Medicare Social Problem, Assessment Example

Medicare Social Problem on Macro Level-Releasing Patients Early

Centre Avenue Health & Rehab Facility offers furnished private rooms designed to provide comfort to individuals seeking a short stay following hospitalization for convalescent care or rehabilitation, long-term care, or end of life care (Columbine Health Systems, 2010).Centre Avenue Health and Rehabilitation Facility is an average sized, for profit, nursing home with 90 beds based in Fort Collins, CO. The facility houses 70 residents indicating that it is 78% occupied which is about average within the state of Colorado. The hospital facility supports senior services such as skilled nursing facilities, both independent and assisted living options, rehabilitation and therapy services, home care, pharmacy, and medical equipment and supplies.  The community consists of over 1100 local residents employed at the facilities, which include the physicians, nurses, pharmacy, technicians, and other assisted living staff. Columbine Centre Health and Rehabilitation has a range of service that service the complete critical care for seniors that most Medicaid services will pay for in other states such as independent and assisted living options, rehabilitation and therapy services, home care, pharmacy, and medical equipment and supplies. They only accept Medicare.

The primary problem at Columbine Centre Health and Rehabilitation is Medicare will only pay for up to 100 days for Rehabilitative services. As a result, the community based rehabilitation facility is forced to release the patient before the patient is recovered. According to Huffington Post (2012)”The problem of sending patients home too early isn’t limited to the U.S. though. The United Kingdom’s National Health Service faced a scandal in 2010 after it was reported that the agency released 500,000 patients every year”.Medicare will base continued care on the progressof a patient during their rehabilitation recovery stage. If no progress is made then Medicare will require Columbine to release this person back to their living environment when they are not ready to go back.

Why Is This an Issue

This is a community issue because Centre Avenue Health and Rehabilitation Facility is one of many healthcare services to help patients with Medicare.  The Columbine Hospital Systems has one the most extensive list facilities that address the needs of Medicare patients:

However, the Medicare stipulations are stringent making it difficult for a Medicare patient to have a qualifying event. As a result, the patient does not meet the threshold, which they are released from the hospital much too early.  Here is a short list of conditions that must be met for the patient to stay beyond the 100 days. This list is not exhaustive but just an example of how much red tape before a patient can meet requirements for Medicare to pay:

1. An individual must be admitted to the nursing facility within 30 days of their hospital discharge.
2. Treatment must be similar nature to that which was treated at the hospital
3. There must be a determination that only inpatient services will be sufficient.
4. In addition to a doctor, specifying daily nursing services. They must also recertify at intervals of 5 days and 14 days after admission. In addition to that the doctor must recertify the need for daily nursing services every 30 days thereafter
5. In addition to Doctor Recertification of the need for services. Medicare will also have to review and approve the need for nursing services.
6. Lastly, and more important the patient must be in nursing care for 100 days or less, but Medicare does not have automatically approved the care.

The patients are being released from the hospital too soon in records numbers that have Medicare coverage. The epidemic has been caused by Medicare rewarding hospitals for volume and not quality of care. The signs are present that Medicare reform is needed as millions of patients are dying while in the care of Medicare. Of the roughly 2.4 million Americans who die each year, approximately 75 percent are insured by Medicare at the time of their death. Death in America is now something that happens primarily to older people (Vladeck,1999).  The community of Centre Avenue Health and Rehabilitation Facility is being impacted negatively because they have to follow the Medicare guidelines to provide the service for the senior populations.

How Are People Impacted

The Medicare patients are impacted because the hospital does not need to meet all Medicare guidelines to receive full payment. As long as the hospital meets the basic admission requirements, they will be paid regardless, if the patient is released too soon.  Medicare is aware that hospitals are taking advantage of the Medicare rehabilitative and nursing home legislation, but Medicare has refused to change the law to prevent patients from being released before they are physically well. Just like hospitals, rehabilitation facilities also have to worry about meeting Medicare guidelines and being paid. And just like hospitals, some may take the path of least resistance and discharge their rehab patients too early (Eldercare Team, 2012). The only requirement that Medicare requires is the hospital provide the patient with a written notice of Medicare Provider Non-Coverage at least two days before discharge. The people most impacted are the patients because Centre Avenue Health and Rehabilitation Facility have 16 different facilities in one location dedicated to the care of seniors. The problem surrounds the facilities needing to follow Medicare guidelines, which may result in the patient being released to home because the facility will not be paid from Medicare. The patient’schance for survival is slim to none.

