IF YOU ARE NOT READING INTO THESE POLICIES THE VISION OF SANITARIUMS FROM THE DAYS OF CHARLES DICKENS------YOU DO NOT UNDERSTAND HEALTH CARE REFORM WRITTEN BY HEDGE FUNDS...THE AFFORDABLE CARE ACT.
THIS IS A LONG BLOG.....PLEASE GLANCE THROUGH ALL ARTICLES!
Regarding corporate commentators Fraser Smith and Basu on private non-profits and health care reform in Maryland:
FRASER SMITH AND BASU HIT IT ON THE HEAD.....JOHNS HOPKINS UNIVERSITY CREATED THE PRIVATE NON-PROFIT MARYLAND HEALTHCARE FOR ALL TO CAPTURE THE POLICY ISSUE OF UNIVERSAL CARE AND MADE SURE IT WENT WITH AFFORDABLE CARE ACT-----PRIVATIZATION FOR PROFIT AT THE EXPENSE OF ACCESS TO HEALTH CARE-------AND SO THE POLICY WOULD NOT GO TOWARDS EXPANDED AND IMPROVED MEDICARE FOR ALL, THE REAL UNIVERSAL CARE POLICY.
So, a corporation created its own private non-profit to push it own policy agenda using taxpayer money and private donations to make sure policy went towards maximizing profit for Johns Hopkins. That is indeed what this proliferation of corporate private non-profits is about.
SO, WHAT ABOUT THIS LADY FRASER MADE TO SOUND THANKFUL TO HAVE THIRD WORLD HEALTH CARE WITH TODAY'S MEDICAID AFTER LOSING A FIRST WORLD QUALITY HEALTH PLAN?
We hear time and again that this Affordable Care Health Reform is a Republican idea pulled together first by Reagan and implemented by Romney in Massachusetts. It is indeed a Republican plan. Affordable Care does not mean affordable for people, it means affordable for corporations and profit-maximizing.....Third Way corporate neo-liberals in Mass passed this plan just as they are now in Maryland. What we are seeing is the requirement to have health insurance partnered with health access that is window-dressing. When Massachusetts says it has almost universal coverage it isn't telling you that the coverage that many people have is just the preventative public health level we are seeing hitting Maryland. Who are those falling into this Medicaid level care? The article below written in 2010 looks at immigrant and low-income care but makes clear that the window is opening as to who will receive this level of care.
Massachusetts health care plan “dangerously restricts access” to primary care
Published August 9th, 2010 iHealthBulletin News!
The first health care plan from a for-profit insurance company approved to offer government-subsidized coverage under Massachusetts’ health care reform has dangerously restricted access to primary care, according to data reported on August 5, 2010 in the New England Journal of Medicine. Researchers say the findings raise troubling concerns about the Obama administration’s new health law, which is modeled after the Massachusetts plan.
Three Harvard-affiliated physicians report that out of a list of 326 doctors identified as members of the provider network of CeltiCare, a for-profit insurer contracted by the state of Massachusetts to take over coverage of about 30,000 legal immigrants (and, more recently, low-income citizens), only 217 were non-duplicate adult primary care providers. Of these 217 doctors, 25 percent could not be reached by telephone.
Of those primary care doctors who were reachable by telephone, only 37 percent, or 60 providers, said they were accepting new CeltiCare patients. In those cases, the average wait time for an appointment was 33 days, even though the patient was described as having a chronic illness like diabetes or hypertension.
Moreover, although many of the patients who had been forced into the CeltiCare plan don’t speak English, only 38 of the doctors who were accepting new patients had any form of translation services.
The plan’s failure to provide adequate access to doctors for its members raises grave concerns not only about Massachusetts’ reform, but also about the recently enacted national reform, the researchers say. The national plan closely mirrors Massachusetts’ reform, but relies far more heavily on for-profit insurers.
The report points out that even when patients have insurance, profit-driven plans may discourage them from getting the care they need by “rationing by inconvenience.”
The data appears in a letter titled “Immigrants’ experience with publicly funded private health insurance” in the August 5, 2010 print edition of the journal. It was written by two resident physicians at the Harvard-affiliated Cambridge Health Alliance and a Harvard Medical School faculty adviser, and is based on the work of a group of interns, residents and medical students from several Boston-area hospitals and medical schools.
These doctors-in-training carried out the research after they became worried when some of their sickest patients – patients with cancer, diabetes and other severe health problems – were forced from their existing insurance plan into the CeltiCare plan. They then were told that they could no longer be treated at many of their previous health clinics, forcing them to find new doctors.
The researchers identified doctors available to the CeltiCare patients using the plan’s “Find a Provider” website. They called each of the doctors’ offices within a 5-mile radius of their hospital, identifying themselves as relatives of a chronically ill, older adult who needed an appointment soon. If an appointment was offered, the researcher asked about the availability of translators.
“Trying to get an appointment was even more daunting than these numbers suggest,” said Dr. Cassie Frank, a co-author of the article. “Many clinics forced me to call several times to get an appointment. One said they only open up appointments on Monday morning, and that to have a chance of getting any appointment slot I’d have to show up an hour before the clinic opened to be first in line.”
Dr. Malgorzata Dawiskiba, another co-author, said: “The state suddenly shifted thousands of sick patients to a cut-rate plan. But instead of getting a bargain, the patients were left stranded – insured, but unable to find a doctor who could care for them. These were people whom we knew. We and our supervisors had been their doctors, sometimes for many years, and overnight they were told ‘you can’t come here anymore.’”
Dr. Ruth Hertzman-Miller, an instructor at Harvard Medical School and study co-author, commented: “The problems faced by CeltiCare’s patients may soon become much more widespread. Our legislative leaders want to require every insurer in Massachusetts to offer a plan with a restricted list of doctors and a lower price tag. But that kind of restricted coverage may be little more than a worthless piece of paper” (Courtesy of Eurekalert).
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What we are seeing in Maryland already is an inability of low-income people or inadequately insured people to get the normal treatment for common diseases. When you have to co-pay a $100,000 treatment, how does that affect your future access? YOU WON'T HAVE ANY. Baby boomers are told they will not be affected, but at age 55 I know that when I start having major health issues in a decade or so, all of this reform will not protect my Medicare coverage.
OTHER COUNTRIES DO UNIVERSAL CARE WITH SATISFACTORY SERVICE......DO YOU HEAR THE ENGLISH, CANADIAN, OR FRENCH SHOUTING OUT AGAINST THEIR HEALTH SYSTEMS? DO YOU HEAR OF THE POOR CLIMBING INTO THE BACKS OF VANS FOR HEALTH CARE WHILE THE RICH HAVE HEALTH BOUTIQUES IN THESE COUNTRIES?
VOTE YOUR NEO-LIBERAL INCUMBENT OUT OF OFFICE!!
Making all of health care about profit moves drugs to market-based operations. So, if a drug is not used much it will be made expensive or will not be manufactured. We already are seeing shortfalls in availability of common drugs because of market-based health policy. IT WILL GET WORSE IF LEFT TO CONTINUE.
No Health Insurance Dims Cancer Fate Cancer Outcomes Worse for People With No Health Insurance or Inadequate Health Insurance
By Miranda Hitti
WebMD Health News Reviewed by Louise Chang, MD
Dec. 20, 2007 -- Cancer patients without adequate health insurance tend to face grimmer odds than those with good health insurance, says the American Cancer Society.
The American Cancer Society today released a new report on health insurance and cancer.
The report shows that people with no health insurance or inadequate health insurance face four main challenges when it comes to cancer:
They're less likely to get screened for cancer.
They're less likely to get counseled about cancer prevention.
