http://www.chicagotribune.com/news/ct-sacred-heart-hospital-sentencing-met-20160812-story.html
Venkateswara Kuchipudi, right, walks with his lawyer Theodore Poulos outside the Dirksen U.S Courthouse on Aug. 12, 2016, after Kuchipudi was sentenced to two years in prison for his part in a fraud scheme at the now-shuttered Sacred Heart Hospital.
http://www.modernhealthcare.com/article/20160723/MAGAZINE/307239984
The November elections surely won’t end the nonstop, eight-year political war over the shape of the U.S. healthcare system. But the ballot results likely will determine whether the changes driven by the Affordable Care Act continue in the same direction or the system returns to its less-regulated, pre-ACA contours.
Heading into this week’s Democratic National Convention, Hillary Clinton has promised to preserve and expand the ACA’s coverage expansions and delivery system reforms. Donald Trump, who accepted the Republican nomination last week, says he wants to repeal them, without offering much detail about what he would put in their place. The fate of the victor’s proposals, however, will depend heavily on the partisan makeup of Congress.
The clearest scenario is if Trump wins and his party retains control of both the House and the Senate, which would enable conservatives to repeal or roll back the ACA and implement at least some of the proposals outlined in the GOP party platform and the recent House Republican leadership white paper on healthcare. But there are divisions even among conservatives over issues such as Medicare restructuring and how to help Americans afford health insurance. And Senate Democrats almost certainly would use their filibuster power to block major ACA changes.
If Clinton wins and Democrats take control of both the Senate and the House—which is considered unlikely—she might be able to push through proposals such as increasing funding for federally qualified community health centers. But Senate Republicans also could use the filibuster to foil her. In the more likely scenario of a Democratic-controlled Senate and a GOP-controlled House, it’s not clear how much Clinton could achieve through the legislative process.
Donna Nickerson spent her last working years as the activity and social services director at a Turlock, California, nursing home.
But when she developed Alzheimer’s disease and needed that kind of care herself, she and her husband couldn’t afford it: A bed at a nearby home cost several thousand dollars a month.
“I’m not a wealthy man,” said Nickerson’s husband Mel, a retired California State University-Stanislaus professor. “There’s no way I could pay for that.”
Experts estimate that about half of all people turning 65 today will need daily help as they age, either at home or in nursing homes. Such long-term care will cost an average of about $91,000 for men and double that for women, because they live longer.
In California and across the U.S., many residents can’t afford that, so they turn to Medicaid, the nation’s public health insurance program for low-income people. As a result, Medicaid has become the safety net for millions of people who find themselves unable to pay for nursing home beds or in-home caregivers. This includes middle-class Americans, who often must spend down or transfer their assets to qualify for Medicaid coverage.
Medicaid, known as Medi-Cal in California, was never intended to cover long-term care for everyone. Now it pays for nearly 40 percent of the nation’s long-term care expenses, and the share is growing. As Baby Boomers age, federal Medicaid spending on long-term care is widely expected to rise significantly — by nearly 50 percent by 2026.
Now that our presidential nominees are set and the general election has begun, what do our nation’s hospitals and health systems need to do, whether Secretary Clinton or Mr. Trump is elected in November? They, and their parties, offer stark contrasts, but what will they mean for hospitals?
Click to access ChronicCareManagement.pdf
The Centers for Medicare & Medicaid Services (CMS) recognizes care management as one of the critical components of primary care that contributes to better health and care for individuals, as well as reduced spending. Beginning January 1, 2015, Medicare pays separately under the Medicare Physician Fee Schedule (PFS) under American Medical Association Current Procedural Terminology (CPT) code 99490, for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions.
CPT 99490 is defined as follows: 99490 Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:
> Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
> Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, `
> Comprehensive care plan established, implemented, revised, or monitored.
CMS proposed Monday a new mandatory bundled payment program for heart attacks and bypass surgeries that includes changes to the existing Comprehensive Care for Joint Replacement Model as part of its larger goal to shift Medicare from quantity to quality incentives.
Here are 10 things to know about the proposed rule.
Hillary Clinton is quick to tout that she will defend the Affordable Care Act (ACA) and build on it to slow the growth of out-of-pocket healthcare costs while Donald Trump vows to repeal the ACA and have a series of reforms ready for implementation that follow free-market principles.
But when taking a closer look at their proposals, Clinton and Trump are keeping mum about some healthcare issues, and that’s raising some critical questions. Managed Healthcare Executive asked industry experts to comment on what topics presidential candidates are being quiet about, and why they suspect they’re not talking about them.
HENRY KOTULA 