Appeals, Observation care

Medicare rules give full hospital benefits only to those withinpatient status

By Susan Jaffe  | September 7, 2010 |  Kaiser Health News produced in collaboration with  WaPo-4sidebar 163x25pix

After Ann Callan, 85, fell and broke four ribs, she spent six days at Holy Cross Hospital in Silver Spring. Doctors and nurses examined her daily and gave her medications and oxygen to help her breathe. But when she was discharged in early January, her family got a surprise: Medicare would not pay for her follow-up nursing home care, because she did not have the prerequisite three days of inpatient care.

“Where was she?” asks her husband, Paul Callan, 85, a retired U.S. Army colonel. “I was with her all the time. I knew she was a patient there.”

Yet some hospitals keep patients under observation for days, and that decision can have severe consequences. Medicare considers observation services outpatient care, which requires beneficiaries to cover a bigger share of drug costs and other expenses than they would when receiving inpatient care.And unless patients spend at least three consecutive days as an inpatient, Medicare will not cover follow-up nursing home expenses after discharge…. more

Appeals, Observation care

What To Do If You’re In Observation Care

By Susan Jaffe  | September 7, 2010 |  Kaiser Health News produced in collaboration with  WaPo-4sidebar 163x25pix

How do I know what my hospital status is? What can I do if the hospital won’t change my observation status to inpatient? If the nursing home or hospital says Medicare won’t cover my nursing home stay, what can I do?  Answers to these and other questions here.

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HEALTH CARE REFORM EXPLAINED        Your questions answered                      [weekly column]   


By: Susan Jaffe | from       BULLETIN  | July 5, 2010

Q. We own a small business and can’t afford health insurance for our part-time employees. Will health care reform make things even tougher by making us pay for their health coverage?

A. The law does not require businesses to provide health insurance (although large companies can be assessed a penalty if they don’t). But if you offer coverage, as a small company, you can receive tax credits worth up to 35 percent of the cost of that insurance for tax years 2010 to 2013, and up to 25 percent for nonprofit organizations.                   More

The New Health Care Law and Small Businesses

CMS, Drugs

Medicare Steps Up Efforts To Monitor Seniors’ Prescriptions

By Susan Jaffe | KAISER  HEALTH  NEWS | March 23, 2010

This story was produced in collaboration with

Irene Mooney survived four heart attacks and still copes with high cholesterol, persistent indigestion and heart problems. Recently, she developed some dangerous new symptoms – suspicious bruising all over her body and severe fatigue. “I could barely put one foot in front of the other,” she says. A pharmacist discovered the culprit: Some of the very medications Mooney was taking to manage her medical conditions.

The pharmacist met with Mooney, examined her 13 medications and then contacted her doctor, who cut the dosage of one drug and replaced another, reducing her risk of uncontrollable bleeding. Mooney, 82, one of the devoted card players at her seniors’ complex, soon noticed the change. “I’ve been so much better,” she says.

The help Mooney got – called “medication therapy management” – was provided by Senior PharmAssist, a Durham, N.C., non-profit group that makes sure seniors use the right prescription drugs and take them correctly to prevent harmful side effects or drug interactions.

Now, medication management is coming to nearly 7 million seniors and disabled Americans enrolled in Medicare drug plans. [Continued at Kaiser Health News and USA Today

 

 

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By Susan Jaffe    |   March 22, 2010                                                       

KAISER HEALTH NEWS in partnership with     

Medication management is coming to nearly 7 million seniors and disabled Americans enrolled in Medicare drug plans. Under new, tougher Medicare rules that took effect in January, private insurers that offer drug coverage must automatically enroll members who have at least $3,000 in total annual drug costs, take several drugs and have chronic health conditions such as diabetes, hypertension or heart disease.    MORE

Drug assistance programs keep seniors on track

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Dialysis crisis followed shift by Medicaid

By Susan Jaffe | Plain Dealer Reporter | February 12, 2007

 For the past year, a dialysis machine has been keeping Karletta Edwards’ mother alive, substituting for her kidneys to cleanse her blood three times a week.

But in January, shortly after Ohio’s Medicaid program transferred her, along with more than 25,000 other low-income people in Northeast Ohio, into an HMO, something went wrong.

The state’s contracts with insurance companies are expected to save Medicaid $24 million this year, by the time some 125,000 blind, disabled or older people are placed in privately run managed care plans.

Even though the companies are paid 6.6 percent less, Medicaid’s average cost to care for the same population, state officials say the health coverage will remain the same…. Four weeks ago, Edwards received a desperate call from her mother. The transportation service that picked up Emma Hansen from her East Cleveland  home and brought her to the dialysis center didn’t show up. [Continued here]

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Consumer guide to prescription drug plans in Northeast Ohio
Susan Jaffe | Plain Dealer Aging Issues Reporter | November 11, 2006

Health insurance companies with contracts from Medicare have been approved to sell a total of 93 plans in Ohio. Some policies cover only drugs, while others include health insurance. This special section provides a consumer guide including the plan basics, some questions to ask before choosing a plan, a translation of the technical jargon companies use, and where to go for assistance.[four-page section here]

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Advocates for Medicaid seniors wary of assigned drug coverage

By Susan Jaffe  |  Plain Dealer Reporter | December 29, 2005

Under the Medicare prescription drug benefit, the federal government enrolled millions of the nation’s poorest and sickest seniors into private drug plans that may not cover all their drugs. [Continued here.]

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Switch to Medicare to cost state millions

By Susan Jaffe  |  Plain Dealer Reporter  |  October 20, 2005

Ohio’s financially strapped Medicaid program will pay millions more when low-income seniors switch to Medicare for their prescription drugs next year.  The federal law that established the new Medicare drug benefit requires the nearly 200,000 seniors in Medicaid – the state health-care program for low-income people – to transfer to Medicare for drug coverage. The law also says that states must reimburse the federal government for 90 percent of those seniors’ drug costs. But any savings that states expected have vanished because of the controversial formula Medicare used to figure how much they owe. The switch will cost Ohio $35 million more in 2007 than if the seniors now in Medicaid had stayed there. [Continued here.]

 

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Medicare dangles Rx carrot
By Susan Jaffe | Plain Dealer Reporter  | February 12, 2005    

Many of the nation’s major corporations providing retiree drug coverage will get help paying the bill  – subsidies worth several billion dollars a year from federal taxpayers. The money totals roughly $71 billion tax-free through 2013 and is part of the Medicare Modernization Act, which added a drug benefit to Medicare.  It is aimed at encouraging employers to maintain their coverage instead of forcing retirees onto Medicare’s tab. [Continued here]

Long term care, Medicare costs, Plain Dealer

You Can Go Home Again: A move to a nursing home needn’t be forever anymore.

A new Ohio program not only supports independent living, but also saves the state money.

By Susan Jaffe  |  Plain Dealer Reporter | November 7,  2004

Without Ohio’s Access Success Project,   Larry Fry might  have lived in a nursing home for the rest of his life.  The program is unwinding the government rules and red tape that trap people in nursing homes who don’t want to be there, don’t need to be there and certainly don’t need to be driving up the state’s enormous nursing home costs (See Graphic, “Paying More for Less,” pg. 19). If it succeeds, the effort targeting 250 nursing home residents could save Ohio millions of dollars a year. Nursing home care costs an average of about $56,000 per resident a year in Ohio. Because Fry needs so little care, living on his own will save Medicaid roughly $50,000 a year.  Continued in The Plain Dealer’s Sunday Magazine