Health Overhaul Could Double Community Health Centers' Caseload - Kaiser Health News

By Michelle Andrews

Community health centers serve 20 million people every year, and that number is expected to double by 2015, thanks to an $11 billion infusion from the health-care overhaul and $2 billion in federal stimulus funds.

If you're a middle-income worker with health insurance through your job, chances are these centers have been under your radar, since their target clients are low-income and uninsured people. But as the number of uninsured has risen to 50 million, more people than ever are struggling to get and pay for health care, and community health centers are an affordable option. As they expand, they're adding new services and new locations nationwide.

Although their mission is to provide a primary-care safety net for people in underserved areas, no one is ever turned away from a community health center. People with incomes up to 200 percent of the federal poverty level ($44,700 for a family of four in 2011) pay on a sliding scale; uninsured people with higher incomes pay the full cost of care, which is generally comparable to costs in the private sector. The centers accept Medicaid and Medicare in addition to many private insurance plans.

The new health care law is full of incentives to encourage doctors to provide "medical homes" for their patients, with coordinated care and close patient monitoring to stay on top of necessary preventive services. But community health centers have always taken this approach, say experts.

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The Partnership for Patients and the Aging Network

Message from the Assistant Secretary for Aging Kathy Greenlee

Today, Health and Human Services Secretary Kathleen Sebelius announced the Partnership for Patients, a new national public-private partnership with the goals of:

* Keeping patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010.  Achieving this goal would mean approximately 1.8 million fewer injuries to patients, with more than 60,000 lives saved over the next three years. 

* Helping patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010. Achieving this goal would mean more than 1.6 million patients will recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge. 

Through the Community-based Care Transition Program, HHS has committed $500 million to community-based organizations partnering with eligible hospitals to help people with Medicare safely transition between settings of care.  Today, community-based organizations and acute care hospitals that partner with community-based organizations can begin submitting applications for this funding.  Applications are being accepted on a rolling basis.  Awards will be made on an ongoing basis as funding permits. In addition, in coordination with stakeholders from across the health care system, the CMS Innovation Center is planning to use up to $500 million in additional funding to test different models of improving patient care and patient engagement and collaboration in order to reduce hospital-acquired conditions and improve care transitions nationwide. 

The aging network – state and local organizations alike -- has a vital role to play in this effort to integrate medical and long-term supports and services and improve care transitions for our clients and their families.  This work also provide an excellent opportunity to integrate other important work you are already doing – including Aging and Disability Resource Centers, benefits outreach and enrollment, caregiving and respite programs, chronic disease self-management and other health promotion/disease prevention programs, and more.  Finally, the partnerships that you build through care transitions work – with hospitals, physician practices, long-term care facilities and other organizations – can also help to position you better for future ACA-related opportunities such as accountable care organizations, health homes, patient-centered medical homes, and more.

Here is how we can work together on this initiative:

* Learn more about the Partnership for Patients and join the partnership by visiting the Partnership website at http://www.healthcare.gov/center/programs/partnership 

* Read our special Affordable Care Act Newsletter which provides you with additional details about the Partnership for Patients and the Community-based Care Transition Program (CCTP).  To access the newsletter, please go to  http://www.aoa.gov/Aging_Statistics/docs/ACA_Enews_P4P_041211.pdf 

* Join us for our next Webinar on Wednesday, April 20, which will offer an overview of the CCTP solicitation, and the opportunities for the aging network that lie within.  (Watch your email for registration details)    

Leadership Council of Aging Organizations Consensus Statement on Older Americans Act Reauthorization

Introduction by LCOA on its consensus recommendations:

The Older Americans Act (OAA) is the major federal discretionary funding source for home and community-based services for older adults. Programs supported through the OAA include home-delivered and congregate nutrition services, in-home supportive services, transportation, caregiver support, community service employment, the long-term care ombudsman program, services to prevent the abuse, neglect, and exploitation of older persons, and other supportive services. These programs provide vital support for those older adults who are at significant risk of losing their ability to remain in their own homes and communities, or who need support and protection in long-term care facilities.