They're more likely to get diagnosed late, when their cancer is harder to treat.
They're more likely to die from cancer than people with adequate health insurance.
Take breast cancer, for instance. The report shows that women with private health insurance are more likely to get mammograms, get diagnosed earlier, and have better survival rates than uninsured women.
The same is true for colorectal cancer. The report shows that among adults aged 50-65, about half of those with private health insurance had gotten screened for colorectal cancer in the past decade, compared with almost 40% of those with Medicaid insurance and about 19% of uninsured people.
Noting that some new cancer treatments cost more than $100,000 per year, the American Cancer Society's report asks, "To what extent will availability and type of insurance coverage, as well as individual financial resources, determine who has access to the most effective therapies?"
Health insurance isn't the only gap in cancer care. Racial and ethnic disparities also affect cancer outcomes.
The American Cancer Society based its report on information from the CDC and from the National Cancer Data Base.
The findings appear in CA: A Cancer Journal for Clinicians.
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CHECK OUT THE DESCRIPTIONS OF THESE HEALTH HOMES THEY PLAN FOR MEDICAID/MEDICARE PEOPLE. THEY ARE SIMPLY COMPOUNDS OF CARE WE ALREADY KNOW WILL BE RUN BY HUGE HEDGE FUND-SIZED CORPORATIONS THAT HAVE NO INTENTION BUILDING A CARING/QUALITY ENVIRONMENT.
What is the difference between the retirement communities and state nursing homes we have today and what ACA is calling community-centered health homes? First, retirement communities and state nursing homes were run by private non-profits like religious communities and the government having the public's interest at heart. What ACA if creating is a national system of corporate businesses often owned by hedge funds and run with only thoughts of profit and raiding entitlement Trusts with fraud. We already had the kinds of facilities ACA is creating only they were not structured for profit.
THINK HOW A HEDGE FUND WILL OPERATE A COMMUNITY HEALTH HOME.
Community homes for seniors and the poor with chronic health conditions.....sound a little like the sanitariums of hundreds of years ago? YOU BETCHA!!!!! Think who will age or fall into poverty in this downward spiral of neo-liberalism------ALMOST EVERYONE. HOW MEDIEVAL OF NEO-LIBERALS!!!
MEDICAL HOMES-----for the poor that means isolated health care focusing on containing communicable diseases and mental health issues. It is third world speak for containing disease vectors as cheaply as possible. As I mention above, the old practice of SANITARIUMS is the model. It will become a Dickens' nightmare as public health is dismantled and no public oversight allows a level of neglect we do not want to allow.
You notice that ACA sends billions of dollars to fund the building of these structures and this is happening as more and more people lose private health insurance or public health plans are getting ready to be thrown into these state health systems relegating most people to the status of Medicaid.
SEE WHY NEO-LIBERALS ARE PUSHING EXPANDED MEDICAID RATHER THAN FIGHTING TO RECOVER TRILLIONS OF DOLLARS LOST FROM ENTITLEMENT TRUSTS FROM CORPORATE FRAUD.
We simply need to rebuild white collar criminal agencies and stop the massive fleecing of Medicare and Medicaid, recover funds lost to fraud, and we will be flush with money to fund a first world quality of health care for all.
HMMMMMMM.....MEDICAL ENTERPRISE ZONES SEEM TO BE THE FEDERAL MONEY BUILDING THIS SYSTEM
Community-Centered Health Homes
Community-Centered Health Homes Bridging the gap between health services and community prevention ...practices, including the patient-centered medical home,
aswww.ravenswoodfhc.org/images/pdf/community-centered...
Transforming Community Health Centers into Patient-Centered Medical Homes: The Role of Payment Reform
September 28, 2011
Authors: Leighton Ku, Ph.D., M.P.H., Peter Shin, Ph.D., M.P.H., Emily Jones, M.P.P., Brian Bruen, M.S.
Contact: Leighton Ku, Ph.D., M.P.H., Director, Center for Health Policy Research in the Department of Health Policy, George Washington University leighton.ku@gwumc.edu
Editor: Deborah Lorber
"FQHCs have long sought to provide quality team-based, comprehensive primary care and typically viewed themselves as serving as medical homes, even before there were formal definitions for medical homes."
Overview This report examines how changes in the way federally qualified health centers (FQHCs) are financed could support the transformation of these critical safety-net providers into high performing patient-centered medical homes. Through surveys and interviews, the authors explore the current landscape of health center involvement in medical home initiatives, adoption of medical home standards, and receipt of payment incentives. Based on their findings, the authors make preliminary recommendations to encourage health centers to serve as patient- and community-centered medical homes. These include: establishing recommended standards for patient- and community-centered medical homes that apply to FQHCs; structuring payment incentives to promote medical homes; including FQHCs in state Medicaid medical or health home projects; adapting payment approaches, including adding monthly case management fees; and encouraging the Health Resources and Services Administration to use quality-of-care measures in making funding decisions.
Executive Summary
The Patient Protection and Affordable Care Act of 2010 (Affordable Care Act) significantly altered the landscape of American health care policy. In addition to expanding coverage to millions of uninsured and increasing funding to expand community health centers, the Affordable Care Act initiates efforts to change how health care is paid for and delivered in the United States. For example, the law encourages state Medicaid programs to develop medical homes, also known as "health homes," for Medicaid patients with chronic diseases. More broadly, the law calls on federal and state governments to consider other methods to transform health care delivery, including strategies such as creating accountable care organizations and bundling episodes of care. The large increases in the number of people with health insurance, including Medicaid patients, after the implementation of health reform will require the nation and the states to consider strategies to strengthen primary care services as part of a high performance health system.
This report examines how changes in the way federally qualified health centers are financed could support the transformation of these critical safety-net providers into high performing patient-centered medical homes. Federally qualified health centers (FQHCs), also known as community health centers or clinics, are nonprofit facilities that provide comprehensive primary medical care—and often dental, vision, and behavioral health services—to low-income patients in medically underserved areas, regardless of a person's ability to pay.
In late 2009, we conducted a survey of state primary care associations, which represent community health centers in their states. We followed up this survey with interviews of selected health center, state agency, and managed care staff about medical home and quality initiatives in their states. In the majority of states, health centers receive payments to serve as primary care providers or medical homes, generally under Medicaid, and more recently have begun to serve as patient-centered medical homes. There was great diversity in the nature of medical home programs, medical home criteria, and stages of development. In some cases, private physicians are eligible for medical home payments, but health centers are not.
FQHCs have long sought to provide quality team-based, comprehensive primary care and typically viewed themselves as serving as medical homes, even before there were formal definitions for medical homes. Nonetheless, many FQHCs have demonstrated interest in attaining formal recognition as a medical home.
Preliminary data from a George Washington University survey of FQHCs, conducted from 2010 to 2011, indicate that about 6 percent of centers have attained National Committee for Quality Assurance–Patient Centered Medical Home (NCQA–PCMH) recognition, another 12 percent have a pending application, and 40 percent expect to seek recognition in the next 18 months. Some (12%) have received or applied for recognition from a state medical home program and 11 percent are considering another national recognition program. One reason some centers do not consider applying is there is no financial reward for attaining recognition, as some states do not have medical home incentive programs for FQHCs.
We present several financing recommendations to increase the incentives for FQHCs to transform themselves into high-performing medical homes:
Establish recommended standards for patient- and community-centered medical homes that apply to FQHCs. A variety of national and state recognition programs exist for medical or health homes, but they generally focus only on patient-centered medical care. Health centers also seek to provide community-centered services, such as offering access to patients regardless of ability to pay; providing nonmedical services like behavioral, dental, or enabling services (like case management, health education, and translation); and conducting community needs assessments and other prevention-oriented projects. It may be relevant to establish standards that emphasize these broader community-oriented service components.
