America has always been a generous country, and some professions encourage practitioners to offer free services to those who need but can’t afford those services. For example, lawyers are encouraged to do pro bono work for the indigent who need legal representation. The American Bar Association and other legal organizations include this in their codes of ethics.
Physicians are also encouraged to provide free or reduced-cost services, but the proportion of doctors who give charity care is on the decline. One of the reasons cited are lower rates of reimbursement from insurers. From the Washington Post:
Overall, higher-paid specialists or doctors working in small private practices were more likely to provide charity care than internists, pediatricians or those employed by large managed-care companies, the survey found.
Nearly 80 percent of surgeons reported providing free care, largely because they spend more time in hospitals, which are required by law to treat indigent patients. Pediatricians, on the other hand, probably saw less demand for charity care because higher percentages of children receive care through government programs. Although the number of physicians providing charity care has remained stable, the proportion has fallen because there are many more doctors practicing medicine.
The information was obtained from a report issued by the Center for Studying Health System Change. You may read the report here.
Nursing homes are bearing the brunt of state budget cuts and after-effects of the hurricane season.
For example, Louisiana faced $70.2 million in budget cuts, but the Senate decided to exclude a provision that called for a $36 billion reduction in Medicare and Medicaid funding. The House of Representatives may choose to include the provision.
From United Press International:
“What we’re looking to do is get the economic stability to do a better job,” said Bruce Yarwood, president and chief executive officer of the American Health Care Association, a long-term-care industry group, at a congressional briefing on Tuesday.
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Currently, Medicaid reimburses care providers an average of $125 per day — just $5 per hour per patient — and in some states, the figure is substantially lower.That is not enough to cover expenses, Yarwood said, and nursing homes rely on Medicare rates, which are somewhat higher, to fill the hole.
Hurricane Katrina alone cost one long term care provider named in the report and which has nursing homes in Louisiana and Texas, $500,000. More funding cuts would make the situation much worse.
Photo source: Acadian Rehabilitation & Nursing Center, Baton Rouge, LA
In January, I blogged about a provider letter issued by the Texas Department of Aging and Disability Services (DADS) to Home and Community Support Services Agencies (HCSSA). At that time, DADS reported lengthy delays in processing applications for initial licensure and Medicare certification because of the number of applications received.
In a new letter, DADS advises HCSSA’s to expect more delays, especially in places like Region 6 (Houston Regional Office) and Region 3 (Arlington Regional Office). To read the letter, click on this link. As before, DADS suggests that HCSSA’s renew licenses at least eight months before expiration dates.
If applying for initial Medicare certification, HCSSA’s should have provided services to at least one patient before applying.
Last month I blogged about an artificial spinal disk called Charite by (Johnson & Johnson). The Centers for Medicare and Medicaid Services proposed to deny coverage for the surgery, citing lack of evidence that it is “reasonable and necessary.” The 30-day period for comments ended last Friday, and it appears Medicare will not cover the procedure. The final ruling is due in May.
From the New York Times:
The Medicare decision was based on several well-known criticisms of Charité. The trials to gain F.D.A. approval did not provide data on how it would perform over the two decades or more that it is expected to last.
In addition, the trials compared the device with a form of spinal fusion no longer considered state of the art and they were designed to show that it was equivalent, not an improvement. Nor did the government find convincing evidence that Charité and other spinal disks leave patients with substantially more range of motion over time and that they do less damage to neighboring disks.
Proponents argue that the government was ignoring or playing down data that cast the disk in a more favorable light while giving too much weight to outdated reports of performance problems.
If Medicare won’t cover Charite, private insurers may follow suit. If CMS decides not to cover surgery for Johnson & Johnson’s product, beneficiaries may still have options. According to the article, a Swiss company has developed a similar product, which could be approved by September.
According to Mike Leavitt, secretary of the Department of Health and Human Services, prescription drug prices have dropped, thanks to “market forces.” (Medical News Today)
So capitalism works? Excellent news!
President Bush must have had the right idea by injecting competition into Medicare’s prescription drug program, the same one that people say is confusing. According to a survey conducted by America’s Health Insurance Plans, however, the plan is not so confusing after all. From the Washington Post:
According to AHIP, three out of five seniors reported they have saved money under the plan, compared to their previous costs, and four out of five said the plans they chose covered the drugs that they needed.
“When you get out of Washington and listen to seniors, you learn that seniors are saving and that the vast majority are not experiencing problems,” Ignagni said.
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The survey reported that 35 percent of “dual eligible” seniors — those who get Medicare and Medicaid benefits — are skeptical about the motives behind those who “attack” the new program. These seniors said politicians who have criticized the plan are motivated by a “desire to score political points,” according to the survey.