In addition, OAA funds resource centers that support the work of the aging services network, these resource centers address a variety of needs, including access to benefits, elder justice, multigenerational service and volunteering, legal services, financial literacy, long-term care ombudsman training, and targeted services to minority and special populations in need.

To develop and implement the wide array of OAA services, a system of federal, state and local agencies and organizations, known as the Aging Network, was established. The core of the Aging Network is the U.S. Administration on Aging (AoA), 56 State and Territorial Agencies on Aging (SUAs), 629 Area Agencies on Aging (AAAs), 246 Title VI Native American and Native Hawaiian aging programs, and more than 30,000 community-based service provider organizations. This critical aging infrastructure is the backbone of our nation’s home and community-based long-term services and supports system offering assistance to older adults. The Aging Network’s activities also benefit other populations such as people with disabilities and caregivers.

Supported by the OAA, the Aging Network has successfully served millions of older adults in the community and in long-term care facilities since 1965, and is positioned to assist the country’s growing aging population to remain healthy, active, and in their communities. With each reauthorization, the OAA has been adapted to meet the changing needs of this growing population, the changing role of family supports, and expanding research and technological advances, often with inadequate funding. Further, the Aging Network and its services have the potential to save the Medicare, Medicaid, and Veterans Administration programs billions of dollars each year by enabling older adults to stay in their homes and communities and out of hospitals and long-term care facilities.

This current reauthorization provides an opportunity to reassess the successes and shortcomings of the OAA’s ability to serve older Americans, particularly those with the greatest social and economic need. In these times of fiscal restraint, the Leadership Council of Aging Organizations (LCAO) offers in this document recommendations for improving the efficiency and effectiveness of the OAA in its delivery of core services and how it interacts and coordinates with other federal programs that serve older adults.

In order to maximize effectiveness, community-based services provided through the Aging Network must be coordinated and integrated with the various federal health care services that older adults receive. In addition, they must work hand in glove with other programs at the state and federal levels such as the Low-Income Energy Assistance Program (LIHEAP), fraud prevention programs, Senior Corps and other programs promoting community service, transportation programs, the State Health Insurance Assistance Program (SHIP), the Adult Protective Services Program and other elder abuse-related programs.

The goal of the following LCAO recommendations is to authorize the AoA, the Assistant Secretary, and the programs and staff across the nation to fulfill their promise by giving them the tools, direction and flexibility to provide the services that the aging population of our nation demands. Our focus is on person and family-centered care with local flexibility to serve the needs of unique communities and sub-populations. LCAO’s recommended improvements do not require major changes to the OAA’s core services or eligibility requirements. LCAO strongly believes that increasing the authorized funding for all titles of the OAA is necessary; however, provision of adequate funding is just one of the ways that we propose to improve and expand services. Additionally, any new programs added to OAA should be given specific authorization levels.

With the population of older individuals expected to grow exponentially in the coming years, the aging network faces incredible challenges associated with the influx of older individuals into OAA programs. The LCAO, which has played a significant leadership role in past reauthorizations, is committed to a reauthorization that will strengthen the OAA for both the older adults currently receiving services and for the boomers who, in 2011, have begun turning 65 years of age.

We urge Congress to update and improve the Older Americans Act, while providing the funding needed for OAA programs to keep older Americans independent and productive, thereby saving federal and state government resources. Therefore, the LCAO makes the following recommendations to strengthen and enhance the OAA.

Full Document

The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding - Institute of Medicine

 

Released: March 31, 2011

Type:  Consensus Report

 

Topics: Select Populations and Health Disparities, Biomedical and Health Research Health Services, Coverage, and Access

Activity:  Lesbian, Gay, Bisexual and Transgender Health Issues and Research Gaps and Opportunities

 

Board:  Board on the Health of Select Populations

 

At a time when lesbian, gay, bisexual, and transgender individuals—often referred to under the umbrella acronym LGBT—are becoming more visible in society and more socially acknowledged, clinicians and researchers are faced with incomplete information about their health status. While LGBT populations often are combined as a single entity for research and advocacy purposes, each is a distinct population group with its own specific health needs.

