In its June 2012 Report to the Congress, the Medicare Payment Advisory Commission (MedPAC) included an examination of current options and activity with respect to programs that integrate – or have the potential to integrate – Medicare and Medicaid services and financing for those individuals with coverage from both programs, often referred to as dual eligibles. While the term "integration" does not have a single meaning in health policy discussions, in this context it generally refers to efforts to bring both Medicare and Medicaid dollars and Medicare and Medicaid services into a single system of care, so that the individuals using the services do not have to pay attention to whether they are from Medicare or Medicaid. It is believed that "integrating" the programs can both improve the quality of health care services people receive and lower the cost of providing that care.
Video: Medicaid, Nursing Homes and Asset Protection
How to Finance Nursing Home Care?
Medicare is one option in paying for nursing home care, but not the best alternative. It only pays for the full cost of the first 20 days of 4 per day. Medicare can pay for the next 80 days if the person has private Medicare supplement, but usually stops before the 100th day. When Medicare stops, the supplemental coverage also stops. An individual must stay for at least three days in a hospital or undergo skilled care. The transfer from hospital should happen at the same time period.
Accessing Medicare and Medicaid: Times Are Changing
Thank you for reading my blog so carefully. Currently, CMS (Medicare) monitors hospital readmission rates as a quality measure. Research by the Medicare Payment Advisory Commission (MedPAC) and others show that as many as 1 in 3 Medicare patients who leave the hospital will be readmitted within 30 days of discharge, and that a large portion of these readmissions can be avoided. Under the Affordable Care Act, CMS plans to implement a Hospital Readmissions Reduction Program that will reduce payments beginning in FY 2013 to certain hospitals that have excess readmissions for certain selected conditions. ALF’s are not relevant to this discussion since they are not certified Medicare providers and do not provide any Medicare covered service. The capacity of a skilled nursing facility to care for an admitted Medicare resident without discharging the resident back to the hospital within 30-days will become a critical to securing a reputation for quality with a SNFs most important referal source: hospital discharge planners. Interestingly, discharge rates to hospitals is not currently a quality measure matrix on the Medicare nursing home compare website (www.medicare.gov/nhcompare/), but that matrix is being redesigned and could be amended to include this data. I do not understand the connection private pay admissions and hospital readmission rates. Please elaborate and I hope you find this answer helpful.
Program to Reduce Hospitalizations of Nursing Home Residents Receives NIH Grant
INTERACT is a quality improvement program designed to facilitate the early identification, assessment, documentation and communication about changes in the status of residents in SNFs, and provide the necessary tools to manage conditions before they become serious enough to necessitate a hospital transfer. The tools target three key strategies to reduce potentially avoidable hospitalizations: preventing conditions from becoming severe enough to require acute hospital care; managing selected acute conditions in the nursing home; and improving advance care planning for residents among whom a palliative or comfort care plan, rather than acute hospitalization, may be appropriate. The NIH funded project will involve an interdisciplinary team of experienced nursing home researchers conducting a randomized controlled trial to test the implementation of the INTERACT program.
INTERACT : South Carolina Nursing Home Blog
"INTERACT is a quality improvement program designed to facilitate the early identification, assessment, documentation and communication about changes in the status of residents in SNFs, and provide the necessary tools to manage conditions before they become serious enough to necessitate a hospital transfer. The tools target three key strategies to reduce potentially avoidable hospitalizations: preventing conditions from becoming severe enough to require acute hospital care; managing selected acute conditions in the nursing home; and improving advance care planning for residents among whom a palliative or comfort care plan, rather than acute hospitalization, may be appropriate."
Advocating for Your Loved One While in a Nursing Home
-Turn, Turn, Turn. Immobility is one of the most important factors in the development and progression of bedsores. One of the keys to preventing bedsore development is to utilize a two-hour turn schedule in a patient’s plan of care, so that pressure is not kept on one part of the body for too long. While the standard “two-hour” turn schedule is taught and re-taught to every Registered Nurse and Licensed Practical Nurse in their schooling and workplace orientation programs, it is rarely put into practice in the daily care routine. The reality of inadequate staffing in the nursing homes is that there is a lack of attention to each individual resident, whether it applies to turning in accordance with protocol, or toileting. These deviations from acceptable nursing practice result in a greater incidence of bed sore development, in addition to other preventable medical issues among the residents.
Medicare trying to curb overuse of antipsychotic drugs in nursing homes
“A CMS nursing home resident report found that almost 40 percent of nursing home patients with signs of dementia were receiving antipsychotic drugs at some point in 2010, even though there was no diagnosis of psychosis,” CMS Chief Medical Officer and Director of Clinical Standards and Quality Patrick Conway, M.D., said in a statement. “Managing dementia without relying on medication can help improve the quality of life for these residents. The Partnership to Improve Dementia Care will equip residents, caregivers, and providers with the best tools to make the right decision.”