SMP Newsletter Edition7 - Community of Vermont Elders
Transcription
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]