Healthcare Headlines Week of April 22, 2013
Confusion Over New Health Laws May Lead to More Scams
Seniors have long been targets for scammers, and that trend may be on the rise. Authorities are reporting an increase in insurance-related scams across the country and the new health care laws are creating a new tool for scammers, who play on confusion about them. Read the story
Poll Shows that Many Americans Avoid Thinking About Long-Term Care and/or Misunderstand It
A poll conducted by The Associated Press-NORC Center for Public Affairs has revealed that most Americans age 40 and over don’t like to think about their long-term care needs and don’t have a clear understanding of what those needs might be and how much they are likely to cost. Read the story
Muscle Power Decreases as we Age: Can we Get it Back?
Focusing on maintaining and increasing muscle power through exercises including strength training done at a faster speed may be an important step to retaining function as we age. Read the story
As we age, muscle power ebbs even more swiftly than strength does. So exercises that can produce gains in power become especially important later in life. That’s why some investigators in the field of physical medicine are now combining the swift or high-velocity moves of power training with more deliberate and slow strength-training exercises to reap the benefits of both activities. — Harvard Health Blog
Health System Using Accountable Care Model Seeks to Offer Value-Based Care
An Illinois health system that is pioneering a value-based model of care is finding ways to provide better care, but less of it, in order to keep costs down. Read the story
Collaborations Between Hospitals and Post-acute Providers May be Wave of the Future
The changing healthcare landscape is creating an environment that may be rich with opportunities for hospitals and post-acute providers to work together to deliver high quality, cost-efficient care. Read the story
Apps Offering Needed Help for Caregivers
Apps, including one that keeps track of medications and dosage information and one that follows the movements of Alzheimer’s patients, are helping weary caregivers manage their workload, and are expected to become increasingly useful as baby boomers continue to age. Read the story
“Super-agers” Have Memory Skills of People 20 to 30 Years Younger
A study shows that certain people’s brains appear to resist the changes that may lead to memory problems, Alzheimer’s and other age-related conditions linked to deterioration in certain areas of the brain. A greater understanding of these findings may eventually lead to better treatments aimed at stalling or reversing some of the brain changes that can lead to problems. Read the story
New Device Keeps Organs Alive Before Transplant
Maintaining blood flow and function in a donated organ as it is being transported for transplant may lead to better outcomes and fewer complications for transplant patients, and a new device is helping doctors do just that. Read the story
Early Research Suggests a Newly-Discovered Hormone May Hold Promise for Better Diabetes Treatment
Researchers have discovered a hormone that stimulates growth of a certain kind of cell in the pancreas that is ineffective in diabetics. Further studies will be necessary, but researchers are encouraged by this discovery and what it might potentially mean for the treatment of diabetes, which affects 25 million Americans, according to the American Diabetes Association. Read the story
Current Slowdown in Health Spending Likely Tied to the Economy
Talked-about initiatives such as bundled payments and accountable care organizations may eventually show results, but a current downturn in health spending seems tied to economic factors, according to an analysis performed by the Altarum Institute and published by the Kaiser Family Foundation. Read the story
Healthcare Headlines Week of April 15, 2013
Read on for a collection of news stories affecting the U.S. healthcare industry this week.
