Tag Archives for Medicare

Gray Power Can Turn a Campaign Sour

Published in Senior Digest on October 2004

After 24 years on Smith Hill that included a 10-year stint as House speaker, John Harwood’s career came to a surprising end recently when 33-year-old former prosecutor J. Patrick O’Neill’s grass-roots campaign brought home the votes.  The lopsided victory, 758 votes for O’Neill to 352 for Harwood, propelled the political novice into the district 59 House seat.

Two years ago, Harwood barely kept his long-held House seat after a vigorous political campaign by write-in independent candidate Bruce Bayuk.  According to Joseph Fleming, of Fleming & Associates, a Cumberland-based polling and political consultant, seniors casting votes for Harwood at the polling place in Kennedy Manor on Broad Street, played a key role in his victory in that election cycle.

Fleming, who also serves as a political analyst for Channel 12 News said that senior voter support for Harwood was almost nonexistent in the recent Democratic primary.  Senior voters joined with anti-Harwood voters throughout the legislative district to give the former House speaker the boot.

“Harwood lost better than 2-to-1 at the polling place in Kennedy Manor,” Fleming said. “Seniors decided it was a time for a change.”

Over the years, political candidates have made pre-election day pilgrimages to Pawtucket’s senior high-rises.  In District 59, both Harwood and O’Neill courted voters in high-rises, providing food during meet and greet events.

“It’s a myth that a good meal at a senior high-rise will ultimately equate to a vote,” quips Fleming. “Seniors may go down to eat the food, but it doesn’t mean that you’ll get their vote.  Everyone feeds them, but they can’t vote for both sides.” Moreover, he said, the majority of older voters don’t reside in senior high rises.

“Seniors read campaign materials look at the campaign issues and vote for people who reflect their views on these issues,” Fleming says.

Darrell West, a Brown University professor and political pollster, notes that seniors are the biggest voting block in Rhode Island. “Not only are they a sizeable group in numbers, they also are more likely to exercise their franchise to vote,” he says.

Ken McGill, registrar for the City of Pawtucket, agrees with West’s assessment.  McGill says that in any election, political candidates can count on senior voters to turn out in high numbers.

“Seniors were brought up respecting the right to vote and how important it is. They know what is at stake and pay careful attention to the issues that not only affect them, but  issues impacting on members of their family, McGill says.

“Compared to young people, seniors are 30 to 40 percentage points more likely to vote, West said. “Seniors vote because they are invested in their community and come from a generation where it was considered any honor to vote,” says West.  He added that young people tend to be very cynical about politics and more likely to feel their vote does not matter.

West said that seniors voter as a bloc only when they see their issues directly at stake in an election. “If an election centers on Social Security or Medicare, they are more likely to overcome differences by gender, income and ethnicity and cast a ‘senior’ vote,” he says.

Adds Kathleen S. Connell, director of AARP-RI, “There are many reasons why candidates look to the senior citizens for votes. One of them being, the issues that affect the concerned seniors are the same issues that will also affect the candidates and their families now or in the future.”  Also, candidates know that seniors are the most reliable and informed voters, she says.

One of the questions surrounding the upcoming election is whether seniors will support the Rhode Island GOP in its efforts to increase the numbers in the General Assembly?

“Seniors lean Democratic because the elderly typically has seen democrats speak out most forcefully about the need to take care of seniors and protect Medicare and Social Security,” says West. However, Republicans have made in-roads with moral or ethical issues, he says.

Aging groups are gearing up for the upcoming November elections to send educated voting seniors to the polls, Connell says.

“This year, some of our volunteers are participating in presidential debate watches with Rhode Island College, and we are distributing voter guides for them to track the candidate responses to issues of importance to AARP members.  They can use these guides to further study the issues before going to the polls.”

Richard Bidwell, executive director of the Rhode Island Gray Panthers, also sees the value of getting educated senior voters to the polls. With the backdrop of the upcoming elections, the Senior Agenda Consortium (SAC), founded by the Gray Panthers and now comprised of 20 aging groups, is working to improve seniors’ knowledge of issues and develop strategies to pressure candidates to support SAC’s legislative agenda.

 As it did two years ago, SAC, which is funded by the Rhode Island Foundation, will organize three regional forums, to prod the candidates to support its legislation positions on issues ranging from ensuring access to low-cost prescription drugs, better funding for community long-term care services and protecting RIPTA bus routes.  The results will be released to the media.

