SMP Newsletter Edition7 - Community of Vermont Elders

PULL Together:
Vermont Senior Medicare Patrol (SMP) Newsletter
Vermont Senior Medicare
Patrol or SMP is funded by
the Administration on
Aging (Grant # 90SP007401-00). There are 54 SMP
projects located throughout the United States,
Puerto Rico and the Virgin
Islands.
From the Director - Anita Hoy
Anita Hoy
VT SMP Director
802-229-4731
[email protected]
see page 4
Summer 2015
Medicare Snarl-Up Gets Spotlight In New Vermont Health Law
Things have been going up and down on the health care front.
INSIDE THIS
ISSUE:
The Southern
Half
2
The Master and
His Fiddle
3
Volunteering
3
SMP Education
5
Medicare Minute
5
Tips &
Membership
8
In the up category the U.S. Supreme Court turned back a suit to gut Obama Care, ruling that
the federal government can provide subsidies for the poor and some of the middle class. In the
down category Governor Peter Shumlin pulled the plug on Vermont’s single-payer, universal
health care initiative, citing costs.
Then there’s Vermont Health Connect, our state’s on-line health service. One of fourteen
independent exchanges set up by states to expedite the implementation of Obama Care, Vermont Health Connect has eaten up about $200 million, alienated many Vermonters and is still
floundering. In an understatement Trinka Kerr, head of health care advocates at Vermont Legal
Aid, recently told The New York Times, “There’s a backlash against all things health care reform
because Vermont Health Connect has been such a bad experience.” Not to be outdone, Progressive State Representative Chris Pearson added, “It’s been a spectacular crash really.”
Well, I come bearing more positive news. It involves a real medical headache: going into the
hospital and thinking you’re pretty well covered by Medicare, then getting bills saying you are not
covered because you were actually admitted for “observation status.” As of December 1,
2015, here in Vermont, you must be told,
continued on page 6
PAGE
2
From the South - Kelly McElheny
The OIG has investigated and made
arrests in 4,000
cases from 20102015 and recovered almost
$18,000,000,000
from tips
Volunteers and the Regional Coordinator have been busy this year fighting Medicare
Fraud in Southern Vermont. In April, we had a visit from the Regional Administrator’s Office
of the Centers for Medicaid and Medicare Services (CMS). The Office of the Inspector General, Phil Coyne, the CMS Regional Administrator, Ray Hurd, the Vermont Attorney General’s
Office, the Regional Administrator for Health and Human Services, Rachel Kaprielian, and the
Brattleboro Police Department, joined Vermont SMP and SHIP at the Brattleboro Senior Center. Tim Johnson from WTSA radio in Brattleboro moderated. Their focus was healthcare
fraud and the consequences. Phil Coyne, stated that the OIG has investigated and made arrests in 4,000 cases from 2010-2015 and recovered almost $18 million from tips to OIG hotline. In Vermont, fraud costs the state about $30-100 million. Medicaid fraud is about $1 billion. Fraud continues to be a major drain on the Medicare fund. It keeps needed services
from expanding and it causes healthcare costs to surge for all of us. Good news though, as a
result of the Affordable Care Act, 480,000 provider accounts were locked out of the CMS program as a result of fraud and another 17,000 providers were not renewed. They encouraged
everyone who suspects healthcare waste, fraud, error or abuse, to call the OIG hotline at 1800-447-8477.
We continue to expand our outreach efforts to those remote parts of Southern Vermont
such as Dorset, Townshend and Wilmington/Dover. We are beginning to offer programming
in Rutland as well. The Savvy Seniors performed for the Rutland Interage Day Service in April
and volunteers will be returning in June for Medicare Bingo. We will also be at the Godnick
(Rutland) Senior Center in June for the Medicare Minute (June 25th @ 12:15). In July we will
be visiting the Thompson Senior Center in Woodstock and from there we will be traveling to
different senior sites around White River Junction and the rest of Windsor County.
Medicare Minutes can now be found in Brattleboro on the 3rd Tuesday of the month at
the Brattleboro Senior Center; Bennington - the 4th Friday of the month at the Bennington
Senior Center; Poultney - the 3rd Thursday of the month; Rutland at the Godnick Center - the
4th Thursday of the month; Bellows Falls - the 3rd Friday of the month; Castleton at the Castleton Senior Center - the 2nd Tuesday of the month and throughout the entire month at the
Springfield Senior Center. You can also find us at the Bennington County Retried Teachers
meetings. We are working to find sites in Dover, Wilmington, White River Junction, Bellows
Falls and Ascutney/Windsor this summer.
