Citing information from the National Center for Health Statistics, the New York Times reports with Venn diagrams to explain how Alzheimer’s disease, high blood pressure and heart disease overlap for those who reside at Assisted Living Facilities.
http://www.nytimes.com/interactive/2013/04/16/science/disease-overlap-in-elderly.html?smid=pl-share
“We care about the citizens of our state. We know this will be bad for our health care. We want jobs in our state. This is going to put American businesses at an unbelievable disadvantage as compared to businesses around the world.”
Gov. Rick Scott, talking to Fox News anchor Greta Van Susteren on Friday night
via Scott says Florida won't implement health care law – Tampa Bay Times.
For another view of Medicaid reform in Florida read below:
Medicaid Cure patients rate better than patients trapped in old Medicaid in nearly two-thirds of national health categories. And Medicaid Cure patients report higher satisfaction rates in 83 percent of satisfaction measures compared to patients in both old Medicaid and commercial HMOs.
The Medicaid Cure makes patients healthier and happier through choice, competition, accountability and personal responsibility. It is saving patients’ lives. But is it saving budgets?
Florida taxpayers have saved an estimated $118 million annually since the five-county pilot began. When the federal government green-lights the Cure for statewide expansion, taxpayers here are expected to save almost $1 billion every year. And if the Medicaid Cure was replicated in every state, not only would Medicaid patients across the country be healthier and happier, American taxpayers would save more than $1 trillion over the next decade.
News Service of Florida is reporting that
Florida will opt out of spending about $2 billion more to expand Medicaid, and wont build insurance exchanges, another optional part of the federal health care law, Gov. Rick Scotts office said Sunday.
via Gov. Rick Scott confirms: No Medicaid expansion for Florida | jacksonville.com.
Gov. Rick Scott having refused millions of dollars of federal grants for setting up an insurance exchange now appears ready to move forward. However the Governor and other Republican leaders still are not in favor of expanding the Medicaid roll by another million citizens. The state may well decide to opt out stay under the funding cap of the old system. This approach would save the state over a billion dollars by 2018.
via Florida reluctantly starts to implement Obama’s health care law – Orlando Sentinel.
A physician’s perspectiveAs a family physician, I have struggled to help my patients get necessary health services, but with Thursday’s Supreme Court ruling upholding the health-care-reform law, my patients and millions of Americans have improved access to health care.The Affordable Care Act ACA provides insurance security for everyone; no longer will health-care access be determined by how much you earn, where you live or what you look like.Under the ACA, insurance companies are required to use more of your premium on insurance benefits instead of salaries and administrative costs. Insurers must cover everyone, regardless of pre-existing conditions, and are no longer able to impose yearly or lifetime caps for needed services. Adult children can stay on parents’ insurance plans until they turn 26. Preventive care is available to all Americans without co-pay, allowing health-care providers to detect illnesses before significant harm is done. The ACA expands access to Medicaid for our nation’s poorest citizens and strengthens Medicare to protect seniors.With the Supreme Court’s ruling, now we can put patients ahead of politics, and Americans can realize all the benefits of the Patient Protection and Affordable Care Act PPACA.— David Evans, M.D., Seattle
via U.S. Supreme Court upholds Obamacare | Northwest Voices | The Seattle Times.
Nearly 9 million poor and sick Americans are “dually eligible” for both Medicare, the federal health care program for seniors and disabled individuals, and Medicaid, the joint federal health system for low-income people. They use a lot of health services and their care is often fragmented.
Melanie Bella’s new job is to help fix that.
The new Affordable Care Act may be helpful to you. Take a look at this handout to find 5 things you need to know.
As the Supreme Court begins hearing arguments on the Affordable Care Act, Tell Me More continues the conversation about state reactions to the law. Guest host Jacki Lyden speaks with Florida Senate President Mike Haridopolos, about opposition to the Affordable Care Act in his state.
Nearly a year after lawmakers approved moving to a statewide Medicaid managed-care system, the Agency for Health Care Administration last week sent another round of detailed information to federal officials about how the plan would be carried out.
The information, in a document dated Friday, indicates that the number of beneficiaries enrolled in HMOs and another type of managed-care plan is expected to double — and possibly triple — by the end of 2014.
Also, with the state divided into 11 Medicaid regions, it says beneficiaries would move into managed-care plans in a “staggered” fashion and that timelines would be developed for each county.
via Agency details Medicaid plan | The News-Press | news-press.com.