Furthermore, the experiences of LGBT individuals are not uniform and are shaped by factors of race, ethnicity, socioeconomic status, geographical location, and age, any of which can have an effect on health-related concerns and needs. Researchers still have a great deal to learn and face a number of challenges in understanding the health needs of LGBT populations.

To help assess the state of the science, the National Institutes of Health (NIH) asked the IOM to evaluate current knowledge of the health status of lesbian, gay, bisexual, and transgender populations; to identify research gaps and opportunities; and to outline a research agenda to help NIH focus its research in this area.

The IOM finds that to advance understanding of the health needs of all LGBT individuals, researchers need more data about the demographics of these populations, improved methods for collecting and analyzing data, and an increased participation of sexual and gender minorities in research. Building a more solid evidence base for LGBT health concerns will not only benefit LGBT individuals, but also add to the repository of health information we have that pertains to all people.

The focus of Chapter 6 is Later Adulthood.

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Complete Report can read online or purchased.

DOD AND VA HEALTH CARE Federal Recovery Coordination Program Continues to Expand but Faces Significant Challenges

Why GAO Did This Study

In 2007, following reports of poor case management for outpatients at Walter Reed Army Medical Center, the Departments of Defense (DOD) and Veterans Affairs (VA) jointly developed the Federal Recovery Coordination Program (FRCP) to coordinate the clinical and nonclinical services needed by severely wounded, ill, and injured servicemembers and veterans. The FRCP, which continues to expand, is administered by VA, and the care coordinators, called Federal Recovery Coordinators (FRC), are VA employees. This report examines

(1) whether servicemembers and veterans who need FRCP services are being identified and enrolled in the program,

(2) staffing challenges confronting the FRCP, and

(3) challenges facing the FRCP in its efforts to coordinate care for enrollees.

GAO reviewed FRCP policies and procedures and conducted over 170 interviews of FRCP officials, FRCs, headquarters officials and staff of DOD and VA case management programs, and staff at medical facilities where FRCs are located.

What GAO Recommends

GAO recommends that VA direct the FRCP Executive Director to establish systematic oversight of enrollment decisions, complete development of a workload assessment tool, document staffing decisions, and develop and document a rationale for FRC placement. GAO received comments from DOD and VA; VA concurred with GAO’s recommendations.

Full Report

The Impact of Trauma on Wellness: Implications for Comprehensive Systems Change

The Impact of Trauma on Wellness: Implications for Comprehensive Systems Change March 30, 2011  |  3 to 4:30 p.m. Eastern Time SAMHSA invites you to a free training teleconference titled, "The Impact of Trauma on Wellness: Implications for Comprehensive Systems Change." According to the Centers for Disease Control and Prevention, almost 60 percent of American adults say they endured abuse and other difficult family situations as children, otherwise known as adverse childhood experiences. Those experiences can have long-term health consequences and can create financial burdens on society due to the need for hospitalization, mental health care, child welfare services and/or law enforcement. This teleconference will educate diverse stakeholders about comprehensive systems change, including preventing both harm and inadvertent retraumatization and ensuring that services and supports are welcoming, engaging, and culturally attuned. The goal is to help facilitate the healing process among people who have experienced trauma so that they can become fully engaged in their communities. Presenters: Cathy Cave, Senior Program Associate, Advocates for Human Potential Roger Fallot, Ph.D., Director of Research and Evaluation, Community Connections Ann Jennings, Ph.D., Founder and Executive Director, The Anna Institute Register Now Registration will close at 5 p.m. Eastern Time on Sunday, March 27, 2011.

ACA Webinar on Care Transitions in Action: From Hospital to Home in Two Communities

On Wednesday, March 30, the Administration on Aging (AoA) will continue its series of webinars focused on the Patient Protection and Affordable Care Act of 2010 (also known as the Affordable Care Act, or ACA) and its impact on the aging network, taking a closer look at two communities actively engaged in care transitions work. 

