$10,000/Month in Rehab? Why Patient Navigators are Needed

You can view all my blog posts at http://www.generationsofnewyork.com

Recently, I became aware of a case of an older man who has spent the last six months in a rehab facility following two surgeries he had.  One was colon surgery and he has ended up using an ostomy bag.  While in rehab he fell and broke a bone and has been using a walker. Neither of these episodes would seem to require six months of rehabilitation.   He had been living independently with his wife.  They have no children and his wife has been living alone for six months.  She doesn’t drive and has had to get rides to see him.

They are a very middle class couple who has saved their money and own their home.  They have had enough money to pay for the nursing rehab facility since Medicare’s coverage ended after 20 days, but they have been paying about $10,000 per month.

The rehab staff recently gave the patient three options for the future. One was that he could stay in rehab!  The second was for him to go to an assisted living facility and the third was to go home with twenty four hour care.  This gentleman wants to go home, not only for himself but to be with his wife who has been alone.  He also doesn’t want to have twenty four hour care with someone in their home all day and night.  He hopes to become independent again and would accept some nursing help at home for a while.

He really needed a navigator or advocate to help him because he wasn’t sure of his rights or how to assert them.  When the rehab center told him he could go home with twenty four hour care, which he didn’t want, he felt they were saying that was his only option to go home or else he would have to stay there or move to an assisted living facility.

Of course, he can go home with help whenever he wants as long as he is not in danger, which he wouldn’t be with his wife there.   He has been offered help from his local church and others who will now advocate for him.

Many times, we hear of patients not be provided enough discharge planning with services arranged before they are sent home from a hospital.  Here is a case of a person who is being given more care than he wants and the social work staff may have not been anticipating or acting on his wishes, thereby causing a great deal of unnecessary stress with the separation of the patient and his wife.    The fact that he was told one option was to stay in rehab and keep paying while his wife is home alone is a cause for concern and may be putting the financial interests of the facility to have a private pay resident ahead of the quality of life of this man and his wife.

Would he have stayed there if he had children or someone to advocate for him?  A patient navigator or advocate certainly would have been on top of the situation and worked to find a plan that was in the best interests of the patient – to go home as soon as he was able to function there.

Hospital Systems Contracting with Community Based Organizations in DSRIP

As the state’s Medicaid reform plan known as DSRIP picks up steam in its second year, health systems (PPS) are contracting with community based nonprofits as “partners” to help them in providing follow up coordinated care after discharge.  Many of the nonprofits are also involved in other projects that are priorities for Medicaid reform under DSRIP such as chronic disease management, asthma treatment or smoking cessations. Some community organizations have been assisting by administering patient activation surveys and patient coaching of Medicaid beneficiaries to urge them to get more involved in their own care.

The New York State Department of Health is actively urging health care systems to work closely with community based agencies that provide the kind of non-medical, social services that will be essential to successfully transitioning patients back into the community and preventing re-admissions.  The New York State Health Foundation, in analyzing DSRIP, noted “Community-based organizations (CBOs) are an untapped resource crucial to meeting DSRIP’s goals of reducing avoidable hospital use by 25% over 5 years. They are well positioned to address population health issues; have long-standing, trusted community relationships; and provide critical services to New York’s most vulnerable populations.”

Albany Medical Center which is running its DSRIP project in a five county area around the Capital District has decided to provide a base contract of about $7000 to a number of community organizations to have them as partners in their plan even though some of the organizations don’t have Medicaid clients but can assist in providing other support.  The nonprofits are involved in the various projects by sitting on committees and working on some of the projects which could include providing care coordination services.

Since DSRIP is a five year program running through early 2020, community based organizations will have opportunities to renew contracts or negotiate new, larger ones as DSRIP projects get underway.  Some organizations, for example, may be interested in developing community patient navigators, in the coming years since this one-on-one patient assistance is something many community organizations which already serve a client base may be able to successfully undertake.


Regardless of Election, Income Inequality Changes Landscape in Favor of Progressive Action

You can read all my posts at http://www.generationsofnewyork.com

No matter who wins the Presidential election and which party controls Congress, the rising focus on income inequality has changed the political dynamic in ways  that will continue to provide opportunities for change for workers, seniors, families and caregivers.  Of course, it will be more difficult if those who favor more tax breaks for the wealthy are in control, but it is quite clear that there will be major resistance to any such efforts to further the gap between the wealthy and the middle class and the poor.  If progressives are either in charge or have a strong position in Washington and state capitals the push for economic reform will be even greater.