Tens of millions of people every year decide they can’t afford or simply won’t buy health insurance. Some are out of work or underemployed. Many are young and early in their working careers, self-employed or without access to large group plans through work.
The Obama administration wants to cover 30 million more people by providing incentives for nearly everyone to buy insurance. The Affordable Care Act expands government programs such as Medicaid, offers subsidies for lower-income people and imposes a penalty for those who don’t sign up with a private, employer-based or government plan.
Now the individual mandate to buy insurance is in the cross hairs of a challenge to the law by Florida, 25 other states and business groups before the U.S. Supreme Court. Among other objections, opponents say forcing people to purchase insurance or pay a penalty is a step too far, an unconstitutional overreach by the government.
The court’s decision, expected as a landmark ruling in June or July, could uphold the law, strike it down or perhaps kill the mandate while leaving other parts intact.
But if the law and the mandate survive, there’s still a fundamental problem with incentives, said Bruce Vogel, associate professor in the Department of Health Outcomes and Policy at the University of Florida’s College of Medicine.
via Experts see few barriers to stop people from buying health-care coverage only when sick.
Hillsborough County has joined an ongoing dispute over health care costs for its poorest residents.
The Hillsborough County Commission on Wednesday unanimously backed a lawsuit challenging the constitutionality of a plan to collect local Medicaid payments before billing. It approved spending $5,000 for legal costs in the Florida Association of Counties lawsuit to be filed soon in Leon County Circuit Court.
The state budget and an implementing bill signed this week by Gov. Rick Scott would delay the phasing in of Medicaid managed care plans for dentistry, but Scott made clear he would support the plans in the future.
The language would require the agency to continue allowing dentists to bill for Medicaid patients under the traditional fee-for-service system in areas outside Miami-Dade County, but would expire in July 2013. The Agency for Health Care Administration announced it was delaying the statewide implementation of the managed care system after the language was approved by the Legislature.
via Budget would delay statewide Medicaid managed care for dentistry | The Florida Current.
Medicaid remains the black sheep of the health care reform litigation. Before the six-and-a-half hours of oral argument at the end of March, commentators focused primarily on whether Congress may require a minimum level of health insurance coverage. Even the number of amicus briefs filed about 23 on the Medicaid issue versus about 78 on the “individual mandate” indicates lack of attention to the spending question in Florida v. US Department of Health and Human Services. Both Solicitor General Donald Verrilli and Paul Clement referred to Medicaid as Medicare, a blunder that may be natural after three days of arguments. But, such stumbles suggested a lack of understanding of both spending doctrine and the Medicaid expansion and do not bode well for the Courts decision-making processes.
via JURIST – Forum: Medicaid in the Supreme Court: Small Errors, Big Problems.
Perhaps ObamaCare will be remembered as the breaking point for top-down planning. There is not enough information available for the government to micromanage a system as complex as health care, which represents more than 15% of the economy. Austrian economist Friedrich Hayek wrote some 50 years ago about the “pretence of knowledge,” meaning the conceit that planners could know enough about complex markets to dictate how they operate. He warned against “the belief that we possess the knowledge and the power which enable us to shape the processes of society entirely to our liking, knowledge which in fact we do not possess.”
The test uses a chemical called florbetapir, known by the brand name Amyvid, which is a radioactive agent that tags clumps of a sticky substance called an amyloid. Amyloid proteins are hallmarks of Alzheimer’s disease. The chemical, which costs $1,600 per dose, then is detected using a brain imaging technique called positron emission tomography, known as PET scans.
For patients who already have some symptoms of cognitive decline, a positive scan suggests that moderate to frequent amyloid plaques are present in the brain, which is consistent with Alzheimer’s disease.
via FDA Approves Alzheimer’s Test Developed by Eli Lilly – WSJ.com.
The Obama administration’s budget proposal to cut defense spending, in part, by increasing the cost of health care for retired service members has riled veterans groups and members of Congress.
via TRICARE fee increases: Hikes in cost of veterans health care draw fire – POLITICO.com.
Although this article addresses the historical issue of debtors, debtors prisons, and Bankruptcy, I find it interesting as the Health Care System evolves. The Number One reason for personal bankruptcy is health care bills
As Health Care restructures its delivery system, watch large health care systems work their way through bankruptcy. This may seem far fetched at this time. However with the significant Medicaid and Medicare budget cuts major cash flows will be altered. Large Health Care Providers which have made large capital outlay to capture what was in the past a major cash flow will experience financial distress.
