A Health Provider Finds Success in Keeping Hospital Beds Empty
By ANNIE LOWREY
CHICAGO — On a stormy evening this spring, nurses at Dr. Gary Stuck’s family practice were on the phone with patients with heart ailments, asking them not to shovel snow. The idea was to keep them out of the hospital, and that effort — combined with dozens more like it — is starting to make a difference: across the city, doctors are providing less, but not worse, health care.
For most health care providers, that would be cause for alarm. But not for Advocate Health Care, based in Oak Brook, Ill., a pioneer in an approach known as “accountable care” that offers financial incentives for doctors and hospitals to cut costs rather than funnel patients through an ever-greater volume of costly medical services. Under the agreement, hospital admissions are down 6 percent. Days spent in the hospital are down nearly 9 percent. The average length of a stay has declined, and many other measures show doctors providing less care, too.
This approach is one small part of a growing effort by providers to hold down costs without restricting needed care. Nationwide, health care spending has grown over the last three years at the slowest rate since the federal government started keeping data more than 50 years ago. While the bulk of that is related to the poor economy, changes among insurers and health care providers have contributed as well. If the trend continues, even at a reduced pace, it could help alleviate Washington’s long-term deficit problems and ease the strain on family budgets.
“The part that’s not driven by the economy, that’s the part we can theoretically control,” said Drew Altman, president of the Henry J. Kaiser Family Foundation. “If we can shave even a small percentage off of it, it has a huge impact on public programs, a huge impact on premiums, a huge impact on employers.”
But even as more health systems seek to replicate Advocate’s early success, its experience shows just how hard it may be to expand the approach and keep medical costs from resuming their relentless rise.
Poll: Aging U.S. in denial about long-term care need
Jennifer Agiesta and Lauran Neergaard / The Associated Press
WASHINGTON — We're in denial: Americans underestimate their chances of needing long-term care as they get older – and are taking few steps to get ready.
A new poll examined how people 40 and over are preparing for this difficult and often pricey reality of aging, and found two-thirds say they've done little to no planning.
In fact, 3 in 10 would rather not think about getting older at all. Only a quarter predict it's very likely that they'll need help getting around or caring for themselves during their senior years, according to the poll by the AP-NORC Center for Public Affairs Research.
That's a surprise considering the poll found more than half of the 40-plus crowd already have been caregivers for an impaired relative or friend – seeing from the other side the kind of assistance they, too, may need later on.
"I didn't think I was old. I still don't think I'm old," explained retired schoolteacher Malinda Bowman, 60, of Laura, Ohio.
Governments may push workers to health exchange
By Mike Baker / The Associated Press
OLYMPIA, Wash. — In a move that would capitalize on provisions under PresidentBarack Obama's health care law but could cost the federal government millions of dollars, Washington state lawmakers have found a creative way to pass a large chunk of their health care expenses along to Washington, D.C. – and analysts say others are likely to follow suit.
The plan threatens to affect the federal budget and the pocketbooks of some part-time workers, as it would push a group of employees out of their current health care plans and into an exchange developed under the Affordable Care Act.
Observers say the shift seems to run counter to the intent of the new health care law. Supporters, however, say it's a viable strategy for governments to pursue as they manage the insurance rules related to part-time staff.
Washington state appears to be the first major government to seriously explore the possibility of pushing workers into the exchange — but it probably won't be the last. Rick Johnson, who advises state and local governments on health care policy at the New York-based consulting firm Segal Company, said he expects it will be an option some governments will look at in the years to come.
"I can see that as one of the solutions out there," Johnson said.
A spokeswoman with the Department of Health and Human Services declined comment, and it's unclear whether the federal government accounted for this possible outcome.
While Democratic lawmakers have expressed concern about the Washington state plan this year, it is drawing growing interest among a bipartisan group of political leaders in the state. Democratic Gov. Jay Inslee, who supported the Obama health care law while in Congress, has reservations about the plan.
But the former congressman said federal rules don't dictate how employers and employees should handle insurance coverage and indicated that he may consider supporting the idea in the future.
"It's one of those ideas that's premature for us to launch this year, but I don't think we should take it off the table," Inslee said Tuesday.
The Washington state proposal has come before lawmakers as governments around the nation are formulating strategies to manage those who don't work 40 hours a week, since the federal law requires employers to provide coverage for those working at least 30 hours.
