Medicaid payment inching up

"We're so far behind that now people estimate that Medicaid pays about 60% of the cost of doing business."



Medicaid payment inching up

Physician payment rates are going up in at least 24 states, but there's a lot of lost ground to make up.

Washington -- Next year -- for the second straight year -- at least two dozen states will increase their Medicaid reimbursement rates to doctors, a departure from years of stagnant pay.
These states will provide an average rate increase of 2% to 3% overall, according to Vernon Smith, PhD, one of the authors of an annual 50-state Medicaid survey released in October by the Health Management Associates and the Kaiser Commission on Medicaid and the Uninsured.
At least 24 states are increasing rates in the upcoming fiscal year, with three undecided. In 2004, only nine states increased Medicaid payment rates, Dr. Smith said. Of those nine states, three are increasing rates for 2006 and 2007, two increased rates for 2006 only, and two are increasing rates for 2007 only.
The states upping their rates are generally applying them across the board to all physicians and others, unlike previous years when most targeted the increases, Dr. Smith added. No states were planning Medicaid cuts when the survey was conducted in the summer -- also a first since the initial survey report in 2002.
Still, in many jurisdictions, even a large across-the-board jump isn't enough to compensate for years of level or reduced payment rates.
For example, although Michigan physicians will see a 2% specialty-wide increase and 68% boosts for certain types of preventive care, the raise follows about a decade of Medicaid rates outpaced by inflation and other rising costs, said Paul O. Farr, MD, president of the Michigan State Medical Society. "We're so far behind that now people estimate that Medicaid pays about 60% of the cost of doing business."

All American Senior Care

Seniors' Fear Often Aggravated After Sun Goes Down

In the dark, she is terrified and often doesn’t know where she is or whom she’s with. Across the city, another woman about the same age also fears nights. It’s then that she wonders who might know she’s alone and if they’ll break into her house and rob her.




Seniors' Fear Often Aggravated After Sun Goes Down

During the day, dementia regularly sends the 86-year-old woman into states of confusion. But at night, her situation worsens considerably. In the dark, she is terrified and often doesn’t know where she is or whom she’s with. Across the city, another woman about the same age also fears nights. It’s then that she wonders who might know she’s alone and if they’ll break into her house and rob her.

Whether the causes are physical or psychological, or related to diseases such as Alzheimer’s disease or other dementias, nighttime can be a frightening time for seniors, especially those who are living alone.

Many of these problems that occur with seniors at night are rooted in the physical changes that take place as the result of aging. And those issues are often connected to sleep disorders.

In a 2005 Gallup poll of 1,000 adults over the age of 50, less than half of those surveyed (32 percent) reported getting a good night’s sleep all seven days of the week. And yet, respondents ranked good sleep as more important even than interpersonal relationships.

This Gallup study revealed a number of factors to explain sleep problems including that of worry, according to Dr. Harrison Bloom, senior associate and director of the Clinical Education Consultation Service of the International Longevity Center USA in New York City.

Bloom, a geriatrician, is interested in efforts to help seniors and healthcare providers identify solutions to sleep-related disorders in older individuals.

A local senior care company has discovered that one answer is companionship. “The seniors that we serve often face challenges at night that can disturb their sleep as well as their peace of mind,” says Andrew Garrean, owner of the Home Instead Senior Care office serving Tulsa.

“That’s why our caregivers are regularly called upon to provide overnight care for seniors, to assist them with the anxiety that can set in at night.” Caregivers help with various non-medical tasks such as companionship and are available daily for a few hours or all day.

Seniors’ sleep problems are rooted in many sources. “There are physiological changes occurring with age, such as a decreased amount of time spent in some stages of sleep,” Bloom says. “And many tend to have diseases that can make sleep difficult.

For instance, people who suffer from congestive heart failure can’t rest in a flat position, and the pain of arthritis keeps some awake at night. Medications for certain diseases also can impact sleep, and bladder or prostate problems prompt people to get up for bathroom breaks. These types of interruptions can fragment sleep.”

