Commentary by Michael Burgess
The Affordable Care Act has introduced not only an expansion of insurance coverage to the uninsured but has launched a transformation of the entire health care system with incentives to improve outcomes and the quality of care. Reform is literally changing the culture of doing business by hospitals, doctors and health care providers. Payment reform is being linked to better outcomes such as reducing hospital re-admissions.
Patient satisfaction is now one of the key measures that reflects outcomes. Hospitals have begun hiring “patient satisfaction officers” to undertake major initiatives to improve communications with patients and to solicit feedback. In addition to the hospital experience, transformation includes better care coordination and post hospital care to prevent unnecessary re-admissions.
A key to the success of all these efforts must be the involvement patients, their families and caregivers. Hospitals and doctors are fairly new to this “customer service” approach. And, even with the transformation underway, efforts involving patient satisfaction and communication are not as robust as those efforts actually involvement direct medical care. Indeed it is overwhelmingly clear that the knowledge and awareness of patients, families and caregivers have not kept up with the dramatic transformations going on in health care. Patients may have heard of the changes and received communications from providers but, by and large, “health care literacy” among patients remains low. They do not understand, the nature of the changes and what the impact will be on them as patients and what role their families and caregivers will need to assume in care coordination. Without this communication and understanding, health care providers run the risk of patients and families cynically thinking that all changes are tied to costs and savings rather than better coordination and outcomes.
It has been clearly shown though that more substantive change and success comes from maintaining very close and continued dialogue with patients. Health providers including doctors, hospitals and home health providers need to do more than just communicate instructions, they need to open a dialogue with patients, particularly older persons and those with limited English to understand what potential problems there are to a successful outcome. Indeed, greater communication is key to success and health providers need to work with community based groups representing patients and families to increase their health care literacy.
Here’s a great article in the April 24 Albany Times Union on patient experience and satisfaction from Dr. Michael Brannigan of the College of St. Rose in Albany
Social Security advocates have stopped playing defense. Now, they are going on offense and saying that just as the minimum wage should be hiked so should Social Security. In fact 43 Senate Democrats went on record in mid-April to support increasing Social Security. As the advocacy organization Social Security Works states, “Social Security expansion has gone from what many considered to be a fringe issue to being a core Democratic value along with raising the minimum wage and equal pay for equal work (both of which would strengthen Social Security in addition to being good ideas on their own).”
The divide between the parties is growing because a number of leading Republican candidates for President, especially New Jersey Governor Chris Christie are highlighting their advocacy of Social Security changes. He advocated raising the retirement age to 69 and also to means testing the program. Some Democrats continue to advocate raising the cap on earnings. Currently the Social Security payroll tax is only levied on the first $118,500 of annual income meaning those with incomes above it get a tax cut in their paychecks when their annual incomes exceed that amount. Democrats want to finance greater benefits for lower income beneficiaries with the added tax revenues generated by raising the cap.
President Obama had proposed the “chained CPI” which would have used a different measurement of inflation and would have lowered the annual increase. He is no longer pushing this position. Retirement security is one of four major issues to be addressed by the 2015 White House Conference on Aging this summer.
The State Senate returned to Albany on Tuesday and passed the CARE ACT which requires hospitals to include a designated caregiver identified by a patient when they go to the hospital and for the caregiver to be given training and support for post hospital care.
The bill now goes to the Assembly where it is sponsored by Assemblywoman Linda Rosenthal. Passage looks good there and the concept of the bill had the support of Governor Cuomo who included a Caregiver Support Initiative in his opportunity agenda released at the start of the legislative session.
According to AARP, “The Caregiver Advise, Record and Enable Act ensures hospital patients can designate a family caregiver and requires hospitals to offer that caregiver instruction and demonstrations of medical tasks they are being expected to provide for their loved ones at home, such as administering multiple medications, dressing wounds and operating medical equipment.”
AARP is making the bill its top legislative priority and launched a major statewide campaign that has included research, community forums, district lobbying and efforts at the State Capitol. The issue has become more important as more and more older persons and other patients are being quickly discharged from the hospital after operations that previously would have kept them for several days. Family caregivers in addition to home health aides are increasingly being expected to assist in providing care at home. Care coordination is also becoming a major priority of health care transformation as Medicare and Medicaid are seeking to reduce hospital re-admissions.
To read more, the news release is linked here.