Virginia, for example, is requiring all part-time employees to work fewer than 30 hours, which will help the state avoid penalties for not providing health coverage. Florida, facing a potential $300 million penalty for not covering workers who have 30 to 39 hours a week, is moving to extend coverage to those employees.
Washington state is in a less common situation, since it already provides coverage for part-timers down to 20 hours a week
Maine lawmaker’s bill highlights novel option for affording long-term care: life insurance
Posted April 23, 2013, at 8:46 p.m.
Maine seniors and the state’s cash-strapped MaineCare program could both win under new legislation up for debate Wednesday in the Legislature, according to the bill’s supporters.
The legislation, sponsored by Sen. Margaret Craven, D-Lewiston, involves an often overlooked way for seniors to pay for long-term care. The bill aims to help some older consumers who, faced with the prospect of paying for expensive assisted-living and nursing facilities, surrender their life insurance policies in order to qualify for MaineCare, Maine’s version of Medicaid.
To qualify for MaineCare, applicants must deplete their financial resources. Life insurance policies can prevent some seniors from qualifying for the health insurance program for the poor because the policies are considered assets.
Craven believes her bill, LD 1092, could help many seniors delay or avoid signing up for MaineCare by informing them about other ways to pay for long-term care themselves. The bill, which is scheduled for a public hearing Wednesday, would create a program at the Department of Health and Human Services, which oversees MaineCare, to help consumers learn about and sort through such alternatives.
The Legislature’s Health and Human Services Committee consistently struggles with how to fund nursing home care through MaineCare, said Craven, the lead Democrat on the committee. Individuals who aren’t covered by the program, meanwhile, often rapidly run through their financial resources paying for such care, she said.
“One of the first things to go is their life insurance policy,” Craven said.
That often proves costly, as consumers typically get back only pennies on the dollar when surrendering their policies for cash, said Chris Orestis, CEO of Life Care Funding, a Portland company that converts life insurance policies to help consumers pay for long-term care. Other seniors simply stop paying their premiums.
By converting their policy, consumers can maintain much more of the policy’s value and use that money to pay for long-term care, he said. But many seniors aren’t aware of that option, he said.
“This is not long-term care insurance,” he said. “People don’t buy this because they think in 20 years they might need long-term care. This is for people with an immediate need for care, with a life insurance policy that they’re getting ready to get rid of.”
Life Care Funding, which worked with Craven to draft the bill and would benefit from its passage, buys out the policies and sets up accounts to pay its customers’ long-term care providers. Customers do take a hit, getting anywhere from 30 to 60 percent of their policies’ value, but can use the money they’ve paid into life insurance, sometimes over decades, while they’re still alive, Orestis said.
Ellsworth hospital files suit against federal government over Medicare status worth $4 million annually
Posted April 23, 2013, at 4:29 p.m.
ELLSWORTH, Maine — Maine Coast Memorial Hospital has asked a U.S. District Court judge to overturn a ruling that denied a Medicare designation that would have resulted in higher payments to the hospital under the federal program.
The hospital applied in June 2010 to be designated a “Medicare Sole Community Hospital,” a label which indicates a medical facility’s role as the linchpin in providing health care to rural Medicare patients.
According to Maine Coast President and CEO Charlie Therrien, the difference between receiving the designation and not is about $4 million annually.
The designation would require the hospital to show that no more than 25 percent of Medicare beneficiaries in its service area receive inpatient care at “other like hospitals” within a 35 mile radius.
Maine Coast claims that only 21 percent of eligible patients receive care at similar facilities — Eastern Maine Medical Center and Saint Joseph Hospital in Bangor. But the federal government, in reviewing the data, found that nearly 28 percent of Medicare patients sought care elsewhere, and denied the sole community hospital status.
The hospital claims the feds got their numbers wrong, and on April 16 filed a civil complaint against Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, in U.S. District Court in an effort to overturn the ruling.
“The secretary’s decision was arbitrary, capricious, an abuse of discretion and otherwise not in accordance with law generally, as well as the plan and unambiguous language [of applicable federal law] read as a whole,” the complaint states.
The arithmetic involved here is actually pretty simple: It’s division. The number of Medicare patients in the hospital’s service area who went to similar hospitals is divided by the number of Medicare patients in the service area who received treatment at any hospital within the 35 mile radius.
