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News Roundup: February 4, 2013

NY Times: Hospice Reform Calls for Better Care, Not Cost

Published by Home Health Care News
Jason Olivia
January 30, 2013

End-of-life hospice and palliative care will continue to experience demand as long as Americans age and die every year. That is just a fact of life New York Times mentions in an article, spotlighting that changes to hospice services should rely on enhancing the quality of care provided rather than the costs of services provided.

Citing that although roughly 6% of Medicare patients who die each year account for 27%-30% of health care costs, NY Times notes that this figure has not changed in decades. The total number of Americans that die every year, not just limited to the elderly, represent less than 1% of the population and account for 10%-12% of total health care spending.

Given these numbers, the article urges that no one knows why hospice care does not save more in costs than it currently does. So costs aside, the NY Times writer on health policy Ezekiel J. Emanuel offers up some solutions to enhance the quality of care for hospice services “even if we can never save a dime.”

First, all doctors and nurses should be trained in how to talk to patients and families about end-of-life care.

A related intervention—an idea that never actually was in the Affordable Care Act but inspired the death panel accusation—is that physicians should be paid a one-time fee to talk with patients about their preferences for end-of-life care.

Third, every hospital should be requires to have palliative care services available both in the hospital and at the homes of dying patients who are discharged.

Finally, we need to revise eligibility for hospice care. Right now, doctors must certify that patients have six months or less to live and patients must agree to forgo life-sustaining treatments.

Home health care helps patients and caregivers

Published by CDA Press
Cynthia Taggart
January 30, 2013

Neither Carl Wamhoff nor John Kaluba envisioned nurses and therapists visiting their homes to care for them.
Carl had multiple sclerosis, but he was convinced it wouldn't keep him down. He'd seen other people with MS in remission. But Carl's MS didn't go into remission. Eventually, he became a long-term home health care patient with the Panhandle Health District (PHD).
John was 44, healthy and in a job that demanded physical fitness. He handled irrigation for the Twin Lakes Golf course. He slipped last June jumping from his truck bed and became a short-term home health care patient with PHD.
"I have had nothing but great care," John says. He's just back on his feet after six surgeries and is hoping to walk Bloomsday in May.
Panhandle Home Health through PHD provides doctor-ordered professional nursing care and licensed physical, speech and occupational therapy to patients in their homes. The goal is to help patients regain as much independence as possible.
John completely supported that goal. He considers himself very independent, but he fractured two bones in his leg when he fell and the bones poked through the skin on his ankle. One bone was broken in three places and the other bone snapped in half.
His doctor ordered home health care through PHD after John's first surgery. Cindy Little, R.N., taught John how to care for his wounds and manage the antibiotics he was receiving intravenously. Cindy taught John's sister, who helped with his care, to clean around pins holding his bones in place.
For six months, Cindy helped monitor John's medication, changed dressings and much more.
"She taught me a lot," John says. "It was hard for me because I'm so independent, but she was so understanding and very helpful."
John's home health care ended just before Christmas.
"Now I'm doing awesome," he says.
Carl's sister, Jan Young, discovered home health care soon after she began caring for Carl.
"I made a promise to him. I said I'd take care of him as long as I could. That was 23 or 24 years ago," Jan says as Shannon Gisclair, R.N. with PHD's home health division, treats bedridden Carl's wounds. "I thank God every night for Shannon."
Shannon visits three or four times a month unless Carl needs wound care. Lying in bed round the clock can produce sores. Shannon visits Carl three or four times in a week to care for wounds and return him to comfort.
"Jan does such a good job with care," Shannon says. "Thanks to her care, Carl's sores are at a minimum."
Jan was picky about the home health care she chose for her brother.
"I looked for someone who knows what she's doing and is there when I call," she says. "I want someone who gives me helpful hints to make things better for Carl."
Knowing Shannon or another nurse from Panhandle Home Health will respond if Carl needs help between scheduled visits is a great relief for Jan. Transporting him anywhere requires an ambulance.
"I rarely have to call because Shannon does a good job," Jan says. "But if I do call, I'm always taken care of. There's always an informed nurse on call on weekends and holidays."
No one wants home health care until they need it. Finding the right care leads to the best outcomes for everyone involved.
"Home health is an absolute godsend," Jan says. "I love the convenience of knowing they're coming, that I can count on them and that they always have supplies. Shannon knows our whole family right down to the person who's helping out around the house. We're like friends."
Panhandle Home Health provides services in the five northern counties. For information on Panhandle Health District Home Health, call (208) 415-5160.

For Medicare Innovations – Think Locally

Published by Keiser Health News Blog
Ankita Rao
January 29, 2013

Reforming Medicare – from changing the way doctors are paid to streamlining patient care – could benefit from a grassroots approach, according to experts and physicians at a policy summit held by National Journal Live in Washington, D.C., Tuesday.