PULL
TOGETHER:
VERMONT
SENIOR
MEDICARE
PATROL
(SMP)
NEWSLETTER
Of course, we will be back at the Bennington Senior Center Ice Cream Social with Medicare Jeopardy from 1 - 3 on August 12th. We still need performers in the Windham/Windsor
counties region. If you are interested in acting or the performing arts and care about senior
issues with relation to fraud, let us know. We encourage you to get involved. It’s an exciting
time to join the COVE – SMP program as a volunteer and help us bring the message to your
meal site, senior housing complex, neighborhood cares group or other organization interested
in assisting seniors or persons with disabilities.
New to Medicare trainings through the local council on aging
Next page…
VOLUME
2,
ISSUE
PAGE
1
3
From the South continued...
are also being planned. In the Southeast, Sharon O’Neill, SHIP coordinator with Senior Solutions is holding Medicare Boot camp in Townshend in June and agency training is scheduled for
August 5th. SMP will be on hand at those training to provide healthcare fraud information and
to answer any questions you may have. Sandi Bartlett, Southwest VT SHIP and I are working to
plan the same for Bennington County sites. Stay tuned! Contact the Senior Helpline at 1-800642-5119 for more information.
Coming this fall, we are beginning to plan two major community fundraising events for
Bennington and Brattleboro featuring the Savvy Seniors. We are also scheduled to visit with
the Brattleboro Chapter of AARP, the Windham County Retired Teachers Association and St.
Paul’s Church, in Manchester, as well as our regularly scheduled monthly Medicare Minutes.
We are beginning
to plan two major
community fundraising events for
Bennington and
Brattleboro featuring the Savvy
Seniors...
For more information, to schedule a presentation or to become a volunteer, please call Kelly
McElheny, Southern VT Regional Coordinator at 802-440-1528 or [email protected].
Join us for COVE’s fundraiser
fiddle concert featuring
Master Fiddler, Louie Schryer
August 15, 2015
7 - 9 p.m.
Barre Opera House
Get your tickets right
away by contacting the
Barre Opera House….
Volunteering with Vermont SMP
Help y
our pe
ers
protec
t them
selves
becom
e a Ve
rmont
SMP v
olunte
er! Ca
ll:
802-22
9-4731
Vermont SMP has had the good fortune of finding highly qualified individuals to provide
volunteer service in a wide variety of capacities. Just this month, a volunteer was located in the Northeast Kingdom
who will provide Community Outreach and Networking as a means to inform local organizations and individuals
about our mission to educate Medicare beneficiaries and their family members or caregivers about healthcare error,
fraud and abuse. Karlene has already started the training process and will soon be ready to reach out to folks in her
area. She will have a valuable role with SMP as she will be our representative for the Newport area! If you are interested in learning more, please contact: Anita at 802-229-4731 or by email: [email protected]
PAGE
4
From the Director, Continued...
...become part
of AARP’s
Fraud Watch
Network and
deliver this
presentation to
inform
Vermonters...



PULL
TOGETHER:
VERMONT
SENIOR
MEDICARE
PATROL (SMP)
NEWSLETTER
VOLUME
2,
ISSUE
1
PAGE
5
Vermont SMP - Community Education Available
Community education works! As Vermonters increase their awareness of healthcare billing errors and scams,
problems are easier to identify and resolve. Now, more than ever Vermont SMP staff receive phone calls and
emails to report errors and fraud from people who have attended one of our educational sessions. Once informed, these people can help friends and family members who wouldn’t otherwise know how to protect themselves from errors or fraud. The programs available in 2015 include:
 Savvy Seniors 30 - 60 minutes: A theatrical performance covering many types of scams
 Medicare Jeopardy 30 - 60 minutes: Just like the televised game show
 Medicare Bingo 30 - 45 minutes: Gifts awarded to winners
 When Healing Hands Harm: A video presentation about drug diversion
 How to Read Your Medicare Summary Notice: 30 minutes
 Understanding Fraud and How the SMP Program Can Help 30 - 45 minutes
 Medicare Minute 5 minutes. Topics vary each month.
 Safe Use of the Internet for Elders 90 minutes.