The two sides agree on the numerator: In a yearlong sample of patient visits, 459 Medicare patients received care at other “like hospitals” within the 35 mile radius.
The dispute is whether that second figure, the denominator, should comprise only the patients who sought care at Maine Coast and the other two “like hospitals,” or all beneficiaries in the service area who were hospitalized for inpatient care anywhere within the 35 mile radius.
ERs Have Become De Facto Psych Wards
The Wall Street Journal, April 24, 2013
WASHINGTON, PRNewswire-USNewswire -- Long waits for insurance authorization allowing psychiatric patients to be admitted to the hospital from the emergency department waste thousands of hours of physician time, given that most requests for authorization are ultimately granted. A letter to be published in the May issue of Annals of Emergency Medicine argues that pre-authorization process is akin to health care "rationing by hassle factor" ("Insurance Prior Authorization Approval Does Not Substantially Lengthen the Emergency Department Length of Stay for Patients with Psychiatric Conditions").
"An emergency department is just about the worst place for a psychiatric patient to wait for an inpatient bed, and yet that is exactly what the pre-authorization process forces on millions of these vulnerable people, " said senior author J. Wesley Boyd, MD, PhD of the Cambridge Health Alliance in Cambridge, Mass. "The thousands upon thousands of hours emergency physicians spend obtaining prior authorization for admission to the hospital are hours we are not spending on direct patient care. Only Medicare does not require prior authorization for us to admit psychiatric patients to the hospital; maybe they are onto something."
Researchers recorded data on 53 patients, most of whom were in the emergency department because they were having suicidal thoughts. Half of the authorization requests took under 20 minutes to be approved, but 10 percent of the patients' authorizations took an hour or more. Only one of the 53 patients' insurance carriers denied pre-authorization. There are approximately 2.5 million psychiatric admissions to hospitals every year in the U.S.
"Psychiatric care is really the poor stepchild in the world of insurance coverage," said lead author Amy Funkenstein, MD, of Brown University in Providence, R.I. "Insurance carriers reimburse poorly and as a consequence, hospitals often have inadequate resources for patients who urgently need this care. The situation is so dire that ERs are now being designed and configured to house psychiatric patients awaiting placement as inpatients. These patients deserve better."
http://www.pnhp.org/print/news/2013/april/ers-have-become-de-facto-psych-wards
WASHINGTON, PRNewswire-USNewswire -- Long waits for insurance authorization allowing psychiatric patients to be admitted to the hospital from the emergency department waste thousands of hours of physician time, given that most requests for authorization are ultimately granted. A letter to be published in the May issue of Annals of Emergency Medicine argues that pre-authorization process is akin to health care "rationing by hassle factor" ("Insurance Prior Authorization Approval Does Not Substantially Lengthen the Emergency Department Length of Stay for Patients with Psychiatric Conditions").
"An emergency department is just about the worst place for a psychiatric patient to wait for an inpatient bed, and yet that is exactly what the pre-authorization process forces on millions of these vulnerable people, " said senior author J. Wesley Boyd, MD, PhD of the Cambridge Health Alliance in Cambridge, Mass. "The thousands upon thousands of hours emergency physicians spend obtaining prior authorization for admission to the hospital are hours we are not spending on direct patient care. Only Medicare does not require prior authorization for us to admit psychiatric patients to the hospital; maybe they are onto something."
Researchers recorded data on 53 patients, most of whom were in the emergency department because they were having suicidal thoughts. Half of the authorization requests took under 20 minutes to be approved, but 10 percent of the patients' authorizations took an hour or more. Only one of the 53 patients' insurance carriers denied pre-authorization. There are approximately 2.5 million psychiatric admissions to hospitals every year in the U.S.
"Psychiatric care is really the poor stepchild in the world of insurance coverage," said lead author Amy Funkenstein, MD, of Brown University in Providence, R.I. "Insurance carriers reimburse poorly and as a consequence, hospitals often have inadequate resources for patients who urgently need this care. The situation is so dire that ERs are now being designed and configured to house psychiatric patients awaiting placement as inpatients. These patients deserve better."
http://www.pnhp.org/print/news/2013/april/ers-have-become-de-facto-psych-wards
Psychiatrists spend 1 million hours a year awaiting insurance approval, study says
By Amanda Woerner
Fox News, April 23, 2013
One million hours: That’s how long psychiatrists across the country spend each year, waiting to get approval from insurance companies before they’re able to hospitalize suicidal or mentally ill patients from the emergency room, according to estimates from a new study in the Annals of Emergency Medicine.
