Archive for March, 2018
Home Health and Hospice Admissions, Utilization Trending Up
Author: Amy Baxter, Home Health Care News
Home health care and hospice admissions and utilization are both on the rise, according to the latest data report from Excel Health.
Hospice admissions grew 4.6% from the third quarter of 2016 to the third quarter of 2017, rising to 313,500, according to the report, which is based on 100% of the most recent Medicare Part A and B claims data. Excel Health offers on-demand, cloud-based data solutions and has robust medical databases.
Over the same year-to-year time period, hospice utilization grew, with 48.8% in the third quarter of 2017 being the highest utilization to date, and 1.7 percentage points greater than in the third quarter of 2016. Utilization is measured as the number of decedents that had hospice care over the number of total decedents.
Hospice admissions grew year over year in all states except five—Maine, North Carolina, New Jersey, New York and Iowa. Wyoming experienced the highest admissions growth, rising 19.2% year over year.
Nearly all states also had higher utilization rates, with only two states—North Carolina and Arkansas—seeing a slight drop in utilization year over year.
Home health care admissions grew 0.7% in the second quarter of 2017 from the same three months in 2016, reversing a negative trend seen over the previous few quarters. Fourteen states saw a decline in admissions year over year. Wyoming had the highest growth in admissions—13.2% year over year.
Utilization remained near its constant rate, around 1.6% for all Medicare beneficiaries in the second quarter 2017, according to the report. All states saw higher utilization of home health care services, with both Massachusetts and Mississippi growing 2.4% year over year.
As more baby boomers age into Medicare eligibility, the proportionate demand for home health care has dropped, as the average age of Medicare beneficiaries declines. Demand will likely rise again as a proportion of the Medicare population as baby boomers age.
The growth of home health care and hospice services is not totally surprising, as 10,000 baby boomers turn 65 every day.
From the third quarter of 2016 to the same period in 2017, the total number of Medicare beneficiaries rose 2.3%, from 56.1 million to 57.5 million, according to the report. And the growth of beneficiaries also means spending will rise. By 2027, the rate of Medicare spending as a percentage of total federal spending is expected to rise to 17.5%.
Another Reason to Avoid Heavy Drinking? Dementia
Dr. Arefa Cassoobhoy, a practicing internist, Medscape advisor, and senior medical director for WebMD in a recent Medscape Morning Report 1-minute news story for primary care, reported that heavy drinking can lead to many health issues. 
Dr. Cassoobhoy shared a new study[1] that looks at alcohol use and dementia. The French observational study included over 1 million adults diagnosed with dementia between 2008 and 2013. It found that of 57,000 cases of early-onset dementia, 39% were due to an alcohol-related condition like Wernicke-Korsakoff syndrome, liver disease, epilepsy, or head injury. And 18% had an additional diagnosis of alcohol-use disorder.
Overall, alcohol-use disorders were associated with a three-times greater risk for all types of dementia.
The researchers concluded that heavy drinking is the strongest modifiable risk factor for dementia. Dr. Cassoobhoy says this should motivate us to focus on early screening, brief interventions, and treatment to help our patients.
Waiting Rooms Encouraged to Show Video with New Medicare Cards
Click for new video featuring the replacement IDs
Originally published in AARP’s Health Medicare Resource Center By Dena Bunis, AARP, March 2018
Medicare is asking doctors to play a new video in their waiting rooms to remind patients that the federal government will begin mailing them new identification cards next month.
The video gives beneficiaries a glimpse at what the new card will look like and explains why and how it was modified. Instead of a Social Security number, the cards will display an 11-digit Medicare beneficiary identifier, and they will no longer include gender and a signature.
Eliminating the personal details, Centers for Medicare and Medicaid Services (CMS) officials say, will better protect an enrollee’s identity and guard against fraud.
The Social Security Administration (SSA) urges Medicare enrollees to make sure the agency has their correct address on file. You can go to socialsecurity.gov/myaccount or call 800-772-1213 to update your address.
Scammers with various ploys have already started to target the 58 million individuals who will be getting new cards. The Federal Trade Commission (FTC) reports that con artists are calling beneficiaries and pretending to be from Medicare, then trying to talk them into paying for the revised card. Medicare will never call and ask for any personal identification or money for the new cards. The cards are free and will be mailed to members’ homes.
Medicare beneficiaries in Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia and West Virginia will be the first enrollees to receive the replacement cards. The mailings will continue through 2019.
Family is biggest influencer of older adult housing and care preferences: study
Author: Lois A. Bowers, Senior Editor, McKnight’s Senior Living
Family support is the biggest influencer of housing and care preferences among older adults, according to a study published Wednesday (March 7, 2018) in the Journal of the American Geriatrics Society.
