I am subscribed to the biweekly electronic newsletter MEDICARE WATCH and so
should most people rather than getting it from here. It is usually just a
bunch of bureaucracy but this one caught my eye.
*Notice #3 below* regarding nursing homes. 91% is a huge number and might
as well be 100%. Further, notice that the nursing homes were only "cited"
for Deficient Care rather than having anything done about it other than a
slap on the wrist.
Then, look at #4 where the topic is --* MEDICARE STOPS PAYING HOSPITALS FOR
MEDICAL ERRORS. *
*It SHOULD READ or SAY* "Medicare Stops Paying Hospitals for Medical Errors
*AND* Hospitals Will Not Be Allowed to go after the patient for ANY
balances."
If ALL that occurred (to protect the patient) -- hospitals would probably
not want to take Medicare patients. But since it is federal I don't think
they would be allowed to do that.
In any case, what I added above Re: #4 -- it should be recognized and
included in the Medicare policy. But apparently it is not.
Sometimes it is so laughable to read "A Patient's Bill of Rights." I know
they hang on the walls of assisted living facilities and probably on nursing
home walls as well but as you can see above -- that is a joke.
Lori
On Tue, Oct 14, 2008 at 10:59 PM, <[EMAIL PROTECTED]> wrote:
> Welcome to MEDICARE WATCH, a biweekly electronic newsletter of the
> Medicare Rights Center
>
> Vol. 11 , No. 21 : October 14, 2008
>
>
> Contents:
>
> *1. FAST FACT* **
>
> *2. LOW-INCOME PEOPLE WITH MEDICARE FACE REASSIGNMENT AS DRUG PREMIUMS
> RISE *
>
> *3. NURSING HOMES WIDELY CITED FOR DEFICIENT CARE*
>
> *4. MEDICARE STOPS PAYING HOSPITALS FOR MEDICAL ERRORS*
>
> *5. CASE FLASH: SWITCHING PRESCRIPTION COVERAGE FROM A MEDIGAP PLAN TO
> PART D *
> ------------------------------
>
> *1. FAST FACT*
>
> According to Douglas Holtz-Eakin, Senator John McCain's senior policy
> adviser, the health care reform plan offered by Sen. McCain will have major
> cuts for Medicare and Medicaid. The nonpartisan Tax Policy Center, a
> Washington think tank, estimates that the McCain plan would cost the
> government $1.3 trillion over 10 years. The McCain campaign has not disputed
> these figures or offered their own. ("McCain Plans Federal Health Cuts",
> *Washington
> Post*, October 2008)
> <http://www.kintera.org/TR.asp?a=glKSK6PQJfIYLrK&s=fqLHJWMCIbLHI0NPG&m=kkJWLaOPLfJ3F&af=y>
>
>
>
> *2. LOW-INCOME PEOPLE WITH MEDICARE FACE REASSIGNMENT AS DRUG PREMIUMS
> RISE*
>
> At least 1.3 million low-income people with Medicare will be reassigned to
> a new prescription drug plan in 2009, as the number of drug plans that
> qualify for a full premium subsidy dropped from 495 in 2008 to 308 in 2009,
> according to Avalere, a health consultancy firm.
>
> Low-income people who qualify for full Extra Help can receive premium-free
> drug coverage, but only in a plan that charges a premium below the regional
> average. When a drug plan's premium rises above that average, which is reset
> every year, the Centers for Medicare & Medicaid Services reassigns most
> Extra Help recipients in that plan to a new drug plan with a premium below
> the average. Because reassignment is random, and plans vary greatly in the
> drugs they cover and the coverage restrictions they impose, low-income
> people will face new coverage restrictions under their new plan.
>
> In all but one state, Wisconsin, the number of drug plan offerings for
> low-income Medicare enrollees decreased. In six states – Arizona, Florida,
> Hawaii, Maine, Nevada and New Hampshire – there will be five or fewer drug
> plans available to automatically enroll low-income people with Medicare in
> 2009. Nevada will have only one drug plan for those people automatically
> reassigned by CMS, eliminating any choice of stand-alone drug plans for
> low-income enrollees unless individuals can pay for part of the premium cost
> from their limited incomes. Arizona has the second fewest options for
> low-income enrollees, with only two zero-premium drug plans for Extra Help
> recipients.
>
> Humana completely withdrew from the low-income market, offering no plans
> with premiums below the benchmark. However, United Healthcare increased the
> number of PDPs it will offer to low-income people with Medicare after it
> lost nearly 600,000 low-income enrollees last year.
>
> The number of people reassigned by CMS has increased annually since Part D
> went into effect in 2006. In 2007 CMS reassigned 250,000 people; the number
> steeply jumped in 2008, when CMS reassigned 1.2 million people.
>
>
> *3. NURSING HOMES WIDELY CITED FOR DEFICIENT CARE*
>
> From 2005 to 2007 more than 91 percent of nursing homes surveyed were cited
> for deficiencies, the Health and Human Services Department Office of
> Inspector General (OIG) reports. Nearly 17 percent of nursing homes had
> deficiencies that caused residents actual harm or immediate jeopardy of
> harm, with a greater percentage of for-profit nursing homes cited for these
> serious violations than not-for-profit nursing homes.