Dr. Sonia Ancoli-Israel, professor of psychiatry at the University of California at San Diego and director of the Sleep Disorders Clinic at the Veterans Affairs San Diego Healthcare System, agrees it’s not necessarily the aging process that disturbs sleep, but rather those changes that accompany getting older.

“In addition to those medical illnesses and medications common in older adults, there can be psychiatric problems and changes in circadian rhythms.” Ancoli-Israel says.

Circadian rhythms are body rhythms that help determine when we sleep and they change as we age. Ancoli-Israel conducted a study five years ago that exposed patients with dementia living in nursing homes to either morning or evening bright light in an effort to adjust the body’s circadian rhythms. Both techniques improved nighttime sleep.

Even though research is helping to identify solutions, statistics indicate that more seniors are searching for medical remedies to sleep problems. Between 2000 and 2004, use of prescription insomnia drugs climbed by 16 percent among people 65 years and older, according to an analysis released recently by the prescription-management firm Medco Health Solutions of Franklin Lakes, N.J.

However, while many aids are on the market, sleep medications might not be the best answer for all older adults, as some may make seniors confused and disoriented, symptoms that, in particular, should not be exaggerated in seniors who already are confused due to Alzheimer’s disease or other dementias.

In fact, those symptoms can wreak nighttime havoc in the lives of seniors and family caregivers, according to Dr. Sharon Brangman, professor of medicine and division chief, Geriatrics, at SUNY Upstate Medical University in Syracuse, N.Y.

“I have an 80-year-old Alzheimer’s patient who is very anxious and nervous during the afternoon. She then naps in front of a television in the evening and doesn’t want to sleep at night,” Brangman said.

Her husband is her primary caregiver, and he’s exhausted at the end of the day. But he’s afraid to sleep at night because she might wander. When she goes to sleep, he often lets her sleep until noon. We’ve tried to encourage him not to let her sleep during the day, and suggested activities for her and respite breaks for him.”

While the issues surrounding older adults with dementia-related illnesses are very different from seniors with sleep disorders and physical ailments, all of those factors can contribute to the psychological anxiety that seniors may experience at night.

“Many seniors undoubtedly are anxious because they know it’s harder to reach help at night,” Ancoli-Israel said. “And there’s more time to think about the things that might be going wrong.”

That’s why companionship can help with the anxiety that often accompanies nighttime problems, according to Home Instead Senior Care. “The 86-year-old woman with dementia who awoke at night was reassured by an overnight caregiver,” said Home Instead Senior Care’s Garrean. “And for the woman who was constantly afraid of being robbed at night, efforts were made to secure her home including lighting the front and back of her house. It’s those kinds of extras that can make the difference between seniors having peace of mind or being afraid in their own homes.”

Residents thrive in small nursing homes

“I love it,” Johnson said. “It’s not a rush anymore. We get to spend quality time with residents. They think we’re family. And we are.”



Residents thrive in small nursing homes

In 10-person houses, staff is happier and elderly healthier

The Philadelphia Inquirer

REDFORD, Mich. — After 14 years as a certified nursing assistant — the bottom of the food chain in the nursing home culture — Linda Johnson has tasted the future. She now is a “Shahbaz” in a “Green House” — a respected worker in a new model of caring for the frailest elderly.

“I love it,” Johnson said. “It’s not a rush anymore. We get to spend quality time with (residents). They think we’re family. And we are.”

The nursing home idea is turned upside down:

• Only 10 residents live in a house, rather than the standard 120 to 180 people, and despite their dementia and infirmities, they are happier and healthier.

• Nursing aides, with their new titles, are empowered and enjoy their jobs.

• Despite more personalized care, costs are the same or less than in nursing homes.

The Green House was conceived by Bill Thomas, a pioneer in long-term care. The first cluster of six houses opened three years ago in Tupelo, Miss. Three more groups in Mississippi, Nebraska and Michigan have since moved nursing home residents into Green Houses.

“The Green House starts with a positive vision,” Thomas said.