States should include FQHCs in Medicaid health home projects. Under the Affordable Care Act, state Medicaid programs may establish health home projects for those with chronic health conditions. In the past, some state medical home programs excluded FQHCs because they are paid differently than physician practices. Since FQHCs provide primary care to a substantial and growing number of Medicaid patients, they should be included in all state Medicaid health home projects.
Clarify that states may pay FQHCs more than the levels prescribed by the prospective payment system. Although federal Medicaid policy that governs health center payments does not prevent states from paying FQHCs more than the prospective payment system (PPS) level, which is based on historical Medicaid costs and then updated, some states appear to interpret the statute as constituting a cap on FQHC payment levels.
If states adopt medical or health home incentives, providing monthly case management fees per Medicaid patient is a reasonable approach. States considering this option could add a monthly medical home case management fee, in addition to regular FQHC reimbursements, as an appropriate way to create a payment incentive for medical home status. This is already used in many states and is the method planned for the Medicare FQHC Advanced Primary Care Practice demonstration project.
Clarify how states may increase FQHC payment levels under Medicaid. Under current federal rules, states may change PPS payments to individual health centers when the centers demonstrate a change in the scope of Medicaid services. However, there is no specific provision for changing the PPS
payments when a health center increases the quality or intensity of services it provides.
Maintain the all-inclusive per-visit payment rates in Medicaid. Under federal law, Medicaid payments to FQHCs are paid on a flat, all-inclusive, per-visit (or per encounter) basis. To change the system would require substantially changing all FQHC payment rates, which would take years to develop. Given current state budget problems, in which state Medicaid programs have often trimmed provider payment rates, opening all FQHC payment rates to recalculation could place them at substantial risk of unanticipated reductions.
The Centers for Medicare and Medicaid Services (CMS) should ensure that Medicare policies are consistent with medical home goals. CMS has announced two Medicare advanced primary care medical home demonstration projects, one for FQHCs and one that permits multipayer projects in several states. CMS should continue to develop these projects. CMS is also actively developing policies in related areas, such as those related to Medicare accountable care organizations, and should ensure that the objectives of those policies are ultimately supportive of medical home policies as well.
The Health Resources and Services Administration has long encouraged quality of care for FQHCs and supports Section 330 grantees as NCQA–PCMHs, but could consider additional efforts. The Health Resources and Services Administration (HRSA) seeks to build on the already strong quality of care delivered by health centers by focusing on quality improvements and ways that payment reforms could affect health centers. HRSA provides grants to subsidize the cost of NCQA–PCHM applications for FQHCs that receive federal Section 330 grants. In allocating funds to grantees, HRSA has not traditionally used quality of care in funding decisions. HRSA is improving information collected about the quality of care at Section 330 grantees under its Uniform Data System. In the future, HRSA could develop incentives to improve the quality of care at health centers or performance as medical homes. It could develop further efforts to help integrate health center coordination in medical home, health home, and advanced primary care projects, working with Medicare, Medicaid, and the Children's Health Insurance Program—and eventually the health insurance exchanges.
As the concept of a medical home and other paradigms to strengthen the health care infrastructure are implemented, FQHCs will serve as laboratories for innovation to test new care models. Adequate and appropriately structured financial incentives are critical to the success of any model of health care delivery, and the medical home is no exception. In addition to changes to the reimbursement system that would better align incentives, other supports for providers such as training and technical assistance are necessary to bolster and support the infrastructure.
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This is what happens when health care becomes about maximizing profits. Staff are not always to blame. People are being sent to do jobs for which they are not prepared. Standardization of care misses lots of individual symptoms and history. Having hedge funds operating medical care can only be a spiraling disaster for health care. SHOUT FOR EXPANDED AND IMPROVED MEDICARE FOR ALL.
This article is a good look at what has happened as health care moves from hospital to nursing facilities, but it doesn't address the gorilla in the room------home health care skilled and non-skilled. If you know nursing homes and community care facilities are rife with bad care you know this booming national health chains of home health care businesses are really, really bad. THEY ARE. This is what all of these private for-profit career job training schools are releasing on the public and it is not pretty. The students graduating are not at fault most times....they are being steered into programs that do not prepare them for the jobs they will do and these health businesses for which they are hired are not monitored or operating legally in many cases.
THIS IS WHAT ACA DOES IN TANDEM WITH PRIVATIZATION OF EDUCATION....IT DEVELOPS A SYSTEM WHERE EDUCATION FEEDS BUSINESSES AND IT IS ALL PROFIT-DRIVEN.
So, Americans are being told they will be serviced at home at the same time academics are seeing the lowest quality of training for students entering these fields. I want to qualify that home health care businesses have been around for decades and many offer strong, quality care and staffing. What we are seeing from ACA is a flooding of the market with national chains simply there to make a buck anyway they can. This article below has a Hopkins professional reporting these shortfalls as Baltimore is ground zero in the worst health care in these kinds of facilities and Hopkins is public health in Baltimore. It's like interviewing the fox about how best to stop foxes from raiding the hen house.
DO YOU SEE HEDGE FUNDS AND GLOBAL CORPORATIONS RISING TO THE CALL TO IMPROVE QUALITY OF CARE?
'About 40 percent of people over age 65 will spend time in a nursing home at some point, Mollot said. Hopefully, he said, the inspector general’s report will help the public see that care needs to improve'.
He said,
“They are dangerous, dangerous places”.
Keep in mind with this article below that in Maryland, where Medicare is being dismantled by privatization with no Federal oversight, has the goal to end all Federal oversight of Medicare. 1/2 of Medicare spending is lost to fraud and you see Federal spending by Medicare is sent to building these skilled nursing businesses. When the Federal Medicare program is privatized to these state systems, there will be no public oversight as described in this article.
One Third of Skilled Nursing Patients Harmed in Treatment
March 16th, 2014
Special Report from ProPublica
by Marshall Allen, ProPublica
One-in-three patients in skilled nursing facilities suffered a medication error, infection or some other type of harm related to their treatment, according to a government report released recently that underscores the widespread nature of the country’s patient harm problem.
Follow up:
Doctors who reviewed the patients’ records determined that 59 percent of the errors and injuries were preventable. More than half of those harmed had to be readmitted to the hospital at an estimated cost of $208 million for the month studied — about 2 percent of Medicare’s total inpatient spending.
Patient safety experts told ProPublica they were alarmed because the frequency of people harmed under skilled nursing care exceeds that of hospitals, where medical errors receive the most attention.
Dr. Marty Makary, a physician at Johns Hopkins Medicine in Baltimore who researches health care quality, said -
“(The report) tells us what many of us have suspected – there are vast areas of health care where the field of patient safety has not matured”.
The study by the inspector general of the U.S. Department of Health and Human Services (HHS) focused on skilled nursing care – treatment in nursing homes for up to 35 days after a patient was discharged from an acute care hospital. Doctors working with the inspector general’s office reviewed medical records of 653 randomly selected Medicare patients from more than 600 facilities.
The doctors found that 22 percent of patients suffered events that caused lasting harm, and another 11 percent were temporarily harmed. In 1.5 percent of cases the patient died because of poor care, the report said. Though many who died had multiple illnesses, they had been expected to survive.
The injuries and deaths were caused by substandard treatment, inadequate monitoring, delays or the failure to provide needed care, the study found. The deaths involved problems such as preventable blood clots, fluid imbalances, excessive bleeding from blood-thinning medications and kidney failure.
One patient suffered an undiagnosed lung collapse because caregivers failed to recognize symptoms. The patient later had a reaction to medication and a blood clot and had to be transferred to a hospital.