Often, the authors found, older adults changed their preferences based on the concerns of family members or a wish to avoid “being a burden” to others. This basis was especially true for preferences regarding the places where people wished to receive care — for example, at home or in a residential care setting, they said.
The researchers, all of whom were affiliated with the Cicely Saunders Institute of Palliative Care Policy and Rehabilitation at Kings College London, examined 57 previous studies about the preferences of older adults with advanced illness. They included research that investigated preferences for where people wanted to be cared for, the kinds of communication and decision-making they wanted and the quality of life they hoped to have over time.
Family involvement is key in care decisions
Although support from family was the most important influence on their care preferences, older adults usually formed their preferences based on several other factors, too, including their experiences related to previous illness and caring for others as well as having a serious illness, according to the study.
The Other Side of the Conversation
Author: Christopher M. Thompson, MD, HMDC
This article originally was published in Winter 2017 NewsLine.
In this post, a physician connects his personal and professional caregiver roles.
As palliative care providers, we spend our careers talking about end-of-life care and helping families make difficult choices about life and death. Have you ever been on the other side of the conversation, answering questions and making decisions for your own loved ones? I have cared for thousands of patients at the end of life, but recently I’ve been on the other side of that conversation – twice.
My first conversation began with “Momma,” my wife’s 91-year-old paternal grandmother. Her decline started with a kidney stone, which then led to urinary tract infections and tremendous pain. Momma made the decision to have lithotripsy. During the procedure, she had respiratory distress and required intubation. Her heart was not strong enough to tolerate this “routine” procedure. She developed right-sided heart failure and pulmonary edema. Doctors were able to extubate her; however, she continued to have more respiratory distress. She was not doing well. They placed her on Bi-pap but she did not tolerate this. She was in the hospital, agitated, dyspneic, and did not want to be re-intubated.
So now what? Our family had to begin those difficult discussions. Do we continue to push aggressive care? Momma told the family she was tired and ready to die. It was hard for our family to acknowledge what this meant even knowing her wishes. Added to that, it was two weeks before Christmas and my family lived six hours away from Momma. We decided my wife and our three-year-old daughter would travel to Georgia while I stayed home to work. I wanted my wife to be there for the conversation in person and to see her grandmother, as I knew this might be her final days on earth. After discussing options, the family agreed to inpatient hospice care.
I was too involved with work and like many times before chose work over family. My wife was at Momma’s bedside for less than 24 hours when she called me telling me that Momma was asking for me, “The Doctor.” I pulled myself away from work in the middle of the day and headed to Georgia.
I was now being asked medical questions as well as “what about Christmas?”, “what do we tell the great-grandchildren?”, and “is this the right thing to do?” I did not have answers. I had memories and emotions for this woman I loved; I did not want to think, “Momma is dying.”
All the signs were there; it was her time to die. The family began the journey with Momma. I have worked in three different inpatient hospice facilities. It’s easier for me to study the staff, their workflow, their EMR, their census, their medical director – this is what I know. My wife reminded me that this time, I was there for Momma and our family. I was not “The Doctor” now; I was family.
Staff managed Momma’s symptoms quickly and she had two good days talking and interacting. We had made the right choice, albeit not an easy one. Long days and nights at the hospice home wear a family down. Hospice staff participate in these experiences daily. We think how hard it must be for the patients and families. When you are on the other side, you feel the sorrow and you learn a lot about the value of hospice care.
Momma died peacefully four days later. We returned home to North Carolina, only to receive a phone call that “Granny” was in the hospital. Granny was my wife’s 78-year-old maternal grandmother. She had Alzheimer’s disease, had fallen at home, and had developed altered mental status. She was not eating, she had a UTI, and a CT scan showed a small hemorrhage in the frontal lobe. Granny was agitated, not eating, and declining. So now what?
Just three weeks earlier we had lost Momma. Now our family was deciding on inpatient hospice for Granny.
My wife, daughter, and I packed the car and headed for Florida. I took the time from work, but I was still on call and was on the phone, giving orders the entire trip. Once again, it was easier for me to do my work as a hospice physician than confront what I had no control over. We were losing both our grandmothers within three weeks.
As we arrived in the middle of the night, we received a call letting us know Granny died. She had declined quickly. That was truly a blessing. After all the heartbreak and tears, we went to Granny’s house and celebrated her life. This is what she would have wanted.
Those two experiences remind me how hard end-of-life conversations are for families. We as palliative care providers need to remember it is different when there are memories and emotions involved. No matter how informed our families are, these decisions are not easy. And, it’s hard being on the other side. We are no longer medical professionals, we are family. All our medical training leaves our mind and we become an emotional basket case. We find it hard to think straight or make rational decisions. It’s difficult living with the decisions and through those choices.