Historical Perspective

Medicare has seen the statistics on the alarming number of Medicare patients that are dying. Since, 2008, the numbers have begun to climb which include specifically the seniors over 65 with Medicare that have a deliberating disease. Several colleagues from the Harvard School of Public Health recently reported that 1.8 million Medicare beneficiaries age 65 or older died in 2008, and over 34% were operated on during their last year, 25% in their last month, and 10% in their last week of life(Wells,2010). The Medicare reforms have historically affected the way the hospital functions and treats Medicare payments. However, the major changes to Rehabilitative Services for patients on Medicare Part A are contributing to the death and early release of Medicare patients from the Centre Avenue Health and Rehabilitation Facility.

Specific Need

The specific need is Medicare needs to provide more incentives and better reimbursement to Medicare physicians, so they are not left with the decision to release patients too early. The blame has plenty of characters that have some accountability. The specific need for Medicare patients with Medicare benefits is providing a reimbursement rate that encourages hospital and physicians to treat. It is an epidemic that patients are being released too early because the hospital or physician determines they will not be paid for their services. According to an article in Colorado Public News,” A survey was given the state of Colorado Medicare physicians who indicated they do not provide care for patients with Medicare basic because they know they will not be paid from Medicare, if all the stringent regulations are not met (CPT12, 2012).

Who is suffering? Who are the least empowered

The Medicare patients at the community of Centre Avenue Health and Rehabilitation Facilities are suffering because the patients have to meet thresholds for each type of facility such as the Independent Living, Assisted Living, Health and Rehabilitation, and Home Health Services. Centre Avenue Health and Rehabilitation Facility nursing home has some the most stringent guidelines for patients because the patient has to be indigent or without any kind of property or cash for at least 3 years before being admitted the nursing. The services are severely needed for patients on Medicare that need medical nursing service for seniors with serious illnesses or disabilities twenty-four hours a day delivered by registered nurses, licensed practical nurses, and certified nurse aids. However, if the patient misses just one threshold regardless of how long they have been on Medicare they will be release to their home or indigent facility before they are well.The least empowered are the patients that do not have any recourse but to be released back into their homes, which does not guaranteed extended life or improved care. Many times these patients are incapacitated and unable to make decisions. Any adult may execute a power of attorney document enabling you to name a person to make those healthcare decisions for you if you are no longer able to make those decisionyourself (Nevada Legal Services, 2009). The Medicare patient may end up with any adult in the family to make decision (Power of Attorney) about their care and their personal property, without knowledge of your personal views on medical care.

Define the population

The Centre Avenue Health and Rehabilitation Facility Nursing care facilities cater to several types of patients: some patients require short-term rehab while recovering from surgery; others require long-term nursing and medical supervision. In addition, some nursing homes offer specialized care programs for Alzheimer’s or other illnesses, or short-term respite care for frail or disabled persons when a family member requires a rest from providing care in the home(Columbine Health Systems, 2010).The community consists of over 1100 local residents employed at the facilities, which include the physicians, nurses, pharmacy, technicians, and other assisted living staff. The facility offers nursing aide training, personal care/working training, and internships for aspiring medical professionals (Columbine Health Systems, 2010). Columbine Centre Health and Rehabilitation has a range of service that service the complete critical care for seniors that most Medicaid services will pay for in other states such as independent and assisted living options, rehabilitation and therapy services, home care, pharmacy, and medical equipment and supplies.

Columbine Health Systems is small community support system that continues to strive to provide educational options, which will enhance the quality of living for our residents, our employees, and our community.  The community has a shared interest concerning the senior’s quality of life and access to healthcare. The hospital community Columbine Centre Health and Rehabilitation for the elderly has shared an emotional connection to the community promising medical services for seniors. The hospital facility supports senior services such as skilled nursing facilities, both independent and assisted living options, rehabilitation and therapy services, home care, pharmacy, and medical equipment and supplies.

Demographics – (see Community Analysis)

The population of Fort Collins is estimated by Troop (2011) at 137, 200. The population growth rate is 1.4% per year (2009).  The community has a great number of seniors and Medicaid eligible patients because Fort Collins, Colorado has thousands of immigrants that migrate to Fort Collins for the senior services. Fort Collins has a reputation as an excellent place for seniors to find excellent social activities for seniors are excellent and exceptional retirement locations that cater to the elderly. The population is 89.6% White, 8.8% Hispanic, 2.6% Asian or Pacific Islander and 1.0% Black (2000 US Census). The elderly community has doubled in the last 2 years, which has put a burden on the Medicaid programs, community programs, state, and city funded healthcare grants and the private funders for the state of Colorado.

