HOW TO REMEDY THE ADMITTED VS. OBSERVATION DILEMMA

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If you have¬†read the¬†article “Medicare Seeks to Limit Number of Seniors Placed in Hospital Observation Care” and feel you would be extremely upset and financially burdened with having to pay your own extended care benefits out of pocket, perhaps you would like to know about a way to remedy the serious situation.

Do you know there is a great solution to the possibility of losing the Extended Care Benefit of Medicare?

In the past, there was generally only one alternative, long-term care insurance, that’s now becoming more difficult to obtain because the application process is increasingly complex and premiums are high making it unaffordable for most.

Some major long-term care insurance carriers have even exited the business.

So what’s the new alternative? It’s called shortterm care insurance and it’s gaining national recognition and insurance industry popularity for many of the following reasons:

– no fear of not receiving benefits

– very affordable premiums

– the same coverage as LTC insurance

– simpler and quick application process

– shorter waiting periods

If you are not interested in long-term care insurance, considering short-term care insurance is definitely in your best interest to at least take a look and avoid any mishaps!

 

 

 

MEDICARE SEEKS TO LIMIT NUMBER OF SENIORS PLACED IN HOSPITAL OBSERVATION CARE

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Medicare officials have proposed changes in hospital admission rules that they say will curb the rising number of beneficiaries who are placed in observation care, but are not admitted, making them ineligible for nursing home coverage.

“This trend concerns hospitals and doctors because of the potential financial impact on Medicare beneficiaries,” medical officials wrote in an announcement Friday, April 26, 2013.

Patients must spend three consecutive inpatient days in the hospital before Medicare will cover nursing home care ordered by a doctor.

Observation patients do not qualify, even if they have been in the hospital for three consecutive days because they are coded as outpatients or observation not as inpatient or admitted.

Outpatients or observation patients also have higher out-of-pocket costs than inpatient or admitted while still in the hospital, including higher copayments and sometimes paying exorbitant charges for non-covered drugs.

Under the proposed Medicare changes, with some exceptions, if a physician expects a senior will stay in the hospital for less than two days, the patient would be considered an outpatient receiving observation care.

If the physician thinks a patient will need a longer observation stay, he will be required to place the patient under admitted care.

Setting deadlines for observation stays, for example only two days, would also limit the growing length of time that may be needed, another trend medical officials said was troubling.

The reaction from patient advocates, doctors, and hospitals has been swift and surprisingly unanimous: they say, “it’s a bad idea.”

The number of observation patients has jumped 69 percent in the past five years, to 1.6 million in 2011, according to federal records. They also are staying in the hospital longer, even though Medicare suggests that hospitals admit or discharge them within 24 to 48 hours. Observation visits exceeding 24 hours has nearly doubled to 744,748 patients.

Medical officials said the longer observation stays occur because hospitals are not sure Medicare will pay them if patients are admitted.

The proposed Medicare changes are intended to address these questions.

The proposed admission changes are part of a 1,400-page annual hospital payment update released Friday, April 26, 2013. If adopted, the new admission rules would apply to more than 3,400 acute care hospitals, and Medicare estimates it will result in 40,000 more inpatient or admitted hospital stays.

In order to offset the expected additional cost of $220 million, Medicare would cut hospital payment by 0.2 percent.

“I can’t imagine anyone is going to like this proposed rule because it makes time the determining factor in whether the services are provided on an inpatient or observation basis,” said Toby Edelman, senior policy attorney at the Center for Medicare Advocacy.

“This proposal is not about what the hospital is actually doing for a patient or what kind of care the patient needs or is receiving.”

Edelman said the Medicare proposal does nothing to help observation patients because it keeps the three-inpatient-days requirement in place, doesn’t require hospitals to tell patients when they are held for observation and doesn’t give patients a right to appeal their observation status.

The center is representing 14 seniors who have filed a lawsuit against the government to eliminate the observation care designation.

A federal judge held the lawsuit’s first hearing on Friday, May 10, 2013 in Hartford, Connecticut, to consider the government’s request to throw out the case because seniors should follow Medicare’s lengthy appeals process before going to court.