A cut of 60.5 million a year will effect Florida Nursing Homes in a big way. These cuts are effecting how the Nursing Homes are paid by Medicaid for those residents that have not paid there bills. There is an a way that the Nursing Home industry can add the bad debt to their cost of doing business, which will effect the rate medicaid will pay. Under a new law this will be changed.
A new Avalere Health analysis detailing the negative impact on Skilled Nursing Facilities (SNFs) resulting from so called “bad debt” provisions passed in the Middle Class Tax Relief and Job Creation Act of 2012 finds facilities in Florida, Ohio, Illinois, Pennsylvania, North Carolina, Louisiana, Indiana, Tennessee, Georgia and New Jersey will absorb the largest Medicare funding cuts. Nationally, the provision will cut SNF payments by at least $3 billion over the FY 2012-21 budget window.
Alan G. Rosenbloom, President of the Alliance for Quality Nursing Home Care (AQNHC), pointed out that the phrase “bad debt” is a complete misnomer. The federal government itself, he said, prevents SNFs from collecting as much as 90 percent of SNF bad debt. “SNFs have no legal recourse to collect ‘bad debt’ from state Medicaid agencies — and is more accurately described as ‘uncollectible debt’ as mandated by federal law,” he stated. He noted the U.S. SNF sector, America’s second largest health facility employer, faces yet another $8-9 billion in cuts between FY 2012-21, resulting just from the looming sequestration threat
On April 2 2012 Alex Sink speaks on the future of florida and Florida
Next.
According to a Kaiser Family Foundation poll .pdf released last week, the Medicaid expansion provision in the Affordable Care Act has 70 percent approval from Americans.
The poll also found that most provisions in the law have considerable support from the public, except for the individual mandate, which bottoms out with a 32 percent approval rating.
via Poll: 70 percent like Medicaid expansion in health care reform law | Florida Independent.
“It is absolutely not sustainable. If we do nothing, this line will bankrupt our state,” Scott said at a news conference
The Financial State Of Florida’s Medicaid | HealthyState.org – Florida Health News.
University of South Florida Public Radio Reporter, David Gulliver has written one of the best analysis of the funding of Medicaid. In great detail he describes the two billion dollar cuts to Medicaid that only saves the state of Florida 442 million. To understand the scale of the Medicaid Program and the programs impact to the state economy, Gulliver reports, that medicaid represents 21.2 billion of Florida total budget of 70 billion. The cuts represent less than a 10 percent cut.
David Gulliver also drives home the point that in tough economic times the Medicaid enrollment grows. From 2003 to 2008 Medicaid caseload was flat. As the recession impacted Florida, over 1 million people joined the Medicaid rolls.
The article ends by looking at the future of Medicaid reform and the pilot program that privatized Medicaid in five Florida counties. It is still unknown if real savings are achieved by this approach. David Gulliver cites the two studies done at the University of Florida and Georgetown University.
Great Reporting.
Over the strong objection of Florida counties and tea party activists, Gov. Rick Scott on Thursday signed a bill that will force the local governments to make good on nearly $300 million worth of unpaid Medicaid bills.
Miller – McCune has a great article about the politics of the Supreme Court. As the Supreme Court considers the Affordable Care Act and Medicaid today, they must do so with great respect for their opinion to be honored. However the backlash will be great what ever decision they will make. It is my prediction that the Supreme Court will not render a decision until after the Presidential election this fall.
If the smear of partisan decision-making tars the unelected U.S. Supreme Court after these decisions, the fundamental legitimacy of the institution may become precarious.Why exactly is legitimacy so important?Legitimacy means that an institution has the right to make decisions, and, because those decisions are fairly, impartially, and procedurally properly made, citizens are under the obligation to accept those outcomes, even when they disagree with them. So, in this sense, legitimacy is for losers — those on the losing side of the issues the Supreme Court decides.
via Can the Supreme Court Survive a Health-Care Decision? – Miller-McCune.
U.S. Tells States How to Expand Medicaid in Health Law – WSJ.com.
Regulations on the expansion of the federal medicaid program are issued to the dismay of many states. Oral Arguments in the Supreme Court of the United States are less than 10 days away. This WSJ article is well written and informative.
The Miami Herald reports:
A controversial measure that would shift $300 million in disputed Medicaid bills to counties has been received by Gov. Rick Scott’s office, triggering the 15-day window for him to either sign or veto the legislation. If Scott does neither by the March 29 deadline, it becomes law automatically.
via Clock ticking for governor to sign controversial Medicaid legislation | Naked Politics.