The State Legislature is returning to Albany today with nine weeks scheduled before adjournment on June 19th. How much is accomplished in the coming weeks is very uncertain even though a number of key issues that Governor Cuomo included in his budget proposal such as the Dream Act, campaign financing reform and education tax cuts were separated from the budget for later action. Also, the cloud of possible further scandals hangs over the Capitol with the New York Times reporting last week that Senate Majority Leader Dean Skelos and his son are being investigated by prosecutor Preet Bharrara for assisting businesses with interests before the state. The Times also ran a major story today about some private financial dealings of new Assembly Speaker Carl Heastie.
There are a number of bills of interest to senior and health advocates that may be acted on in the next two months. These include;
A3870/S3004 Assemblywoman Nolan and Senator Addabo are sponsors of the bill Paid Family Leave. This bill passed the Assembly in March and the Senate Independent Caucus also supports it but had a different proposal in the budget that was not enacted. The Senate Labor Committee led by Senator Jack Martins held a hearing on the issue on March 21st.
A1323-a/S676 Assemblywoman Rosenthal and Senator Hannon are sponsors of the CARE ACT pushed by AARP which requires hospitals to allow patients to designate and train a caregiver if post hospital assistance is required of them
A4036/S2809 Assemblyman Quart and Senator Lanza are sponsors of this bill which enables pharmacies to synchronize prescriptions for the same day of the month for patients
Other legislation to protect consumers access to prescription drugs such as restricting “step therapy” are part of the focus of an Rx lobby day next week. Another bill of interest who strengthen efforts against financial abuse of the elderly requiring reporting of suspicious activity. Details on these and other bills will be reported soon.
The number of Americans who lived to age 100 has increased to over 61,985 according to the latest statistics from the Administration on Community Living of the Department of Health and Human Services. This figure represented an increase of 93% from the 32,194 centenarians in 1980.
Here is the link to the profile on the older population from the Administration.
Current advances in health care and possible major increases in longevity resulting from cutting age research on genes are the subject of a new book, 100 Plus: How the Coming Age of Longevity will Change Everything, from Careers and Relationships to Family and Faith. The book is authored by Sonia Arrison, a senior fellow at the Pacific Research Institute.
Paying privately for a nursing home can cost over $10,000 per month in New York State and most people cannot continue to do that before going on Medicaid. However, for those who do pay privately even for a short period of time, they are eligible to get a tax credit for the 6.8% nursing home surcharge that New York State imposes. Most people are not aware of this but it can add up to close to $8000 per year. State officials say this tax generates about $580 million. There is a New York State tax form IT-258 to submit to get back 6.0% of the tax. Even if the tax form is submitted the state is sending letters questioning the refund.
Another area of concern that can costs potentially thousands of dollars has occurred with prescription drugs. Most nursing homes use an outside pharmacy to handle both prescription drugs and over the counter drugs. One family reported getting hundreds of dollars in extra charges for drugs on top of the $11,000 nursing home bill every month. The drug costs were being charged even though the resident had coverage through Medicare Part D and the New York State EPIC program. While some of the costs for over the counter drugs were not covered by those programs, the nursing home’s pharmacy had never billed Medicare and EPIC for several months and just charged the patient. The pharmacy ended up having to issue hundreds of dollars in credits to the resident’s account, but that was only after the family questioned why they were being billed for the drugs and complained.
Here is a link to a Rochester’s WHEC TV story on the tax issue from April 16
This blog is being created as a community forum to provide current information on public issues regarding health care, seniors, families and caregivers in New York State. We will be providing news as well as commentary on federal and New York State legislation along with community services issues. We also will highlight remarkable civic engagement activities of older persons in New York State. Please feel free to sign up for the website and get alerted when new posts are added.
The Paid Family Leave Coalition is planning a May 6th lobby in Room 711 of the Legislative Office Building in Albany to continue the momentum for the legislation (A3870/S3004 Nolan/Addabbo) that occurred during budget negotiations. The Assembly has passed the bill again this year while the Senate including funding for a different version in its budget resolution.
The Senate funding came at the request of Independent Democrat Caucus which pushed for it. Now, there is a move to try to get a Senate Republican to sponsor the Assembly bill which passed that house. Senator Jack Martins who chairs the Labor Committee held a hearing on the issue on March 17. The Assembly bill uses New York’s Temporary Disability Insurance program to fund the program which would provide up to 2/3 of a worker’s salary for up to twelve weeks.
The final state budget bill added $500,000 in new money for the Long Term Care Ombud Program (LTCOP) This money was added after a number of local program operators had pulled out of the program because of the limited funding available. The State Office for the Aging is in the process of releasing a request for proposals based upon a regional model that will ask bidders to cover several counties. Language in the budget required that local area agencies on aging have an opportunity to continue to run the program after some said a regional model would create problems for the county governments they work for which usually allow them only to operate programs in their own counties.