Two-thirds of Georgia hospitals facing Medicare penalties for excessive readmissions

By Andy Miller - For the AJC



Piedmont Henry Hospital in Stockbridge. (Photo / Piedmont Healthcare)

Medicare plans to fine two-thirds of Georgia hospitals for having too many patients return within a month for additional care, federal data show.

The 67 percent of Georgia hospitals facing penalties is higher than the national average of 54 percent, according to a Kaiser Health News analysis.

The readmission penalties, part of the Affordable Care Act, encourage hospitals to pay closer attention to what happens to patients after discharge.

Since the fines began, national readmission rates have declined, but roughly one of every five Medicare patients sent to the hospital ends up returning within a month of being released, Kaiser Health News reported.

The fines will be applied to Medicare payments when the federal fiscal year 2016 begins in October. In this round, the average Medicare payment reduction is 0.61 percent per patient stay. Georgia’s average penalty is 0.47 percent.

The maximum possible fine is 3 percent. The highest fine in the state, 2.59 percent, will be assessed against Piedmont Henry Hospital in Stockbridge.

The fines are based on readmissions between July 2011 and June 2014 and include Medicare patients who were originally hospitalized for heart attack, heart failure, pneumonia, chronic lung problems or elective hip or knee replacements.

The Georgia Hospital Association said Tuesday it sees progress on readmission rates. The organization said 32 states have a higher average penalty than Georgia. And of the 89 Georgia hospitals that will be penalized, 57 will see their penalties decrease from fiscal 2015 levels, GHA said.

“Although many hospital readmissions are outside of the control of the hospital, Georgia hospitals take these reports very seriously and continue to work diligently in making improvements in areas that can be controlled,” Dr. Doug Patten, chief medical officer for GHA, said in a statement.

Hospitals facing stiffest penalties

The federal government will assess penalties against dozens of Georgia hospitals in fiscal 2016, which begins in October, for excessive readmission of Medicare patients. The penalty is expressed as a percentage of the hospital's total reimbursement from Medicare for inpatient care. The maximum penalty per year is 3 percent.

Hospital	Location	FY15 penalty	FY16 penalty
1. Piedmont Henry Hospital	Stockbridge	0.75 %	2.59 %
2. Houston Medical Center	Warner Robins	2.13 %	1.95 %
3. Elbert Memorial Hospital	Elberton	2.39 %	1.53 %
4. Chestatee Regional Hospital	Dahlonega	1.45 %	1.37 %
5. Fannin Regional Hospital	Blue Ridge	3.00 %	1.30 %
6. University McDuffie County	Thomson	0.45 %	1.20 %
7. Spalding Regional Hospital	Griffin	0.95 %	1.13 %
8. Habersham County Medical Center	Demorest	0.54 %	1.07 %
9. Colquitt Regional Medical Center	Moultrie	0.64 %	1.04 %
10. Archbold Memorial Hospital	Thomasville	0.71 %	0.88 %

Source: U.S. Centers for Medicare and Medicaid Services

This article was done in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. Andy Miller is CEO and editor of Georgia Health News.

5 Things That Happen When You Quit Eating Sugar

First, let’s set the record straight by saying that sugar in and of itself isn’t evil, per se. It occurs naturally in plenty of foods, including fruits and milk. With that being said, adding excess sugar to your dietary intake simply isn’t necessary. In fact, you’ll notice numerous positive things happen when you decide to quit sugar for life.

Although people living in the Western world have been trained to desire sugary treats, as well as foods that include copious amounts of sugar for flavoring, we certainly don’t need it. If you stop eating anything but naturally occurring sugars, you’ll notice that 5 very distinctive things will happen.

1. Your Energy Will Improve

Ironically, many of us have a tendency to reach for sugar-filled items, including so-calledenergy drinks and caffeinated beverages, when we’re tired. Yet without all the sugar, we’re guaranteed to have a higher energy level naturally. In other words, all that sugar is blocking our body’s ability to keep our energy stores at maximal levels. Plus, there will be no up-and-down with your blood sugar, so afternoon crashes will become an experience of the past.

