July 14, 2016 – The Center for Medicare Advocacy (CMA) is thrilled to be partnering with The John A. Hartford Foundation to improve care for older adults with long-term and chronic conditions. With the Foundation’s generous two-year grant, CMA will be able to focus on solutions for older adults caught in the web of hospital “outpatient” Observation Status, which reduces access to key health and therapeutic care.
Over the two-year grant period, CMA, will gather existing resources and collect stories from beneficiaries, produce and update advocacy materials, and conduct extensive outreach and education that will improve observation status policy through regulatory change, improved federal guidance, and increased awareness by legislators. The grant funding for this project will also strengthen CMA’s advocacy on other important issues, including increasing access to oral health care for older adults.
“Outpatient” Observation Status is a policy created by the Centers for Medicare & Medicaid Services to classify certain very short hospital stays for billing purposes. The intent was to identify, and pay less for, these stays.
Medicare hospital patients are increasingly classified as “outpatients” on Observation Status, rather than admitted inpatients. This is true even for patients who are in the hospital for many days, for diagnosis, tests, nursing, physician care and treatment. Unfortunately, Observation Status results in myriad unintended consequences. For example, Medicare coverage for post-hospital nursing home care is often entirely unavailable for Observation patients since it requires a 3-day prior inpatient hospital stay. Thus, Observation Status “outpatients” are ineligible for Medicare nursing home coverage even if they were in the hospital for many days or weeks.
Hospital Observation Status has profound consequences for the quality and cost of care available for older, vulnerable Medicare patients. It also harms hospitals and nursing homes, the Medicare appeals process, the integrity of the Medicare program – and shifts costs to State Medicaid budgets. With support from The John A. Hartford Foundation, CMA will be able to enhance efforts to reduce the harm caused by Observation Status and to advocate for better care for older adults.
“We are very pleased to support the passionately driven and highly expert staff at CMA, led by the indomitable Judith Stein,” said Terry Fulmer, PhD, RN, FAAN, president of The John A. Hartford Foundation. “As our Foundation works to create age-friendly hospitals and health systems, CMA’s important policy work will raise visibility and diminish the negative impact of the Observation Status classification of older hospitalized adults through outreach and education.”
Elder Abuse in Nursing Facilities: The Over-Administration of Antipsychotic Drugs to Nursing Home Residents
Today, June 16, 2016 is World Elder Abuse Awareness Day (#WEAAD2016 ). Each year, an estimated 5 million older persons are abused, neglected, and exploited. Often overlooked are less obvious, but no less dangerous forms of abuse. The overuse of antipsychotic drugs in skilled nursing facilities is one such form.
The Administration on Aging defines a subcategory of elder abuse – “physical abuse” – as “inflicting physical pain or injury on a senior, e.g. slapping, bruising, or restraining by physical or chemical means.” Administering antipsychotic drugs to more than a quarter of a million nursing home residents clearly meets this definition of elder abuse and, left unanswered, is a national scandal.
Despite the clear, consistent, and ever-growing body of evidence that antipsychotic drugs should not be prescribed for older people, hundreds of thousands of nursing home residents are given these drugs on a regular basis. The Centers for Medicare & Medicaid Services (CMS) reports that, in the first quarter of 2016, information self-reported by nursing facilities indicates that 20.77% of 1,300,222 nursing home residents – 270,056 individuals – took antipsychotic drugs. The overwhelming majority of these residents have not been diagnosed with a psychosis that could possibly support the administration of antipsychotic drugs. Instead, these residents have dementia or are otherwise unable to explain with words what is causing them stress or discomfort.
Why are residents chemically restrained and abused? There are two critical reasons: inadequate staffing levels at nursing facilities and inadequate enforcement of federal standards of care.
We are troubled by both the scale of estimated improper payments to Medicare Advantage plans due to inappropriate upcoding – at a rate of 9.5% or $14.1 billion in 2013 – and CMS’ lack of progress on recouping and deterring such payments.
We hope that policymakers who protect MA profit at all costs, while at the same time often proposing to shift more costs on to the majority of beneficiaries in traditional Medicare – take heed of this GAO report and ensure that the recommendations are implemented.
Read the GAO report at: http://www.gao.gov/assets/680/676441.pdf
As Drew Altman of Kaiser Family Foundation wrote in the Wall Street Journal (4/15/2016):
“To some degree many changes long sought by conservatives are already happening incrementally: More than half of Medicaid beneficiaries are in private managed-care plans. Almost one-third of Medicare beneficiaries are enrolled in private Medicare Advantage Plans this year, rather than the traditional program, and the share is projected to grow to more than 40% by 2026. The same is true of private health insurance. Conservatives complain about the ACA, but their preferred vision of health insurance–with high deductibles and lots of “skin in the game” plans–is dominating in the marketplace. The trend is reinforced by many of the policies being sold in the ACA’s insurance marketplaces.”
Join us as we celebrate 30 years of Medicare advocacy and plan for the future!
April 1, 2016
8:30 am – 5:30 pm
Kaiser Family Foundation
Barbara Jordan Conference Center
1330 G Street, NW
Washington, DC 20005
We are delighted to announce that Senator Jay Rockefeller will join us at the 2016 National Voices of Medicare Summit to speak briefly, answer questions and personally introduce Ms. Tamera Luzzatto, who will be giving this year’s Senator Jay Rockefeller Lecture.
And this year’s program is bigger than ever, with panels including:
- Good Morning Medicare!
After a brief welcome, the morning will open with an address from, and an opportunity to talk with Sean Cavanaugh, the Deputy Administrator and Director of the Center for Medicare at the Centers for Medicare & Medicaid Services. After his talk, Mr. Cavanaugh will be available for a question and answer period.