Title:  Care Transitions in Action: From Hospital to Home in Two Communities

Date:  Wednesday, March 30, 2:00-3:30 p.m. Eastern

Description:
This next session in our ACA webinar series will explore care transitions partnerships between hospitals and area agencies on aging in two communities in more depth.  How did their partnerships develop?  What have their successes and challenges been? And finally, what do their results look like?

Speakers:
Kyle Allen, D.O., AGSF, Summa Health System, Akron, OH

Robyn Golden, LCSW, Rush University Medical Center, Chicago, IL

Robert Mapes, AgeOptions, Oak Park, IL

Joseph Ruby, Area Agency on Aging 10B, Inc., Uniontown, OH
   
Moderator:     Marisa Scala-Foley, Administration on Aging


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To register for the online event
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1. Go to https://aoa-events.webex.com/aoa-events/onstage/g.php?d=663084836&t=a
2. Click "Register".
3. On the registration form, enter your information and then click "Submit".

Once your registration is approved, you will receive a confirmation email message with instructions on how to join the event.

Please note: Space is limited, so please register as early as possible.  This webinar will also be recorded and posted on the AoA web site (www.AoA.gov) soon after the webinar.   

Increased Price Transparency in Health Care — Challenges and Potential Effects | Health Policy and Reform

by Anna D. Sinaiko, Ph.D., and Meredith B. Rosenthal, Ph.D

Slowing the growth of health care costs is critical to the long-term fiscal stability of the United States and is the direct or indirect focus of most U.S. health policy initiatives today. One tactic for reducing spending is to increase price transparency in health care — to publish the prices that providers charge or those that a patient would pay for medical care — with the aim of lowering prices overall. More than 30 states are considering or pursuing legislation to increase price transparency (see table). Most initiatives focus on publishing average or median within-hospital prices for individual services, though information on total and out-of-pocket costs for episodes of care across different sites are available in some markets (e.g., New Hampshire). At the federal level, three bills designed to increase transparency were introduced in Congress in 2010 and attracted some early bipartisan support. In addition, several commercial health insurance plans release information to their members about the prices charged by hospitals and physicians for common services and procedures.

At one level, it’s the wide variation in medical prices within U.S. markets that creates an opportunity for transparency to reduce spending. This variation exists even for relatively common procedures. In New Hampshire in 2008, the average payment for arthroscopic knee surgery was $2,406 with a standard deviation of $1,203 in hospital settings and $2,120 with a standard deviation of $1,358 in nonhospital settings.¹ In Massachusetts, the median hospital cost in 2006 and 2007 for magnetic resonance imaging (MRI) of the lumbar spine, performed without contrast material, ranged from $450 to $1,675.²

Since consumers are generally ignorant of such price differences, publishing price information could both narrow the range and lower the level of prices, in part by permitting consumers to engage in more cost-conscious shopping and select lower-cost providers and in part by stimulating price competition on the supply side, forcing high-priced providers to lower their prices (or accept smaller annual increases) in order to remain competitive. Proponents argue that consumers have price information and compare costs when purchasing just about any other good (imagine buying a car, a house, or a computer without knowing its price) and that health care should be no different.

Health care does differ from other consumer goods in a few important ways, however, that are likely to affect patients’ responses to price information.
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Health Business Blog » Blog Archive » HealthEdge COO Desrochers on ICD-10 (podcast)

by David E Williams

ICD-10 is a health care coding scheme that increases the number of diagnosis and procedure codes by an order of magnitude, permitting much more granularity for payers and providers. In this podcast interview, HealthEdge COO Ray Desrochers describes ICD-10 and why it’s taking plans so long to implement, and explains why ICD-10 implementation is the Y2K of health care. Ray’s optimistic that a combination of health care reform efforts, ICD-10 implementation and value based benefit design will finally begin to constrain the growth of health care costs.

