Michigan Estate Planning Blog

Hospice Not Feeling the Love from Medicare

Healthcare in the U.S. has been in a state of transition since 2010. Unfortunately, many of the most important aspects of healthcare reform, those promising to protect the elderly and those in end-of-life care, have yet to take effect. As reported quite recently through the Kaiser Health News, hospice care has yet to be expanded under the Medicare project set out three years ago. The article titled “Medicare Lags In Project to Expand Hospice” examines the very real conflict between “curative” treatment and “palliative” treatment. The former is meant to cure a condition and thereby prolong life, and the latter is meant to ease the pain caused by a condition without a focus on effecting a cure. Naturally, the curative and palliative treatments are often considered opposites. In fact, choosing palliative care would mean giving up all hope on curative care. Consequently, it is only natural that rapidly declining patients delay their entry into palliative hospice care. The 2010 law was to begin inroads into exploring combined care, the possibility of both curative and palliative concurrently. Logically, this should ease transitions without forsaking hopes, likely reducing costs in the process. To date, however, this has not happened. Health care planning is complicated, and since so much is at stake be sure to consult a professional when exploring your options.

Reference: Kaiser Health News (May 9, 2013) “Medicare Lags In Project to Expand Hospice”

For more information, see www.jerryreiflawyer.com

 

Right to Appeal Medicare Decisions for Hospice Patients

It is always disappointing when Medicare fails patients due to bureaucratic impasses. What’s worse is when the patient is already in hospice care and doesn’t know their rights. Much can be learned through the unfortunate case of Howard and Emily Back. Emily, now deceased, was a California hospice patient covered by Medicare. Howard appealed his wife’s lack of treatment through the court process. However, the court was quick to point out that there is an administrative appeals process through Medicare regarding its hospice care decisions. The entire case is detailed in a recent post in The New Old Age a blog through the New York Times, titled “Court: You Can Appeal Medicare Decisions About Hospice Services.” As this blog post notes, Emily was denied coverage for a pain medication while in hospice and in the last stages of life. Consequently, Howard paid for them out of pocket and later (after Emily’s passing) appealed to Medicare to cover the expenses for doctor-ordered medication. While initially told there was no such Medicare appeals process and was turned away, Howard learned otherwise. As Howard sought to set a precedent so future couples would not face the same roadblocks, the court has finally found and verified that a Medicare appeals process exists. In fact, one can appeal a Medicare decision regarding hospice services with a form labeled “CMS-1490S,” if the beneficiary believes they have been inappropriately denied services. Many Medicare beneficiaries may have experienced this same short fall when entering hospice care, but hopefully this case can shed light on the solutions that are available to patients and their families.

Reference: The New Old Age
blog of The New York Times
(September 7, 2012) “Court: You Can Appeal Medicare Decisions
About Hospice Services”

For more information, see www.jerryreifflawyer.com

 

Right to Appeal Medicare Decisions for Hospice Patients

It is always disappointing when Medicare fails patients due to bureaucratic impasses. What’s worse is when the patient is already in hospice care and doesn’t know their rights. Much can be learned through the unfortunate case of Howard and Emily Back. Emily, now deceased, was a California hospice patient covered by Medicare. Howard appealed his wife’s lack of treatment through the court process. However, the court was quick to point out that there is an administrative appeals process through Medicare regarding its hospice care decisions. The entire case is detailed in a recent post in The New Old Age a blog through the New York Times, titled “Court: You Can Appeal Medicare Decisions About Hospice Services.” As this blog post notes, Emily was denied coverage for a pain medication while in hospice and in the last stages of life. Consequently, Howard paid for them out of pocket and later (after Emily’s passing) appealed to Medicare to cover the expenses for doctor-ordered medication. While initially told there was no such Medicare appeals process and was turned away, Howard learned otherwise. As Howard sought to set a precedent so future couples would not face the same roadblocks, the court has finally found and verified that a Medicare appeals process exists. In fact, one can appeal a Medicare decision regarding hospice services with a form labeled “CMS-1490S,” if the beneficiary believes they have been inappropriately denied services. Many Medicare beneficiaries may have experienced this same short fall when entering hospice care, but hopefully this case can shed light on the solutions that are available to patients and their families.

