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Program for ‘medically fragile’ kids in Illinois hanging on despite threatened cuts
MARQUETTE HEIGHTS — The little boy jumping in the middle of the bed, screeching out his favorite song, “Play that Funky Music White Boy,” has congenital central hypoventilation syndrome, a gene mutation that causes his body to forget to breathe.
The rare disease is also the reason 5-year-old Alex has had a tube sprouting from his windpipe since he was 6 weeks old and a bedroom that doubles as a hospital room. But right now, it is not the rarity of Alex’s disease that concerns his parents. It’s Illinois’ effort to reduce wide-ranging Medicaid costs, his father says, at the expense of children like Alex who rely on medical technology and round-the-clock nursing care to live at home.
Bill and Holly Thompson are among some 500 families throughout the state who depend on what’s called the MFTD waiver, or the Medically Fragile and Technology-Dependent Waiver program.
With the waiver, their children are eligible for Medicaid regardless of parental income. Without it, parents can’t afford the round-the-clock nursing care — at an average cost of $188,000 a year — their children require to avoid institutionalization.
MFTD-waiver families have popped up as one of the most vociferous grass-roots groups fighting specific changes in the state’s Medicaid reform package. So far, families have played a role in blocking state plans to shift more of the costs to families, impose income eligibility caps and change standard-of-care definitions. They’ve cornered Julie Hamos, head of the state Department of Healthcare and Family Services, at public forums and filed a lawsuit to stop the changes.
The federal Centers for Medicare and Medicaid Services stepped in, asking state officials to request a deadline extension so federal officials would have time to review the changes. An initial Sept. 1 deadline has been extended 90 days.
Families no longer eligible for the waiver would face huge out-of-pocket expenses with no transition plan. Some say they’d have to quit their jobs, work part time or divorce to make sure their children get the proper care. Or their children might be forced to move into a nursing home, which would cost Medicaid three times as much as the waiver program.
See on www.sj-r.com
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Curbing hospital readmission vital, Connecticut making progress
Recent headlines about high readmission rates forcing 2,200 hospitals nationwide to forfeit Medicare funds for patients who are readmitted to hospitals raises the questions: Can hospital readmission rates be reduced? …
The individual and combined successes of Connecticut health care communities show that improved medical processes, transfer of critical information and standardized education leads to better health care outcomes, and that translates to healthier patients and families, and a health care system that is much more cost-effective.
Reducing preventable hospital readmissions should continue to be a national priority. However, the community care transitions work in Connecticut is a harbinger of hope. We can be proud and optimistic that Connecticut is taking a proactive stance to reduce avoidable hospital readmissions in all communities statewide. This is not a challenge that can be fixed overnight, but real progress has been made.
See on articles.courant.com
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Telemedicine to Lower Cost for 5 Health Issues
Telemedicine is the advanced technology that will allow patients to monitor their own health at home.
These devices can upload patient test outcomes to an online database, where their physicians can keep an eye out for dangerous patterns in the patient’s health. The prevalence of telemedicine is slowly increasing and becoming more advanced, leaving the impetus behind improved health with the patient.
Healthcare IT News (2012) recently announced the five areas of healthcare that telemedicine will likely improve greatly over the coming years:
(1) active heart monitoring,
(2) blood pressure,
(3) diabetes,
(4) prescription compliance, and
(5) sleep apnea.
Physicians and product developers hope that telemedicine will be able to improve patient health by increasing continual monitoring and therefore catching problems before symptoms show up.
Telemedicine is also expected to decrease healthcare costs in these areas by eliminating unnecessary doctor visits and preventing bigger health problems earlier.
See report: http://ihealthtran.com/pdf/Telemedicine_iHT2.pdf ;
See on iht2blog.com
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Mostashari says EHR incentives estimated to reach $20 billion by 2015 | Legal Transcription
There are no set appropriations for how much the federal government can spend on rewarding providers who adopt and use electronic health records under the Medicare and Medicaid meaningful use EHR incentive program, according to National Coordinator for Health IT Farzad Mostashari, M.D.
“Whoever qualifies, gets paid; there’s no hard cap,” said Mostashari, who gave a keynote at the Annual Policy Summit for the Health Information Management and Systems Society (HIMSS) on Wednesday.
Mostashari said the federal government estimates it will pay out around $20 billion in incentives before the program shifts to a penalty in 2015, but there is no fixed budget set in the HITECH Act that mandated the program. The government recently announced it has paid out nearly $7 billion since the program began in 2011.
See on www.lawscribes.com
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Texas Tribune — Proposed Medicaid Fraud Rules Worry Providers
The state’s Health and Human Services Commission is seeking formal approval for new Medicaid fraud rules that doctors allege deny them due process and expand investigators’ power to halt their funding.