Health Business Blog » Blog Archive » HealthEdge COO Desrochers on ICD-10 (podcast)

Health Care Opinion Leaders' Views on Congressional Priorities - The Commonwealth Fund

More than nine of 10 leaders in health care and health care policy believe the general direction set by the Affordable Care Act is appropriate, with nearly seven of 10 favoring implementing the law with little or no change, according to a Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey. A large majority of leaders support moving forward with each of the major elements of reform, including the individual mandate, state-based health insurance exchanges, and Medicaid expansion. Survey respondents believe payment approaches that encourage care coordination for patients with chronic diseases, establish greater alignment across public and private purchasers, and incentivize the use of evidence-based medicine will be effective in achieving a high performance health system. Eighty-one percent of leaders support expanding successful cost-containment pilots contained in the Affordable Care Act as part of a federal budget deficit reduction strategy.

Citation

K. Stremikis, S. Guterman, and K. Davis, Health Care Opinion Leaders’ Views on Congressional Priorities, The Commonwealth Fund, February 2011.

Downloads

• Data Brief (540K PDF)
• Chartpack (62K PDF)
• Chartpack (216K PPT)
• Tables (343K PDF)

Affordable Care Act Sets Nation on Right Course for Health Reform, Experts Say - The Commonwealth Fund

In New Survey, Majority of Health Care Opinion Leaders Favor Implementing Health Reform Law with Little or No Change

More than nine of 10 leaders in health and health care policy believe the Affordable Care Act sets the right course for health reform, according to a new survey. And despite wide differences of opinion in Congress, and varied levels of support among the general public, nearly seven of 10 (68%) experts favor implementing the law with little or no change, according to the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey, which asked respondents their views about priorities for the 112th Congress.

Few leaders surveyed expressed clear opposition to the law: only 9 percent believe the health reform law sets the wrong course for the nation; none said that the health system as it stands now requires no major changes.

Respondents voiced strong support for moving forward with all the major provisions of the law, note Commonwealth Fund researchers Kristof Stremikis, Stuart Guterman, and Karen Davis, in a new data brief on the survey findings. More than eight of 10 think it is important or very important to implement state-based health insurance exchanges (86%), the requirement that individuals purchase insurance coverage (84%), and the expansion of Medicaid to cover more lower-income individuals (82%). In addition, delivery system reform provisions including the Center for Medicare and Medicaid Innovation to develop and implement new payment and delivery system approaches (83%), the Patient-Centered Outcomes Research Institute to develop best practices in health care delivery and organization (79%), and the Independent Payment Advisory Board to help reduce the growth of Medicare spending (71%) received support from a large majority of experts.

"While health reform very much remains a work in progress, it is heartening to see broad support among health care leaders for the direction laid out in the Affordable Care Act," said brief coauthor and Commonwealth Fund President Karen Davis. "The law's major provisions for expanding coverage, creating new methods of payment, and encouraging integration and innovation are supported by leaders from a range of sectors—including academia, care delivery, business, and consumers. That sort of consensus is encouraging indeed."

Health care leaders were asked about their views on new payment methods to curb costs and promote efficiency. Nine of 10 leaders believe that improving care coordination for patients with chronic conditions will be effective. Other options that received substantial support include permanent increases in Medicare and Medicaid payments to primary care physicians (72%), aligning payment methods and rates across public and private payers (69%), and accelerating the implementation of bundled payment methods (66%). Few leaders believe allowing consumers to purchase insurance across state lines (38%) or expanding the use of health savings accounts (22%) will be effective in achieving a high performance health care system.

Reducing federal health spending can play an important role in helping to shrink the federal budget deficit. The survey asked respondents for their views on several proposed cost-reduction measures included in recent proposals, most notably from the National Commission on Fiscal Responsibility and Reform. Health care leaders surveyed support expanding successful cost-containment pilots included in the Affordable Care Act (81%) and extending Medicaid prescription drug rebates to individuals who are dually eligible for Medicare and Medicaid (61%). Few leaders support converting Medicaid into a block grant program for states (26%) or converting Medicare into a premium support or voucher program (22%).