Some of questions asked by the Federal Government to the State of Florida regarding the transition to managed care for those on Medicaid. In a recent article some of these questions have been revealed. If you were the State of Florida how would you answer them.
“The State must ensure that plans maintain a network of providers in sufficient number, mix, and geographic distribution to meet the needs of Medicaid beneficiaries,” one part of the list said.
“What are the standards that will be used by the state to ensure access to Medicaid services and to which managed care plans will be held accountable? How have these standards been vetted? Describe the ongoing oversight and review that will be in place to ensure plans maintain a sufficient network.”
Florida Medicaid shift could take longer than expected | The News-Press | news-press.com.
Well written article, about the shift to managed care for seniors on medicaid and how the state and federal governments still do not understand how it will all work. The need for independent advice on choices and care seems manifest for seniors and their families as these changes in the medicaid program are put in place.
A very good basic Frequently Asked Questions is provided by the Washington Post on the upcoming oral arguments in the Supreme Court over the Affordable Care Act.
FAQ: The Supreme Court and health reform – The Washington Post.
The Miami Herald editorial page reviewed the Florida legislature 2012 session with a judgmental tone. The editorial staff at the Herald were concerned that the legislature failed Neglected Elders and meaningful reform of the Medicaid Program.
NEGLECTED ELDERLY
Gov. Rick Scott and lawmakers talked a good game, calling for major reforms to improve assisted living facilities in the state. In the end, however, only the Senate was willing to impose serious reforms to help vulnerable ALF residents. But with no willing partners in the House and little leadership from the governor — who swore that this issue was a priority — ALF reform went nowhere this session. Shameful.
MEDICAID CUTS ON FAST TRACK
Jackson Health System dodged a bullet from the governor’s original proposal, which sought to cut a quarter billion dollars in Medicaid funding. Instead, the Legislature’s formula trimmed Jackson’s Medicaid allotment by about $47 million, with the ability to recoup about $12 million of that amount and possibly more through expected federal revenue.But even so, the Legislature forced Florida hospitals to absorb a cut of more than 5 percent in Medicaid funding in a state that already covers far less than what it costs to care for sick, indigent patients.Most maddening: The Legislature rejected $440 million from the feds to improve Medicaid reimbursement rates to physicians, money designed to encourage more doctors to serve the poor and disabled. This is all politics, designed to show displeasure over the Obama administration’s Affordable Health Act, but it winds up hurting Florida’s neediest.
Forbes is reporting Long Term Care Issues are not a top issue for presidential candidates. An exception is Newt Gingrich. Forbes reveals:
Gingrich, who has shown real interest in long-term care issues in the past, was typically provocative though sometimes contradictory and often not specific. The former speaker used the survey as a platform to renew his calls for repealing the 2010 Affordable Care Act, turning Medicare from a guaranteed federal benefit into a defined contribution program, and replacing the existing Medicaid system with a federal block grant.
Gingrich said consumers should be able to use tax-advantaged Health Savings Accounts and Flexible Savings Accounts to buy long-term care insurance. This is somewhat curious since Gingrich has also proposeda flat income tax system that would seem to effectively end HSAs and FSAs.
Still Gingrich also said he’d “promote new models of care” that focus on primary medical care and home care. He also embraced the use of new assistive devices, though he didn’t say how consumers would pay for them.
In addition, Gingrich said Medicare should cover training for family caregivers. This is a very interesting idea through it is not clear how such a mandate would be implemented once Gingrich shifts Medicare to a largely private insurance model.
via Long-Term Care Services: Forgotten By Most Presidential Candidates – Forbes.
Local and County governments are on the hook for more cost sharing for Medicaid patients. Currently at stake is over 300 million dollars in disputed Medicaid billings. These funds owed are over a three year period.
p>The state wants to get that money, as well as future Medicaid payments, by withholding revenue sharing dollars from counties. That in an unfair burden on local governments that will hurt taxpayers, the Tea Party says.
“This is going to require counties to cut services or raise taxes to pay for what the state is mandating for the counties,” said Henry Kelley of Ft. Walton Beach, the Tea Party Network’s legislative liaison.
via Tea Party defends counties in Medicaid billing dispute | Naked Politics.
As Courts interpret Medicare and Medicaid laws, they ponder the language that the public policy is described in the laws. In todays Wall Street Journal JOE PALAZZOLO, writes about the difficulty in understanding the plain meaning of the enabling laws.