>
> The most common deficiency categories cited in each of the past three years
> were quality-of-care, resident assessment and quality of life. Almost 74
> percent of nursing homes surveyed were cited for deficiencies involving
> accident hazards, and failure to prove the highest physical, mental and
> psychosocial care for the residents' well-being. Around 34 percent of
> nursing homes were cited for improper storage, preparation or serving of
> food.
>
> In addition, 17 percent of nursing homes surveyed in 2007 were cited for
> actual harm or immediate jeopardy deficiencies. Examples of these problems
> included infected bedsores, medication mix-ups, poor nutrition and abuse and
> neglect of residents.
>
> *4. MEDICARE STOPS PAYING HOSPITALS FOR MEDICAL ERRORS*
>
> The Centers for Medicare & Medicaid Services (CMS) will no longer reimburse
> hospitals for ten categories of preventable medical errors that result in
> serious risk of injury to patients. CMS prohibits hospitals to charge people
> with Medicare for the additional costs associated with treating these
> conditions.
>
> Hospitals will now assume the costs of procedures associated with "never
> events," so called because they should never occur. While Medicare will save
> $21 million as a result of the new policy, the primary purpose of the rule
> is to improve quality of care for people with Medicare by creating greater
> incentives for doctors and hospitals to avoid preventable errors. The
> expectation is that if these errors affect hospitals' overall budgets,
> doctors and hospitals will take more aggressive measures to prevent these
> errors.
>
> The ten categories of "never events" Medicare no longer covers include
> remedial treatments related to foreign objects retained by patients after
> surgery; transfusion of incompatible blood; falls and traumas during a
> hospital stay; manifestations of poor glycemic controls; catheter-associated
> urinary tract infections; surgical site infection following a coronary
> artery bypass graft or orthopedic surgery; and deep vein
> thrombosis/pulmonary embolism.
>
> *
> **5. CASE FLASH: SWITCHING PRESCRIPTION COVERAGE FROM A MEDIGAP PLAN TO
> PART D *
>
> Mr. S has had Original Medicare Parts A and B since 2005. He has also had a
> Medicare supplemental plan with drug coverage, Medigap Plan H. Medigap Plan
> H (along with Plans I and J) with drug coverage has not been sold since
> January 1, 2006, when the Medicare drug benefit (Part D) began. However,
> people like Mr. S, who bought one of these Medigap plans with prescription
> drug coverage before that time, can keep the Medigap's drug coverage.
>
> In the past year, Mr. S's overall health has declined. As a result, his
> prescription drug costs have gone up, but Mr. S's Medigap plan only pays up
> to a certain amount each year for his drugs, leaving him paying a high price
> out-of-pocket for the medications he needs. Mr. S began looking for other
> options to get more comprehensive coverage for his prescription needs. He
> decided that he would prefer to enroll in a Medicare Part D plan for his
> prescription drug coverage.
>
> In August Mr. S called the Medicare Rights Center for help choosing a Medicare
> Part D plan. The Medicare Rights Center hotline counselor told Mr. S that
> he would have to wait until the Annual Coordinated Election Period (ACEP) to
> switch plans; the ACEP runs from November 15th to December 31st. For
> people who sign up for a Part D plan during the ACEP, Part D coverage
> becomes effective on January 1st.
>
> The hotline counselor went on to warn Mr. S that he would likely have to
> pay a Part D premium penalty when he enrolled in a drug plan because Medigap
> Plan H drug coverage is not considered "creditable coverage"—coverage that
> is as good as or better than the Medicare drug benefit. In most cases,
> people with Medicare who do not enroll in Part D when they are first
> eligible and do not have creditable coverage have to pay a premium penalty
> for enrolling late. People who qualify for Extra Help—a federal program that
> helps pay for Part D costs—can avoid this penalty regardless of when they
> enroll. Since Mr. S had income too high to qualify for Extra Help, he would
> have to pay a premium penalty in addition to his monthly premium for as long
> as he remained enrolled in Medicare Part D. Since Mr. S could have enrolled
> in a Medicare drug plan in the spring of 2006 when the first Part D
> enrollment period ended, he would have to pay a premium penalty that would
> be calculated based on the number of months that he delayed enrollment in
> Part D.
>
> Mr. S decided that even with the premium penalty, it would be a better idea
> for him to choose a prescription drug plan that provided him better coverage
> than to stick with his Medigap plan with prescription drug coverage. The
> longer Mr. S waited to enroll in Part D, the greater his premium penalty
> would be. Together, Mr. S and the hotline counselor used the Prescription
> Drug Plan Finder on Medicare.gov and searched for different Part D plans
> that covered Mr. S's medications without restrictions at the lowest cost.
>
> The hotline counselor also mentioned that Mr. S has the option of enrolling
> in a Medicare private health plan with prescription drug coverage, but Mr. S
> told the hotline counselor that he wanted to stay in Original Medicare
> because he would be able to continue to see the same doctors. If Mr. S
> wanted to keep the health benefits of his Medigap Plan H, Mr. S could enroll
> in a Part D plan and then call his Medigap plan to request that they drop
> him from the prescription drug component of the plan and adjust his monthly
> Medigap premium so that he is no longer paying a prescription drug premium
> to his Medigap plan.
>
> ------------------------------
>
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--
Lori
C4/5 complete quad, 27 years post
Tucson, AZ