The results have been dramatic. Some residents who were hand-fed in nursing homes have begun feeding themselves. A few who only sat in wheelchairs have begun to use a walker.

“We are just stunned,” said Mariellen Davis, head of the Village of Redford Senior Living Community, part of Presbyterian Villages of Michigan. “A switch goes on” for the residents.



All American Senior Care

Bob DeMarco

Medicare Drug Aid No Longer Automatic

More than 600,000 low-income elderly and disabled people who automatically received federal help to pay for their Medicare drug coverage this year will have to actively apply to get such assistance in 2007, Medicare officials said yesterday.




Medicare Drug Aid No Longer Automatic

By Christopher Lee
Washington Post Staff Writer

Friday, October 20, 2006


More than 600,000 low-income elderly and disabled people who automatically received federal help to pay for their Medicare drug coverage this year will have to actively apply to get such assistance in 2007, Medicare officials said yesterday.

The change affects people who were automatically enrolled in the inaugural year of the drug benefit and got the low-income subsidy in 2006 but who are no longer eligible for Medicaid or two other government assistance programs.

Some advocates say the affected seniors may not have understood a letter about the change that the Centers for Medicare and Medicaid Services sent last month. And even beneficiaries aware of the change might have trouble completing the six-page application, they said.

"Just sending these folks a letter and an application doesn't mean they necessarily are going to apply for the extra help even though they may need it," said Marisa Scala-Foley, associate director of the Access to Benefits Coalition at the National Council on Aging. "These are still likely to be low income folks who need all the help they can get. . . . These folks are going to need a lot of hand-holding."

There is no danger of them losing Medicare drug coverage. Even if they do nothing, they will be automatically enrolled in their current plan for 2007. But in January, most would be charged a monthly premium for the first time.

Kathleen Harrington, director of external affairs for the Medicare agency, said it has provided drug plans and community organizations with information about the affected seniors and encouraged greater outreach. The open enrollment period is Nov. 15 to Dec. 31, and the affected group will have three extra months to switch to a plan with no monthly premium, she said.

"We're very concerned about this," Harrington said. "We want to ensure that they know and that they've been contacted by plans, by us, by advocates, by community resources to make sure that they apply for this low-income subsidy, so if they have a premium liability they can minimize it."

More than 9 million of the 23 million people enrolled in Medicare drug plans this year qualified for the low-income subsidy, which meant they paid no monthly premiums and only $1 to $5 in co-payments for their prescriptions. Of those, about 7.2 million were automatically enrolled in the program and the subsidy, while the rest applied and got it, Medicare officials said.

Medicare drug plan beneficiaries qualify for special help if their annual incomes are at or below 150 percent of the poverty level, which is $14,700 for individuals and $19,800 for married couples. Also, individuals must have no more than $11,500 in assets, and married couples no more than $23,000 in assets.

Some of the affected people who no longer automatically qualify for a subsidy might have had a change in income but could still qualify for premium assistance under the drug benefit, officials said.

"The worst outcome will be someone getting surprised that they have a premium and then dropping their coverage," Harrington said. "We want to do everything we can to keep them in coverage."


All American Senior Care

Candidates for U.S. Senate square off on health care

This article includes part of a debate on the issue of Medicare and the new prescription drug benefits.

When the new Medicare prescription drug benefit took effect this year, Republicans praised the program for helping millions of elderly Americans cope with rising drug prices.


Candidates for U.S. Senate square off on health care

Sam Hananel
The Associated Press

When the new Medicare prescription drug benefit took effect this year, Republicans praised the program for helping millions of elderly Americans cope with rising drug prices.
Many Democrats disparaged the plan for being too complex and failing to let the government negotiate prices with pharmaceutical companies to bring drug costs down. More recently, millions of beneficiaries have complained about facing a temporary break in their Medicare drug coverage, commonly known as the "doughnut hole."

The conflict is playing out in Missouri's Senate race, where incumbent Republican Sen. Jim Talent says most voters are benefiting from the new drug program and his opponent, state Auditor Claire McCaskill, says the plan is too generous to drug companies at the expense of seniors who need help.