2. Your Weight Will Stabilize

Sugar makes you crave more sugar, and we’re not just talking about sugar in its raw form.

Let’s face it: most sugar comes in high-fat and/or high-carb foods that have been processed or at least contain tons of unwanted ingredients. There is, of course, the exception of fruit, which are nearly all sugar.

By going on a sugar detox, your body will not be subjected to the need to deal with all those additional calories.

You won’t feel hungry, and you’ll end up losing weight – or at least not seeing the scale fluctuate as dramatically.

3. Your Intestines and Colon Will Perform More Efficiently

If your insides could tell you what they wanted on a daily basis, they would say lots of fiber and a minimum amount of tough-to-digest, impure foods. When you remove sugar, you’re enabling your tummy and bowels to reset their abilities to process what you’ve eaten. You may even find that you go to the bathroom more often … this is a good thing. It means everything is getting back to a normal routine.

4. You’ll Stop Wanting Sugar

It’s a fact: sugar begets sugar. After you rid it from your food regimen, you’ll slowly begin to lose the desire to eat anything with sugar in it. Fruits will taste plenty sweet, and if you do take a bite of a cake or pie, you’ll be shocked at how overpowering and overly sweet it seems.

5. Your Skin Will Look Healthier

Have you noticed that you can’t seem to crack the case on why your acne appears and disappears despite all the creams, potions, and ointments you’re using? It may be that sugar is hurting your skin from the inside out. Many people report that their skin feels and looks healthier after they stop giving in to sugar’s pull.

Ready to Start Your Sugar Detox and Quit Sugar for Life?

While a cold turkey approach to your sugar detox isn’t always recommended, especially if you’ve been a sugar-holic for most of your lifetime, it’s definitely a good idea to start cutting back now. The faster you begin, the faster you’ll start to reap the advantages of going sugar-free.

In fact, in light of the countless dangers of consuming too much sugar, the World Health Organization has changed its sugar recommendation—advising no more than 5% of your daily calories should come from the sweet stuff, down from the previously recommended 10 percent. Considering that more than 50 percent of all Americans consume one-half pound of sugar PER DAY—translating to a whopping 180 pounds of sugar per year, we have some work to do.

Start small by evaluating everything you’re eating and drinking. If you are addicted to sugar-laced coffee drinks sold at popular coffeehouses, scale back on how many times you drink them. Then, scale back some more. Soon, omit certain sugar-laden products. Over time, you will physiologically adjust to your new habits.

Remember that it takes about three weeks before a new way of doing something becomes a comfortable routine. If you have slight missteps, such as eating a candy bar after a stressful workday, just keep forging ahead. The results of your diligence will definitely be worth it.

Editors note: Click here to Find a Local Farmer

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Long-Term Care Insurance Premiums Rise Almost 9 Percent

Overall costs for new long-term care insurance coverage -- which pays for care in nursing homes and, increasingly, at home as well -- increased 8.6 percent compared to a year ago, according to the 2015 Long Term Care Insurance Price Index.

A healthy 55-year-old man can expect to pay $1,060 annually for $164,000 in current long-term care insurance benefits, according to the Index, an annual report from the American Association for Long-Term Care Insurance, an industry group. This amount is a 15 percent increase from the 2014 figure of $925, although the 2014 figure represented a 15 percent decline from 2013, meaning that the annual premium has stayed steady between 2013 and 2015, at least for healthy middle-aged men.

Leading insurers began charging women higher premiums in 2013 due to their increased likelihood of needing long-term care. Coverage equal to that of the man in the example above would cost a 55-year-old single woman $1,390, a 13 percent increase from 2014’s figure of $1,225 per year.  (TheNational Women's Law Center is suing four insurers on the grounds that gender-based pricing violates the Affordable Care Act's prohibition against sex discrimination in health care.)   