The survey is the 24th in a series from The Commonwealth Fund, and the 16th conducted in partnership with the publication Modern Healthcare. Commentaries by David M. Cutler, the Otto Eckstein Professor of Applied Economics at Harvard University, and Gail Wilensky, a senior fellow at Project HOPE, appear in the February 21 issue of Modern Healthcare. The commentaries are also posted on the Fund's Web site, along with a Commission data brief discussing the survey findings. 

Methodology

The Commonwealth Fund/Modern HealthCare Health Care Opinion Leaders Survey was conducted online within the United States by Harris Interactive on behalf of The Commonwealth Fund between January 3, 2011, and February 1, 2011, among 1,311 opinion leaders in health policy and innovators in health care delivery and finance. The final sample included 203 respondents from four sectors: academic/research institutions, health care delivery, business/insurance/other health care industry, and government/labor/consumer advocacy, for a response rate of 15.5 percent. The complete methodology is available on The Commonwealth Fund Web site.

• News Release (26K PDF)

RealCareNowTV: Person-centered Alzheimer's care

Intermountain Healthcare's McKay-Dee Hospital Center: Driving Down Readmissions by Caring for Patients the "Right Way" - The Commonwealth Fund

Authors: Sharon Silow-Carroll, M.B.A., M.S.W., and Jennifer N. Edwards, Dr.P.H.

Downloads-Case Study (1745K PDF)

Overview

McKay-Dee Hospital Center in Ogden, Utah, part of the Intermountain Healthcare System, had readmission rates in the lowest 3 percent of hospitals across the nation for all three clinical areas reported to the Centers for Medicare and Medicaid Services (CMS) for the selection period, and its heart failure and pneumonia readmission rates were within the best 1 percent of hospitals reporting (Exhibit 1).
McKay-Dee’s success may be attributed to the following:

• comprehensive quality improvement strategies, supported by extensive, systemwide clinical research and training in evidence-based care;
• standardization of care through "care process models," or clinical protocols, and heavy use of hospitalists;
• information systems designed to monitor quality;
• interdisciplinary care coordination and discharge planning with individualized patient education and scheduling of follow-up appointments before discharge;
• comprehensive identification of heart disease patients for education, post-discharge phone calls, and referral to the outpatient heart failure clinic;
• integration with community providers, both within and outside of Intermountain's network, which provides a continuum of care and helps ensure patients are connected with a medical home; and
• Intermountain's role as a leader in health care delivery and payment innovations, exemplified in its involvement with pilots of bundled payment/accountable care arrangements.

The Intermountain Healthcare System is a highly integrated system with multiple hospitals, primary care practices and clinics, an outpatient heart clinic, home health service, and a renowned clinical research institute. Membership in this system provides clear advantages in terms of shared resources and expertise, and enhanced communication across care settings. Nevertheless, McKay-Dee's experiences provide lessons for other hospitals and systems—even less-integrated entities—that are striving to reduce readmission rates as well as improve outcomes and maximize systemwide efficiencies.

First, McKay-Dee Hospital Center and Intermountain Healthcare operate on the premise that lower readmission rates, better quality measure scores, and financial savings are not the primary focus of their efforts, but rather byproducts of caring for patients correctly. Second, alignment of hospital care with outpatient care improves transitions and health outcomes. Third, it is critical to select and nurture physician leaders who embrace a hospital's quality measurement and reporting philosophy. If other physicians do not respond through medical leadership and incentives, it may be necessary to hold them to a higher level of accountability to encourage their adherence to clinical protocols. Current payment policy that rewards volume rather than clinical outcomes conflicts with some of these desired practices. Over the long term, changes to the incentives in the health care system are needed to align goals across hospitals and other stakeholders.

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This study was based on publicly available information and self-reported data provided by the case study institution(s). The aim of Commonwealth Fund–sponsored case studies of this type is to identify institutions that have achieved results indicating high performance in a particular area of interest, have undertaken innovations designed to reach higher performance, or exemplify attributes that can foster high performance. The studies are intended to enable other institutions to draw lessons from the studied institutions' experience that will be helpful in their own efforts to become high performers. Even the best-performing organizations may fall short in some areas or make mistakes—emphasizing the need for systematic approaches to improve quality and prevent harm to patients and staff. The Commonwealth Fund is not an accreditor of health care organizations or systems, and the inclusion of an institution in the Fund's case study series is not an endorsement by the Fund for receipt of health care from the institution.

