A change in a Medicaid waiver reimbursement system for the state’s special-needs population has left some health providers without enough funding to sustain their services.
Changes to the home- and community-based services waiver — which affects approximately 5,000 Iowans who have traumatic brain injuries, developmental or intellectual disabilities — moved the payment model from a fee-for-service model to a tiered rate system, effective Dec. 1, 2017.
While Iowa Department of Human Services officials say this change will create more stability to the reimbursement system, it leaves some such as Jean Sturtz, who care for those covered by the waiver, concerned for their loved ones’ future.
In 2000 about 10% of the world’s population were aged 60 or over. By 2015 that had risen to 12%. United Nations projections indicate that will have increased to 16% by 2030, and jumped to 22% by 2050. The percentages may not seem alarming but to put this into perspective let’s look at the following: by 2025, the world’s population is set to be 8 billion, of which approximately 15% or 1.2 billion will be elderly. Essentially, that is almost equivalent to the population of the second most populous country in the world – India! Another alarming statistic is the projected decline in the working-age population (25-59) between 2030 to 2050 meaning that there will be fewer people to support the growing elderly population – financially and otherwise!
But why does this matter so much? The answer is medical costs! Healthcare expenditure on the elderly is a growing concern, as it accounts for a higher share of expenditure compared to other age groups.
Stroke victims who use Medicaid or are uninsured were more likely to die, stay hospitalized longer and have worse medical outcomes than patients with private insurance, a study by University of Florida Health researchers has found.
The uninsured and Medicaid patients were also more likely to develop a new medical condition in the hospital, according to a study published recently in the Journal of Neurosurgery. The study was the largest and most comprehensive analysis of how insurance status relates to stroke outcomes in the United States. Researchers analyzed nationwide data from more than 1.5 million hospital admissions involving stroke patients between 2002 and 2011.
The most concerning part of the findings was the statistically higher rate of patient-safety issues for those without private insurance, as well as their higher death rate, longer stays and worse outcomes, researchers said. Among Medicaid and self-pay patients, 5.1 percent of stroke victims died in the hospital, compared with 4.4 percent of those with private insurance.
Hospital readmission, an important measure of quality care, costs the United States an estimated $17 billion each year. And according to the Centers for Medicare and Medicaid Services (CMS), about half of those readmissions could be avoided.
Therefore, there is significant interest in identifying factors that influence readmission rates, especially those that can be identified prior to discharge. To pinpoint which stroke patients are most at risk, researchers at Wake Forest Baptist Medical Center undertook a retrospective case-control study to determine factors associated with readmission within 30 days. The study is published in the June 11 online edition of the American Journal of Medical Quality.
The nearly 9 million Americans who are dually eligible for both Medicare and Medicaid have long been poorly served by the healthcare system.
These elderly poor and disabled Americans suffer disproportionately from serious medical conditions. In the case of full duals, half initially qualified for Medicare because of disability rather than age, and nearly one-fifth have three or more chronic conditions. Many are obligated to poverty precisely because their serious health problems make it hard for them to sustain jobs or build savings.
Now as a result of Obamacare, many will be forcibly moved into Medicaid HMOs once another long-delayed element of the bill starts to get implemented this fall.
For all of these duals, medical care is especially costly. That has made the “duals” a focus of policy attention. According to a new report from the Congressional Budget Office the average “dual” beneficiary costs the government $33,300 per year. This compares with $8,300 for the average senior who only receives Medicare.
Finding better ways to serve the needs of these “dually eligible” Americans has been a bi-partisan goal that’s eluded successive administrations. Whenever the issue was broached, one of the questions was whether these Americans would end up in Medicare or Medicaid — and which program would better serve their needs. The Obama Administration is betting heavily on states to take control of these patients. The states, in turn, are looking to their Medicaid systems.
Nearly one-third of elderly Americans turn to skilled nursing care during their last few months of life, despite the fact that some may be better served by seeking palliative care services, such as hospice, according to a recent analysis published in the Archives of Internal Medicine.
Researchers from the University of California, San Francisco (UCSF) discovered that 31 percent of Medicare beneficiaries who were newly released from the hospital utilized the program’s skilled nursing benefit (the program pays for up to 100 days of nursing home care if a senior was hospitalized for three or more days) in their last six months of life.
What was surprising was that many of these aging adults failed to take advantage of Medicare hospice coverage during this time, even though elders who reside in nursing homes can apply to receive additional palliative care if they are close to death.
This finding raises the question of whether or not these ailing adults are getting the optimal care for their terminal conditions.
Skilled nursing facilities primarily deliver care aimed at either getting an elder functional and back on their feet, or prolonging their life through medical intervention. Hospice care, on the other hand, strives to help an elder (and their family) manage the physical and mental pain of a terminal illness such as cancer or Alzheimer’s disease.
When the federal government recently gave Florida the green light to vastly expand its experiment in privatizing Medicaid, patient advocates quickly raised an alarm.
They cite serious, well-documented problems with the state’s five-county pilot managed-care program and urged close monitoring of the companies that run private Medicaid plans to ensure that they don’t scrimp on care.
Advocates and experts say that the need for oversight is growing nationally as states increasingly contract out the huge state-federal program for the poor to insurance companies, aiming to control costs and improve quality through close management of patient care.
About 30 million people are in these plans now. Eligibility will be expanded under the federal health law that launches Jan. 1, and Medicaid will cover about 7 million people. Many will be placed in managed care.
Meanwhile, people born in the U.S. accounted for a $30.9 billion deficit.
The biggest reason immigrants are able to contribute more than their share is because they’re more likely to be of working age and part of the labor force. Of all immigrants in the U.S., 80 percent are between the ages of 18-64, versus 59 percent of the U.S.-born population, according to 2010 census data.
You generally have to be 65 years of age or older to receive Medicaid. There are a lot more native-born people than immigrants eligible for the federal healthcare program, so that means immigrants are less likely to be a drain.
Last year, health economists started noticing a welcome – but surprising – slowdown in the growth of health-care spending in America, and particularly in Medicare. The recession alone probably didn’t explain it. “If there’s something else going on,” former Medicare and Medicaid administrator Gail Wilensky said recently, “we don’t know what it is yet.”
There’s surely no single answer to that puzzle. But one possibility hasn’t really been discussed. Perhaps the medical system is beginning to feel the earliest stirrings of a shift in generational attitude. Baby boomers comprise the first generation to have witnessed, en masse, the indignities and miseries that can accompany medical efforts to extend life – specifically, the life of a parent or other elderly relative — when it’s in its final months. Among those miseries: severe pain, drugs with toxic side effects, delirium, and tubes — as the physician Atul Gawande puts it — “in most natural orifices and a few artificial ones.”
Desperate to do everything they could for their parents at the time, boomers might well have pushed for such care. But now, as more and more have come to see with their own eyes what such treatment can entail, will fewer and fewer want it for themselves? If so, then as boomers take their place in the ranks of the elderly, the demand for expensive and aggressive interventions to extend life might fall over time. Demand for palliative and hospice care, which allows for a more comfortable and conscious end-of-life experience, may rise. And this shift might ease cost pressures on the system in years to come.