Medicare Toughens Standards on Nursing Homes

By Katie Thomas

The star ratings of nearly a third of the nation’s nursing homes were lowered on Friday, as federal officials readjusted quality standards in the face of criticism that the ratings were inaccurate and artificially inflated.

Federal officials said they hoped the changes would make it easier for consumers to differentiate between facilities, as well as spur nursing homes to make improvements.

The changes that took effect on Friday were mainly aimed at one of three major criteria used to rate the homes on the Nursing Home Comparewebsite, which ranks more than 15,000 nursing homes on a one- to- five-star scale. Officials essentially adjusted the curve for the quality-measures rating, which is based on information collected about every patient.

Representatives for the nursing home industry said that rather than helping consumers, the changes could frustrate them.

“Any time that nearly a third of an entire sector is impacted by a change of this magnitude, there will be confusion,” said Mark Parkinson, the chief executive of the American Health Care Association, the trade group for profit-making nursing homes. “We’re not helping patients and their families get the information they can trust when the star rankings don’t match the quality care being delivered.”

Advocates for nursing home residents, however, described the changes as long overdue.

“We think that rescaling the quality measures will result in improved reporting of the quality of care a nursing home may provide,” said Robyn Grant, director of public policy and advocacy at the group Consumer Voice.

Nursing Home Compare has become the gold standard for evaluating the nation’s nursing homes, even as it has been criticized for relying on self-reported, unverified data. The website receives 1.4 million visits a year, federal officials said.

In August, The New York Times reported that the rating system relied so heavily on unverified information that even homes with a documented history of quality problems were earning top ratings. Two of the three major criteria used to rate operations — staffing levels and quality measures statistics — were reported by the homes and not audited by the federal government.

In October, the federal government announced that it would start requiring nursing homes to report their staffing levels quarterly — using an electronic system that can be verified with payroll data — and that it would begin a nationwide auditing program aimed at checking whether a home’s quality statistic was accurate.

Before the change on Friday, about 80 percent of the nation’s nursing homes received a four- or five-star rating out of five on their quality measures score; afterward, nearly half did. The number of homes receiving one star in that area increased to 13 percent, from 8.5 percent, after the recalibration.

The changes led to declines in the quality-measures rating of 63 percent of homes. The staffing scores of about 13 percent of homes also fell because of other adjustments that took effect on Friday.

Federal officials said the higher bar reflected the fact that the industry had improved since December 2008, when the rating system was put into effect.

 http://www.nytimes.com/2015/02/21/business/nursing-home-ratings-fall-as-tougher-standards-take-effect.html?ref=health&_r=0

The Boomer’s Guide to Medicare.

AARP has posted the top 8 “Do’s and Dont’s” when it comes to Medicare. Make sure you are not only aware…but truly in the know when it comes to the future of your health care.

Here’s what you should know…

1. Do give yourself time to learn about Medicare: It’s a system with many choices and deadlines. Being informed is the best way to avoid mistakes that cost money.

2. Don’t expect to be notified when it’s time to sign up: Unless you’re already receiving Social Security benefits, you must apply for Medicare. But you won’t get any official notice on when or how to enroll.

3. Do enroll when you’re supposed to: To avoid permanent late penalties, enroll at age 65 if you’re not working, don’t have employer insurance or live abroad; or, beyond 65, enroll within eight months of stopping work — even if you continue to receive COBRA or retiree health benefits from an employer.

4. Don’t despair if you haven’t worked long enough to qualify: You may qualify for Medicare on your current or former spouse’s work record. Or you may be able to buy into the program.

5. Don’t worry that poor health will affect your coverage: If you qualify for Medicare, you receive full benefits. You can’t be denied coverage or charged higher premiums because of current or past health problems.

6. Do remember that Medicare is not free: You pay premiums for coverage and copayments for most services, unless you qualify for a low-income program or have other, extra insurance.

7. Don’t assume that Medicare covers everything: It covers a wide range of health services (including expensive ones like organ transplants), prescription drugs and medical equipment. But there are gaps.

8. Don’t expect Medicare to cover your dependents: Nobody can get Medicare under age 65, except those who qualify through disability. Medicare has no family coverage.