Here, they discuss their views on Medicare and other health care issues.

Associated Press: What is your position on the Medicare prescription drug program? If changes are needed, please specify what they are.

Talent: I am the only candidate for U.S. Senate who supported the Medicare prescription drug bill which is benefiting hundreds of thousands of Missouri seniors.

I decided when I came to the Senate that Congress needed to stop playing politics with Medicare and pass a sound, affordable prescription drug plan. Such a bill did pass the Congress, with my strong support. The bill does two things: forces prescription drug companies to discount prices and then pays part of the discounted price for our seniors. As a result, hundreds of thousands of Missouri seniors are getting drug coverage for the first time through Part D. In fact, nearly three quarters of Missouri seniors are benefiting from the new drug benefit.

In Missouri, there is no "doughnut hole," or gap in coverage for seniors. There are seven plans available which contain no gap in coverage. On average, seniors are saving $1,100 a year and the bill is costing billions less than predicted.

I've supported changes to help make the program work even better for our seniors. We've already extended the deadline and eliminated the penalty for low-income seniors, but I believe the Congress should take the extra step and eliminate the penalty for all Medicare beneficiaries. I've also co-sponsored legislation to help local pharmacists get reimbursed more quickly by the Medicare drug plans.

This is another issue where there's a big difference between me and my opponent. I strongly supported the Medicare prescription drug bill and McCaskill said she would have voted against it. There were some very close votes during the debate on this bill. If McCaskill had been in the Senate instead of me, our seniors would not have the prescription drug coverage they have now.

McCaskill: I support giving America's seniors a prescription drug benefit plan that works. The current Medicare part D was written by drug companies and goes much further in lining the pockets of pharmaceutical companies than it does helping Missouri's seniors. I supported extending the Medicare D deadline, a measure opposed by large pharmaceutical companies, and believe seniors should not be penalized if they failed to sign up in time for the program.

I support allowing Medicare to use its bulk purchasing power to negotiate with drug companies for lower prices, a practice that the current bill explicitly bans. The Veterans Administration, however, has been able to secure drug prices 80 percent lower than the average Medicare Part D plan. My opponent supported legislation that blocked Medicare from negotiating for lower prices. I think we can have a better, cheaper Medicare program that benefits more seniors and costs taxpayers less money if we are willing to put seniors first instead of profits for big drug companies.

AP: Both the Bush and Clinton administrations have so far rejected efforts in Congress to lift the ban on prescription drug imports. Should Americans be allowed to import cheaper prescription drugs from Canada or other countries?

Talent: Yes. I've always supported permitting reimportation through a process that guaranteed safety. Many of these drugs are manufactured in Third World countries, and I want to make sure our consumers are protected.

I have voted in the Senate to allow reimportation and support a provision in the Homeland Security funding bill that would allow U.S. citizens to bring a 90-day supply of prescription drugs for personal use back from Canada.

In addition, we passed the Medicare Prescription Drug bill which is providing more affordable prescription drugs to hundreds of thousands of Missouri seniors and many now have drug coverage for the first time.

McCaskill: As long as strict safety standards are met, I am in favor of allowing American seniors to buy their drugs from Canada and other countries, and this is a priority about which I have a sense of urgency. I realize how many people there are that need help with their medications.

From senior citizens to families with young children, the costs of prescription drugs are a drain on our pocketbooks that puts further stress on the family budget. I believe reimportation is one way to address the issue and Congress should stop appeasing the drug companies and implement it.

AP: Well more than 100,000 Missourians have dropped off the Medicaid rolls after the state Legislature and Gov. Matt Blunt enacted budget cuts last year to the federally and state-funded health care program for the poor. Do you support the cuts? Why or why not?

Talent: Since I was elected to the U.S. Senate, Medicaid funding has increased at the federal level by more than $44 billion. That's a 30 percent increase. Because the last two governors have proposed Medicaid reductions in Missouri, in 2003, I cast the deciding vote to provide Missouri with nearly $400 million to support its Medicaid budget. Auditor McCaskill said she opposed this legislation.