Projected nationally, the study estimated that 21,777 patients were harmed and 1,538 died due to substandard skilled nursing care during August 2011, the month for which records were sampled.
Medicare patients “deserve better,” said Sen. Bill Nelson, D-Fla., chairman of the U.S. Senate Special Committee on Aging. Nelson said he would push for better inspections of the facilities. He said,
“This report paints a troubling picture of the care that’s being provided in some of our nation’s nursing homes”.
The report said it is possible to reduce the number of patients being harmed. It calls on the federal Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services (CMS) to promote patient safety efforts in nursing homes as they have done in hospitals.
The authors also suggest that CMS instruct the state agencies that inspect nursing homes to review what they are doing to identify and reduce adverse events.
In its response to the report, CMS agreed with the findings and noted that the Affordable Care Act requires nursing homes to develop Quality Assurance and Performance Improvement programs. The agency’s quality improvement work includes a website for nursing homes that was launched in 2013.
A “skilled nursing” facility provides specialized care and rehabilitation services to patients following a hospital stay of three days or more. There are more than 15,000 skilled nursing facilities nationwide, and about 90 percent of them are also certified as nursing homes, which provide longer-term care.
As hospitals have moved to shorten patient stays, skilled nursing care has grown dramatically. Medicare spending on skilled nursing facilities more than doubled to $26 billion between 2000 and 2010. About one-in-five Medicare patients who were hospitalized in 2011 spent time in a skilled nursing facility.
John Sheridan, a member of the American College of Health Care Administrators, which represents nursing home executives, called the report valuable but noted that it sampled only a small number of patients. He questioned whether the findings apply broadly to skilled nursing facilities.
Sheridan also strongly disagreed with the report’s observation that there’s less known about patient safety in skilled nursing facilities compared to hospitals. He said Medicare has robust inspections of nursing homes it certifies – they take place annually or when there are complaints and are usually conducted by state contractors. Medicare also keeps detailed data on the violations, he said. (ProPublica’s Nursing Home Inspect makes it easy to search and view Medicare inspection reports.)
Sheridan agreed that skilled nursing facilities could improve, but said the caregivers face a daunting task and work diligently despite low reimbursements Medicare pays to the facilities.
Sheridan said of the providers that -
“They don’t go to work every day to cause an adverse event. They do it to care for the residents there. They do it with sacrifice and love.”
Dr. Jonathan Evans, president of the American Medical Directors Association, a group focused on nursing home care, said while he doesn’t dispute the estimates in the inspector general’s report, they are typical of problems that exist throughout the health care sector.
Evans said that patients receiving skilled nursing care are leaving hospitals sooner and that many are not medically stable and have more intensive needs. Nursing homes, originally designed for long-term patients who did not need intensive care, and have been slow to adapt, Evans added.
He said,
“You have a system of long-term care that’s trying to retrofit to be a system for post-acute care. The resources to care for them and commitment from those sending them from one facility to another haven’t kept pace.”
Evans called the study significant and said he hopes it raises awareness and sparks improvements.
Makary, the Johns Hopkins’ doctor, said the patient safety movement has been more focused on problems at hospitals than in nursing homes.
A 2010 report by the HHS inspector general estimated that 180,000 patients a year die from bad hospital care, and other estimates have been higher. The patient safety research community has focused on reducing bloodstream infections and surgical errors at hospitals but has done less to address issues specific to nursing homes, Makary said.
Developing metrics to track improvement would be more effective than annual inspections, which don’t do a good job of capturing a facility’s everyday performance, Makary said.
Patient advocates said the study verifies what they’ve heard from skilled nursing patients and their families. Richard Mollot, executive director of New York’s Long Term Care Community Coalition, said he was “flabbergasted” by medication errors, bedsores and falls that were identified in the report.
They are prominent problems that nursing homes should be “well versed” to address, he said.
Mollot said the report should have more forcefully called for better enforcement of the existing standards in nursing homes.
States inspect nursing homes on behalf of Medicare every year and when there are complaints, he said, but some inspectors are tougher than others. Medicare’s current standards of care are good, he said, and “if they were enforced we wouldn’t have these widespread problems.”
About 40 percent of people over age 65 will spend time in a nursing home at some point, Mollot said. Hopefully, he said, the inspector general’s report will help the public see that care needs to improve.
He said,
“They are dangerous, dangerous places”.
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This article show too where things will go in the US if neo-liberals remain in charge. Spain has been taken by the worst of TROIKA politicians and the public sector is being gutted and a strong public health care system and quality wages and staffing dismantled. Remember, Trans Pacific Trade Pact (TPP) and its Atlantic Trade deal pushes the dismantling of public health all over the world so US private health systems will maximize profits. Here is a former first world country moving to third world in one fell swoop. This is the goal of TPP---to take formerly first world nations to the level of developing countries under the guise of needing to be competitive globally.
THAT'S A NEO-LIBERAL FOR YOU----ALL MARYLAND POLS ARE NEO-LIBERALS!
Outrage as nurses are appointed at less than €4 per hour
by TPN/ Lusa, in News · 05-07-2012
Portugal’s national nurses register publicly announced on Monday that it considered it “scandalous” for nursing professionals to be placed on contracts earning less than four euros per hour and appealed for those who could “not to accept” the proposals.
Outrage as nurses are appointed at less than €4 per hour
This is a scandal for Portugal, for a first world country, that is offering highly qualified professionals at a price per hour that is incompatible with their profession and their dignity," said Germano Couto from the national nurses register Ordem dos Enfermeiros, adding that he had received "a series of denunciations" from "tens of nurses who have contracts at €3.96 per hour."
Mr. Couto spoke in reaction to news published in Diário de Noticias that nurses hired by temping agencies for the health centres of Lisbon and the Tagus Valley region who started work on Monday will receive less than four euros per hour.
He guaranteed that the news piece "is real" and "there are facts and evidence", although he added that he hoped it "isn’t more than a series of intentions" and so "may be reverted by the Lisbon and Tagus Valley regional health authority and the Ministry of Health."
Mr. Couto added that the government may be "paying more to these companies" for them to "obtain their profit" but highlighted that it is necessary to check whether these companies are fulfilling the contract conditions, as the €3.96 per hour the nurses will earn equates to €300 in their pockets at the end of the month, which doesn’t even qualify as minimum wage.
Currently, the average wage deemed acceptable for nurses in Portugal is around €1,020 per month, which is around seven euros per hour and that value "should be the yardstick the government should use."
Following the news of the reduced wages for new nursing contracts in the Lisbon area, the national nurses register has "appealed to nurses not to accept these contracts if they are able," adding that they do however understand if some go ahead "so as not to lose their status."
Mr. Couto considers that many health professionals prefer to move abroad rather than end up unemployed or lose their status, criticising that Portugal is "training nurses for export" at a time when there is need in the country.
In response to the news, the Lisbon and the Tagus Valley health authority (ARSLVT) announced that the nursing contracts were put to tender at prices per hour varying between €4.77 and €5.19 and declined any responsibility of wages being paid below four euros per hour.
The price per hour "results from the public tender whereby the companies involved presented their proposals," ARSLVT said in a statement.
The health authority said it had launched a public tender for the acquisition of nurses with a base value of €8.50 per hour, which corresponds to the average price on the market for this type of service.
"The values presented by firms that responded to the public tender were substantially lower than the base value, and all those 50 percent below it were excluded from the public tender because of the legal reason that they were abnormally low values," said the statement.
ARSLVT added that "the majority of firms presented values much reduced compared to that proposed by ARSLVT, with a price being fixed between €4.77 and €5.19" in the end.