For a complete Medicare starter kit, head to http://www.aarp.org/health/medicare-insurance/info-04-2011/medicare-starter-guide.html.

 

Knee Pain? Eat to feel better…

Besides knee pain, we face daily aches and pains that require more than just a short rest or a nap. Below we have listed AARP’s recommendations for 7 foods that can help battle off those daily ailments.

 

Take the first step with…Ginger.

Long used as a digestive aid, ginger is also an effective painkiller. Almost two-thirds of patients with chronic knee pain reported less soreness upon standing after taking a ginger extract, according to a six-week study from the University of Miami. Those who consumed ginger also reported less pain after walking 50 feet than those taking a placebo — and they needed less pain medication. And new research suggests ginger may also help tackle post-workout pain.

“Ginger relieves pain by blocking an enzyme that’s a key component of the inflammatory process,” says investigator Christopher D. Black, Ph.D., assistant professor of kinesiology at Georgia College and State University in Milledgeville, Georgia. Two to three teaspoons a day should do the trick. “That’s not an overwhelming amount,” he says. “You could easily add that to a stir-fry or soup.” Other options include ginger tea and beverages made with fresh ginger.

…Soy

Want to cut your osteoarthritis knee pain by 30 percent or more? Add some soy to your diet. An Oklahoma State University study found that consuming 40 grams of soy protein daily for three months slashed patients’ use of pain medication in half. The secret lies in soy’s isoflavones — plant hormones with anti-inflammatory properties, says main study author Bahram H. Arjmandi, Ph.D., R.D., now professor of nutrition, food, and exercise sciences at Florida State University in Tallahassee.

Tofu, soy milk, burgers, edamame: All are good options. But be patient. “It takes two or three weeks for it to take effect,” Arjmandi says.

…Turmeric

A recent Thai study found that the spice common in many Indian foods fights the pain of rheumatoid arthritis as effectively as ibuprofen. Turmeric also seems to inhibit the destruction of joints from arthritis, according to National Institutes of Health – supported research on rats at the University of Arizona in Tucson.

Turmeric inhibits a protein called NF-kB; when turned on, this protein activates the body’s inflammatory response, leading to achy joints. Investigator Janet L. Funk, M.D., and others are still working out the optimal dose, but “using turmeric as a spice in cooking is safe,” she says.

…Cherries

High amounts of antioxidants called anthocyanins are the key to cherries’ pain-fighting power. In a U.S. Department of Agriculture study, participants who ate 45 Bing cherries a day for 28 days reduced their inflammation levels significantly. And a Johns Hopkins study of rats given cherry anthocyanins hinted that anthocyanins might also protect against arthritis pain. Unpublished preliminary data from the Baylor Research Institute in Dallas further showed that a tart-cherry pill reduced pain and improved function in more than 50 percent of osteoarthritis patients over an eight-week period. A cherry-juice drink likewise reduced symptoms of muscle damage among exercising men in a University of Vermont study: Their pain scores dropped significantly compared with the scores of those who did not drink the juice. Pain-calming anthocyanins are also found in blackberries, raspberries, and strawberries.

…Coffee/Caffeine

Ever wonder why so many over-the-counter cold and headache medicines contain caffeine? Studies show it enhances the effects of common painkillers such as aspirin and acetaminophen. But recent data suggest caffeine has pain-lowering powers of its own — at least when it comes to the pain associated with exercise. University of Georgia researchers showed that moderate doses of caffeine — equivalent to two cups of joe — reduced post-workout pain by almost 50 percent.

And a caffeine buzz may boost your workout. Caffeine seems to raise your pain threshold, making it easier to keep exercising or work out harder than you would have otherwise. Just don’t overdo it. “If you are going to work out, get a cup of coffee on the way,” Black says. “There’s good evidence it makes your muscles feel better

…Fish

The omega-3 fatty acids in fish that help keep your ticker in top shape may also tame the pain or inflammation of rheumatoid arthritis, migraines, and some autoimmune diseases, including Crohn’s disease. Even chronic neck- and back-pain patients can benefit: In an open trial at the University of Pittsburgh, 60 percent of respondents experienced some relief after taking fish oil for three months, and almost as many dropped their pain drugs altogether. “We found we could substitute fish oil in place of drugs — an anti-inflammatory with no side effects in place of pharmaceuticals with side effects,” says Joseph C. Maroon, M.D., clinical professor in the Department of Neurological Surgery at the University of Pittsburgh Medical Center and the study’s coauthor.