Home Care Quality Data Not Always Easy to Interpret

Published in Pawtucket Times on November 10, 2003

A 70-year-old widow was recently discharged from a local hospital after surgery for cancer. Her daughter has agreed to take on caregiving duties, but because of her demanding job, there will be frequent periods of time that the elderly woman will be left home alone.

To keep this elderly woman at home after her hospital stay, her physician has referred her to a home health agency that will provide skilled nursing services for wound care and medication management.

Additionally, physical therapy has been ordered for rehabilitation. By being eligible for skilled nursing care, Medicare will also pay for a certified nursing assistant for five weekly visits to provide personal care services.

Although fictional, this situation is very typical of the care provided by 21 Medicare-certified home care agencies to 12,000 older Rhode Islanders who have a medical need for skilled care.

These agencies offer an array of health care (i.e. skilled nursing care, physical, occupational, respiratory and speech therapies, social services, psychiatric nursing and palliative care) and personal care services to patients in their own homes.

Federal and state officials, home care agency providers and Rhode Island Partnership for Home Care recently gathered at the Quality Partners of Rhode Island offices to unveil the Centers for Medicare & Medicaid Service’s (CMS) new quality improvement initiative.

CMS’s quality data will allow consumers to evaluate Medicare certified home care agencies on 11 quality measures. They include four measures related to improvements in getting around, four measures related  to improvement in meeting basic daily needs, two measures related to medical emergencies and one measure related to mental health improvements.

Quality Partners has been involved in the state’s public reporting program, which is designed to facilitate consumer choice and promote quality improvement in health care. The Providence-based independent quality improvement organization, under contract with CMS, is working with local home health agencies to improve the quality of care and inform consumers about the availability of the federal agency’s recently released quality performance data.

CMS’s new initiative is a “key step toward improving quality in getting consumers the information they need to make informed health care choices,” said CMS Administrator Tom Scully in a written statement. “By generating and publishing quality data, we are helping consumers make decisions that best meet their needs and are creating incentives for home health agencies to further improve quality.

“These quality measures should be used as an additional resource when making decisions about a home health agency or addressing the quality of care that a loved one is receiving,” said Scully. “Use these measures as an opportunity to discuss the care provided by the home health agency and address not only the areas of care covered by the quality measures, but all services as well.”

Lt. Gov. Charles j. Fogarty, who chairs the state’s Long-Term Care Coordinating Council, added, {CMS’] rating system for home health agencies fits in nicely with what we are doing here in Rhode Island. Having this information will help foster quality among the rated agencies. It will create an environment for home health care agencies to continue to improve on their quality of care.”

“Most home care agency providers embrace this quality initiative as an opportunity for agencies to focus more resources on quality for all agencies to achieve the highest standards of care which will result in an informed pubic,” noted Paula Parker, executive di rector of the Rhode Island Partnership for Home Care.

“Consumers can e confident that their home care provider has practices and policies in place to measure quality indicators. This will empower consumers to discuss quality with their providers,” she says.

While recognizing the merits to this initiative, Maria Barros, clinical director of the Pawtucket-based Nursing Placement and Saranna Home Care, is concerned that consumers may have difficulty in interpreting the quality data.

“The Home Health Quality Initiative does not really measure the agencies’ performances (in some situations),” says Barros, especially when agencies take care of patients who have chronic disabling or terminal conditions. “The patients do not improve and the quality measurers reflect this, ultimately giving a false impression that quality care is not being provided,” she says.

“Not all of our patients with diseases get better or are cured,” Barros adds. “We help them to manage their disease processes, keep them at home and enhance their quality of life until they are ready to enter into hospice care.”

Moreover, Barros said some agencies that take care of younger patients with acute medical conditions that only require short-term home health services will have better outcome data when compared to agencies that care for sicker patients’

“The intensity of the medical care is not always reflected in these 11 quality indicators,” she said.

Parker agreed, stressing that it is important for consumer to interpret the numbers released by the CMS in the context in which home care is provided.

For Medicare certified home health agencies, CMS has published advertisements in local newspapers that will include three of the quality indicators. The complete listing of quality data along with  other consumer information on home health care agencies in Rhode Island, is available at Home Health Compare located on Medicare website, www.medicare.gov and throughout Medicare’s 24-hour help line at 1-800-MEDICARE (1-800-633-4227).