"Negotiation of salaries and conditions is the exclusive responsibility of the firms that responded to the public tender and their staff," the regional health authority concluded.
THIS IS A LONG BLOG.....PLEASE GLANCE THROUGH ALL ARTICLES!
Regarding corporate commentators Fraser Smith and Basu on private non-profits and health care reform in Maryland:
FRASER SMITH AND BASU HIT IT ON THE HEAD.....JOHNS HOPKINS UNIVERSITY CREATED THE PRIVATE NON-PROFIT MARYLAND HEALTHCARE FOR ALL TO CAPTURE THE POLICY ISSUE OF UNIVERSAL CARE AND MADE SURE IT WENT WITH AFFORDABLE CARE ACT-----PRIVATIZATION FOR PROFIT AT THE EXPENSE OF ACCESS TO HEALTH CARE-------AND SO THE POLICY WOULD NOT GO TOWARDS EXPANDED AND IMPROVED MEDICARE FOR ALL, THE REAL UNIVERSAL CARE POLICY.
So, a corporation created its own private non-profit to push it own policy agenda using taxpayer money and private donations to make sure policy went towards maximizing profit for Johns Hopkins. That is indeed what this proliferation of corporate private non-profits is about.
SO, WHAT ABOUT THIS LADY FRASER MADE TO SOUND THANKFUL TO HAVE THIRD WORLD HEALTH CARE WITH TODAY'S MEDICAID AFTER LOSING A FIRST WORLD QUALITY HEALTH PLAN?
We hear time and again that this Affordable Care Health Reform is a Republican idea pulled together first by Reagan and implemented by Romney in Massachusetts. It is indeed a Republican plan. Affordable Care does not mean affordable for people, it means affordable for corporations and profit-maximizing.....Third Way corporate neo-liberals in Mass passed this plan just as they are now in Maryland. What we are seeing is the requirement to have health insurance partnered with health access that is window-dressing. When Massachusetts says it has almost universal coverage it isn't telling you that the coverage that many people have is just the preventative public health level we are seeing hitting Maryland. Who are those falling into this Medicaid level care? The article below written in 2010 looks at immigrant and low-income care but makes clear that the window is opening as to who will receive this level of care.
Massachusetts health care plan “dangerously restricts access” to primary care
Published August 9th, 2010 iHealthBulletin News!
The first health care plan from a for-profit insurance company approved to offer government-subsidized coverage under Massachusetts’ health care reform has dangerously restricted access to primary care, according to data reported on August 5, 2010 in the New England Journal of Medicine. Researchers say the findings raise troubling concerns about the Obama administration’s new health law, which is modeled after the Massachusetts plan.
Three Harvard-affiliated physicians report that out of a list of 326 doctors identified as members of the provider network of CeltiCare, a for-profit insurer contracted by the state of Massachusetts to take over coverage of about 30,000 legal immigrants (and, more recently, low-income citizens), only 217 were non-duplicate adult primary care providers. Of these 217 doctors, 25 percent could not be reached by telephone.
Of those primary care doctors who were reachable by telephone, only 37 percent, or 60 providers, said they were accepting new CeltiCare patients. In those cases, the average wait time for an appointment was 33 days, even though the patient was described as having a chronic illness like diabetes or hypertension.
Moreover, although many of the patients who had been forced into the CeltiCare plan don’t speak English, only 38 of the doctors who were accepting new patients had any form of translation services.
The plan’s failure to provide adequate access to doctors for its members raises grave concerns not only about Massachusetts’ reform, but also about the recently enacted national reform, the researchers say. The national plan closely mirrors Massachusetts’ reform, but relies far more heavily on for-profit insurers.
The report points out that even when patients have insurance, profit-driven plans may discourage them from getting the care they need by “rationing by inconvenience.”
The data appears in a letter titled “Immigrants’ experience with publicly funded private health insurance” in the August 5, 2010 print edition of the journal. It was written by two resident physicians at the Harvard-affiliated Cambridge Health Alliance and a Harvard Medical School faculty adviser, and is based on the work of a group of interns, residents and medical students from several Boston-area hospitals and medical schools.
These doctors-in-training carried out the research after they became worried when some of their sickest patients – patients with cancer, diabetes and other severe health problems – were forced from their existing insurance plan into the CeltiCare plan. They then were told that they could no longer be treated at many of their previous health clinics, forcing them to find new doctors.
The researchers identified doctors available to the CeltiCare patients using the plan’s “Find a Provider” website. They called each of the doctors’ offices within a 5-mile radius of their hospital, identifying themselves as relatives of a chronically ill, older adult who needed an appointment soon. If an appointment was offered, the researcher asked about the availability of translators.
“Trying to get an appointment was even more daunting than these numbers suggest,” said Dr. Cassie Frank, a co-author of the article. “Many clinics forced me to call several times to get an appointment. One said they only open up appointments on Monday morning, and that to have a chance of getting any appointment slot I’d have to show up an hour before the clinic opened to be first in line.”
Dr. Malgorzata Dawiskiba, another co-author, said: “The state suddenly shifted thousands of sick patients to a cut-rate plan. But instead of getting a bargain, the patients were left stranded – insured, but unable to find a doctor who could care for them. These were people whom we knew. We and our supervisors had been their doctors, sometimes for many years, and overnight they were told ‘you can’t come here anymore.’”
Dr. Ruth Hertzman-Miller, an instructor at Harvard Medical School and study co-author, commented: “The problems faced by CeltiCare’s patients may soon become much more widespread. Our legislative leaders want to require every insurer in Massachusetts to offer a plan with a restricted list of doctors and a lower price tag. But that kind of restricted coverage may be little more than a worthless piece of paper” (Courtesy of Eurekalert).
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What we are seeing in Maryland already is an inability of low-income people or inadequately insured people to get the normal treatment for common diseases. When you have to co-pay a $100,000 treatment, how does that affect your future access? YOU WON'T HAVE ANY. Baby boomers are told they will not be affected, but at age 55 I know that when I start having major health issues in a decade or so, all of this reform will not protect my Medicare coverage.
OTHER COUNTRIES DO UNIVERSAL CARE WITH SATISFACTORY SERVICE......DO YOU HEAR THE ENGLISH, CANADIAN, OR FRENCH SHOUTING OUT AGAINST THEIR HEALTH SYSTEMS? DO YOU HEAR OF THE POOR CLIMBING INTO THE BACKS OF VANS FOR HEALTH CARE WHILE THE RICH HAVE HEALTH BOUTIQUES IN THESE COUNTRIES?
VOTE YOUR NEO-LIBERAL INCUMBENT OUT OF OFFICE!!
Making all of health care about profit moves drugs to market-based operations. So, if a drug is not used much it will be made expensive or will not be manufactured. We already are seeing shortfalls in availability of common drugs because of market-based health policy. IT WILL GET WORSE IF LEFT TO CONTINUE.
No Health Insurance Dims Cancer Fate Cancer Outcomes Worse for People With No Health Insurance or Inadequate Health Insurance
By Miranda Hitti
WebMD Health News Reviewed by Louise Chang, MD
Dec. 20, 2007 -- Cancer patients without adequate health insurance tend to face grimmer odds than those with good health insurance, says the American Cancer Society.
The American Cancer Society today released a new report on health insurance and cancer.
The report shows that people with no health insurance or inadequate health insurance face four main challenges when it comes to cancer:
They're less likely to get screened for cancer.
They're less likely to get counseled about cancer prevention.
They're more likely to get diagnosed late, when their cancer is harder to treat.
They're more likely to die from cancer than people with adequate health insurance.