Aim for two to four meals a week of fatty fish such as salmon, Atlantic mackerel, sardines, or trout — all top omega-3 sources. Halibut, light tuna, snapper, and striped bass are good, too. Not a fan of the fin? Consider a daily supplement containing both EPA and DHA — the key omega-3 fats — suggests Maroon. If you are taking a blood thinner, check with your doctor first; omega-3s may increase that drug’s effects

…Red Grapes

This deeply hued fruit contains resveratrol, a powerful compound that blocks the enzymes that contribute to tissue degeneration. The evidence: In lab experiments at Rush University Medical Center in Chicago, resveratrol protected against the kind of cartilage damage that causes back pain.

Although the research is preliminary, it can’t hurt to fill up on foods rich in resveratrol, including blueberries and cranberries, which contain other powerful antioxidants as well. Or have a glass of wine. “Resveratrol in red wine is far more easily absorbed due to the form it is in,” says researcher Xin Li, M.D., Ph.D., a biochemistry instructor at Rush.

Obama’s Solution to the Doughnut Hole (Medicare Part D)

In a surprise move that will please millions of Medicare beneficiaries, President Obama yesterday announced plans to cut in half the prescription drug expenses of those who fall into the Part D coverage gap, universally known as the doughnut hole. They would only pay 50 percent of the cost of brand-name medications in the gap instead of the 100 percent they must pay now.

The new benefit is expected to be part of health care reform legislation that Congress will consider later this fall. If passed, it will likely go into effect July 2010.

“For millions of beneficiaries, especially those with high drug costs, this could literally be a life saver,” says John Rother, AARP’s executive vice-president of strategy and policy. “It’ll certainly make a substantial financial difference to everybody who falls into the doughnut hole.”

This unexpected shrinking of the doughnut hole, which affects about 26 percent of Part D enrollees, is the result of a deal between the White House and the pharmaceutical industry. All drug manufacturers agreed to donate half the cost of their brand-name and biologic products (but not generic drugs) to people in the gap, at no cost to the government.

“As part of the health reform legislation that I expect Congress to enact this year, pharmaceutical companies will extend discounts on prescription drugs to millions of seniors who currently are subjected to crushing out-of-pocket expenses within the doughnut hole,” Obama said in a statement. “This gap in coverage has been a continuing injustice that has placed a great burden on many seniors.”

The discounts will cost the drug industry about $80 billion over 10 years, according to its trade group, the Pharmaceutical Research and Manufacturers of America (PhRMA).

Part D enrollees in the gap will be able to access the discounts directly at the pharmacy, White House officials say. The amount will be half of the price already negotiated by the Part D plan they’re enrolled in. They won’t have to apply for the discounts or fill out any paperwork.

Furthermore, the full cost of drugs bought in the gap will count toward the out-of-pocket limit ($4,350 in 2009) that triggers low-cost catastrophic coverage, even though enrollees will actually pay only half of this amount to get there. So the discount will not reduce their chances of qualifying for catastrophic coverage.

The discount program would be run by an independent third party, according to Senate Finance Chairman Max Baucus, D-Mont., a key player in brokering the deal. “The agreement includes a provision to discourage private employers from dropping prescription drug coverage currently provided to retirees,” he said in a statement. “It also establishes audits of drug company manufacturers to ensure the discounted prices are appropriately set.”

The discount will apply to the great majority of Part D enrollees, though not all. Those excluded are:

– People who pay the income-related Part B premium (in 2009, those with incomes over $85,000, or $170,000 for married couples).
– Low-income people who qualify for Part D’s Extra Help benefit, as they already receive full coverage throughout the year, with no gap.

Click here to read the rest of the article.

Source: Patricia Barry | Source: AARP Bulletin Today | June 21, 2009