The Centre Avenue Health and Rehabilitation Facility Nursing care facilities has community-meeting places within the area such as Centre Pharmacy that often provides educational meetings for the community. The area has an abundance of parks, apartments, stores, Movie Theater and City Hall. The community is very tight knit that has a separate facility for the Columbine Health Systems that often holds preventative care events for seniors. The most recognizable landmark is Ft. Collins. The community is a prime location for seniors because of the beautiful scenery that has housing for short or long-term seniors. The Ft. Collins communities demographics consist of 45882 households with 56% of those households are families (MDNH, 2012).

Where is the greatest need

The greatest need is the Medicare A (Hospital Benefits) Reform that will prevent seniors from being misplaced or sent home because they did not meet the Medicare threshold. The primary problem is Medicare providers will not take patients with basic Medicare coverage. The immediate greatest number would be changing the Medicare laws that would hold hospital liable for releasing patients. Hospitals understand under the Medicare hospital care, the hospital can still get paid even if the patient is discharge home too early.

Agencies that address this need

One of the agencies that are addressing the needs of Medicare patients is the Center for Medicare Advocacy, Inc. The Center for Medicare Advocacy, Inc., established in 1986, is a national nonprofit, nonpartisan organization that provides education, advocacy, and legal assistance to help older people and people with disabilities obtain fair access to Medicare and necessary health care. The Center is headquartered in Connecticut and Washington, DC withoffices throughout the country (Centers for Medicare Advocacy, Inc, 2012). The Center’s staff act as consultants and trainers for groups that are interested in learning about health care rights, Medicare coverage and appeals, or in developing Medicare advocacy projects. The Center is staffed by attorneys, nurses, legal assistants, and information management specialists.  The Center’s work includes representing thousands of individuals in appeals of Medicare denial and responding to approximately 7000 telephone and email inquiries each year (Centers for Medicare Advocacy, Inc, 2012).

Needs versus Strengths

The initial assessment of the Medicare needs is based on the Ft. Collins, Colorado senior population that is growing. The Ft. Collins area needs additional funds to service the large senior population and receive more support from Medicare reform that will address the patients being released too early because of Medicare laws. The State of Colorado currently has over 500 assisted living facilities in Colorado. According to Assisted Living Directory (2012),” this number will certainly grow steadily in the coming years, as our baby boomer generation and Colorado seniors reach retirement age”. Currently, there are over 5,116,796 people living in the state of Colorado, with approximately 10.9% of Colorado residents being over the age of 65. This percentage is almost 2% lower than our national average of 13% (U.S. Census Bureau, 2012).

The strength of the Ft. Collins, Colorado community is funding. The state of Colorado has one the most resourceful grantors that are spending funds for healthcare for the elderly. The Colorado Health Foundation is one of the largest foundations in the state, with $2.2 billion in assets. In 2010, we invested $97 million in improving health and health care in Colorado (The Colorado Health Foundation (2012). Today, those funds have improved by filtering to the seniors that need the services however, the migrating seniors are putting more pressure on an already burden Medicare system.

Current assets

Columbine Health Systems net worth is not published but they have plenty of disposal cash. The owner Bob Wilson is creating a community safe house using one of his nursing home Columbine East assets to convert. In addition, Bob Wilson donated another expensive building to the Crossroads in 2008. This gift that Bob Wilson gave to the community was worth over $2.5 million. Other current assets in the Ft. Collins area has given donations of $350,000 ,waivers worth $67,000, the Colorado, the Colorado Department of Local Affairs, which donated more than $418,000 to the project; and the Gates Foundation with a $250,000 grant(Sokoloski,2010).

Current barriers

The current barriers are affecting the community. The Medicare patients are migrating to the Ft. Collins because of available nursing home, and elderly resources that may not be accessible in other states. The addition burden comes in the form of staffing needed per senior facility. The population is outgrowing the number of nurses, LPN’s, interns, social works, and other necessary healthcare workers. The secondary social problem is based on Colorado elderly not receiving quality healthcare because of Medicare has such stringent polices that prevent Medicare patient from getting the proper care before they are releases. This is a barrier because the Medicare and private Colorado funds are stretched to meet the current needs of the elderly; the programs continue to exhaust the resources to take care of the elderly.

Community Capital

The Ft. Collins area and the state have an abundance of community capital such as donations from Bill Gates that provides a yearly community block grant of $250,000. The Department of Local Affairs has donated over $418,000 to the community. The owner of Bob Wilson believes in the community growth, so he made a $2.5 million dollar gift to build a homeless shelter. The Colorado Health Foundation is one of the largest foundations in the state, with $2.2 billion in assets. In 2010, we invested $97 million in improving health and health care in Colorado.