This has already played out in New York as we saw earlier this year with the enactment of a minimum wage increase to $15.o0/hour in New York City and downstate counties and $12.50 in upstate regions.   The passage of paid family leave also was a landmark victory for families and caregivers.  Both of these proposals were considered to be going nowhere just a year or two ago.

Other issues are playing into the mix though.  Talk of increasing Social Security benefits particularly for those with lower incomes was never even mentioned before but now, it is in the platform of the Democratic Party.  Even though the Social Security system has financial problems and won’t be able to pay full benefits in 2034, that problem and an increase for lower income retirees could be paid for by lifting the earnings cap of $118,000.  Workers making above that no longer pay the tax when they reach that level each year in their salaries.

The high price of prescription drugs and increasing premiums and cost sharing in health care plans are opening the door for bigger discussions again about allowing Medicare to negotiate drug prices and also about expanding Medicare and allowing younger workers to buy-in.  That idea is also in the platform for the Democrats.  Insurance companies are dropping out of the Affordable Care Act and that is raising questions about whether universal health care would cut out a lot of administrative overhead and profits.  That issue is on the ballot in Colorado and controlling drug prices is on the ballot in California this November.

Then, there is the book I mentioned last week called Unretirement.  This book claims that Baby Boomers, rather than being a drain on the economy, will have many members who keep working because they want to and some because they have to.  Some will be entrepreneurs free to start their own businesses in retirement.  In other words, they will continue to be contributing to Social Security and Medicare and will be benefitting the economy.

When have we heard that idea presented?  Usually, all we hear is that older people and retirees are a burden, not an asset.  The ground is shifting because of our advocacy and messaging.  Baby Boomers are not going to allow themselves to be cast off as “burdens,” no longer able to participate and contribute.  No matter the election result, it is clear that our advocacy for workers, seniors, retirees and caregivers has a progressive agenda to pursue and to fight back against  those who want to marginalize people with ageism.

Mike Burgess






Schneiderman Opens Investigation into Mylan Pharmaceuticals

Last week, I wrote about how Mylan Pharmaceuticals was so short-sighted with its dramatic increase in the price of epi-pens used to prevent severe allergic reactions especially in children.  I said that the executives of Mylan and other drug companies make poor business decisions when they think they can jack up prices and increase profits, apparently unconcerned or unaware of the risks of a public relations backlash.  Mylan was overwhelmed by a major social media campaign of parents of children using the epi-pens which cost $600 for a pack of two.  By the end of last week, Mylan was saying it was going to produce a generic version for half that price.

This week comes the news that New York State Attorney General Eric Schneiderman has opened an investigation into Mylan because his staff is concerned that Mylan had anti-competitive practices in its business with health providers and consumers.  The company, of course, denies that it has had any restrictions in his contracts.   It is likely that attorney generals in other states will also begin to investigate the company’s activities in their states.  All of this is more bad news and bad public relations for Mylan.

Stockholders in these companies who have benefitted from the great profits need to be very concerned about what is going on in the pharmaceutical industry.  The kinds of exorbitant profits with little control or accountability inevitably lead to a consumer backlash which spills into the media and into the public sector and halls of power.

It is time for the drug companies to realize that they need to regulate themselves and balance their profits with the public interest.  Even if they can charge whatever they want, they need to realize that there are dangerous longer term risks like what we are seeing in these last two weeks and other cases in the past year of price gouging.



Angry Parents Use Social Media to Overpower Drug Company

you can read all posts at http://www.generationsofnewyork.com

Today, I am going to keep going after drug companies.  I have worked with their representatives and know that they make valuable products but the leadership of these companies is putting profits and high prices ahead of the public interest.  

Pharmaceutical companies enjoy the image of being one of the most powerful interest groups in America.  They spend millions on campaign contributions, lavish gifts and consulting contracts on doctors and donate strategically to key non profit, disease-related organizations that represent patients who then join them in lobbying for greater access to their drugs.  None of this is illegal but it is had the impact of building political power that has thwarted grassroots support to push for  more responsible prices or for government negotiated drug prices in Medicare for example.

However, Mylan pharmaceuticals, which produces the epi-pen which is used to stem an acute allergic reaction, often in children, was blindsided by the power of parents and social media this month about their price increases for this product.  With no competition after the FDA refused to approve a competitor, they had raised the price to $600 for a pack of two and with high deductible insurance plans becoming more common, many parents were having to pay the whole cost.  Some members of Congress with children needing the product also became more vocal. Parents took to social media with online petitions and quickly put the company on the defensive so much that it immediately said it would offer a generic alternative at half the price.  That just makes you realize they could do that while still making a good profit.

