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Medicare

The Personal Side: Looking into getting older

While recently sharing a seafood dinner, three of my old high school friends and I also shared an inventory of our medical conditions.

“Old’’ is a relative term. We’re in our early 60s. And our annual reunion is a golf vacation in Florida, so we’re mobile enough to get around the links (and send too many Titleists splashing into lagoons).

After some initial chitchat, our dinner conversation eventually got around to health.

Andy MillerWe’re members of the generation born in the aftermath of World War II — the so-called baby boomers. But we haven’t been babies for a long time. And the older we get, the more the talk among us friends veers into what’s ailing us. One of our foursome is a physician, so he can often fill in the blanks of our knowledge.

First off, none of us has a perfectly functioning body. Few people at our age have everything in good working order.

One of my friends is in the early stages of Parkinson’s disease. Another has atrial fibrillation, a heart condition he controls with medication. A third has high blood pressure. And I have occasional lower back problems, and take pills for cholesterol and thyroid conditions.

We’re all intent on maximizing our relative health for as long as we can. full story

Progress being made against costly readmissions

Hospital readmissions are bad for everyone.

They’re obviously bad for discharged patients. No one wants to leave the hospital, get worse instead of better and then have to be hospitalized again.

Readmissions are also bad for the hospitals involved, because they can be penalized by Medicare for a high readmission rate within 30 days of discharge.

signERIn turn, readmissions are bad for nursing homes that have to send patients back to the hospital. Given their incentive to reduce readmissions, hospitals may not want to steer people to nursing homes that send back too many recently discharged patients.

But new efforts to improve care coordination among hospitals, nursing homes and other providers are succeeding in reducing readmission rates, experts say.

Georgia’s nursing homes and hospitals are collaborating more than ever to reduce readmissions, say officials with Georgia’s Quality Improvement Organization (QIO), a state-based group funded by Medicare to review medical care.

A big driver in this change has been the readmission penalties that hospitals now face. These penalties were created by the 2010 Affordable Care Act.

Jonathan Blum, deputy administrator of the federal Centers for Medicare and Medicaid Services, told GHN recently that the penalties have forced hospitals and nursing homes to improve their coordination. full story

A lingering gap in nursing home safety

More than 900 U.S. nursing homes, including six in Georgia, have been listed by federal officials as not fully complying with a regulation to have automatic fire sprinklers in every patient area.

The Centers for Medicare and Medicaid Services (CMS) sent a memo to state officials last week on the sprinkler rule compliance. It did not identify the nursing homes that are not fully sprinkler-equipped. The deadline for installation was Aug. 13.

smslogoIn 2008, CMS issued a rule that the long-term care industry had five years to install the systems in the approximately 16,000 U.S. nursing homes, where more than 1 million Americans live.

The federal rules came in response to the deaths of 31 people in nursing home fires in Nashville, Tenn., and Hartford, Conn., in 2003.

After the deadly fires, “there was enormous pressure on CMS to respond,’’ said Alan Horowitz, an Atlanta attorney with  law firm Arnall Golden Gregory who specializes in long-term health care issues.

Georgia’s record appears to be good compared with other states on the rate of compliance with the sprinkler regulation. full story

Lawmakers try to ease burden of Alzheimer’s

Rep. Hank Johnson

Rep. Hank Johnson

“It’s about people,” said U.S. Rep. Hank Johnson, a Georgia Democrat.

Johnson was referring to proposed legislation (H.R. 1507) to provide enhanced services for those affected by dementia, including Alzheimer’s disease. It’s the Health Outcomes, Planning, and Education Act, also known as the HOPE Act.

If passed, the bill would provide Medicare coverage for clinical diagnosis of Alzheimer’s and treatment planning, and would require documentation of evaluation and any care planning in an individual’s medical record. Johnson is an originating co-sponsor of the bill, which would amend title XVIII of the Social Security Act.

“Alzheimer’s is a devastating disease that not only robs patients of their essence, but has huge implications for their loved ones,” Johnson said.

Currently more than 5 million Americans suffer from Alzheimer’s disease, making it the sixth leading cause of death for those 65 and older in the United States. According to the Alzheimer’s Association, the cost of caring for those with Alzheimer’s and other types of dementia is expected to total about $203 billion in 2013, with the estimated cost increasing to $1.2 trillion (in today’s dollars) by mid-century.

In Georgia, there were 120,000 people with Alzheimer’s disease in 2010, and the number is expected to grow to 160,000 by 2025, according to a 2012 Alzheimer’s Association report. full story

Most hospitals in state face readmission fines

Medicare will impose fines on 73 Georgia hospitals for excessive readmissions of patients within 30 days of discharge.

Kaiser Health News reported that 68 percent of eligible hospitals in the state received a penalty — roughly the national average.

In all, 2,225 hospitals nationally will have payments reduced for a year starting Oct. 1. Eighteen hospitals — though none in Georgia — will lose 2 percent, the maximum fine possible and double the current top penalty.

Another 154 will lose 1 percent or more of every payment for a patient stay, including three hospitals in Georgia: Elbert Memorial in Elberton; Coffee Regional in Douglas; and Crisp Regional in Cordele. full story

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