“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

NOTICE ACT Goes into Effect Regarding Medicare “Observation Status”

 

A new federal law HR 876 called the NOTICE Act went into effect on Saturday, August 6th, requiring all hospitals to give patients a notice within twenty four hours whether they have been admitted to the hospital or are in “observation status.”  This has been a years-long controversy as the number of observation status cases has skyrocketed because of financial penalties for unnecessary re-admissions as well as auditing fears that Medicare would retroactively deny payment for initial admissions.

A patient who has not been admitted for three nights in the hospital would have to pay out of pocket for any rehab in a skilled nursing facility for example.  If the patient is given notice, he or she can seek a change to admission status if they will be in the hospital for at least three nights.   If a patient is not admitted to a hospital, then Medicare Part B outpatient coverage is provided for insurance.  Part A of Medicare covers inpatient services.  A similar law has already been in effect in New York State.

Here are seven things to know about the NOTICE Act.

1. The legislation calls for hospitals to provide written notice to patients who are in the hospital under observation status for more than 24 hours. Hospitals would need to provide notification no later than 36 hours after the time observation status begins.

2. The written notice must include why the patient was not admitted to the hospital and the financial implications of observation status, including subsequent eligibility for coverage for a skilled nursing facility.

3. Medicare does not cover skilled nursing facility stays unless the patient was admitted as an inpatient for a minimum of three nights. In some cases, physicians reclassify people as inpatients when more than observation is needed. Medicare patients who are not reclassified have to either forgo SNF care or pay for it themselves, regardless of the length of their hospitalization.

4. Medicare Part A pays for inpatient stays. If you are hospitalized on observation status, payment by Medicare is under Part B, which covers physician and outpatient services. Patients without Part B coverage are often left with the bill for observation status, even though there was not a perceptible difference in the type or level of care they received in the hospital.

5. A number of states, including Connecticut, Maryland, New York, Pennsylvania and Virginia, already require hospitals to give patients notice about observation care.

6. There were an estimated 1.5 million observation stays among Medicare beneficiaries in 2012. The number of observation stays increased 100 percent from 2001 to 2009, likely because of financial pressure on hospitals to reduce potentially preventable readmissions of inpatients within 30 days.

7. Under the NOTICE Act, hospitals would be required to notify patients about observation status, but patients can only change that status by swaying a physician or the hospital to do so. Yale-New Haven (Conn.) Hospital CEO Marna Borgstrom noticed that after learning they were under observation care, many patients left the hospital against medical advice

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A group of 40 consumer advocates held a press event outside the State Capitol last week urging Governor Cuomo to sign a bill that would create an appeals process for doctors who  believe that “step therapy” hurts their patient’s treatment.    Step therapy refers to the practice of health insurers who require patients to “fail first” on cheaper medications  or medications preferred by insurance plans before being able to use a drug that has been effective for them.   Governor Cuomo has not indicated a position on this bill though his Division of the Budget has supported these types of cost restraints.

The bill passed is S.3419C/A.2834D and was sponsored by Senator Catherine Young and Assemblyman Matthew Titone.  The bill has not been delivered to the Governor yet for his action so the ten day period for him to make a decision has not begun.

Surprise! Some New Medicare Beneficiaries Enrolled in Private Managed Care Plans Without Their Knowledge

Kaiser Health News reported this week that Medicare has given some Medicare Advantage plans permission to automatically enroll their health plan members into their Medicare managed care plan when they turn 65 – and that many beneficiaries are not aware this change has happened.  This “seamless conversion” allows companies to keep members of their plans they might have had with their employers or if they were in the company’s Medicaid plan.  The companies are required by Medicare to send a notice 60 days before the person joins Medicare.  However, some beneficiaries didn’t read or understand the letter or in some cases ignored it, thinking they were going to be enrolled in traditional fee for service Medicare when they turned 65.

This conversion can have serious consequences as one beneficiary learned because the Medicare Advantage plan had different terms and participating providers than her previous plan.  Kaiser reported her situation:

Only days after Judy Hanttula came home from the hospital after surgery last November, her doctor’s office called with bad news: Records showed that instead of traditional Medicare, she had a private Medicare Advantage plan, and her doctor and hospital were not in its network.Neither the plan nor Medicare now would cover her medical costs. She owed $16,622.

“I was panicking,” said Hanttula, who lived in Carlsbad, N.M., at the time. After more than five hours making phone calls, she learned that because she’d had individual coverage through Blue Cross Blue Shield when she became eligible for Medicare, the company automatically signed her up for its own Medicare Advantage plan after notifying her in a letter. Hanttula said she ignored all mail from insurers because she had chosen traditional Medicare.

This report is causing alarm bells with many beneficiaries and advocates who were unaware Medicare allows this and many other Medicare Advantage private companies are seeking permission for this “seamless conversion.”    Congresswoman Jan Schakowsky, an Illinois Democrat, is already considering legislation that would require beneficiaries to opt-in to this conversion rather than have to opt-out.

The Medicare Advantage plans have been arguing that this conversion allows persons to stay with their same company as they turn 65.  What they are not saying though is that the Medicare plan they offer is different than the plan the beneficiarey previously had and it can cost beneficiaries thousands if the providers they used are not part of the Medicare Advantage plan.

 

Health Advocates Attack Long Term Care Plans for Cutting Care to Patients

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

The New York Times reported last week (July 20 story by Nina Bernstein) that some managed long term care insurance plans (MLTCs) operating for Medicaid patients arbitrarily reduced the number of hours of care to some of the most vulnerable and high cost aged and disabled patients.  Most of the complaints centered on a few plans.  56% of the complaints were about Senior Health Partners of Health First in the New York City area.    In fair hearings over 80% of these cuts were reversed.