And it all comes down to politics.
This past November, employers were required to notify Medicare-eligible employees, retirees and dependents about whether their current prescription drug coverage was “creditable” for purposes of Medicare Part D. Employers must now notify the Centers for Medicare & Medicaid Services (CMS), and CMS has published guidelines for doing so.
To comply with the disclosure requirement, employers must fill out the form on the Creditable Coverage Disclosure to CMS Website at: www.cms.hhs.gov/apps/ccdisclosure/default.asp. Difficult if not impossible to determine whether spouses or dependents are eligible for Medicare, any employer offering prescription drug coverage should be overly cautious and simply notify CMS.
The initial disclosure notice must he provided by March 31, 2006. Other disclosure notices must be provided:
• Within 60 days after the beginning of the plan year, for plan years that end in 2007 and beyond;
• Within 30 days after the termination of the prescription drug plan; or
• Within 30 days after any change in the creditable coverage status of the prescription drug plan.
Who is covered? Group health plans; government-sponsored plans; military coverage; individual health insurance; Indian health service, tribe or other tribal organizations and urban Indian organizations; and Medigap (Medicare supplement) plans; pre-standardized plans; waiver state plans; and plans with innovative benefits.
Exempt: Prescription Drug Plans (PDPs); Medicare Advantage Plans with prescription drug coverage (MA-PDs); Programs of All-Inclusive Care for the Elderly (PACE) or cost-based Health Maintenance Organizations (HMOs) Competitive Medical Plans (CMPs) that provide “qualified Part D coverage”; and employers that have claimed the 28% retiree drug subsidy.
The Fair Labor Standards Act (FLSA) requires employers to pay workers for all hours actually worked. So, mistakes in calculating break times can sometimes lead to wage errors resulting in penalties and fines assessed by the Department of Labor (DOL).
What does the law say? It is illegal to dock hourly non-exempt employees for short breaks (typically between five and 20 minutes) and for any portion of their meal breaks that they actually worked.
Example: An employer docked hourly employees for brief rest periods and one hour for lunch breaks when only 30 minutes were taken. In the face of a DOL complaint, the employer agreed to pay $204,000 in back wages and a $39,380 fine.
When is break time not compensable? When sluggish workers extend a scheduled rest break into long ones, employers do not have to pay for the extra time taken by the employee. Per the DOL, a company must expressly and unambiguously notify employees that:
1. The authorized break may only last for a specific length of time;
2. Any extension of the break is contrary to company rules: and
3. Any extension of the break will result in disciplinary action.
What does the law say? You can restrict employees’ activities during their unpaid meal break, but they must be completely relieved of duties for it to remain unpaid.
Example: An employer required employees to remain on the company premises during lunch breaks. They had to eat in a small lunchroom, and they could not change clothes, make telephone calls or leave the building. Employees claimed that should be paid for the time because of all these restrictions. Not so, said the DOL in its opinion letter. Despite all these restrictions, the company never interrupted employees to do work during their breaks. Therefore, the breaks were unpaid time. (Caveat: DOL opinion letters are informative concerning the DOL’s position on certain topics, but they are only binding on the specific employer requesting the letter.)
A New Jersey Superior Court has held that an employer that fails to act on evidence of an employee’s criminal online activities should be held accountable. Specifically, co-workers had complained about the employee’s computer abuse, and the employee’s supervisor had become suspicious that the employee was abusing his Internet use on the Company’s computers. The company failed to take any action until later monitoring showed the employee was accessing numerous pornography sites, including child pornography. The company instructed the employee to stop but took no further action, and the employee’s web access continued unabated. Months later, the employee was fired after he was arrested for uploading nude and semi-nude images of his 10-year-old stepdaughter. The employee’s wife sued the company for negligence on behalf of the daughter. In rejecting the employer’s claim it had no duty to the daughter, the court held that an employer that is on notice of an employee using a workplace computer to access pornography, possibly child pornography, has a duty to investigate the employee’s activities and take prompt and effective action to stop the unauthorized activity lest it result in harm to innocent third parties which can be anyone, not only a child. (Doc v, XYC Corp., N.J. Super. Ct. App. Div., No, A-2909-04T2, 2005)
The facts of this case were particularly egregious, but all employers should be prepared to investigate and put a halt to an employee’s suspected on-duty illegal activity, such as distributing child pornography. The case is also a reminder that employers may be held responsible for employees’ use of company computers that might create an offensive workplace environment.
What can you do to protect against co-workers’ or third party claims based on employee abuse of company computers?