Younger Patients More Likely to Skip Meds
A study from the Centers for Disease Control and Prevention found that people under the age of 65 are twice as likely as older Americans to not take their medications as prescribed, and not taking medications correctly can lead to worsening health and more emergency room visits. Read the story
Hospitals in Boston Resembled War Zones After Bombings
The STACH response in the wake of the Boston bombings was swift. Those who were there say the wounds they saw were more typical of what would be seen in a war zone. Read the story
Insurers Look to Pay-for-Performance Health Plans
Insurers and doctors are wondering if a strategy that works in corporate America might work in the medical world as well – paying for performance. Read the story
Flu Season May be Over
A long and brutal flu season may be finally coming to an end. Read the story
Scientists May be on the Right Track in the Fight Against Alzheimer’s
Medications to slow or stop the progression of Alzheimer’s Disease may be less than five years away, according to researchers. Read the story
Missed Mammograms May Lead to Worse Outcomes in Women Over 75
Older women who were either diagnosed with breast cancer years after their last mammogram, or who had never had a mammogram, were more likely to die from their disease than counterparts who had more recent mammograms, according to a study. Read the story
New Medicare Cuts Threaten Non-Profit Hospitals – Moody’s
Sequestration cuts threaten to make a difficult financial situation that much worse for not-for-profit hospitals, many of which serve low-income patient populations, says rating agency Moody’s. Read the story
Long-Term Care Staff Needs to be Attuned to Swallowing Issues
Many members of our aging population face swallowing issues that can be serious and even life-threatening, and long-term care staff members – from clinicians to volunteers – need to be tuned into these potential issues in order to prevent serious problems. Read the story
HIPAA Continues to Evolve with the Times
To keep up with changes in technology and an ever-evolving healthcare environment, HIPAA will continue to change accordingly, says the industry group the American Health Information Management Association. One area of change involves who bears responsibility for keeping data secure. Read the story
Skilled Nursing Facilities Could Face Readmissions Penalties, Too
According to a MedPAC recommendation, skilled nursing facilities, like acute care hospitals, could soon be subject to penalties for too many avoidable hospital readmissions. Read the story
Help With Choosing a Nursing Home
Choosing a nursing home for yourself or a loved one can be a daunting task. But there are tools available to help, such as the annual U.S. News & World Report ratings of nearly all of the 16,000 nursing homes in the country — including Kindred’s 224 nursing centers.
Information for the rankings comes from Nursing Home Compare, a website sponsored by the federal Centers for Medicare & Medicaid Services (CMS).
Using data collected from surveys of local agencies and facility self-reporting, CMS assigns a one- to five-star rating to the three categories of state-conducted health inspections, nursing staffing, and quality of care measures (based on nine different factors). The ratings are then combined to produce an overall facility rating of one to five stars.
“The report is designed to help the consumer understand the quality of care provided by a nursing home. In addition to the most recent score, people can look back at the survey history of a facility for the last three years,” says Kathy Owens, Division Senior Vice President of Clinical and Resident Services.
The ratings are periodically updated throughout the year, which gives a facility an opportunity to take corrective actions if an issue is identified. However, the improvement will not be reflected in the ratings right away. According to Owens, there is an enormous amount of very complicated information feeding the reporting system that is constantly being updated to ensure accuracy.
On the U.S. News & World Report website, nursing homes are easily searchable by zip code, state or metro area. But the report is just one factor to be reviewed when comparing nursing homes. The site makes good suggestions for doing comparisons, such as visiting homes at different times of the day and looking for signs that the staff has a good relationship with residents (like calling them by name).
Learn more about the report from Avery Comarow, Health Rankings Editor of U.S. News and World Report in this step-by-step video.
Looking for more help making a decision? Do you need information on Medicare coverage, how to prepare for your stay, or important checklists? Click here for answers to those questions and more!
At the 2013 American Medical Directors Association (AMDA) convention in Washington, D.C., speakers from Kindred Healthcare and the Cleveland Clinic presented on acute care to post-acute care relationships. The session highlighted aspects of their own clinical and quality initiatives while giving participants a tutorial in how to get started forming their own collaborations. It is through these types of relationships that health care organizations can work to design and to improve care transitions to meet the challenges of the changing healthcare environment.
Kindred and the Cleveland Clinic began a Joint Quality Committee (a formal and structured relationship) three and a half years ago. This relationship provides mutual benefits. The acute care hospitals have insight and influence on the care provided to patients after discharge and the post-acute care providers have stronger relationships with the facilities that send the patients. The beauty of these relationships is that they can be developed with providers, payors and facilities alike. All you need is willingness to partner, a commitment to patient outcomes across the continuum and an upfront commitment of time and resources for a long-term benefit.
The presentation, titled “Success Through Relationships : A Guide to Initiating Joint Quality Committees,” offered the opportunity for Kindred and the Cleveland Clinic to share their own best practices. The session encouraged other organizations to work to build relationships in their own markets or skilled nursing facilities. The speakers recommended that participants complete an internal assessment, determine the most beneficial partnering relationships, work to identify aligned goals between the organizations and use a Joint Quality Committee to accomplish the mutual goals.