Health advocates in the Medicaid Matters NY coalition of over 100 nonprofit organizations issued a report saying the reversal of these cuts indicates that some of these MLTC plans were arbitrarily reducing home care hours for clients.  The Times story profiled a woman whose weekly hours were cut from 50 to 25.   The plans have argued that managed long term care was designed to reduce expenditures on high cost users.  However, the plans are also supposed to be “managing” the client’s care and maintaining quality not just cutting hours and costs.  Many persons like the woman profiled are left struggling to find a way to manage without the help they have had.   A lawsuit is also being filed by elder law attorneys on behalf of some clients against their managed care companies.

The state has moved in recent years to require most Medicaid beneficiaries needing long term care to enroll in managed care plans or be automatically placed in one.  Advocates have expressed concerns from the beginning that this new policy was untested and that there are dangers that could result in many clients losing care in order to lower costs. The financial incentives in the program favor cost cutting:  plans are generally paid a set rate  and they can save what isn’t spent.  The state has argued that care would be better managed and beneficiaries would get more comprehensive care.  That may be true if plans do it right but it is costly to provide all the care needed and some companies that tried to provide extensive services like Senior Whole Health went out of business in some upstate areas.

The state says that 87% of those in managed long term care expressed satisfaction in surveys they have done.  That number may not show those who haven’t responded or are too ill to respond.  And, even 13% of people being dissatisfied is not acceptable if their health care has declined or been threatened with cuts.

This is an unacceptable situation that was predictable when you put the most vulnerable with the highest costs under a system that financially  rewards plans  for less care and allows for arbitrary and capricious cost cuts.  The state likes to pride itself on changing health services to an “evidence based” model that requires state money spent to prove that it has been effective in meeting its stated goals.  Perhaps there are some efficiencies that can be achieved with managed long term care but where is the care coordination and “evidence based” component of these decisions that proves that all of these plans are maintaining or improving the quality of care?

102 Year Old Woman Delegate at Democratic Convention

102 year old Jerry Emmett helped announced the vote of the Arizona delegation in the roll call vote at the Democratic convention Tuesday.  Emmett was born in 1914, six years before women even had the right to vote.  She told the media that she remembers her mother casting her first vote after women got the vote.  She was born two years after Arizona became a state and she knew the first Governor.

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These centenarians are amazing.  I want to mention that I have been speaking with 103 year old Gene Shea on the phone from Florida for an article and book I have been writing. He told me about growing up with his brother, Jack, who won two gold medals at the 1932 Winter Olympics in Lake Placid.  They both went to Dartmouth and Gene helped Jack with his training.

I just finished writing Jack’s story, how he refused to skate in the 1936 Winter Olympics in Nazi Germany.  He said he couldn’t go there because of the way the Jewish population was being treated by the Nazis.  The Shea family owned a market there and had many Jewish customers who asked him not to go to Germany.  He challenged the American Olympic Committee and its leader, Avery Brundage, who rejected the movement to boycott those Olympics in Germany.  Brundage said that politics and sports shouldn’t mix, Jack Shea, who loved the Olympics, said that the discrimination against Jews was more important than than skating in the Olympics to him.

My book about Jack, Keeper of the Olympic Flame, is now published and up on amazon.com and in local bookstores in Albany, Saratoga and Lake Placid.  Here’s the link on amazon

https://www.amazon.com/Keeper-Olympic-Flame-Brundage-Olympics/dp/1533313512/ref=sr_1_1?ie=UTF8&qid=1469673829&sr=8-1&keywords=keeper+of+the+olympic

New York State Joins Justice Department Health Insurance Mega-Mergers Lawsuit

The United States Department of Justice has moved to stop the two big mergers of private health care insurance giants.  Aetna has proposed to buy Humana and Anthem wants to buy Cigna.  On Thursday, the Justice Department filed a lawsuit to stop the mergers saying they would reduce competition and cause higher price in Medicare Advantage plans as well as for the Affordable Care Act and private employers.   New York State and ten other states and DC joined the lawsuit  Doctor and hospital organizations are also supporting the lawsuit.

The Department has studied the markets served by Aetna and Humana and said that 1.6 million people in 364 counties who are customers of Medicare Advantage would be negatively impacted through reduced competition.   Medicare Advantage has consistently been promoted as offering “choice” for older and disabled persons, yet the merger will reduce choices.  The companies dispute that and say they would be more efficient.

New York Attorney General Eric Schneiderman announced the state’s participation in the lawsuit saying,  “Affordable, quality health care is essential to the well-being of all Americans.  Most consumers are covered by insurance plans that their employers choose and negotiate with companies like Anthem and Cigna. By reducing competition, this proposed merger has the potential to significantly increase the merged firm’s power in the marketplace, to the detriment of consumers. Employers will be left with fewer choices, and ultimately consumers could be saddled with higher premium costs, reduced access to providers, and lower quality care.”

Consolidation across the health care field is happening right now as local hospitals are being bought or aligned by larger, regional facilities and doctor groups are being bought by hospitals or expanding themselves. The Justice Department has become more aggressive in the antitrust field, particularly in health care.  It has moved to stop some hospital systems from mergers and helped derail the planned merger of Pfizer and Allergan, a plan that would have allowed Pfizer to call Ireland its headquarters and avoid  some taxes in this country.