“We need to focus more on responding to and joining local initiatives,” said Len Nichols, director of George Mason University’s Center for Health Policy Research and Ethics. As an example, he pointed to an initiative in Rochester, N.Y., that brought local doctors and hospitals together to successfully reduce hospital readmissions.

The panelists agreed that solutions to address the system’s inefficiencies should begin at the ground level with physicians, community members and patients, who could provide valuable feedback and ideas when designing new approaches to quality care and cost control.

“What the ACA has done is to set up an environment where there is support for new innovation,” said Gail Wilensky, an economist who previously directed the Medicare and Medicaid programs.

With much of the health law going into effect in 2014, the U.S. will likely see increased coverage, insurance marketplaces and an expanded Medicaid program.

But Wilensky said the health law’s limited role in changing payment models and encouraging patient engagement in the health system operations could prove to be a “fatal flaw” in what should be an overhaul of the system. “These are huge constraints in how and how fast Medicare can move,” she said.

Dr. Edward Murphy, a professor of medicine at the Virginia Tech Carilion School of Medicine, said physicians’ attachment to the status quo was slowing down efforts to move to a system that rewards better health outcomes and lowers consumer costs. He said doctors need to adopt fundamental new practices.

“To get a broadwave movement of change across the country, it seems to me, we need a cultural shift,” he said.

Prevent Hospital Readmission with Home Care

Published by Synergy Home Care Blog
January 28, 2013

Being readmitted to the hospital is a common health risk among older adults. Some statistics show that as many as one-fifth of seniors are re-hospitalized within 30 days of returning home, usually with a different condition than they were originally admitted for. When an elderly loved one comes home from the hospital, whether it is after a prolonged illness or injury, it’s important for family members to take steps to provide the best senior care possible.

One of the biggest reasons seniors are more likely to return to the hospital than younger adults is that their weakened state puts them at a greater risk for developing another ailment. Family caregivers can help prevent this by ensuring their loved one gets plenty of food, rest and relaxation. However, it’s still important to encourage a senior relative to rebuild his or her strength and get moving.

Although rest and relaxation is important, family caregivers should work to get their loved ones to return to their routine pre-hospitalization. Though they should take it slow, building back up to what they used to do can help them recover more quickly.

Family caregivers may also want to consider looking into home care to facilitate an older adult’s recovery. Care professionals can help out with everything from meal preparation to home making to preventing return trips to the hospital.

Senior Care Facilities Participating in New Community Care Transitions Programs

Published by Senior Housing News
Alyssa Gerace
January 27, 2013

The Center for Medicare & Medicaid Studies (CMS) has announced 35 new Community-based Care Transitions Program (CCTP) sites in 23 states, five of which feature skilled nursing facilities as participating members.

A five-year program that’s part of the Affordable Care Act, the CCTP now has 82 sites that are testing models to improve care transitions from hospitals to other post-acute care settings, thereby reducing costly, unnecessary readmissions for high-risk Medicare beneficiaries.

About 20% of Medicare beneficiaries, or 2.6 million seniors, are readmitted to hospitals within 30 days of being discharged, according to CMS. This costs the program more than $26 billion every year.

Although hospitals have traditionally been the main player in seeking to reduce readmission by focusing on components leading to rehospitalization that they are responsible for, including the quality of care during the initial hospital visit and the discharge planning process, CMS says it’s “clear” there are multiple factors along the care continuum impacting readmissions.

Identifying key drivers of rehospitalizations is the first step toward implementing appropriate interventions to reduce or prevent them, causing CMS to create the CCTP program. The initiative’s goal is to “encourage a community to come together and work together to improve quality, reduce cost, and improve patient experience” through sites that coordinate care between various post-acute care providers.

Skilled nursing facilities and home health agencies are represented in five of the new sites that have recently joined the program, in Colorado, Florida, Mississippi, and New York. The sites including or partnering with senior care organizations include:

Denver Regional Council of Governments (Colorado)
Catholic Health Care Transitions Services, Inc. (Florida)
West Central Florida Area Agency on Aging (Florida)
Three Rivers Planning & Development District (Mississippi)
Isabella Geriatric Center (New York)
“The presence of these [CCTP site] facilities speaks to the importance of post-acute and skilled nursing centers in the care transitions from hospitals,” says Greg Crist, vice president of public affairs at nursing home trade group the American Health Care Association. “We’ve made reducing rehospitalizations a key quality goal profession-wide. This year is no different. If we can enhance those successful transitions while keeping the process free of complexities, everyone wins and costs can come down.”