I've also sponsored legislation to lower health care costs by allowing small businesses to join together nationally through their trade associations to sponsor health insurance for themselves and their employees. In addition to lowering the cost of health care, the Congressional Budget Office said small business health plans will save the federal government $790 million in Medicaid funding and the states would save $600 million over 10 years.

I should also mention that Auditor McCaskill has aired television ads attacking me on the issue of Medicaid. Those ads have been highly criticized and called "misleading" by the Kansas City Star.

McCaskill: Republicans have a two-word plan for health care in Missouri: cut Medicaid. Medicaid is the nations health safety net and serves as a vital source of health coverage for over 53 million Americans of all ages, including over 990,000 Missourians. Unfortunately, last year, Republicans in Missouri legislature decided to kick 100,000 Missourians off Medicaid. As Medicaid is both a federal and state program, my opponent refused to even comment on the Missourians impacted by these devastating cuts, saying it was a "state issue," despite his 19 votes to cut billions to Medicaid.

Due to the shortsighted actions of the Missouri legislature, Missouri stands to lose $700 million in economic activity and hundreds of millions in federal money that will now go to Medicaid programs in other states like Iowa, Kansas, Arkansas and Illinois. I believe strongly that these outrageous cuts should be reversed. Instead of undermining Medicaid, we need to strengthen it.

Many of Missouri's families rely on the federal Children's Health Insurance Program for their children's health coverage, which in Missouri is called MC+ for Kids. MC+ for Kids provides crucial health services for over tens of thousands of children, including emergency ambulances, ambulatory surgical care and prenatal care. Before last year's budget cuts to the program, MC+ for Kids had seen great success. After Congress approved the program in 1997, the number of insured children in Missouri increased nearly 20 percent. But due to the Republican cuts, for the first time in nearly a decade, enrollment in MC+ for Kids is on the decline.

In addition to the harmful actions in Jefferson City, Missouri also now faces a $27 million gap in federal funding for our MC+ for Kids program starting on October 1. Because of the actions of Republican-led governments in Jefferson City and Washington, over 50,000 children could lose their coverage in a little over a year. I believe we should act swiftly to protect Missouri's children by reversing these harmful cuts.

AP: What is your plan for providing more affordable health care coverage for millions of Americans who cannot afford it?

Talent: I strongly support allowing small businesses to pool together to lower the cost of health care for millions of Americans. I've sponsored legislation to allow small business associations to pool their members together to purchase the same quality health insurance offered by Fortune 500 companies, labor unions and the federal government. Trade groups such as the American Farm Bureau or the National Restaurant Association could then offer these health care plans to their small business members, who could purchase health insurance for themselves, their employees and their families.

I passed Small Business Health Plans when I served in the House and I've gotten the bill further in the Senate than ever before, but it was filibustered in the Senate. Auditor McCaskill said she opposes small business health plans.

I also support greater use of information technology in health care. Electronic medical records and electronic prescriptions can save both lives and resources. I joined a bipartisan group of senators to introduce the Wired for Health Care Quality Act. This bill, which passed the Senate, will create an office to coordinate greater use and investment in health care information technology. We have seen dramatic productivity gains in almost every other sector of the American economy. The ability to link patient records and physicians electronically will save time and prevent costly medical mistakes. The technology is available to accomplish this without compromising patient privacy.

McCaskill: Missouri has suffered devastating cuts to Medicaid at the state level while Washington is adding to the problem at the federal level. More than 100,000 Missourians have lost health coverage due to these cuts. Instead of cutting Medicaid, we need to fully fund the program and expand the MC+ for Kids program.

I believe it is urgent that Congress address health insurance for small businesses. Many of our small businesses want to provide employee insurance, but cannot due to enormous costs. I support legislation for small employers modeled off the successful Federal Health Benefits Program. Small businesses could band together for lower health care prices negotiated by the Office of Personnel Management, which has a proven track record of low overhead costs. Insurance policies would have to follow any state mandates, such as breast cancer screenings or mental health coverage.