The epi-pen story is a metaphor for everything wrong with the pharmaceutical industry. It should be possible in America to earn a good profit while also serving the public.  These companies have forgotten that.  They have been given almost free rein to charge whatever they want, whatever the market will bear, to literally price gouge the public with their greed.  Then, they use the excess profits to shower money on Congress, doctors and interest groups.  Drug companies like to make arguments for high prices, saying they need extra money for research and development costs, but basically they now just keep raising prices and try to force insurers and government programs to pay.  They claim that the patients won’t get hurt since they only have co-pays.   They offer patient assistance programs to cover those who can’t afford their products.

The parents who started the rebellion have shown us how to take on these companies.  Despite all their sophisticated political planning most drug company executives are tone deaf to understand how the public resents their greed.    Bad public relations is not good business.  Bad public relations spilling over into the political arena is not just a political problem.  Drug companies are continually having to reverse course when they realize their bad public relations is hurting their confidence with investors and driving down their stock prices.  They are their own worst enemies.

Using social media and people and consumer power is what we all need to keep doing to counterbalance the enormous power of the drug companies.  It is a grassroots remedy to counter their unwillingness to balance their profits and the public service their products provide.  The other is to question and vote against those candidates for office who refuse to hold these companies accountable.



“Unretirement” Comes into Focus in New Book

I am on vacation on Cape Cod this week so I am not keeping a regular schedule of blog writing.  Two years ago when I was in the Three Cousins bookstore here in Falmouth, Massachusetts I picked up The Boys in the Boat, the bestseller about the USA rowing team that won the 1936 Olympics in Berlin.  That book inspired me to write my own book, Keeper of the Olympic Flame, which I just published about Lake Placid Olympian Jack Shea who boycotted the 1936 Olympics because of the German discrimination against the Jewish population.

This week, I ran across another book in the bookstore I am buying called Unretirement by Chris Farrell.   It’s about how the Baby Boom generation is seeking to redefine retirement as many are looking for meaningful jobs to continue working on their terms.  Some even will be entrepreneurs starting new businesses they always wanted to.  Farrell basically talks about how the Baby Boom generation is not going to be what some once thought, so large it would drain the national treasury.  Rather, many will keep contributing by working and volunteering.

I am looking forward to reading the entire book and will be talking more about this in the next few weeks.  I have actually been in discussions which community groups are having about a workshop in the Albany area about Meaningful Retirement and discussing the options for continued work and voluntarism along with a good life balance with leisure, social and spiritual activities.  There will be more details on that to come as we hope to plan it for November.

Mike Burgess

Governor’s Office Engaging Advocates on Paid Family Leave Act Implementation

The Paid Family Leave Coalition is continuing to work on the implementation of the new law passed in this year’s budget which takes effect on January 1, 2018.  The coalition has had discussions with the Governor’s staff about issues related to the rollout of the program.  Some of these issues include outreach and notification of the public and working with employers to publicize it.  These discussions will include the language about the program that should be used by employers in any written employee benefit materials.  Also, there will need to be information materials explaining the differences between the TDI (Temporary Disability Insurance) program, the federal non-paid Family and Medical Leave Act and how the new program interacts with paid sick days and vacation time.

A number of state agencies including the Department of Health, the Department of Labor, the Department of Financial Services, the Workers’ Compensation Board and others are working on regulations for the program.  The regulations are expected to be issued this fall, perhaps as early as September, and will include a public comment period.  The agencies are also reviewing the best practices in the handful of states which have been operating paid family leave programs for several years.

The Governor’s office seems eager to publicize the program this fall with key groups which might be benefit.  In addition to labor unions, and child care groups, it is important for the aging and caregiver networks to be involved as outreach plans are developed.  Local offices for the aging should be involved in the outreach and publicity since all are responsible for family caregiver programs which they either run themselves or subcontract to other local nonprofits.  Hospitals and health providers need to be involved especially  with education that can be provided by discharge planners and hospital social workers.

The Paid Family Leave Coalition will look to take part in information sessions for aging and caregiver advocates, perhaps at existing fall meetings of these groups.    If your organization wants to take part, please contact me at mjburgess1002@gmail.com since I am still serving on the steering committee for the coalition.

-Mike Burgess