However, rates vary significantly from insurer to insurer for virtually identical policy benefits, and this is even more the case this year than in prior years, the association said.  "In some situations the difference between the lowest-cost policy and the highest-cost was 34 percent but it could be as much as 119 percent," the association’s executive director, Jesse Slome, pointed out.  "Our average 55-year-old woman could pay as little as $890 a year or as much as $1,829 based on which insurer she buys from."

A married couple both age 60 would pay $2,170 per year combined for a total of $328,000 of long-term care insurance coverage.  In 2014, the association reported that a couple could expect to pay $1,980.  Adding an inflation growth option that builds their benefit pool to a combined $730,000 at age 85 would add $1,760 to the couple's yearly cost for a total of $3,930.

This year’s Index includes rates from 10 insurers, using policies sold in Tennessee, a “representative” state, Slome told the New York Times.

Consumers Buying Less Coverage

These prices, of course, are for new policies.  Some long-term care insurers have been raising premiums on existing policyholders by even greater rates.  Sellers of long-term care coverage  have been hit particularly hard by the climate of historically low interest rates and higher-than expected future claims.  For example, Genworth Financial, the industry leader, hiked premiums on some of its older policies by as much as 50 percent in 2012.

Higher premiums mean that fewer consumers are buying long-term care coverage, and those who are buying are purchasing less protection, says Forbes magazine columnist Howard Gleckman.  Gleckman notes that an industry-wide survey published in July 2014 found that sales of three-year policies increased from 23.6 percent in 2007 to 35.3 percent in 2013, while sales of five-year policies dropped from 18.9 percent to 13.5 percent. Sales of more expensive policies that offer lifetime coverage fell from 5.7 percent to just 3.6 percent.  Consumers are also opting for lower daily benefit amounts and less inflation protection.

Gleckman noted that the price disparity in inflation protection is especially striking.  According to the magazine Broker World, a typical 60-year old male could buy a $200,000 policy with no inflation protection for about $1,300 a year, depending on the carrier. The same policy with 5 percent inflation protection would cost almost three times as much, nearly $3,700.

When home care workers can’t care for themselves

Home care workers bathe your mother and change your father’s bandages. We cook for your grandmother and help your grandfather use the toilet. We help your brother or sister with their physical therapy. But despite doing the hard work that enables older Americans and people with disabilities to live with dignity and independence in their own homes, few people understand that home care workers can barely take care of their families. 

But I’m determined that will change. And I’m not alone.

This week I’ll join home care workers in Raleigh and thousands more in 20 cities across the country as we gain momentum in our growing fight for $15 and a union.

What started in September, with home care workers in a handful of cities joining together with fast-food workers to call for higher pay and better rights, has now spread from coast to coast. And beginning this week, as we hold town hall meetings in every corner of the country with members of the clergy, community leaders and government officials, including Secretary of Labor Thomas Perez, we are saying loud and clear that our call for $15 and a union needs to be heard.

I work for three different home care agencies and the last raise I received was a year ago, to $10 an hour, from $9.75, after five years of service. Additionally, none of the three agencies I work for provide medical benefits, paid vacation or sick leave to workers. If I have to miss work because I’m sick or if I have an emergency, I don’t get paid.

RELATED: Home health workers push for higher wages

Sadly, I’m not alone. The median salary for America’s 2 million home care workers is $13,000. It’s almost impossible to support myself on such low pay. And the burden of the industry’s low pay falls disproportionately on women of color like me. Nationally, the home care workforce is 91% female and 56% non-white. 

I take care of clients who have a variety of backgrounds. In a normal day I bathe them, prepare their meals, drive them to appointments and help with their physical therapy. Over the years I’ve become their trusted caregiver and the front line of their healthcare team. It’s because of the connection I have with my clients that I love my job. But the wages I am paid are so low that I have to work 90 to 120 hours a week just to scrape by. It’s not uncommon for me to work 72 hours straight, taking 20 and 30-minute naps in the car before my next client.