In addition, we need to re-establish and support community-based health centers for the uninsured and the underinsured. These can provide proactive and preventative health care in a much more cost-effective way than the current use of emergency rooms, which simply pass costs onto Missouri families who then pay higher health insurance premiums. These clinics can be staffed by young doctors and nurses, in return for forgiveness of some of their student loans.

A good deal for AARP members

I don't know if this is common knowledge among AARP members but you can use your AARP card and receive discounts at retail stores.

One of the best deals I have seen is between AARP and the outlet stores of Reebok and Rockport. These stores offer a 20 percent discount on all purchases year round. Here is the best part: it applies to any and all purchases.

Here is what you might expect. Buy a first pair of shoes at the discounted outlet price; buy a second pair at 50 percent off. And then, show your AARP card and take an additional 20 percent off the entire purchase.

Both Reebok and Rockport make a high quality product and excellent footwear.

Imagine this transaction. Buy a first pair of walking shoes that retail for $69 for the outlet price of $49. Then buy a second pair of a similar shoe for your spouse. That brings the total to $98. Take off 20 percent and you pay $78.40 plus any local taxes. You now walked away with goods worth $138 for just $78.40 plus tax. That's a 43 percent savings!!!

Bob DeMarco

Report faults Pa.'s in home senior care

This article points out a problem in Pennsylvania that is also pervasive across the country--the State's are not doing enough to allow seniors to get help at home.

"Those who do receive home care report problems finding and keeping qualified caregivers," the report said, noting that 40 percent of home health workers have been with their employer less than one year.






Report faults Pa.'s senior car

It says the state isn't doing enough to allow seniors to get help at home.

By Michael Vitez
Inquirer Staff Writer


Pennsylvania, despite recent progress, still lags in efforts to care for the frail elderly in their homes rather than in nursing homes, according to a report released yesterday by the Action Alliance of Senior Citizens and the Service Employees International Union.

"Pennsylvania is the second-oldest state in the nation, but ranks among the worst states for providing senior citizens with access to home care," begins the report, titled "No Direction Home."

"Those who do receive home care report problems finding and keeping qualified caregivers," the report said, noting that 40 percent of home health workers have been with their employer less than one year.

"The turnover is fueled by poverty-level wages and a lack of benefits such as health-care coverage, sick days, and vacation for caregivers," it said.

"The pay is bad, the working conditions are bad, the protections are bad, and they have no medical benefits," said Pedro Rodriquez, president of Action Alliance. "And seniors can identify. They want the person taking care of them to be taken care of as well."

The report also said that in 2004, Pennsylvania spent nearly three times more on nursing homes than on home care.

"The toughest nut to crack will be: How do we shift payments from nursing homes to community- and home-based care?" Rodriguez said. "We're looking for more dedicated funds."

State officials say they have made dramatic strides doing what the report asks - giving Pennsylvanians more access to care in their homes.

Michael Nardone, executive director of the governor's Long Term Living Council, stressed that Pennsylvania started out in the back of the pack, with the culture heavily reliant on nursing homes.

"We've tripled the funding for home- and community-based care for the elderly since 2002," he said.

In the current budget, Nardone said, the administration funded 2,800 more people in home and community care. It also provided funding for 1,500 people with disabilities to receive care at home.

"I feel like we put our money where our mouth is," he said.

Yesterday's report says 80,000 Pennsylvanians are in nursing homes, 54,000 of them paid for with money from taxpayers. "Fewer than 15,000 Medicaid recipients get home care," the report says, although Nardone says the number this year exceeds 20,000 when other state funding, such as the lottery, is included.

Other points in the report:

Pennsylvania has more skilled-nursing facilities - 700 - than public high schools.

By 2020, 18.8 percent of Pennsylvanians are expected to be older than 65, an increase of half a million since 2000. The over-85 population is expected grow by 52 percent.

There is a shortage of about 10,000 direct-care workers.


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Contact staff writer Michael Vitez at 215-854-5639 or mvitez@phillynews.com.