Medicare

The Washington Post this weekend had a human interest story in the Metro section -- a 110-year-old woman reunited with her 85-year-old daughter, who had been in a nursing home for the past three years. The mother Eddye Williams is believed to be Washington's oldest citizen. They are able to live together again in their home because of an innovative program by Washington Hospital Center that provides home-based care for sick elderly people, including house-calls by a physician and a home health aide under a Medicaid waiver. It's a touching story, of family, faith and medicine, but what really caught our eye is that it's a wonderful example of what health care can look like under health reform.

(Left out the Health Affairs link -- reposting)

Too hot in DC (literally and metaphorically) to think of anything snappier than "good news, bad news" about Don Berwick’s recess appointment to head the Center for Medicare and Medicaid. Good of course because CMS needs a dynamic, visionary (and remarkably optimistic) leader to transform what by many accounts is a somewhat ossified and demoralized bureaucracy into a new era of innovation and improvement. Bad because a recess appointment only lasts until the end of 2011 when the current Congress expires.

And really, really bad because a professional appointment that should have been embraced with a bipartisan Hallelujah choir has become another political volleyball. Even though numerous medical organizations, including the AMA, and his Republican predecessors have sung his praises.

(This post first appeared on the Altarum Health Policy Forum. In a future post I'll tie it into advanced medical homes and other aspects of health reform  that address the needs of  the chronically ill and the elderly.)

Transitions are one of the weak points in the U.S. health care system. Poor coordination and inadequate communication around transitions is particularly pronounced in the care of frail elderly people with multiple chronic diseases -- or maybe an acute illness or injury on top of a whole big bunch of chronic diseases.

Wishard Memorial Hospital in Indianapolis is a large urban safety net hospital serving largely low-income people, many of whom are “dually eligible” for Medicaid and Medicare. Led by geriatrician Dr. Steve Counsell, the hospital has been developing a multi-pronged strategy to improve care and care coordination for this at-risk population. The programs have a smart approach to the shortage of geriatricians, leveraging the skills of geriatricians and geriatric nurse practitioners to support, not supplant, hospitalists (inpatient) and the primary care doctors (outpatient) caring for at-risk patients.

President Obama and Health and Human Services Secretary Sebelius addressed a live teletown hall meeting at the Park Multipurpose Senior Center in Maryland on Tuesday. The focus was Medicare and how health reform affects seniors. As the president said, seniors are targeted most often by those spreading misinformation about reform, and he wants to set the record straight.

The president started by comparing health reform now to Medicare reform in the 1960s. Both programs were derided as “socialist” and likely to bring about the end of the free market insurance system. But Medicare didn’t lead to a government takeover of health care -- and neither will new health reform law. “Medicare made a promise to seniors that they would have health coverage” said Obama, “and the Patient Protection and Affordable Care Act renews and strengthens that promise.”

As the summer heat sets in, schools will let out, America’s beaches will grow more crowded (if they are out of the way of the oil spill), bars will be populated with football (aka soccer) fans around the globe watching an African nation hold the World Cup for the first time -- and office managers in physician practices across the land will face a big question mark when it comes to estimating revenue from Medicare.

That is because as May 31 approached, the Centers for Medicare and Medicaid Services (CMS) had to hold processing claims to Medicare providers -- part of the lovely activity known as the “doc fix” which has essentially become an annual or sometimes even a semiannual headache for Hill staffers across the aisle.

Blogging Boston hospital CEO Paul Levy has published an open letter to Sen. Scott Brown telling him to put his money where his Berwick is, so to speak. Levy, apparently on first name basis with his state's new senator, wrote that this isn’t about blocking or not blocking health legislation. It’s about making the new law work. And about living up to health care quality goals that IHI"s Don Berwick has crusaded for and Scott in the past has supported.

I am working on  two longer posts about aspects of health reform that enhance our ability to address the needs of older Americans, particularly older people with chronic or life-limiting diseases. While I was doing some research I came across a useful resource from the John A. Hartford Foundation that's worth sharing.

Hartford's program director Chris Langston wrote on the health AGEnda blog about how health reform promotes better health for seniors, including paying a lot more attention to hospital readmissions and care transitions. His blog post will also take you to a PowerPoint he put together on the geriatric care provisions of health reform, aspects of which tie into the Institute of Medicine April 2008 report on Retooling for an Aging America: Building the Health Care Workforce.

The proposition that more immigration can forestall or eliminate projected shortfalls in Social Security and Medicare funding is a perennial favorite on Op-Ed pages. But it's been shot down again and again by scholars who know what they're talking about. Bad policy ideas, though, never stay dead for long, and so it is that Robert Reich is now trying to revive this fallacy.

Former Medicare-Medicaid directors Tom Scully and Mark McClellan are saying kind things about Dr. Don Berwick, the Harvard pediatrician and president of the Institute for Healthcare Improvement who is reportedly the White House pick to lead Medicare and Medicaid as we enter the era of health reform.

Almost immediately after President Obama signed the Patient Protection and Affordable Care Act, the conversation about health-care reform changed. Advocates of the proposal suddenly hit cautionary notes, insisting that difficult choices had to be made.