Reference: The New Old Age
blog of The New York Times
(September 7, 2012) “Court: You Can Appeal Medicare Decisions
About Hospice Services”

Letting Go – End of Life Realities

Have you sat down and written your “end of life” advance health care directives? It can be a difficult chore, to be sure. Carrying out your wishes, can be a difficult chore, too, especially for the palliative care doctors and hospice medical staff who will carry out your decisions. Some of these challenges were recently featured in an article titled Amongst Doctors, Fierce Reluctance to Let Go on the New Old Age Blog at the New York Times. Indeed, we live in a culture of medicine aimed at preserving life. However, when does such “medicine” actually get in the way and prolong biological life beyond what is desired by the patient? In addition to the medical culture of preserving life, the family of the patient receiving care can be a powerful force in the mix. Many times they do not want to let go, even though their loved one is ready. Add these three ingredients together – the medical culture, the patient’s wishes and the family’s fears of loss – and you have a recipe for conflict. The palliative or hospice care doctor is well attuned to the intentions of their patient and their wishes. Unfortunately, the rest of the medical community and the patient’s own family may be less attuned. In fact, they may be hostile at best and litigious at worst. I recommend reading the original article, as you will better appreciate the unfortunate tension thrust upon so many healthcare professionals in these cases. On the other hand, the lessons gleaned may encourage you to design advance health care directives with clarity and then communicate your wishes to your primary care doctor and family members now.

Reference: The New York Times -- The New Old Age Blog (March 29, 2012) “Amongst Doctors, Fierce Reluctance to Let Go”

Hospital-Induced Delirium Hits Seniors Hard

When the elderly visit the hospital it’s simply not the same as when they were younger. No, everything is more dangerous. The New Old Age Blog at the New York Times recently discussed a danger that is all too common, but still under the radar screens of medical and the everyday worlds alike. It’s the problem of elderly delirium. Usually, when we talk about an elderly person no longer being themselves, we think of dementia. Nevertheless, another dramatic neurological problem is delirium and it is often, ironically, brought on by hospital visits. Here’s what happens: When the elderly are put under such heavy medication it can generate a neurological imbalance that results in dramatic disorientation, sudden confusion, and loss of attention. The list of medications that can have this affect is fairly long, including sedatives, sleeping pills, narcotic painkillers and some allergy, blood pressure and incontinence drugs. As a result, it’s not a surprise that delirium is common. Each year 20 percent of the 11.8 million elderly patients in hospitals develop delirium. This includes some 60 percent to 85 percent of those in intensive care on ventilation and more than half of postoperative surgical patients. The problem is that delirium also can have long-term affects, according to recent research. In the end, many hospitals may be doing long-term damage to their patients. For more information and a stirring example, read the original story here. Be sure to take a look at the checklist to help determine the difference between dementia and delirium.

Reference: The New York Times (November 2, 2011) “Another Hospital Hazard for the Elderly”

 

Hospice: Medicare and Medicaid Profit Center?

Healthcare lawsuits involving the various ways that the elderly can be taken advantage of turn up in the news on a daily basis these days. Why? Well, partly for political reasons and partly for the sheer number of egregious situations that have been created. As an informed citizen/taxpayer, it’s important to think about and understand the big picture. However, as a family member, it’s vitally important to remember them for the sake of your elderly loved ones. A new legal battle has begun to churn, as recently reported at Kaiser Health News. Yet another healthcare company is being accused of taking advantage of the elderly and their families to draw the greatest yield from Medicare and Medicaid coffers. Here a large company, operating across several states, is accused of actively recruiting and cycling patients through nursing home and hospice services. Such companies are compensated by Medicare based on the length of time patients receive care. Medicare picks up the entire nursing home tab for the first 20 days (after that the patient has to contribute), and conversely, if a patient spends too much time in hospice care, Medicare demands their money back since the patient was clearly admitted to end-of-life care under false pretenses. Here’s the rub: If you cycle between nursing home regimens and then jump into hospice care as early as possible (but not too early), Medicare will pick up the entire tab and for the maximum amounts, and that’s the issue. The legal battles, as well as the politics and economics aside, stories like these also demand a certain amount of attention since they could directly impact your family. If you have a loved one in need of nursing home and/or hospice care, it’s important that they find and receive that care… and that they not be abused by an uncaring system.

