Study: Behavioral Therapy More Beneficial To Dementia Patients Than Drugs

For caregivers serving those suffering from Alzheimer’s disease or other dementias, the biggest challenge is often coping with other behaviors common in dementia. Antipsychotic drugs to treat these symptoms has become increasingly common with approximately 1 in 3 dementia patients in nursing homes being prescribed them. Outside of nursing homes, 1 in 7 dementia patients are prescribed these drugs – all despite a warning from the Food and Drug Administration saying that antipsychotics increase the risk of death for people with dementia.

According to a recent study published in the British Medical Journal, antipsychotics are much less effective than non-drug treatments in controlling the symptoms of dementia. Researchers say the treatments that show the best results were ones that trained caregivers on how to communicate calmly and clearly, and those that introduced hobbies and other activities to the patient. Researchers believe caregiver interventions work because they train caregivers to look for the triggers of the symptoms. When a caregiver sees the triggers of the symptoms, they train patients on how to manage them.

Healthcare providers typically use antipsychotics because they have not been trained to use non-drug approaches and when they do know how to use them, they are rarely reimbursed for doing so by Medicare or private insurance.

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Report: More Than 65% Of Medicaid Is Now Managed Care

According to recently released report, Medicaid managed care may have reached a “tipping point” in 2014, as the number of managed care beneficiaries increased while fee-for-service enrollment dropped. The number of people on private managed care plans has increased by 9.3 million, while the number in traditional fee-for-service or public managed care plans decreased by 300,000. The growth can be attributed to two factors. The first is that states expanding Medicaid eligibility through the ACA are opting for private managed care for new populations. The second is that states are relying more on private plans to “better control costs and deliver services.” Typically, states achieve these cost controls by providing capitated payments to the private plans. Many long-term care providers have protested that managed care organizations may prioritize efficiency over quality care. They also believe many managed care organizations do not have the expertise in working with specialized beneficiary populations-like the ones utilizing long-term services and supports.

Click here to see the report.

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2015 OIG Work Plan Highlights: Nursing Home Services

We recently highlighted the home health and hospice services sections of the 2015 OIG Work Plan. Today, we’ll delve deeper into the nursing home services section:

Medicare Part A billing by skilled nursing facilities. The OIG will describe skilled nursing facility (SNF) billing practices and the differences among SNFs in specific years. The OIG found that SNFs billed one-quarter of all 2009 claims in error, resulting in $1.5 billion in inappropriate Medicare payments. The OIG notes that CMS has made significant changes to how SNFs bill for Medicare Part A stays.

Questionable billing patterns for Part B services during nursing home stays. The OIG will identify and review questionable billing patterns of nursing homes and Medicare providers for Part B services provided to nursing home residents during stays not paid under Part A.

State agency verification of deficiency corrections.The OIG will determine whether State survey agencies verified correction plans for deficiencies identified during nursing home recertification surveys. Federal regulations require nursing homes to submit correction plans to the State survey agency or CMS for deficiencies identified during surveys.

Program for national background checks for long-term-care employees. The OIG will review the procedures implemented by participating States for long-term-care facilities or providers to conduct background checks on prospective employees and providers who would have direct access to patients.

Hospitalizations of nursing home residents for manageable and preventable conditions. The OIG will determine the extent to which Medicare beneficiaries residing in nursing homes are hospitalized as a result of conditions thought to be manageable or preventable in the nursing home setting. The OIG states hopitalizations of nursing home residents may indicate quality-of-care problems in nursing homes.

Click here to see the plan.

MedPAC Proposes Eliminating Observation Stays

During a meeting last week, members of the Medicare Payment Advisory Commission (MedPAC) proposed eliminating observation status, declaring it ineffective in classifying hospital patients. Medicare will only cover skilled nursing services after a beneficiary spends three days as a hospital inpatient and any time spent in observation is not counted toward this threshold. In 2012, 11,000 hospital stays ended with a non-covered discharge to a skilled nursing facility.

However, other members of MedPAC believe that making observation stays into inpatient stays “could wreak havoc with billing procedures and increase costs for beneficiaries.” Other remedies for the surge in observation stays include having MedPAC focus their oversight more strictly on hospitals that have a high percentage of one-day inpatient stays and changing the three-day requirement for skilled nursing coverage.

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Report: Hospice Is Growing Fastest In Skilled Nursing Facilities

According to a new report from the National Hospice and Palliative Care Organization, hospice services are increasing in nursing homes more than in any other care setting. From 2012 to 2013, the percentage of hospice patients receiving end-of-life care in nursing homes grew from 17.2% to 17.9%. Researchers say more people with chronic diseases are living longer, explaining the growth of hospice in this setting.

Most hospice patients receive care in their own home or other private residences, but the number of hospice patients in this setting showed the lowest annual increase. Additionally, the proportion of hospice patients in residential facilities and hospice inpatient facilities decreased. Acute care hospitals grew significantly from 6.6% to 7.0% although they are still not major sites for hospice care.

The median length of stay for hospice patients is also becoming a concern for hospice professionals. Researchers noted that many dying Americans receive care for a week or less and that “we need to reach patients earlier in the course of their illness to ensure they receive the full benefits that hospice and palliative care can offer.”

Click here to access the report.

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OIG 2015 Work Plan Released

The Office of the Inspector General (OIG) has just released its 2015 Work Plan and it looks a lot like its 2014 plan. The OIG will still be focused on inappropriate Part A and Part B billing in Nursing Facilities; general inpatient care billing for Hospice; compliance with PPS requirements in home health, with special scrutiny on newly enrolled home health agencies as well as review of employment of individuals with criminal convictions in the home care setting. The OIG will also still be looking at inappropriate Part B billing for Chiropractor services; place of service coding errors for Physician services; and the high use of outpatient Physical Therapy services.

To read the OIG’s full plan, click here.

CMS Proposes 1.4% SNF Payment Increase

The Centers for Medicare & Medicaid Services (CMS) has proposed a 1.4% hike in Medicare payments to Skilled-Nursing Facilities (SNFs) for FY 2014. The agency estimates the bump would increase payments to these providers by about $500 million from 2013 levels.

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