An infrastructure that promotes successful and lasting relationships includes leadership, physician engagement, communication protocols and complementary clinical capabilities, and above all: tracked and transparent outcomes.
Outcomes tell the story, and the speakers spent a significant amount of time talking about the all-important clinical and patient outcomes measures that organizations can use to track their results.
They included:
- Internal quality metrics (readmission rates, nosocomial rates, patient satisfaction)
- External quality indicators (5 star rating, publicly reported measures)
- Patient reported outcomes (monitoring patient perception of depression, functional status)
Let’s break those down a little.
Organizations were encouraged to look at the data they are currently collecting and how it might be useful in tracking results of partnership efforts. This might include patient satisfaction data, return to level of function at discharge (using PT and OT data), and discharge disposition– what happens to the patient after he or she is discharged from either or both partner entities.
The most important aspect of sharing data and information is assuring an understanding of the quality and outcome indicators by “speaking the same language.” This means the definitions and terms used in one setting translate to the other, specifically utilizing the same equations. Partners must either share or have understanding of each other’s information.
Monitoring performance constantly and tracking the impact of process improvement initiatives are ways to gain a deeper understanding of performance. The most potent area for organizational collaboration is reducing unnecessary returns to acute care. This can be done by:
- Physician involvement and availability
- Clinical competency, confidence and trust
- Availability of diagnostic testing
- Candid conversations and realistic communication about current health status
- Accurate transfer data and medical information for continuity of care
- Collaborative review of each return-to-hospital case
In summary, consistent measurement of quality and outcome measures; strong working relationships, open, clear communication and a commitment to focusing on key quality outcomes are critically important as organizations move to take the lessons learned by the work being done at Kindred and the Cleveland Clinic and apply them to their own spheres.
What It Takes to be an Occupational Therapist
Occupational therapists and assistants play a vital role in the care of Kindred patients. Carey Anderson-Hoyt, OT/L, Program Director of Rehab Care at Kindred Transitional Care and Rehabilitation-The Greens in Ohio, talks about the profession that’s being spotlighted in April for National Occupational Therapy Month.
Q. How did you become interested in OT?
Carey has a true passion for occupational therapy and enjoys the creative opportunities it allows.
A. I had horses growing up and loved how therapeutic they were. When I was learning about career options, I came across hippotherapy, which is the practice of using horses as a therapeutic modality. After doing some research, I found that I had to become a physical therapist or occupational therapist, but decided on the latter because it offered more opportunities to be creative.
Q. What type of schooling do occupational therapists need?
A. Currently, a master’s degree is required. A lot of universities offer an accelerated, five-year undergraduate/master’s degree program. Occupational therapy assistants complete a two-year associate’s program.
Q. Can you describe a typical day?
A. An OT or OTA usually manages eight to 10 clients. The day often starts with helping clients groom, bathe and dress. During meals, we may help clients relearn how to feed themselves and use adaptive equipment.
Individual therapy generally lasts for about an hour each day, five to six times per week. Clients participate in functional tasks such as preparing meals or transitioning in and out of a bathtub to improve strength, balance and safety. The goal is to return them to whatever activities of daily living that are important to them. If the patient is a golfer, we might practice on a putting station.
Q. What do you enjoy most about being an occupational therapist?
A. OT is known for its out-of-the-box thinking. I enjoy helping people complete meaningful activities that gets them better faster. Care is very client-centered, and adjustments are constantly being made. If it’s meaningful to them, it’s meaningful to me.
Interested in learning more about Occupational Therapy? Click here to view our rehabilitation counterpart’s blog, RehabCare Advantage.
What is an ACO?
Born out of the Affordable Care Act of 2010, the concept of the Accountable Care Organization (ACO) is tied to the goal of providing better and more efficient, coordinated health care to more people at lower cost. The organizations themselves are composed of groups of physicians and other providers of Medicare-covered services, and venues where care is provided, connected by networks of individual practices or partnerships, joint ventures or hospital-employed ACO professionals. Payment is tied to the achievement of health care quality goals, and the organization is expected to be patient-centered, with patients and providers working together toward optimum health care delivery.
To continue to qualify as an ACO, an organization has to meet certain criteria, including caring for at least 5000 Medicare beneficiaries for a period of three years. It also must have a governing board that includes health care providers, suppliers and Medicare beneficiaries. (Disclaimer: though ACOs are often paired with Medicare, there are some ACO providers that utilize private insurance programs.)