Take breast cancer, for instance. The report shows that women with private health insurance are more likely to get mammograms, get diagnosed earlier, and have better survival rates than uninsured women.
The same is true for colorectal cancer. The report shows that among adults aged 50-65, about half of those with private health insurance had gotten screened for colorectal cancer in the past decade, compared with almost 40% of those with Medicaid insurance and about 19% of uninsured people.
Noting that some new cancer treatments cost more than $100,000 per year, the American Cancer Society's report asks, "To what extent will availability and type of insurance coverage, as well as individual financial resources, determine who has access to the most effective therapies?"
Health insurance isn't the only gap in cancer care. Racial and ethnic disparities also affect cancer outcomes.
The American Cancer Society based its report on information from the CDC and from the National Cancer Data Base.
The findings appear in CA: A Cancer Journal for Clinicians.
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CHECK OUT THE DESCRIPTIONS OF THESE HEALTH HOMES THEY PLAN FOR MEDICAID/MEDICARE PEOPLE. THEY ARE SIMPLY COMPOUNDS OF CARE WE ALREADY KNOW WILL BE RUN BY HUGE HEDGE FUND-SIZED CORPORATIONS THAT HAVE NO INTENTION BUILDING A CARING/QUALITY ENVIRONMENT.
What is the difference between the retirement communities and state nursing homes we have today and what ACA is calling community-centered health homes? First, retirement communities and state nursing homes were run by private non-profits like religious communities and the government having the public's interest at heart. What ACA if creating is a national system of corporate businesses often owned by hedge funds and run with only thoughts of profit and raiding entitlement Trusts with fraud. We already had the kinds of facilities ACA is creating only they were not structured for profit.
THINK HOW A HEDGE FUND WILL OPERATE A COMMUNITY HEALTH HOME.
Community homes for seniors and the poor with chronic health conditions.....sound a little like the sanitariums of hundreds of years ago? YOU BETCHA!!!!! Think who will age or fall into poverty in this downward spiral of neo-liberalism------ALMOST EVERYONE. HOW MEDIEVAL OF NEO-LIBERALS!!!
MEDICAL HOMES-----for the poor that means isolated health care focusing on containing communicable diseases and mental health issues. It is third world speak for containing disease vectors as cheaply as possible. As I mention above, the old practice of SANITARIUMS is the model. It will become a Dickens' nightmare as public health is dismantled and no public oversight allows a level of neglect we do not want to allow.
You notice that ACA sends billions of dollars to fund the building of these structures and this is happening as more and more people lose private health insurance or public health plans are getting ready to be thrown into these state health systems relegating most people to the status of Medicaid.
SEE WHY NEO-LIBERALS ARE PUSHING EXPANDED MEDICAID RATHER THAN FIGHTING TO RECOVER TRILLIONS OF DOLLARS LOST FROM ENTITLEMENT TRUSTS FROM CORPORATE FRAUD.
We simply need to rebuild white collar criminal agencies and stop the massive fleecing of Medicare and Medicaid, recover funds lost to fraud, and we will be flush with money to fund a first world quality of health care for all.
HMMMMMMM.....MEDICAL ENTERPRISE ZONES SEEM TO BE THE FEDERAL MONEY BUILDING THIS SYSTEM
Community-Centered Health Homes
Community-Centered Health Homes Bridging the gap between health services and community prevention ...practices, including the patient-centered medical home,
aswww.ravenswoodfhc.org/images/pdf/community-centered...
Transforming Community Health Centers into Patient-Centered Medical Homes: The Role of Payment Reform
September 28, 2011
Authors: Leighton Ku, Ph.D., M.P.H., Peter Shin, Ph.D., M.P.H., Emily Jones, M.P.P., Brian Bruen, M.S.
Contact: Leighton Ku, Ph.D., M.P.H., Director, Center for Health Policy Research in the Department of Health Policy, George Washington University leighton.ku@gwumc.edu
Editor: Deborah Lorber
"FQHCs have long sought to provide quality team-based, comprehensive primary care and typically viewed themselves as serving as medical homes, even before there were formal definitions for medical homes."
Overview This report examines how changes in the way federally qualified health centers (FQHCs) are financed could support the transformation of these critical safety-net providers into high performing patient-centered medical homes. Through surveys and interviews, the authors explore the current landscape of health center involvement in medical home initiatives, adoption of medical home standards, and receipt of payment incentives. Based on their findings, the authors make preliminary recommendations to encourage health centers to serve as patient- and community-centered medical homes. These include: establishing recommended standards for patient- and community-centered medical homes that apply to FQHCs; structuring payment incentives to promote medical homes; including FQHCs in state Medicaid medical or health home projects; adapting payment approaches, including adding monthly case management fees; and encouraging the Health Resources and Services Administration to use quality-of-care measures in making funding decisions.
Executive Summary
The Patient Protection and Affordable Care Act of 2010 (Affordable Care Act) significantly altered the landscape of American health care policy. In addition to expanding coverage to millions of uninsured and increasing funding to expand community health centers, the Affordable Care Act initiates efforts to change how health care is paid for and delivered in the United States. For example, the law encourages state Medicaid programs to develop medical homes, also known as "health homes," for Medicaid patients with chronic diseases. More broadly, the law calls on federal and state governments to consider other methods to transform health care delivery, including strategies such as creating accountable care organizations and bundling episodes of care. The large increases in the number of people with health insurance, including Medicaid patients, after the implementation of health reform will require the nation and the states to consider strategies to strengthen primary care services as part of a high performance health system.
This report examines how changes in the way federally qualified health centers are financed could support the transformation of these critical safety-net providers into high performing patient-centered medical homes. Federally qualified health centers (FQHCs), also known as community health centers or clinics, are nonprofit facilities that provide comprehensive primary medical care—and often dental, vision, and behavioral health services—to low-income patients in medically underserved areas, regardless of a person's ability to pay.
In late 2009, we conducted a survey of state primary care associations, which represent community health centers in their states. We followed up this survey with interviews of selected health center, state agency, and managed care staff about medical home and quality initiatives in their states. In the majority of states, health centers receive payments to serve as primary care providers or medical homes, generally under Medicaid, and more recently have begun to serve as patient-centered medical homes. There was great diversity in the nature of medical home programs, medical home criteria, and stages of development. In some cases, private physicians are eligible for medical home payments, but health centers are not.
FQHCs have long sought to provide quality team-based, comprehensive primary care and typically viewed themselves as serving as medical homes, even before there were formal definitions for medical homes. Nonetheless, many FQHCs have demonstrated interest in attaining formal recognition as a medical home.
Preliminary data from a George Washington University survey of FQHCs, conducted from 2010 to 2011, indicate that about 6 percent of centers have attained National Committee for Quality Assurance–Patient Centered Medical Home (NCQA–PCMH) recognition, another 12 percent have a pending application, and 40 percent expect to seek recognition in the next 18 months. Some (12%) have received or applied for recognition from a state medical home program and 11 percent are considering another national recognition program. One reason some centers do not consider applying is there is no financial reward for attaining recognition, as some states do not have medical home incentive programs for FQHCs.
We present several financing recommendations to increase the incentives for FQHCs to transform themselves into high-performing medical homes:
Establish recommended standards for patient- and community-centered medical homes that apply to FQHCs. A variety of national and state recognition programs exist for medical or health homes, but they generally focus only on patient-centered medical care. Health centers also seek to provide community-centered services, such as offering access to patients regardless of ability to pay; providing nonmedical services like behavioral, dental, or enabling services (like case management, health education, and translation); and conducting community needs assessments and other prevention-oriented projects. It may be relevant to establish standards that emphasize these broader community-oriented service components.