Medicare Minute: New to Medicare
Medicare Coverage Options - There are 2 ways to receive Medicare benefits: Original Medicare or a Medicare Advantage Plan. Original Medicare, (sometimes
called traditional Medicare), includes Part A (hospital) and Part B (medical) coverage. If
you want Medicare drug coverage (Part D) with Original Medicare, you will need to
actively choose and join a stand-alone Medicare private drug plan (PDP). You can
also receive your Medicare coverage through a Medicare Advantage Plan which
must cover all original Medicare services, but each Medicare Advantage Plan can
charge different out-of-pocket costs and have different restrictions.
Medicare Part B Enrollment - Don’t consider delaying Part B unless 1) you
have health coverage from your or your spouse’s current work and 2) the employer
coverage pays before Medicare. Having coverage from a current employer allows
you to enroll in Medicare Part B at a later date without penalties or coverage gaps
BUT, you should check in with your Human Resources Director to be sure that you
are covered.
Questions to ask when you have another type of insurance coverage




Will my current insurance coverage allow me to delay Medicare Part B?
When should I enroll in Medicare if I am delaying now?
How will delaying enrollment now affect my Medicare premium later?
What information and documents will I need to provide to Social Security
when I do enroll?
You can contact the State Health Insurance Assistance Program (SHIP) for help
1-800-642-5119
Medicare Minute was supported, in part by grant number 90SM0010-01-00, from the U.S. Administration for Community Living, Department
of Health and Human Services, Washington, DC 20201
Would you like to host a
Medicare Minute at your
site on a regular basis to
keep your members up to
date? Monthly, Quarterly,
Semi-annually?
Would you like to become
a Vermont SMP volunteer
so you can lead these
scripted presentations
….Contact Vermont SMP
to learn more….
PAGE
6
Medicare Snarl-Up Gets Spotlight…
continued from page 1
verbally and on a form, if you are a Medicare patient under observation status.
In our time observation status means this: you are not an inpatient, you are an outpatient. Outpatients are billed differently. A key difference in determining whether you are an
observation status outpatient or an impatient is something called the ’48-hour rule.” Basically, if you’re in a hospital two days or more, you meet the rule and you are an inpatient. That
status follows you for meds, rehab, a possible stay to get on your feet at a nursing facility. Fine. But there are other possible snags in addition to the 48-hour rule.
Hospitals have Utilization Review Committees, URCs that review Medicare billings. A
URC can reverse your inpatient status to OS, after the fact. In other words, you might think
Medicare Parts A & B, plus supplemental insurance, have you covered. But after review,
guess what? They did not.
Joe Sherman is a
writer of international
acclaim. His books
include: Fast Lane of a
Dirt Road: A Contemporary History of Vermont; In the Rings of
Saturn, which was
nominated for a Pulitzer Prize, and The
House at Shelburne
Farms: The Story of
One of America’s
Great Country Estates.
Joe lives in Montgomery, VT, with his wife,
Martina Tesarova.
PULL
TOGETHER:
VERMONT
SENIOR
MEDICARE
PATROL (SMP)
NEWSLETTER
“The problem is real,” Michael Benvenuto, director of The Elder Law Project at Vermont
Legal Aid, tells me. “This has been hitting hundreds of patients in Vermont. Some have been
sued for 30, 40, 50 thousand dollars in nursing home bills. It’s a glitch in Medicare.” I ask how
status is decided quickly, at admission, Benvenuto says, “It’s an anticipatory decision.” That is,
one based on an initial assessment and professional judgments. “The average user presumes
they’re covered.”
Which can be a big mistake.
A cautionary tale from the Vermont Senior Medical Patrol archives clarifies one possible
outcome if your status is not clear or gets screwed up. A few years back a Medicare patient
we’ll call X fell, shattering the pelvis. Ushered to the E.R. by ambulance, X got painkillers, had X
-rays and a battery of tests. After an overnight stay in the hospital the patient was asked to
sign forms for the care to continue. Drugged, in traction, needing more care, X signed, and
after several more days in the hospital was transferred to a skilled nursing care facility where
X remained for weeks, then went home. Bills soon arrived for hospital and nursing care services, one bill alone for $7,000, because X, drugged and weary, had signed a form confirming
observation status. Efforts by lawyers and SMP to rectify the situation were futile. The financial responsibility stayed on the Medicare patient.