 

Citation

S. Silow-Carroll and J. N. Edwards, Intermountain Healthcare's McKay-Dee Hospital Center: Driving Down Readmissions by Caring for Patients the "Right Way," The Commonwealth Fund, Feb. 2011.

You're Sick. It's Serious.

The American Academy of Hospice and Palliative Medicine has just released a new video called "You're Sick. It's Serious."

Too Little Focus On Medical Care For The Elderly In Productivity Commission's Aged Care Draft Report, Australia

AMA President, Dr Andrew Pesce, called on the Government to place a higher priority on medical care for the elderly in its response to the recommendations in the Productivity Commission's draft report, Caring for Older Australians, and its final report in June.

Dr Pesce said that although the Commission made occasional reference to medical care needs and the AMA's submission in its 500-plus page draft report, ongoing access to medical care was given low priority and little urgency in the recommendations to Government.

"Older Australians need and deserve ongoing access to their doctors when they enter the aged care system," Dr Pesce said.

"Older Australians living in residential aged care are very frail and most have complex health conditions. Access to ongoing medical care and supervision is essential to ensure they receive the same standard of medical care enjoyed by the rest of the population.

"Any reform of the aged care system must incorporate specific recommendations around preserving a person's access to quality medical care when they enter the aged care system, and create programs and incentives that will allow doctors and other health professionals to provide quality health care in residential aged care and in the community.

"Every elderly person in Australia deserves a right to medical care, regardless of whether they're in their own home or in a nursing home. The doctor-patient relationship must be preserved for older Australians at the time in their lives when they need it most.

"As a community, we need to put more humanity into the aged care debate," Dr Pesce said.

The AMA is calling on the Government to adopt the following aged care reforms:

- Aged care accreditation arrangements that more closely monitor and guarantee that aged care residents receive medical care and supervision on an ongoing basis;

- Specific financial support to allow approved residential aged care providers to enter into arrangements with medical practitioners, underpinned by a retainer, to ensure residents can access appropriate medical care;

- MBS rebates that better reflect the complexity of providing ongoing medical care to residents of aged care facilities for doctors and general practice nurses;

- Government support to residential aged care providers to ensure there are adequately equipped clinical treatment areas that afford patient privacy and information technology to enable access to medical records and to improve medication management; and

- Sufficient numbers of registered nurses to monitor, assess and care for residents and liaise with doctors.

The AMA will make a further submission to the Productivity Commission's draft report and will participate in the public hearings scheduled for March and April.

Source:
Australian Medical Association

Israel May Increase Healthcare Tax to Pay for Aging Population

Many countries have been concerned with how to best pay for aging baby boomers and seniors. Israel's deputy health minister Yaakov Litzman recently proposed increasing the country's healthcare tax by 0.5 percent to pay for geriatric insurance for all citizens, according to the Haaretz newspaper.

Approximately 64 percent of Israelis have an iteration of this package, but these are generally only offered by extended insurance plans.

Litzman announced the new reform at a recent conference at the National Institute for Health Policy, explaining that it would be the next big change in the healthcare system, the news source reports.

Full Article

National Health Spending Growth Held to Record-breaking Low... American Medical News

By Doug Trapp, amednews staff

The most recent economic recession slowed the growth of national health spending to 4% in 2009 -- the slowest rate since at least 1960. Patients delayed elective care and limited out-of-pocket spending, in part because millions of people lost private health coverage.

However, the percentage of the nation's gross domestic product devoted to health care increased to 17.6% in 2009, a full percentage point higher than in 2008, because health spending grew at a faster pace than the economy as a whole. Overall health spending reached $2.49 trillion, according to an annual report on national health spending by the Centers for Medicare & Medicaid Services Office of the Actuary, published online Jan. 5 in the journal Health Affairs.