James Madison warned in the Federalist Papers about laws "so voluminous that they cannot be read, or so incoherent that they cannot be understood."
If only he had lived to see the Medicare and Medicaid programs.
via Here's a Funny Idea: Medicare Laws That Are Easy to Read – WSJ.com.
As goes Florida so does Kansas.
Medicaid in Kansas has grown by 7.4% annually over the last decade, and Mr. Brownback would reform it by contracting with managed-care organizations to oversee and coordinate care. His plan would also provide monetary incentives for insurers and providers to improve quality and use health-care dollars more economically.But heres the rub. To execute most of these Medicaid changes, Mr. Brownback needs Health and Human Services Secretary Kathleen Sebelius to issue a global waiver, which frees the state from most Washington strictures in return for a cap on federal funding. George W. Bush granted Rhode Island a global waiver that has had excellent results, but Ms. Sebelius is a former Kansas Governor and may not want to give her party rival the power to succeed.
What’s it show? It’s the hospitals — the hospitals that are behind the unchecked growth in state Medicaid spending, even though their rates have been cut and they’ve cried “crisis” year after year.
Florida’s one of only 10 or 11 states that pays hospitals a per-diem rate rather than a per-service rate. The hospitals themselves must submit cost reports to the state Agency for Healthcare Administration, and each hospital’s per-deim rate is set according to a complex formula.”
What’s behind Florida’s Medicaid spending surge: It’s the hospitals | On Call with Stacey Singer.
The Wall Street Journal reports on new resources for caregivers.
Home Instead Senior Care has started training its home-care workers in new techniques and strategies to improve care for dementia patients—and is starting to offer the same instruction at no cost online and in person to family caregivers.
“Families need help keeping their loved one safe and mentally engaged and stimulated, and managing difficult behaviors,” says Jeff Huber, Home Instead’s president.
To that end, Home Instead developed a life journal, designed to collect information about a patient’s history “to create a much more effective caring experience,” he says.
[Gov.] Scott said the reimbursement “adjustment” would create a flat rate for hospital groups using average costs. “No program has grown as fast and as much as Medicaid, and we must find a way to control the cost. If we do nothing, this program will bankrupt our state,”
via Florida plans to slash Medicaid funds ahead of health reform | Government Health IT.
In the Gainsville Sun Attorney Anne Swerlick writes “The Florida Legislature has an opportunity to address these problems. The state pays billions of dollars to mostly private-for-profit HMOs to care for some of the most vulnerable Floridians. It is imperative that these health plans provide Medicaid patients, their physicians and the public a transparent process by which health care decisions are made. This is especially important now as more Medicaid patients will be required to enroll in HMOs and other managed care plans.”
via Anne Swerlick: Will the Legislature protect Florida’s most vulnerable? | Gainesville.com.
The Tampa Tribune Editoral makes the point “Continued deep cuts will compromise Floridians’ care.”
RCPALM Editorial Page points out ‘Here’s what is particularly insidious about the Legislature’s proposed cuts to Medicaid: At the same time Florida lawmakers are planning to reduce vital health care services for hundreds of thousands of state residents, both chambers have approved state budgets that continue to offer overly generous health insurance premiums for high-ranking state officials. The governor, lawmakers and other powerful elites would remain eligible for health insurance premiums at significantly reduced rates — $8.34 a month for single coverage; $30 a month for family coverage. (By contrast, rank-and-file state employees pay $50 a month for single coverage and $180 for family coverage.)”
Fred Grimm in the Miami Herald writes “If the Senate version prevails over a less Draconian appropriation in the House, 34 percent of the mental health funding, and 25.5 percent of the money for substance abuse, would disappear. Some 140,000 patients would be tossed from their community treatment programs. A number of these non-profit programs would shut down. (Even without the Negron cuts, the Department of Children & Families has admitted that it hasn’t been able to provide services to 170,000 adults and 40,000 children with serious mental illnesses.)”
The state [of Florida] has been fighting with the feds for sometime now over implementation of its plan to privatize most of its Medicaid program.
via Florida legislators passing ceremonial bills denouncing health care reform | Florida Independent.
The Tampa Bay Times reports use of a Yacker Tracker at Tampa Bays two veterans hospitals. A Yacker Track “is a testing device that measure the decibel level on inpatient wards. Placed at nursing stations and looking like a red light signal, the device flashes red when the noise exceeds levels set by the hospital.”
VA hospital officials, it is reported, understand that noise can delay recovery and healing. Look for signs in the hospital that state “Quite please Patients healing.”