I’m 40 years old, my parents are approaching retirement, and my grandparents are dying. I have friends who are struggling with acute and chronic illnesses. All of this has made me a better hospice and palliative care physician and I’m glad I can reflect on my training and life experiences to help my patients and families. I make the conversations personal and emotional. I have more empathy during family meetings. I think this adds a new dimension to the work I do, the work I’m proud to do.
These two experiences brought our family closer together and I’m grateful I could help in the decision-making process. My family saw firsthand how our jobs as hospice and palliative care providers are intensely emotional. We all need to realize the impact we have on the families we care for, how a well-trained hospice and palliative care staff can have an impact on a family.
During our trip home from Florida, my wife looked at me and asked, “How do you do this day after day? I am proud of you and now understand your job even more and how rewarding it must be.”
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Christopher M. Thompson, MD, HMDC, assisted in developing the palliative medicine programs at two hospitals prior to joining Transitions LifeCare as Medical Director for Transitions Kids, Transitions LifeCare’s pediatric hospice program. Dr. Thompson is board certified in Family Medicine. After completing his Fellowship, Dr. Thompson became board certified in Hospice and Palliative Medicine with the added qualification of Hospice Medical Director Certification.
March Celebrates Social Work
Professionals who care. Helping improve people’s lives is at the heart of social work
In honor of National Social Work Month in March, below are facts about social workers from the National Association of Social Workers:
About Social Workers
Social workers seek to improve the lives of others.
Social work is a profession for those with a strong desire to help improve people’s lives. Social workers assist people by helping them cope with issues in their everyday lives, deal with their relationships, and solve personal and family problems.
According to the Bureau of Labor Statistics, there were almost 650,000 social workers in the United States in 2014. With an expected growth in jobs of 12 percent by 2024, social work is one of the fastest growing professions in the United States.
Who are social workers?
Social work is a profession for those with a strong desire to help improve people’s lives. Social workers assist people by helping them cope with issues in their everyday lives, deal with their relationships, and solve personal and family problems.
Some social workers help clients who face a disability or a life-threatening disease or a social problem, such as inadequate housing, unemployment, or substance abuse. Social workers also assist families that have serious domestic conflicts, sometimes involving child or spousal abuse.
Some social workers conduct research, advocate for improved services, engage in systems design or are involved in planning or policy development. Many social workers specialize in serving a particular population or working in a specific setting.
What do social workers do?
- Social workers help individuals, families, and groups restore or enhance their capacity for social functioning, and work to create societal conditions that support communities in need.
- The practice of social work requires knowledge of human development and behavior, of social, economic and cultural institutions, and of the interaction of all these factors.
- Social workers help people of all backgrounds address their own needs through psychosocial services and advocacy.
- Social workers help people overcome some of life’s most difficult challenges: poverty, discrimination, abuse, addiction, physical illness, divorce, loss, unemployment, educational problems, disability, and mental illness. They help prevent crises and counsel individuals, families, and communities to cope more effectively with the stresses of everyday life.
Who employs social workers?
- Professional social workers are found in every facet of community life—in schools, hospitals, mental health clinics, senior centers, elected office, private practices, prisons, military, corporations, and in numerous public and private agencies that serve individuals and families in need. Many also serve as social and community service directors.
- According to the Substance Abuse and Mental Health Services Administration (SAMHSA), professional social workers are the nation’s largest group of mental health services providers. There are more clinically trained social workers—over 200,000—than psychiatrists, psychologists, and psychiatric nurses combined. Federal law and the National Institutes of Health recognize social work as one of five core mental health professions.
- The S. Department of Veterans Affairsemploys more than 13,000 professional social workers. It is one of the largest employers of MSWs in the United States.
- More than 40% of all disaster mental health volunteers trained by the American Red Cross are professional social workers.
- There are hundreds of social workers in national,state and local elected office,These include one U.S. Senator and six U.S. Representatives. Sen. Debbie Stabenow (MI), Rep. Barbara Lee (CA-13), Rep. Kyrsten Sinema (AZ-9), Rep. Carol Shea-Porter (NH-1), Rep. Luis Gutierrez (IL-4), Rep. Niki Tsongas (MA-3) and Rep. Susan Davis (CA-53).
- Today, almost 50 special interest organizations contribute to the vitality and influence of the social work profession. There are social work groups for educators and researchers, as well as organizations for practitioners in health care leadership, nephrology, oncology, child welfare, schools, prisons, courts, and many other settings.