be reduced
* Rehospitalizations must be avoided
* Transitions between institutions and homes must be improved

June could have benefitted from all of these initiatives but especially from an integrated approach to her care. With a focus on case management and supportive services in her long-term-care settings June may have had a successful final year.

By focusing on June’s experience I hope to illustrate how these problems in our health care system create misery in patients’ lives and waste huge amounts of resources. It is time to make changes to prepare to meet the needs of aging baby boomers. Let’s not forget that each person deserves a meaningful and dignified end-of-life experience.

To learn more about these issues read the report from the 1st Innovative Communities Summit: Innovative Communities: Breaking down barriers for the good of consumers and their family caregivers: http://www.ltqa.org/wp-content/themes/ltqaMain/custom/images//Innovative-Communities-Report-Final-0216111.pdf

Check out the new Center for Medicare & Medicaid Innovation: http://innovations.cms.gov/

Next: Person-centered living vs. person-centered care

The author, Candice Rose, is a specialist on the topic of aging and elder care.  She is currently serving as the Chairwoman of the Arlington County Commission on Aging in Virginia.  You can follow her on Twitter at  www.twitter.com/CandiceRose.

“Be the change you want to see in the world.” M.Ghandi