States should include FQHCs in Medicaid health home projects. Under the Affordable Care Act, state Medicaid programs may establish health home projects for those with chronic health conditions. In the past, some state medical home programs excluded FQHCs because they are paid differently than physician practices. Since FQHCs provide primary care to a substantial and growing number of Medicaid patients, they should be included in all state Medicaid health home projects.
Clarify that states may pay FQHCs more than the levels prescribed by the prospective payment system. Although federal Medicaid policy that governs health center payments does not prevent states from paying FQHCs more than the prospective payment system (PPS) level, which is based on historical Medicaid costs and then updated, some states appear to interpret the statute as constituting a cap on FQHC payment levels.
If states adopt medical or health home incentives, providing monthly case management fees per Medicaid patient is a reasonable approach. States considering this option could add a monthly medical home case management fee, in addition to regular FQHC reimbursements, as an appropriate way to create a payment incentive for medical home status. This is already used in many states and is the method planned for the Medicare FQHC Advanced Primary Care Practice demonstration project.
Clarify how states may increase FQHC payment levels under Medicaid. Under current federal rules, states may change PPS payments to individual health centers when the centers demonstrate a change in the scope of Medicaid services. However, there is no specific provision for changing the PPS
payments when a health center increases the quality or intensity of services it provides.
Maintain the all-inclusive per-visit payment rates in Medicaid. Under federal law, Medicaid payments to FQHCs are paid on a flat, all-inclusive, per-visit (or per encounter) basis. To change the system would require substantially changing all FQHC payment rates, which would take years to develop. Given current state budget problems, in which state Medicaid programs have often trimmed provider payment rates, opening all FQHC payment rates to recalculation could place them at substantial risk of unanticipated reductions.
The Centers for Medicare and Medicaid Services (CMS) should ensure that Medicare policies are consistent with medical home goals. CMS has announced two Medicare advanced primary care medical home demonstration projects, one for FQHCs and one that permits multipayer projects in several states. CMS should continue to develop these projects. CMS is also actively developing policies in related areas, such as those related to Medicare accountable care organizations, and should ensure that the objectives of those policies are ultimately supportive of medical home policies as well.
The Health Resources and Services Administration has long encouraged quality of care for FQHCs and supports Section 330 grantees as NCQA–PCMHs, but could consider additional efforts. The Health Resources and Services Administration (HRSA) seeks to build on the already strong quality of care delivered by health centers by focusing on quality improvements and ways that payment reforms could affect health centers. HRSA provides grants to subsidize the cost of NCQA–PCHM applications for FQHCs that receive federal Section 330 grants. In allocating funds to grantees, HRSA has not traditionally used quality of care in funding decisions. HRSA is improving information collected about the quality of care at Section 330 grantees under its Uniform Data System. In the future, HRSA could develop incentives to improve the quality of care at health centers or performance as medical homes. It could develop further efforts to help integrate health center coordination in medical home, health home, and advanced primary care projects, working with Medicare, Medicaid, and the Children's Health Insurance Program—and eventually the health insurance exchanges.
As the concept of a medical home and other paradigms to strengthen the health care infrastructure are implemented, FQHCs will serve as laboratories for innovation to test new care models. Adequate and appropriately structured financial incentives are critical to the success of any model of health care delivery, and the medical home is no exception. In addition to changes to the reimbursement system that would better align incentives, other supports for providers such as training and technical assistance are necessary to bolster and support the infrastructure.
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This is what happens when health care becomes about maximizing profits. Staff are not always to blame. People are being sent to do jobs for which they are not prepared. Standardization of care misses lots of individual symptoms and history. Having hedge funds operating medical care can only be a spiraling disaster for health care. SHOUT FOR EXPANDED AND IMPROVED MEDICARE FOR ALL.
This article is a good look at what has happened as health care moves from hospital to nursing facilities, but it doesn't address the gorilla in the room------home health care skilled and non-skilled. If you know nursing homes and community care facilities are rife with bad care you know this booming national health chains of home health care businesses are really, really bad. THEY ARE. This is what all of these private for-profit career job training schools are releasing on the public and it is not pretty. The students graduating are not at fault most times....they are being steered into programs that do not prepare them for the jobs they will do and these health businesses for which they are hired are not monitored or operating legally in many cases.
THIS IS WHAT ACA DOES IN TANDEM WITH PRIVATIZATION OF EDUCATION....IT DEVELOPS A SYSTEM WHERE EDUCATION FEEDS BUSINESSES AND IT IS ALL PROFIT-DRIVEN.
So, Americans are being told they will be serviced at home at the same time academics are seeing the lowest quality of training for students entering these fields. I want to qualify that home health care businesses have been around for decades and many offer strong, quality care and staffing. What we are seeing from ACA is a flooding of the market with national chains simply there to make a buck anyway they can. This article below has a Hopkins professional reporting these shortfalls as Baltimore is ground zero in the worst health care in these kinds of facilities and Hopkins is public health in Baltimore. It's like interviewing the fox about how best to stop foxes from raiding the hen house.
DO YOU SEE HEDGE FUNDS AND GLOBAL CORPORATIONS RISING TO THE CALL TO IMPROVE QUALITY OF CARE?
'About 40 percent of people over age 65 will spend time in a nursing home at some point, Mollot said. Hopefully, he said, the inspector general’s report will help the public see that care needs to improve'.
He said,
“They are dangerous, dangerous places”.
Keep in mind with this article below that in Maryland, where Medicare is being dismantled by privatization with no Federal oversight, has the goal to end all Federal oversight of Medicare. 1/2 of Medicare spending is lost to fraud and you see Federal spending by Medicare is sent to building these skilled nursing businesses. When the Federal Medicare program is privatized to these state systems, there will be no public oversight as described in this article.
One Third of Skilled Nursing Patients Harmed in Treatment
March 16th, 2014
Special Report from ProPublica
by Marshall Allen, ProPublica
One-in-three patients in skilled nursing facilities suffered a medication error, infection or some other type of harm related to their treatment, according to a government report released recently that underscores the widespread nature of the country’s patient harm problem.
Follow up:
Doctors who reviewed the patients’ records determined that 59 percent of the errors and injuries were preventable. More than half of those harmed had to be readmitted to the hospital at an estimated cost of $208 million for the month studied — about 2 percent of Medicare’s total inpatient spending.
Patient safety experts told ProPublica they were alarmed because the frequency of people harmed under skilled nursing care exceeds that of hospitals, where medical errors receive the most attention.
Dr. Marty Makary, a physician at Johns Hopkins Medicine in Baltimore who researches health care quality, said -
“(The report) tells us what many of us have suspected – there are vast areas of health care where the field of patient safety has not matured”.
The study by the inspector general of the U.S. Department of Health and Human Services (HHS) focused on skilled nursing care – treatment in nursing homes for up to 35 days after a patient was discharged from an acute care hospital. Doctors working with the inspector general’s office reviewed medical records of 653 randomly selected Medicare patients from more than 600 facilities.
The doctors found that 22 percent of patients suffered events that caused lasting harm, and another 11 percent were temporarily harmed. In 1.5 percent of cases the patient died because of poor care, the report said. Though many who died had multiple illnesses, they had been expected to survive.
The injuries and deaths were caused by substandard treatment, inadequate monitoring, delays or the failure to provide needed care, the study found. The deaths involved problems such as preventable blood clots, fluid imbalances, excessive bleeding from blood-thinning medications and kidney failure.
One patient suffered an undiagnosed lung collapse because caregivers failed to recognize symptoms. The patient later had a reaction to medication and a blood clot and had to be transferred to a hospital.
Projected nationally, the study estimated that 21,777 patients were harmed and 1,538 died due to substandard skilled nursing care during August 2011, the month for which records were sampled.