Unlike other doctors, psychiatrists are required to seek permission from a patient’s insurance company, before admitting anyone to the hospital from an emergency room.
“If we think logically about what it would be like if someone came into the ER with a life-threatening illness and they had to wait to get admitted – that would be ridiculous,” study author and child psychiatry fellow at Brown University, Dr. Amy Funkenstein told FoxNews.com. “Our patients have life-threatening illnesses too, and we need to not question whether they deserve the hospitalization.”
After determining a patient needs to be treated – often because he or she is suicidal, psychotic or even homicidal – psychiatrists must call the patients’ insurer and present their case as to why they believe hospitalization is necessary. They present initially to an administrator and then to a social worker. If the case is denied by the social worker, the psychiatrists must present their case to a doctor.
Approval is required for all insured patients – except those on Medicare.
Funkenstein became increasingly frustrated with the insurance approval process while completing her psychiatric residency, so she asked her colleagues to begin recording the amount of time they spent seeking insurance approval – as well as the total time their psychiatric patients spent waiting in the ER, over the course of three months.
The study, published April 23, showed the approval process takes on average, 38 minutes, and with approximately 1.6 million psychiatric admissions requiring approval every year, that translates into 1 million hours of a psychiatrist’s time, which Funkenstein described as “wasted.”
Funkenstein pointed out the process can often take much longer.
“I once had a child who boarded for three days in the ER because the social worker didn’t believe admission was appropriate, while I waited for a doctor from the insurance company to call me back,” Funkenstein said.
The study also revealed the median time psychiatric patients spent in the emergency room before being admitted was 8.5 hours.
http://www.pnhp.org/print/news/2013/april/psychiatrists-spend-1-million-hours-a-year-awaiting-insurance-approval-study-says
Fox News, April 23, 2013
One million hours: That’s how long psychiatrists across the country spend each year, waiting to get approval from insurance companies before they’re able to hospitalize suicidal or mentally ill patients from the emergency room, according to estimates from a new study in the Annals of Emergency Medicine.
Unlike other doctors, psychiatrists are required to seek permission from a patient’s insurance company, before admitting anyone to the hospital from an emergency room.
“If we think logically about what it would be like if someone came into the ER with a life-threatening illness and they had to wait to get admitted – that would be ridiculous,” study author and child psychiatry fellow at Brown University, Dr. Amy Funkenstein told FoxNews.com. “Our patients have life-threatening illnesses too, and we need to not question whether they deserve the hospitalization.”
After determining a patient needs to be treated – often because he or she is suicidal, psychotic or even homicidal – psychiatrists must call the patients’ insurer and present their case as to why they believe hospitalization is necessary. They present initially to an administrator and then to a social worker. If the case is denied by the social worker, the psychiatrists must present their case to a doctor.
Approval is required for all insured patients – except those on Medicare.
Funkenstein became increasingly frustrated with the insurance approval process while completing her psychiatric residency, so she asked her colleagues to begin recording the amount of time they spent seeking insurance approval – as well as the total time their psychiatric patients spent waiting in the ER, over the course of three months.
The study, published April 23, showed the approval process takes on average, 38 minutes, and with approximately 1.6 million psychiatric admissions requiring approval every year, that translates into 1 million hours of a psychiatrist’s time, which Funkenstein described as “wasted.”
Funkenstein pointed out the process can often take much longer.
“I once had a child who boarded for three days in the ER because the social worker didn’t believe admission was appropriate, while I waited for a doctor from the insurance company to call me back,” Funkenstein said.
The study also revealed the median time psychiatric patients spent in the emergency room before being admitted was 8.5 hours.
http://www.pnhp.org/print/news/2013/april/psychiatrists-spend-1-million-hours-a-year-awaiting-insurance-approval-study-says
Federal Government long term care insurance is a good choice for the veterans to give them the worthy care that they need. Converting their policy, consumers can maintain much more of the policy’s value and use that money to pay for long-term care. Sadly, lots of seniors are not aware of that option.
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