"The slowdown was widespread among all health care goods and services," said Anne Martin, CMS economist and report co-author.

But the recession -- which officially lasted from December 2007 to June 2009 -- particularly affected physicians, dentists and nursing facilities, and it did so faster than in previous recessions, she said.
...

The two major exceptions to restrained spending increases in 2009 were retail prescription drugs, which rebounded from historically low growth in 2008, and home health care. Drug spending growth was driven by higher drug prices and increased utilization, partly because of the influenza A (H1N1) pandemic.

Patient out-of-pocket spending experienced a historic deceleration in 2009, growing by only 0.4%, or 2.7 percentage points slower than in 2008. This was driven partly by the first decline in dental spending since at least 1960 but also by slower growth in spending on physicians and clinical services, nursing care and other sectors of the health system, the report found.
Full Article

Can Good Care Produce Bad Health?

Excerpts from the Amy Berman post on the John A. Hartford Foundation blog

For those of you who haven’t yet heard, I have recently been diagnosed with Stage IV inflammatory breast cancer. This rare form of breast cancer is known for its rapid spread. True to form, it has metastasized to my spine. This means my time is limited. As a nurse, I knew it from the moment I saw a reddened spot on my breast and recognized it for what it was.

My recent journey through the health care system has been eye-opening. In only a few months, I have witnessed the remarkable capabilities and the stunning shortcomings of our health care system firsthand. I am writing here because in the time I have left, I hope my story and my journey can help illustrate why some of the reforms that my colleagues and I at the John A. Hartford Foundation, as well as many others, have championed are so important.

. . .

Based on a perverse set of metrics, the Philadelphia oncologist was offering technically the “best” care America had to offer. Yet this good care was not best for me. It wouldn’t give me health. Instead, it might take away what health I had. It doesn’t matter if care is cutting-edge and technologically advanced; if it doesn’t take the patient’s goals into account, it may not be worth doing.

. . .

I was determined not only to choose treatment that would maximize the healthy time I had remaining, but also to use that time to call on our health care institutions and professionals to make a real commitment to listening to their patients. In the health policy field, we call this patient-centered care. As a nurse and a senior program officer at a health care foundation, I understood my disease and my health care options well enough to make an informed decision about my treatment.

What about the millions of older Americans facing a terminal illness or chronic disease? How can they possibly stand up to the juggernaut of our health system and say, “No. I want care that focuses on my goals, care that is centered on me.” We need to make it easier for everyone to obtain care that fits their health care goals. How can we change the system and the measurement of quality to place the patient at the center? I call on everyone involved in health care practice and reform efforts to give serious thought about how we can reorient our health care system toward patient-centered care.

Read the full post at The John A. Hartford Foundation blog

Palliative CareRresearchers Tackle Whether to Stop Statins for Terminally Ill

By Kevin B. O'Reilly, amednews staff

Patients' lives might be improved if freed of nagging side effects of the medications, but some doctors express concern about shortened survival times.

Research in palliative medicine is moving into determining what kinds of care can be withdrawn safely for patients near the end of life, say doctors behind a new research consortium.
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H.R. 79: To amend title 38, United States Code, to provide certain abused dependents of veterans with health care (GovTrack.us)

To amend title 38, United States Code, to provide certain abused dependents of veterans with health care

Sponsor:	Rep. Sheila Jackson-Lee [D-TX18](no cosponsors) Cosponsors:
Text:	The text of this legislation is not yet available on GovTrack. It may not have been made available by the Government Printing Office yet.
Status:	Introduced Jan 5, 2011 Referred to Committee View Committee Assignments Reported by Committee ... House Vote ... Senate Vote ... Signed by President ... This bill is in the first step in the legislative process. Introduced bills and resolutions first go to committees that deliberate, investigate, and revise them before they go to general debate. The majority of bills and resolutions never make it out of committee. [Last Updated: Jan 6, 2011 11:18AM]
Last Action:	Jan 5, 2011: Referred to the House Committee on Veterans' Affairs.

Current Status