Medicare Open Enrollment is NOW

Now thru December 7,2014 is open enrollment for Medicare health and prescription drug plans. It is so simple. Just go to Medicare.gov/find-a-plan.

Screen one will ask for your zip code. Click to the next screen.

Screen two will ask for your medication list. After you enter all of your medications, click on complete.

Screen three will ask for your pharmacy of choice. Click on add a pharmacy.

Screen four will give you the results. I received seven pages of different programs that I could choose from.

It really is simple. Remember you only have thru December 7,2014.

If you are not Medicare eligible remind those friends and family members who are.

PQRS AND CAHPS

There was a time when if you said PQRS you thought of the 16th, 17th, 18th and 19th letters of the alphabet. CMS (Center for Medicare &Medicaid Services) on the other hand will tell you that it means Physician Quality Reporting System. And along with PQRS there is an additional letter grouping- CAHPS which stands for Consumer Assessment of Healthcare Providers and Systems. Both of these program have been created as we reform healthcare . We know the Triple Aim focuses on better health, better healthcare, and lower costs. The focus for both PQRS and CAHPS is better healthcare .

Here is how it works. CMS requires providers to hire a survey company to contact patients and ask questions with regards to the care they received. The contact can either be by phone or by mail. The responses are tabulated and based upon the results, providers with lower satisfaction scores are most likely to receive lower Medicare reimbursement.

In the CMS memo of October 9, 2014, the PQRS survey questions are made available. Let’s look at a few of the questions which are numbered as shown in the survey tool.

#6. In the pst 6 months, when you phoned the provider’s officer to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed it?

Never
Sometimes
Usually
Always

#12. In the last 6 months, when you phoned the provide’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed it?

Never
Sometimes
Usually
Always

#22 In the past 6 months, how often did this provider show respect for what you had to say?

Never
Sometimes
Usually
Always

You may be asked to answer questions like these.

Better healthcare requires patient satisfaction.

Care Coordination – A Must in healthcare today

I joined a friend for dinner last night. My friend has not been feeling well so he shared sone of his concerns. Right now he has four physicians in three systems. I asked if the physicians spoke with one another and he didn’t think so. “They all ask me the same questions about medications and my daily routine. I get a little tired of repeating myself.. No one seems to know what the other is doing.”

The latest opportunity to coordinate care cones from Medicare. January 2015, Medicare plans to begin paying physicians a monthly fee to coordinate the care of patients with chthonic disease. My friend has both Congestive Heart Failure and Diabetes.

Medicare would pay the physician $42 per month . The physician must develop a comprehensive plan. There needs to be a psychosocial and social needs assessment completed, ensure patients take their medications, care of other physicians is monitored and coordinated and also ensure there is a smooth transition when a patient moves between providers.

The outcome sought with physician care coordination is lower hospital readmission rates which would easily pay for the program. There would be one central “captain of the ship” with 24/7 access. The patient would have a champion to contact and have questions answered.

Another opportunity besides Medicare is for the patient and or family to purchase care coordination services. There are several private care coordination companies. Families that are located-far from aging parents find security in working with a private care coordination service.

Care coordination = connectivity. All providers for a patient are connected to assure the best outcomes possible.

Remember to stay tuned. Healthcare is changing rapidly.

Bundled Payment

Bundled payment is soon to become a household word especially for those over 65 years of age. Introduced this year is the Bundling and Coordinating Post Acute Care Act of 2014. Passage of this Act would require that payment for a designated period of time would include payment for multiple services.

With regards to payment for a period of time, CMS (Center for Medicare and Medicaid Service) has demonstration projects already in place. Projects include the hospital stay and care delivered for either the next 30 days, 60 days, or 90 days.

As for multiple providers included in the bundle are Acute Care Hospitals, Long Term Acute Care Hospitals, Inpatient Rehab Facilities, Skilled Nursing Facilities, Home Health Agencies, Durable Medical Equipment Companies, and outpatient drugs and biologicals.

The following is an example of how this might work. Each medical condition would be assigned an amount of money. Let’s say $10,000. If we were in a 30 day bundle program, all care delivered by the providers just mentioned would be paid out of the $10,000. Savings gained would be profit.

The benefit to the bundle program is lower cost and the necessity that providers will need to work together to provide the best health care possible. This follows right in line with the Triple Aim from the Affordable Care Act.

Much is yet to be determined. What is essential is understanding that changes are in the future. Stay tuned with me.

Preparations When You Can’t Speak For Yourself

I was traveling home from Asia and met a wonderful couple on the plane. During brief introductions revealing our occupations , I shard this blog. Our conversation has led me to today’s topic.. As we age it is important that we make preparations when we cannot speak for ourselves.

The first step is to talk with your family. It is critical to establish who will make medical decisions for you if you become unable. Discussion with family should include what your care decisions would be if you could speak for yourself and is there an adult family member that would execute your wishes. Most states allow for you to complete a power of attorney for healthcare, advance directive or a living will. The guidance of an attorney is not necessary. The forms are fill in the blank and available at your hospital discharge planning department. Once the form is completed a copy should be given to the hospital of your choice and with your physicians, both primary care and specialists, and to the person who will speak on your behalf. Keep the original yourself. An additional benefit of executing a power of attorney for healthcare is that in most states it will be accepted without requiring applying to the courts for a guardianship.

The second step is to talk with your physicians. Share what your wishes are. Ask that your wishes be documented in your medical director. In some states you can ask your physician to execute a POLST , Physician Order Life Sustaining Treatment. POLST is not available in all states.

The third step is to talk with your faith leader. I have always thought that when we are facing a medical situation at the head of our bed is our physician and faith leader with our family at the foot. It can be very comforting for a family to talk with clergy if a difficult decision must be made. There is value if your faith leader knows your wishes.

Most people, once they have taken these steps have peace of mind knowing that they have made known their wishes.

Introductions

I have spent my entire career, 40 years, in health care focused on geriatrics in post acute care. Note that post acute care includes Home Health, Hospice, Skilled Nursing Facilities, Assisted Living, and Durable Medical Equipment. The first 30 years were spent in direct operations of large 150 patient plus nursing homes. The past 9 years I have served as a Vice President of Post Acute Care for a multi state Hospital System. I had the opportunity to develop a Senior Health Service Line in the hospital system as well. I retired four months ago.

With the encouragement of my adult children, I now have time to write this blog and share the knowledge I have gained. First and foremost for me is the belief that growing old is a privilege that many are denied. Growing old isn’t for sissies either. We will all have challenges as we age. Once those challenges present patient and family will need information quickly to secure the help and services that will insure the patient returns to their highest level of function. There is help every step of the way if you know which doors to knock on and open.

Enough for introductions now. I am certain that my experiences and knowledge will be evident as we move forward.