Key leaders and people

The owner of Columbine Health Systems, Bob Wilson has provided millions of dollars to healthcare, social and Medicare projects in the Ft. Collins area. He is one the most influential community leaders in the last 30 years in Colorado. Dr. Beeson M.D is a leader in healthcare in Colorado. Dr. Beeson has been instrumental in developing data analysis profiles to meet the needs of practicing physicians, hospitals, and health care organizations. He helped create one of the first interactive medical web pages for one of the nations largest managed care organizations (Colorado Beacon Consortium 2011). This secure web page contained coded patient hospital data, formulary data, eligibility information, and clinical pathways, as well as links to multiple medical reference web sites.In his role with the executive committee, Dr. Beeson is able to provide insight into how best approach and integrate hospitals into a community wide network of outcomes focused initiatives.

Steve ErkenBrack currently serves as President and Chief Executive Officer of Rocky Mountain Health Plans. Prior to assuming this position, he served as Vice President of Legal and Government Affairs for the organization since 2002. Steve has a reputation in the community of knowing healthcare law and bringing important Medicare changes to the forefront.

Dr. Reicks is an important community leader that has a family practice physician in Grand Junction since 1989 is an active staff member with Community Hospital and St. Mary’s Hospital.  As the president of the local IPA since 2004, he has been instrumental in providing strong leadership to the physician community of Mesa County. Dr. Reicks is making the news in the community with 90% ambulatory care provider participation in Mesa County and one of the lowest cost Medicare communities in the country, physician collaboration in a virtual accountable care organization is making the difference in highly effective delivery of care.

Needs for leaders/people

Colorado has many leaders in the state that are supporting the Medicare Reforms, however the state need more advocates that will speak for the people in Washington, DC. The picture of the national economy is not as bright but Colorado need more activist, community members, churches, civic leaders, and individuals to put the Medicare issue in the news.

Resources needs and assets

Colorado has a plethora of financial resources including a wealth of assets in the community to business owners to community supporters. This proves that the Medicare release of patients too soon is a policy and procedure problem not a monetary one, per se. The Medicare programs need to re-direct the funds ensuring that the patients are ensured when they arrived at any hospital they will receive quality care regardless of their admission or discharge status. The state of Colorado need local resources and private businesses that can fill that void to ensure every senior gets the best possible care, regardless of Medicare stringent policies and procedures.

References

Assisted Living Directory (2012). Colorado assisted living facilities & senior care. Retrieved from http://www.assisted-living-directory.com/content/colorado.htm

Centers for Medicare Advocacy, Inc. (2012). About Medicare. Retrieved from http://www.medicareadvocacy.org/about/

Colorado Beach Consortium. (2011).Executive Leadership. Retrieved from http://www.coloradobeaconconsortium.org/executive-leadership/

Columbine Health Systems. (2010).Centre Avenue Health & Rehab Facility, LLC. Retrieved from http://www.columbinehealth.com/health_rehab/cahr/cahr.html

CPT12. (2012). Medicare physicians not taking Medicare basic insurance. Retrieved from www.cpt12.org/news/

ElderTeam.com (2012). What if rehab wants to discharge too soon? Retrieved from http://www.eldercareteam.com/public/475.cfm

Huffington Post (2012).  For-profit Hospitals pushing patients out too early: Report. Retrieved from http://www.huffingtonpost.com/2012/05/14/revenue-driven-hospitals-1514570.html

MDNH. (2012). Fort Collins demographics families statistics. Retrieved from http://fortcollins.areaconnect.com/statistics.htm

Nevada Legal Services (2009). Elderly law issues. Retrieved from http://www.nlslaw.net/elderlaw.html#healthcarepoa

Sokoloski, C. (2010).Crossroads nears fund-raising goal for new shelter. Retrieved from http://www.northfortynews.com/Archive/A20100803_CrossroadsFundingBldg.htm

The Colorado Health Foundation. (2012). Financial information. Retrieved from http://www.coloradohealth.org/finances.aspx

Troop97.com (2010). Fort Collins, Colorado. Retrieved from http://www.troop97.net/fcinfo.htm

Vladeck, B. C. (1999). The problem isn’t payment: Medicare and the reform of end-of-life care. generations, 23(1), 52.

Wells.S.D. (2010). Hospitals raking in cash from unnecessary surgery for dying seniors. Retrieved from http://www.fourwinds10.net/siterun_data/health/ama_pharmaceutial_and_insurance/medi1320168525.com

U.S. Census (2010).Fort Collins Demographics. Retrieved from www.uscensus.com