1. Reiterate in company policies and practices that employees have no reasonable expectation of privacy for Internet and e-mail use when company-provided computers and networks are involved.
2. Implement some type of protective measure, such as blocking or monitoring software that tracks employee Internet usage.
3. Don’t ignore inappropriate use of the company’s computers. Follow your company’s disciplinary steps with the goal of either eliminating the behavior or eliminating the employee.
4. Follow up on findings - a mistake made in Doe. The company actually found multiple examples of the employee entering explicit websites and then decided not to pursue the matter or investigate. Just as in all harassment issues, if employees bring to management’s attention information that suggests an employee is using company computers to access improper websites, you have an obligation to investigate and take appropriate action.
5. Document the company’s efforts to eliminate the misuse of the company equipment.
In the long term care industry, there is what’s known as the “Quality First Pledge,” containing seven core principles:
- Continuous Quality Assurance and Quality Improvement
- Public Disclosure and Accountability
- Patient/Resident and Family Rights
- Workforce Excellence
- Public Input and Community Involvement
- Ethical Practices
- Financial Stewardship
(Source: American Health Care Association)
Harborside Healthcare, a long term care provider, released a quality report titled, Fulfilling Our Pledge (PDF). From the press release:
In the report, Harborside makes available to the public detailed information on its approaches to quality care, its systems and processes, and their results. Since the pledge was signed in 2002, Harborside has made significant investment in its workforce, its systems and its infrastructure.
As the report reveals, these investments are paying off. Harborside’s report reveals improvements in many areas. Regulatory deficiencies are down, and clinical indicators continue to improve. Harborside has made significant gains in the stability of its workforce, cutting turnover by 38% and the use of agency staff by 83%. In the critical area of customer satisfaction, Harborside was ranked first among its peers in several important categories including quality of licensed care and CNA care.
The quality principles are akin to industry standards, which are beneficial for many reasons. They provide consistent and proven guidelines for what works and what doesn’t, and they eliminate the need to reinvent the wheel, so to speak. The principles outlined by the AHCA take into consideration patient care, and workforce and financial accountability. Long term care providers should strive for excellence in all three areas.
The Japanese love gadgets. First, it was the Japanese Boyfriend pillow,
Now, they are inventing Robots to care for the elderly. Regarding the Robot in the top picture,
A Japanese-led research team said it had made a seeing, hearing and smelling robot that can carry human beings and is aimed at helping care for the country’s growing number of elderly. Government-backed research institute Riken said the 158-centimeter (five-foot) RI-MAN humanoid can already carry a doll weighing 12 kilograms (26 pounds) and could be capable of bearing 70 kilograms within five years.
The Robot can detect odors,
The 100-kilogram (220-pound) robot can also distinguish eight different kinds of smells, can tell which direction a voice is coming from and uses powers of sight to follow a human face.
“In the future, we would like to develop a capacity to detect a human’s health condition through his breath,” Mukai said.
The Japanese have also invented Robot assist limbs,
The purpose is,
A researcher at Japan’s University of Tsukuba, Sankai has developed a robotic suit designed to make it easier for elderly people with weak muscles to move around or for care-givers to lift them.
The sleek, high-tech get-up looks like a white suit of armor. It straps onto a person’s arms, legs and back and is equipped with a computer, motors and sensors that detect electric nerve signals transmitted from the brain when a person tries to move his limbs.
When the sensors detect the nerve signals, the computer starts up the relevant motors to assist the person’s motions.
Here is a Robot bath invented by the Japanese for the elderly,
One of the most labor-intensive nursing home tasks is bathing frail residents. For this job, Sanyo Electric has introduced what is essentially a robot bathtub. Costing about $50,000, it closes around a patient who is seated in a wheelchair. The wash and rinse cycles operate automatically. A nurse’s aide takes care of washing hair and toweling the resident off. Japan’s need for elder-care robots is partially driven by a falloff in its national birthrate, which has left the country with too few young to care for the old.
There are even robot dogs for the elderly,
OHBU, Japan - The elderly patients suffer from severe dementia, but their faces light up when they see the dog-shaped robot, swaddled in soft clothing, waddle around the hospital floor. Some clap; others break into feeble smiles. Urged by nurses, a few cautiously reach out and touch it.
“It’s cute,” one female patient cries out.
This is one in a budding series of robot-therapy sessions at Japanese hospitals and senior citizens’ homes. To some scientists, robots are the answer to caring for aging societies in Japan and other nations where the young are destined to be overwhelmed by a surging elderly population.
I could live with a robot bath, but a robot dog?