Sean Cavanaugh, Deputy Administrator and Director of the Center for Medicare at the Centers for Medicare & Medicaid Services
- Best Practices in Advocacy and Caregiving
What practices are working to ensure older people and people with disabilities have access to, and coverage for, necessary health care? This panel will bring together leading advocates with national leaders representing caregivers and individuals needing care. The group will explore best practices from multiple perspectives within the health care delivery system.
Moderator: Toby S. Edelman, Senior Policy Attorney, Center for Medicare Advocacy
Leslie Frane, Healthcare Director, Service Employees International Union
Sarita Gupta, Co-Director, Caring Across Generations
Sarah Lenz Lock, Senior Vice President for Policy, AARP
Ted Thompson, CEO, Parkinson’s Action Network
- A Values-Based Approach to Medicare Redesign
“Medicare Reform” is a term we hear frequently, but generally that seems to mean cutting benefits and increasing costs to beneficiaries. What would Medicare redesign look like if it was focused on both serving beneficiaries and ensuring a stable and comprehensive Medicare program? We’ve assembled a panel of national Medicare policy experts with decades of combined experience in areas of health care financing, public policy, and Medicare reform. The panel will explore various factors that must be weighed in developing a truly consumer-focused redesign.
Moderator: David Lipschutz, Senior Policy Attorney, Center for Medicare Advocacy
Judy Feder, Professor & Former Dean, McCourt School of Public Policy, Georgetown University
Marilyn Moon, Director, Center on Aging, American Institutes for Research
Patricia Neuman, Senior Vice President, Kaiser Family Foundation
Judith Stein, Executive Director, Center for Medicare Advocacy
- Senator Jay Rockefeller Lecture – Introduced by Senator Jay Rockefeller
In recognition of her extraordinary public service in advancing access to affordable health and long term care in her work with Senator Rockefeller, the Pepper Commission, and former Senator Hillary Clinton, the Center for Medicare Advocacy is honored to have Ms. Tamera Luzzatto, Vice President of Government Relations at The Pew Charitable Trusts delivering this year’s Senator Jay Rockefeller Lecture.
- Recent Advocacy Highlights & Challenges
What’s happening today in advocacy for older people and people with disabilities? What’s on the horizon? What challenges are beneficiaries and their advocates facing today and what are they preparing to face in the near future? From challenges accessing necessary benefits, equipment and oral health care to efforts regarding audiology and hearing aid coverage, this panel will assess the current landscape faced by advocates and the people they serve.
Moderator: Kathy Holt, Associate Director/Attorney, Center for Medicare Advocacy
Ben Belton, Senior Advisor to the Acting Commissioner, Social Security Administration
Peter Thomas, Principal, Powers Pyles Sutter & Verville
Larry Coffee, DDS, Founder & CEO, Dental Lifeline Network
Clare Durret, Executive Director, Team Gleason
Max Richtman, President and CEO, National Committee to Preserve Social Security and Medicare
- Show Time! 30 Years of Medicare Advocacy
Based on the Weekly NPR news quiz show, this interactive panel is guaranteed to be both informative and fun. Using a “Lightning Round” format, it will review the last 30 years of Medicare and advocacy aimed at supporting a strong Medicare program and meeting the needs of beneficiaries. Attorneys from the Center for Medicare Advocacy will start us out, but be forewarned — you could be called upon!
Moderator: Judith Stein, Founder/Executive Director, Center for Medicare Advocacy
Center Attorneys and Colleagues
- Be sure to stay, as a special guest kicks off the Center’s 30th Anniversary to close the day.
And of course, you will hear real voices of Medicare beneficiaries, and enjoy plenty of networking opportunities.
The January 4th New York Times story, “The Hidden Financial Incentives Behind Your Shorter Hospital Stay,” describes how hospital stays classified under “Observation Status” are skewing admission and readmission data. As Dr. Jha states in the article, Observation Status is driven by incentives for the hospital. This is an ever-increasing phenomena in which Medicare deems patients as “outpatients,” although they are in the hospitals for days.
The Center for Medicare Advocacy has worked for many years to end the harm that Observation Status causes people who rely on Medicare. We have helped hundreds of beneficiaries and families, assembled a broad national coalition to support legislation to fix the problem, and filed lawsuits on behalf of elderly patients.
“Outpatient” hospital observation status limits access to necessary post-hospital nursing home care, alters public health data regarding hospital admissions and readmissions, increases Part B costs and cost-sharing, and creates lengthy delays in the Medicare appeals system. With all this harm, one must ask: Why does the Centers for Medicare & Medicaid Services insist on continuing this dreadful policy?
The December 2, 2015 Wall Street Journal story “Medicare Rules Reshape Hospital Admissions” described how hospital stays classified under “observation status” can lead to big bills for patients without their knowledge.
The Center for Medicare Advocacy has worked for many years to eliminate, or at least reduce, the harm that observation status causes people who rely on Medicare. We have developed self-help materials,http://www.medicareadvocacy.org/self-help-packet-for-medicare-observation-status/, assisted beneficiaries and families, brought together a coalition of national organizations to support federal legislation that would fix the problem, and filed lawsuits.
“Outpatient” hospital observation status is limiting access to necessary nursing home care, skewing public health data regarding hospital admissions and readmissions, increasing Part B costs and cost-sharing, and creating lengthy delays in the Medicare appeals system. With all this harm, one must ask: Why does the Centers for Medicare & Medicaid Services insist on continuing this dreadful policy?