$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.