For months, HHSC’s Office of the Inspector General has been increasingly relying on a federal rule — part of President Obama’s health care plan — that allows the agency to freeze financing to any health provider accused of overbilling Medicaid. That means they can halt the flow of funding before they complete a full-fledged investigation, and often, providers say, before doctors are given any chance to defend themselves.
HSC says the new state rules — a rewrite of the existing statute — give investigators the tools to stop the bleeding before bad actors run off with the state’s money. They say fraud investigations aren’t opened without good reason, and the idea that there’s no due process is preposterous.
The agency says the new rules, which must be approved by the executive commissioner, are necessary to bring the state in line with federal health reform and measures passed in the last legislative session. It is “mostly a clean-up of the existing rules,” agency spokeswoman Stephanie Goodman said.
But attorneys for health care providers, who are still trying to parse the rewritten rules, say the language the state is preparing to codify appears to put even more power into investigators’ hands than what they’ve already received from the federal government.
See on www.texastribune.org
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Are meaningful use incentives worth the hassle?
It’s no secret that hospitals are unlikely to recover much of the money they spend on electronic health record (EHR) implementation through the meaningful use incentive program. But experts say hospitals need to watch out for the long-term costs associated with using EHRs. If technology initiatives are not planned effectively, these expenses may quickly swamp a hospital’s finances and have a much more lasting impact than the up-front money hospitals have to pay to get systems up and running.
Methodist Health System, a Texas group comprised of six hospitals and a network of ambulatory medical offices, has implemented EHRs throughout its system and is currently receiving incentive payments. But Pamela McNutt, the system’s senior vice president and CIO, said these payments only covered a fraction of the up-front implementation costs. When the total cost of ownership of the EHR system is added up, the meaningful use incentives may not actually be all that meaningful for the system’s bottom line.
See on searchhealthit.techtarget.com
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JAMA Forum: A Tale of 2 Health Plans
Consider 2 plans for health coverage.
In plan No. 1 (the ACA), the approach is to help everyone under the age of 65 years who doesn’t have insurance coverage. Everyone who is really poor is offered Medicaid. Everyone else will be put into a regulated market.
In plan No. 2 (the Romney plan for Medicare), the approach is to change the way everyone over the age of 65 years gets health insurance. Everyone who is really poor is offered Medicaid. They—along with everyone else—will also be put into a regulated market.
The differences between the end points of the ACA and the Romney plan for Medicare are shockingly similar. With enough tweaks and some serious efforts at compromise, one could be accepted in exchange for the other. The powers of both competitive bidding and regulatory reform could be used.
We could stop demonizing the other side for trying to “end America” by seeking results that aren’t much different from our own.
I’m not optimistic. It’s an election year. And despite protestations that good policy is the goal, it seems far too often that politicians care more about winning elections than about Americans winning a better health care system.
See on newsatjama.jama.com
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Gov. Brown Calls Special Session On Health Care Reform – CBS San Francisco
Gov. Jerry Brown is telling California lawmakers that he will call a special legislative session on health care at the end of the year.
See on sanfrancisco.cbslocal.com
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For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Virginia moving on implementing health reform
Virginia has made progress in updating its computer system for verifying eligibility for Medicaid and has passed insurance regulations in preparation for implementing federal health care reform, according to a report by a nonprofit organization tracking states’ efforts.
But Virginia is behind in some key areas — it hasn’t created health insurance exchanges or marketplaces where people could buy affordable health insurance plans, and it may not be producing enough doctors to care for hundreds of thousands of newly insured people expected to be covered when reform is fully implemented.
The report, paid for by the Robert Wood Johnson Foundation, a health care philanthropy, was done by researchers at the Urban Institute, a nonprofit policy research organization, “Virginia has made significant progress in health reform implementation, despite significant political opposition in and out of the state government,” conclude the report’s authors, Linda J. Blumberg, John Holahan and Vicki Chen, of the Urban Institute.
See on www2.timesdispatch.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
State health initiative in Indiana for poor may be on last legs
The future of a state health insurance program for the working poor is in jeopardy after the federal government granted only a one-year extension for the effort.
The denial puts extra pressure on state lawmakers and the next Indiana governor who must decide next year whether to expand Medicaid, which provides health care for the poor and disabled.
Michael Gargano, Family and Social Services Administration secretary, said Friday he received notification from the Centers for Medicare & Medicaid Services offering to approve a one-year extension for the Healthy Indiana Plan to Dec. 31, 2013.
The Centers for Medicare & Medicaid Services did not approve a multiyear extension for the program and declined to respond to the state’s questions about using it to serve Hoosiers who may be eligible under a Medicaid expansion if the state decides to do so in 2014.
See on www.journalgazette.net
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
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