On Tuesday, April 30, 2013, government lawyers submitted the proposed rule change to the judge to bolster its argument for dismissal, claiming it clarifies “when we believe hospital inpatient admissions are reasonable and necessary, based on how long beneficiaries have spent or are reasonably expected to spend time in the hospital.”

The American Medical Association is still reviewing the proposed changes, which do not include steps it asked Medicare to take last year:

either drop the three-day policy or count observation days toward the requirement.

“This policy is of great concern to the physician community because it has created significant confusion and tremendous, unanticipated financial burden for Medicare patients,” James Madara, the AMA’s executive vice president, wrote to Medicare.

He also criticized hospitals’ ability to overrule the physician decision to admit a patient, which creates more confusion when the physician bills Medicare for inpatient services and the hospital bills for observation services.

 

 

FORGET TO TAKE MEDICINE? THESE PILLS WILL TELL YOUR DOCTOR

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Startup companies are coming up with new technologies, such as “digital pills,” aimed at getting people to take medicine only as directed.

Taking medication haphazardly – skipping doses, lapsing between refills or taking pills beyond their expiration date – has been linked to health complications and hundreds of millions of wasted dollars for insurers and hospitals.

“After six months’ time, only half of people taking prescription medicines are taking them as directed,” said Troyen Brennan, chief medical officer of drug retailer CVS Caremark Corporation.

Health insurers and pharmacy-benefits managers like CVS have long relied on robo-calls, mailers and face-to-face meetings with pharmacists to keep patients on their dosing schedule.

Now they are evaluating a range of more cost-effective technologies, from pills and bottles with digital sensors, to data analytics software and social games that offer patients rewards.

Insurers and pharmacies are motivated in part by Medicare, which offers financial rewards for to their members who have improved their overall adherence to a medication schedule.

CVS is pilot-testing technology from Virginia-based RxAnte Inc., which sells an analytics platform that looks at millions of patients’ claims data and clinical data to identify people who have a high risk of failing to comply with doctor’s orders. These patients include people with a spotty track record of adherence, those who take several different medicines or those facing unwanted side effects, Chief Executive Josh Benner said.

“It’s all a targeting game,” Mr. Benner said. “We predict individual behaviors, and suggest interventions.”

Other companies are coming up with ways to help entice, rather than badger, customers. San Francisco-based Mango Health Inc. just released an app that lets users earn points toward prizes – such as gift cards from Target Corp. or a charitable donation in the patients’ name – for adhering to their prescription schedules.

Beyond data and apps, startups are working on digitizing the pills and bottles themselves.

Proteus Digital Health Inc. places tiny, digestible sensors inside of pills to get an objective accounting of who is taking what medicine.

The sensors are the size of a grain of sand and are made up of copper, magnesium and silicon, amounts well below a human being’s recommended daily allowance of such minerals, said Andrew Thompson chief executive of the Redwood City, California company.

The sensor beams data such as when the pill was ingested to a disposable strip worn on the skin like a Band-Aid that sends the data to a mobile app. With patient permission, doctors or loved ones can access the phone app to track compliance.

“There is no radio, no antenna,” Mr. Thompson said. “It’s literally powered by you.”

Mr. Thompson said the first digital drugs will be available in 2014 or early 2015.

Proteus, which is backed by Medtronic Inc., Otsuka Pharmaceutical Co., Novartis AG, Kaiser Permanente and venture firms, has licensing and commercialization deals with Otsuka and Novartis, he said.

Mr. Thompson said that sensor-embedded pills are appropriate for older patients, who often take multiple medications, and for sufferers of conditions like tuberculosis, where going off a medication regimen can have disastrous consequences.

Other companies are remaking the medicine bottle. AdhereTech Inc. is developing an automated pill bottle filled with sensors that measure how much medicine is left.

The bottle glows blue when it is time to taka a dose, and red when the dosage is missed.

The bottle can also beam data to AdhereTech’s servers and send text alerts as reminders.

Even product-design firm IDEO is thinking about ways to boost prescription adherence.

IDEO designers Kuen Chang and Jin Ko have designed a pill bottle that begins to resemble an overripe banana with black spots all over it once a medicine is past its expiration date.

The bottle is in concept stage and hasn’t been developed.

“It produces a gut reaction,” the husband-and-wife team said.

“Without thinking about it, you just really don’t want to eat that banana.”