Medicare patients “deserve better,” said Sen. Bill Nelson, D-Fla., chairman of the U.S. Senate Special Committee on Aging. Nelson said he would push for better inspections of the facilities. He said,
“This report paints a troubling picture of the care that’s being provided in some of our nation’s nursing homes”.
The report said it is possible to reduce the number of patients being harmed. It calls on the federal Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services (CMS) to promote patient safety efforts in nursing homes as they have done in hospitals.
The authors also suggest that CMS instruct the state agencies that inspect nursing homes to review what they are doing to identify and reduce adverse events.
In its response to the report, CMS agreed with the findings and noted that the Affordable Care Act requires nursing homes to develop Quality Assurance and Performance Improvement programs. The agency’s quality improvement work includes a website for nursing homes that was launched in 2013.
A “skilled nursing” facility provides specialized care and rehabilitation services to patients following a hospital stay of three days or more. There are more than 15,000 skilled nursing facilities nationwide, and about 90 percent of them are also certified as nursing homes, which provide longer-term care.
As hospitals have moved to shorten patient stays, skilled nursing care has grown dramatically. Medicare spending on skilled nursing facilities more than doubled to $26 billion between 2000 and 2010. About one-in-five Medicare patients who were hospitalized in 2011 spent time in a skilled nursing facility.
John Sheridan, a member of the American College of Health Care Administrators, which represents nursing home executives, called the report valuable but noted that it sampled only a small number of patients. He questioned whether the findings apply broadly to skilled nursing facilities.
Sheridan also strongly disagreed with the report’s observation that there’s less known about patient safety in skilled nursing facilities compared to hospitals. He said Medicare has robust inspections of nursing homes it certifies – they take place annually or when there are complaints and are usually conducted by state contractors. Medicare also keeps detailed data on the violations, he said. (ProPublica’s Nursing Home Inspect makes it easy to search and view Medicare inspection reports.)
Sheridan agreed that skilled nursing facilities could improve, but said the caregivers face a daunting task and work diligently despite low reimbursements Medicare pays to the facilities.
Sheridan said of the providers that -
“They don’t go to work every day to cause an adverse event. They do it to care for the residents there. They do it with sacrifice and love.”
Dr. Jonathan Evans, president of the American Medical Directors Association, a group focused on nursing home care, said while he doesn’t dispute the estimates in the inspector general’s report, they are typical of problems that exist throughout the health care sector.
Evans said that patients receiving skilled nursing care are leaving hospitals sooner and that many are not medically stable and have more intensive needs. Nursing homes, originally designed for long-term patients who did not need intensive care, and have been slow to adapt, Evans added.
He said,
“You have a system of long-term care that’s trying to retrofit to be a system for post-acute care. The resources to care for them and commitment from those sending them from one facility to another haven’t kept pace.”
Evans called the study significant and said he hopes it raises awareness and sparks improvements.
Makary, the Johns Hopkins’ doctor, said the patient safety movement has been more focused on problems at hospitals than in nursing homes.
A 2010 report by the HHS inspector general estimated that 180,000 patients a year die from bad hospital care, and other estimates have been higher. The patient safety research community has focused on reducing bloodstream infections and surgical errors at hospitals but has done less to address issues specific to nursing homes, Makary said.
Developing metrics to track improvement would be more effective than annual inspections, which don’t do a good job of capturing a facility’s everyday performance, Makary said.
Patient advocates said the study verifies what they’ve heard from skilled nursing patients and their families. Richard Mollot, executive director of New York’s Long Term Care Community Coalition, said he was “flabbergasted” by medication errors, bedsores and falls that were identified in the report.
They are prominent problems that nursing homes should be “well versed” to address, he said.
Mollot said the report should have more forcefully called for better enforcement of the existing standards in nursing homes.
States inspect nursing homes on behalf of Medicare every year and when there are complaints, he said, but some inspectors are tougher than others. Medicare’s current standards of care are good, he said, and “if they were enforced we wouldn’t have these widespread problems.”
About 40 percent of people over age 65 will spend time in a nursing home at some point, Mollot said. Hopefully, he said, the inspector general’s report will help the public see that care needs to improve.
He said,
“They are dangerous, dangerous places”.
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This article show too where things will go in the US if neo-liberals remain in charge. Spain has been taken by the worst of TROIKA politicians and the public sector is being gutted and a strong public health care system and quality wages and staffing dismantled. Remember, Trans Pacific Trade Pact (TPP) and its Atlantic Trade deal pushes the dismantling of public health all over the world so US private health systems will maximize profits. Here is a former first world country moving to third world in one fell swoop. This is the goal of TPP---to take formerly first world nations to the level of developing countries under the guise of needing to be competitive globally.
THAT'S A NEO-LIBERAL FOR YOU----ALL MARYLAND POLS ARE NEO-LIBERALS!
Outrage as nurses are appointed at less than €4 per hour
by TPN/ Lusa, in News · 05-07-2012
Portugal’s national nurses register publicly announced on Monday that it considered it “scandalous” for nursing professionals to be placed on contracts earning less than four euros per hour and appealed for those who could “not to accept” the proposals.
Outrage as nurses are appointed at less than €4 per hour
This is a scandal for Portugal, for a first world country, that is offering highly qualified professionals at a price per hour that is incompatible with their profession and their dignity," said Germano Couto from the national nurses register Ordem dos Enfermeiros, adding that he had received "a series of denunciations" from "tens of nurses who have contracts at €3.96 per hour."
Mr. Couto spoke in reaction to news published in Diário de Noticias that nurses hired by temping agencies for the health centres of Lisbon and the Tagus Valley region who started work on Monday will receive less than four euros per hour.
He guaranteed that the news piece "is real" and "there are facts and evidence", although he added that he hoped it "isn’t more than a series of intentions" and so "may be reverted by the Lisbon and Tagus Valley regional health authority and the Ministry of Health."
Mr. Couto added that the government may be "paying more to these companies" for them to "obtain their profit" but highlighted that it is necessary to check whether these companies are fulfilling the contract conditions, as the €3.96 per hour the nurses will earn equates to €300 in their pockets at the end of the month, which doesn’t even qualify as minimum wage.
Currently, the average wage deemed acceptable for nurses in Portugal is around €1,020 per month, which is around seven euros per hour and that value "should be the yardstick the government should use."
Following the news of the reduced wages for new nursing contracts in the Lisbon area, the national nurses register has "appealed to nurses not to accept these contracts if they are able," adding that they do however understand if some go ahead "so as not to lose their status."
Mr. Couto considers that many health professionals prefer to move abroad rather than end up unemployed or lose their status, criticising that Portugal is "training nurses for export" at a time when there is need in the country.
In response to the news, the Lisbon and the Tagus Valley health authority (ARSLVT) announced that the nursing contracts were put to tender at prices per hour varying between €4.77 and €5.19 and declined any responsibility of wages being paid below four euros per hour.
The price per hour "results from the public tender whereby the companies involved presented their proposals," ARSLVT said in a statement.
The health authority said it had launched a public tender for the acquisition of nurses with a base value of €8.50 per hour, which corresponds to the average price on the market for this type of service.
"The values presented by firms that responded to the public tender were substantially lower than the base value, and all those 50 percent below it were excluded from the public tender because of the legal reason that they were abnormally low values," said the statement.
ARSLVT added that "the majority of firms presented values much reduced compared to that proposed by ARSLVT, with a price being fixed between €4.77 and €5.19" in the end.
"Negotiation of salaries and conditions is the exclusive responsibility of the firms that responded to the public tender and their staff," the regional health authority concluded.
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