Tag Archives for Tom Scully

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.

Kennedy Must Lead Fight Against Medicare HMO Rate Hikes

Published in The Pawtucket Times on November 19, 2001

Across the nation, seniors who have enrolled in Medicare HMOs are getting hit hard in the pocketbook.  Premiums and copays for hospital care, nursing services and prescription drugs are skyrocketing. Complaining about inadequate federal funding offered to provide health care services to seniors, a growing number of Medicare HMOs are opting out of the program, leaving their senior enrollees high and dry.

In Rhode Island, seniors are also seeing this alarming trend. Last year, United Healthcare discontinued its Medicare Plus Choice program, first in Newport County, then in Bristol County.  Now Blue Cross Blue Shield of Rhode Island (BCBS) informs its seniors that higher premiums and copays come next year for two of their three BlueCHiP for Medicare plans. The increases include prescription drugs, inpatient care, skilled nursing services, and more. The added out-of-pocket costs impacts about 41,000 seniors across the state.

However, Rep. Patrick Kennedy (D-RI) is not buying BlueCHiP’s request for a rate increases.

In a strongly worded letter Tom Scully, the administrator of the Centers for Medicare and Medicaid Services, the agency charged with overseeing the Medicare program, the Rhode Island congressman strongly protested the rate hikes.

He called on the federal official to investigate whether the current market for Medicare HMOs in Rhode Island has created a situation where the types of increases charged by BCBS are more likely to occur and be approved.

Furthermore, he requested a review to determine if the increases are actuarially sound.

Scott Fraser, BCBS spokesperson, acknowledges that the premium increases of the two BlueCHiP plans were the result of higher medical costs passed onto the BlueCHiP plans by hospital and other medical providers. “It’s medical inflation,” he quips, adding that even higher medication costs charged by drug companies has resulted in an increase in drug copays.

Even with next year’s increases, the BlueCHiP plans will not increase the premiums for the most commonly used services, specifically physician visits, laboratory tests and X-ray services, Fraser adds. “These co-pays have been the same for the last three years.”

CMS has reviewed BCBS’s application for the changes in rates and benefits over the summer, says Fraser, adding that the rate increase was given a thumbs up by the Feds.

Are BCBS’s rate increase actually sound thus justifiable?

CMS spokesperson Peter Ashkenaz told All About Seniors “the fact that the request has been approved by CMS speaks for itself. If the costs seem to be higher than what would be paid for in fee-service Medicare, we would have questioned them.”

Ed Zesk, president of Aging 2000, a non-profit consumer advocacy group. Believes that Rep. Kennedy has asked the right questions in his letter to CMS, specifically, “Are these premium and deductible increases justifiable?”

“Consumers just don’t have access to that type of information, Zesk said.

With Medicare reform now on the back burner as the nation gears up to fight terrorism, Rep. Kennedy must use his position on the House Appropriations Committee and Subcommittee on Labor, Health and Human Services and Education, to address the rising out-of-pocket healthcare costs for Medicare HMO enrollees. As the Congressional elections approach, seniors will want to see concrete congressional action leading to meaningful Medicare reforms.