Reference: Kaiser Health News (January 4, 2012) “Lawsuit Accuses Company of Fraudulently Cycling Patients through Nursing Homes, Hospice Care.”

ELDER CARE – TRANSITION TREVAILS

Moving between hospitals or into rehabilitation and other care centers can be a stressful time, especially for an elderly loved one. Unfortunately, too, these “care transitions” can create far greater problems than stress, as they also are prone to creating problems with the patient’s care. Potentially, these problems can have long-term affects. Care transitions are not a recent concern of health professionals, but been on their radar screen for some time. In fact, a recent study is the subject of a recent post on the New York Times’s blog series, “The New Old Age.” According to the study, a very large Canadian study of older adults and published in the Journal of the American Medical Association found that the main problem is with essential medications. It seems these meds can be accidentally stopped by healthcare professionals when the patient is in transition. And, older persons can be on many medications at once, often with little understanding of each drug and with complete faith in the multiple doctors prescribing them. For example, what happens if an elderly loved one (who may be on as many as 10 medications) has an “episode” requiring a trip to the emergency room? The emergency room staff may have to take them off some of those medications to administer needed care. Unfortunately, thereafter the doctors may forget to have those medications started up again once they are stabilized, moved to regular care or even transferred out to a rehabilitation center. In turn, your loved one might not notice any changes without the meds, or simply might assume the doctors know what’s best. Ultimately, this lack of communication and coordination in transition care can be life threatening. It’s something that happens all too often, particularly with medications for cardiac and blood conditions, such as statins (e.g., Lipitor) and blood thinners (e.g., Plavix). All of this gives family caregivers one more thing to bear in mind when tending to an elderly loved one, but it can also be an important one. It’s important to ask questions and be aware of all medications an elderly loved one is taking, and if these meds change (or stop) after a hospital visit… find out why.

Reference: The New York Times Blogs (September 8, 2011) “A Big Risk in the Health Care Handoff”

Government Cuts Affect Nursing Homes

The last few months have been a wild ride on multiple levels, to include concerns over Medicare and the “debt crisis.” While many more challenges lie ahead in terms of budget cuts, some cuts already have been made under the radar screen. Several you should know about actually go into effect this fall, as reported in a recent SmartMoney article. According to SmartMoney, nursing home residents could face higher costs or reduced care once these cuts kick in. Background On July 29, The Centers for Medicare and Medicaid Services (CMS) decided and announced that they would be compensating for last year’s $4 billion shortfall by cutting reimbursement rates to nursing homes by 11.1%. In real terms, the shortfall is going to reduce government reimbursements to nursing homes. In 2010, nursing homes increased charges on residents by an average of 5%. Bad news: These reduced government reimbursements likely will trigger even higher nursing home costs for residents beginning this fall. Alternatively, it might trigger a reduction in services to nursing home residents. Either way, the forecast is not pleasant. Perhaps I am wrong. Perhaps nursing home residents won’t see increases in costs or decreases in services. After all, the CMS actually justifies the 11.1% cut by pointing out that it is simply a more accurate reimbursement amount based on a government report indicating that Medicare has been overpaying. In fact, a spokesperson for the CMS maintains, “We do not believe that nursing homes will respond to the payment changes by decreasing the quality of care furnished to patients. However, we intend to carefully monitor changes in utilization and staffing patterns to ensure that patients continue to receive high quality care.” Still, the nursing home industry appears to be monitoring the situation with caution. Bottom line: If you have a loved one in a nursing home, then you, too, should take notice.