The back story for observation status then, and now, is a troublesome one. It weaves
together a number of factors: Medicare’s fee structure for reimbursements, which was set
back in the 1980s; the high costs of Medicare ($600 billion in 2013; fraud (around $60 billion
for Medicare in 2013), and waste from escalating over diagnosis and overtreatment, a curse
of our profit-making medical system whose default mode is now SNARL-UP. (see Dr. Atul
Gawande’s “Overkill” at this link for a riveting overview: http://www.newyorker.com/
magazine/2015/05/11/overkill-atul-gawande )
Few Medicare beneficiaries are up to speed on the new reality. As Benvenuto notes,
most of them still enter hospitals gowned in innocence, thinking they are covered, and are
shocked to learn they’ve tumbled into what some critics call the “observation status loop-
VOLUME
Medicare Snarl-Up Gets Spotlight…
2,
ISSUE
1
PAGE
7
continued
hole.” The loop hole is real. It is kept in place by Medicare enforcement procedures, which mandate
that hospitals reduce unnecessary admissions and control the length of stays. Hospital review often
relies on clinical-decision support software, which seems to shift decisions ever farther away from the
control of local hospitals, physicians and health care workers.
A column is no place to dig deeply into this new reality. But as Julia Shaw, a Health Care Policy
Analyst for Vermont Legal Aid succinctly reminds me over the phone, “If placed on OS, that status has
implications.” The status is totally legal, changeable by review, enforced by Medicare, and supported
by Congress, now trying to hold the line on America’s medical bill.
The new Vermont law, mandating notice of OS, is good news for Vermonters. It won’t put a dent
in Medicare costs. That’s a Congressional issue, not a state one. And Congress remains stubbornly last
century when it comes to changing Medicare. Observation status does make sense when you think
about the turnaround times of an average hospital stay. What used to take a week can now be a
whirlwind thirty-six hours and you’re out of there. High technology and medical advances are favored
by hospitals. Outpatient care is cheaper than inpatient, at least for the government.
For patients? The jury is out. Observation status is one of those terms which, in a more sane
health system, only a crossword puzzle addict would know, plugging it in when the puzzle asked for
“health labyrinth phrase of mass confusion.” And that would be that. At least now the often confusing and costly label will be less onerous in Vermont. You enter a hospital as a Medicare beneficiary,
you must be told, in words and ink, signed and dated by a hospital representative, that you are on
observation status. This should reduce post-stay bureaucratic stonewalling of angry Medicare patients
and could even help inch along a much-needed reassessment of our Medicare system’s rules, definitions and enforcement rationale.
Sounding pleased that both Vermont lawmakers and hospitals have stepped up on the issue,
Rachael Seelig, an attorney for Vermont Legal Aid, acknowledges that “hospitals may have objected,
but not strongly.” The bill moved through the Vermont legislature relatively swiftly. It has some fixes
for hospitals, which are squeezed by the conflicting needs to simultaneously fix patients and generate
profit, all the while drawing money from the federal Medicare till.
“The Vermont bill does not solve charges being made retroactively,” Seelig adds. “There are limits to what states can do to change this.”
“The real fix,” says Benvenuto “is up to Congress.”
Hence, the reason we should be pleased by our legislature going to bat for Medicare recipients
here and adding Vermont’s voice to a national chorus of loud criticism. Now, can we just do something about the mess called Vermont Health Connect?
Contact Joe Sherman with your thoughts and feedback at: [email protected]
Observation
status does
make sense
when you think
about the
turnaround
times of an
average
hospital stay. ..
PAGE
8
Protect, Detect and Report incidences of Medicare Error, Fraud and Abuse
A few tips from the Office of Inspector
Tips of the Month
General (OIG)
Community of Vermont Elders
Vermont SMP Director, Anita Hoy
P.O. Box 1276
Berlin, VT 05601
Phone: 802-229-4731
E-mail: [email protected]
Website: www.vermontelders.org
Medicare Advantage and drug plans must follow certain
rules when promoting their products. It is illegal for
plans:
 to send you unsolicited emails
 Request payment by telephone
 Or visit you in your home or nursing home room
without an invitation.
To report fraud, contact Vermont SMP 802-229-4731
Would you like to provide time and service? We are looking for folks to assist with scheduling and leading presentations, help develop website and social networking too. Come join the Vermont SMP
team to help us connect with community organizations...There is always a need for volunteers in every area
of Vermont. You design your schedule and we’ll work with you to design a position to suit your interests and
skills. Contact Anita at 802-229-4731 or by email: [email protected] right away.
Only 3 spots left Sign up for the Safe Use of the Internet right away
COVE Organizational Membership
Flagship.. ………………….$1,000 - $10,000
Statewide.………………………………$250
Regional………………………………...$100
Local (County/Community)………………...$50
Small Business Memberships
$150 - $500
For more information about member benefits and how to apply, contact Gini by
phone: 802-229-4731
by
email: [email protected]