When implemented and working properly, ACOs are eligible to share savings with Medicare or other payers, though they may also be held accountable for losses. The goal is to incentivize organizations to provide care for patients that is more efficient and better organized, and by having many providers under one proverbial “roof,” medical record sharing should be easier and care streamlined by more efficient communication.
Quality improvement standards to which ACOs are held accountable include:
- Patient/caregiver experience of care
- Care coordination
- Patient safety
- Preventive health
- At-risk population/frail elderly health[i]
What does the advent of this healthcare delivery model mean for a post-acute provider like Kindred? Well, it potentially shrinks the population of potential referrers by placing large groups of them under one referral roof; developing effective partnerships with these organizations will be key to ensuring ACO patients’ access to our full complement of post-acute services, especially in our integrated care markets, such as Dallas, which already has three ACOs up and running.
The three Dallas ACOs all have different personalities – one is interested in joint ventures with post-acute providers, a
nd Kindred has been successful in getting some of its transitional care hospitals and transitional care and rehabilitation centers on their referral list, all based on proximity.
One is a shared savings model whose philosophy is that they want to work with other providers who have skill sets they don’t, making a Kindred collaboration potentially realistic.
Finally, one is operating under the philosophy of owning everything they operate, which makes it a tougher challenge with potentially less room for collaboration.
ACOs are also operating in many of Kindred’s other integrated care markets, including Indianapolis, Las Vegas and Boston.
When and if ACOs become more prevalent, we can expect to see these unique issues become more prevalent. What do you think healthcare reform might mean for the post-acute world?
[i] “Accountable Care Organizations: Improving Care Coordination for People with Medicare.” HealthCare.gov. U.S. Department of Health and Human Services. 12 March 2012.
What is a Transitional Care Hospital?
Transitional Care Hospitals (TCHs) offer aggressive, medically complex care, intensive care and short-term rehabilitation.
Certified as long-term acute care hospitals and licensed as acute care hospitals, Transitional Care Hospitals are unique in their ability to care for critically ill patients who require specialized and goal-directed care over an extended recovery time. They have an additional Medicare certification that supports a length of stay measured in weeks as compared to the typical five-day stay for patients in traditional hospitals. At Kindred, about two-thirds of our TCH patients have Medicare.
TCH patients require an average length of stay of 25-30 days, and have many co-existing medical conditions, some acute and some chronic. Examples of some of the services TCH patients require are:
- Dialysis
- Ventilator management and weaning
- Special monitoring
- Wound care
- Nutritional therapy
- Pain management and IV therapy
Some of the conditions commonly seen in a TCH are:
- Pulmonary disease
- Chronic obstructive pulmonary disease (COPD)
- Emphysema
- Multiple organ system failure
- Ventilator dependence
- Cardiac disease
- Pressure wounds
- Neuromuscular diseases
- Gastrointestinal diseases
- Post-operative complications such as infection, bleeding or stroke
In a TCH, care is provided by an interdisciplinary team that may be made up of physicians, nurses, social workers, occupational therapists, speech therapists, physical therapists or others. The team’s goal is to identify the patient’s medical conditions, formulate a treatment plan, set reasonable goals and coordinate care to meet those goals, ultimately resulting in improvement over the long term.
In some cases, the patient’s regular physician will continue to see the patient if he or she is moved to a Transitional Care Hospital; in other cases, the patient’s care will be transferred to a physician who specializes in caring for patients who require long-term acute care. Nursing staff levels are comparable to those at a short-term acute care hospital, as are staffing levels for therapists and other clinicians.
Family members play a crucial role in the patient’s recovery and healing process. They provide a valuable service to the patient and to the interdisciplinary team by offering support as well as background information. Family conferences, case management and social services help connect the TCH team with the critical family caregivers.
Kindred’s Transitional Care Hospitals have had great success in reducing readmissions to acute care hospitals, and government studies show that choosing a TCH reduces the odds of readmission by almost half. Fewer readmissions relieves stress on patients and also saves money for Medicare and insurers.
Kindred’s mission for each patient and family is: hope, healing and recovery.