Reference: SmartMoney (August 18, 2011) “Medicare Cuts Could Up Nursing Home Costs”

ELDER LAW / HOSPICE

Hospice care can provide a great benefit to many families and their dying loved ones, and Medicare has been generally praised for its support through reimbursements to providers over the past 28 years. However, according to a recent article by Kaiser Health News and The New York Times, there is growing concern now about misuse of the program by for-profit hospice providers. Hospice care is intended to provide dying patients with palliative care in their own homes, or in a hospice facility or nursing home. But, as hospice has moved into the mainstream, concerns about excessive costs and misuse have mounted. A primary concern is that Medicare’s flat-fee payment system encourages hospices to seek out patients likely to live much longer than the six month time period for which hospice was originally intended. Medicare pays a flat fee ranging from $147 to $856 a day, depending on the level of care, whether a hospice actually provides services or not. For-profit hospices in particular tend to have longer-staying patients. "The financial incentives do in fact dictate behavior," said Eugene Goldenberg, a research analyst for BB&T Capital Markets who follows the hospice industry. "It's a lucrative business, at least under the current reimbursement system." In response, Medicare has adopted a restriction: It won’t pay for hospice beyond six months unless a physician or nurse practitioner visits the patient and attests that his or her condition is still terminal. But this requirement, part of the health care law passed last year, has provoked a backlash from hospice providers who say that sending a doctor or nurse practitioner out to see every patient at the six-month mark is too expensive. But given the financial and political pressures facing Medicare, government officials are concerned that hospice care may be misused. The inspector general of the Department of Health and Human Services looked at one fast-growing segment — hospice patients in nursing homes — and found hospices routinely failed to document that those patients belonged in a hospice or that they were getting the care to which they were entitled. If you or a loved one is considering hospice care, be sure to thoroughly investigate the care provider before making a commitment. Perhaps the most chilling aspect of these findings is not that people are using a hospice benefit for too long – but that they may be enrolling too soon …perhaps before giving other, more aggressive medical procedures a chance to work .

Reference: The Kaiser Health News (June 27, 2011) “Growing Hospice Care Costs Bring Concerns About Misuse”

ELDER LAW / HOSPICE

Hospice care can provide a great benefit to many families and their dying loved ones, and Medicare has been generally praised for its support through reimbursements to providers over the past 28 years. However, according to a recent article by Kaiser Health News and The New York Times, there is growing concern now about misuse of the program by for-profit hospice providers. Hospice care is intended to provide dying patients with palliative care in their own homes, or in a hospice facility or nursing home. But, as hospice has moved into the mainstream, concerns about excessive costs and misuse have mounted. A primary concern is that Medicare’s flat-fee payment system encourages hospices to seek out patients likely to live much longer than the six month time period for which hospice was originally intended. Medicare pays a flat fee ranging from $147 to $856 a day, depending on the level of care, whether a hospice actually provides services or not. For-profit hospices in particular tend to have longer-staying patients. "The financial incentives do in fact dictate behavior," said Eugene Goldenberg, a research analyst for BB&T Capital Markets who follows the hospice industry. "It's a lucrative business, at least under the current reimbursement system." In response, Medicare has adopted a restriction: It won’t pay for hospice beyond six months unless a physician or nurse practitioner visits the patient and attests that his or her condition is still terminal. But this requirement, part of the health care law passed last year, has provoked a backlash from hospice providers who say that sending a doctor or nurse practitioner out to see every patient at the six-month mark is too expensive. But given the financial and political pressures facing Medicare, government officials are concerned that hospice care may be misused. The inspector general of the Department of Health and Human Services looked at one fast-growing segment — hospice patients in nursing homes — and found hospices routinely failed to document that those patients belonged in a hospice or that they were getting the care to which they were entitled. If you or a loved one is considering hospice care, be sure to thoroughly investigate the care provider before making a commitment. Perhaps the most chilling aspect of these findings is not that people are using a hospice benefit for too long – but that they may be enrolling too soon …perhaps before giving other, more aggressive medical procedures a chance to work.