For those 5,000 Rhode Islanders who receive home care through programs other than Medicare quality of care is measured by the R.I. Department of Health through their performance measurement and reporting program, mandated by legislation introduced by then-state Senator Charles Fogarty and passed by the General Assembly in 1998. Signed by the governor, this law is designed to provide consumers with published reports of quality measures for every segment of Rhode Island’s health care system.

Congress is Close to Passing Prescription Drug Legislation

Published in Pawtucket Times on June 23, 2003

Within days of the July 4th congressional recess, the House and Senate continue their debates on enacting legislation to lower the cost of pharmaceuticals for the nation’s elderly.

The AARP will kick off a media blitz to get a point across to lawmakers that while they may take a short break during recess, the nation’s elderly don’t get a break when it comes to affording the costly medications they need.

“There’s no recess [for seniors] from high prescription drug costs,”  AARP declares in a press release sent to the nation’s media outlets.

In a written statement, Lt. Gov. Charles J. Fogarty, who chairs the state’s Long-Term Care Coordinating Council, calls on Rhode Island’s congressional delegation to pass meaningful Medicare drug benefits, rather than the legislative proposals being debated in the House and Senate chambers.

“While it is nice that after many years of promises Congress has finally taken on this issue these proposals will cause nothing but heartburn and headaches for seniors if passed,” said Fogarty, noting that many seniors will pay more for the program than they will get back in benefits. He charged that others will even be left without prescription drug coverage when they need it the most.

Under the Senate proposal, seniors would pay a $ 35 monthly premium and then have to meet a $275 deductible before Medicare starts to kick in to pay for half of the drugs costs.  Once senior’s reach a cost cap of $ 4,500 for the last year, they would then have to pick up the entire cost until they reach yet another cap of $ 5,800 in total drug spending. At this point, Medicare would then pay 90 percent of the covered drug costs.

Fogarty noted the Congressional Budget Office found that one-third of seniors would pay more money to enroll in the plan than they would actually get back in benefits.

That’s because a senior with $ 1,000 in annual drug costs would actually end up

$ 1,057 annual for the benefits ($420 in premiums, a $ 275 deductible and half of the drug costs).  A senior with $ 2,000 in drug costs would pay $ 1,557 out-of-pocket for the benefits.

Fogarty also called attention to the major gap in coverage for those whose costs exceed the $ 4,500 limit until they reach that $ 5,800 mark.

Furthermore, Fogarty, who authored the state’s expanded prescription drug program, said a study by Columbia University found that only those annual drug costs about $ 1,100 would benefit through the plan.  

In the House chamber, the Republican proposal also calls for monthly premiums of $ 35 along with a lower annual deductible of $ 250 with Medicaid paying 80 percent of the cost of drugs up to $ 2,000.

There is a gaping hole in coverage (in this legislative package).” Fogarty warned “Seniors would then have to spend at least another $ 1,500 depending on their income, on medications before coverage would again begin.”

According to Fogarty, Consumer Union, the publisher of the widely-read magazine, Consumer Reports, noted the “skimpy benefits [in the House and Senate proposal] and the historically high growth of prescription drug costs means that most who lack coverage today would wind up paying more for prescription drugs in four years than they do now.”

Will seniors see a prescription drug proposal enacted this year?

Probably, said Jason Ormsby, director of policy at the Washington, D.C.-based Allilance for Health Reform.

“There is a tremendous drive that I have not seen in the last there years [to enact a prescription drug bill],” said Ormsby.

He noted the House passed a legislative proposal to assist seniors in paying for costly pharmaceuticals, but it died in the Senate.

“The somewhat similar House and Senate bills will have a good change to pass by the July 4th recess,” Ormsby predicted.  Once passed, the legislative proposal will go to conference committee to iron out the differences between the 600-page House and 350-pshr Senate bills,” he said.

The prescription drug benefits are just a small portion of these massive legislative proposals, he noted.

Robert Greenwood, vice-president of public affairs for the National Pace Association, added: “Many Democrats see the limitation of these bills.  This legislation passed presents a historic opportunity to get this law on the book so it can be amended and improved in future years.”

While not a meaningful drug prescription proposal, it’s the first step in the right direction.

Once enacted into law, the Rhode Island congressional delegation must begin their efforts to improve the law – improve access for all: make out-of-pocket costs and cost sharing affordable; lessen gaps in coverage; more important, put the breaks to the steady increase in high-cost drugs.