“The wages I am paid are so low that I have to work 90 to 120 hours a week just to scrape by.”

There are countless days that I've gotten an hour of sleep after coming home from a 12-hour shift, only to receive a call asking me to drive across town to a new three-hour assignment. It’s hard to do that day after day on these wages. And after a while it’s hard to deliver high quality care to clients on only a few hours of sleep spread across two or three days.

A pay raise to $15 an hour would allow me to work more livable hours and help me to save for my retirement. I’m 50 years old and my agencies do not provide retirement benefits. If I want to ensure my stability for the future, I need $15 an hour.

Raising pay in the home care industry won’t just help workers like me. It is also a critical priority for aging Americans and their families across the country. As the baby boom generation ages over the next 10 years, the number of people who need home care to stay out of nursing homes is going to double. By 2022, 1 million more home care workers will be needed to care for America’s seniors and people with disabilities and more home care jobs will be created than any other occupation in America.

Where will the home care workers we need to meet that challenge come from? Who will want to enter this profession for a poverty wage and little or no paid time off? Shouldn’t these jobs be good jobs that pay workers enough to support ourselves, our families and our communities? I think so, which is why I’m joining thousands of home care workers in town halls across the country this week to add my voice to the call for $15, a union and a better future for my family and those families who depend on workers like me to care for their loved ones.

Kimberly Thomas has been a home care worker in North Carolina for six years. She is one of many workers from N.C. who are joining thousands of home care workers across the country in town halls as they call for $15 and a union.

By Kimberly Thomas

Home Health Care Policies: Court Blocks Home Care Overtime Protections

Posted by Nathan Hope on Jan 6, 2015

Over the Christmas holidays, the Federal Court struck down some of the proposed overtime rules and protections for home health employees and issued a 14-day stay on the ruling to analyze the plaintiffs’ arguments. The rules were highly opposed by many stakeholders and home health advocacy interest groups, while many care giving employees found the rules to be long overdue. The rules were set to take effect January 1^st, 2015.

In the case Home Care Association of America v. David Weil, the new overtime rules championed by the U.S. Department of Labor were overturned. The rules would have gone into effect beginning January 1^st. Many trade associations in the home care industry were opposed to the proposed overtime rules by stating that they (the rules) would directly hurt the home care industry and drive up spending for an already financial strained Medicare system. This is all despite the fact that Medicare spending has shown to currently sit below the expected spending levels that were projected several years ago.

The plaintiffs, including Home Care Association of America, National Association for Home Care and Hospice, and the International Franchise Association for Home Care and Hospice challenged a rule that would prohibit the exemption of companionship services and live-in domestic services. With the rules being overturned, “Fellowship and protection” services provided by care workers will continued being denied overtime protections. Additionally, live-in service providers will also continue to be denied overtime protections with the court now blocking rule’s implementation.

A representative of the National Association for Home Care and Hospice stated that the rule would have affected 90% of care in regards to the court ruling.

“This is a victory for elderly and disabled persons who rely on home care,” said NAHC President Val Halamandaris. “This victory proves the value of industry unity. United, fighting on behalf of the elderly and disabled we cannot fail, divided, we cannot succeed.”

However, many health care employees do not share the same sentiments. Many advocacy groups claim that this ruling provides a clear example of the exploitation of home caregivers throughout the country. The Paraprofessional Healthcare Institute (PHI) is one such group that highly opposes the court’s actions in allowing the ruling to be delayed past its January 1^st implementation date. A quote from the PHI blog states:

“As we previously stated after the December 22nd ruling, the Final Rule’s extension of minimum wage and overtime protections to most home care workers is the right policy—both for those employees, whose demanding work merits these fundamental wage guarantees, and for recipients of services who deserve a stable and professional workforce allowing them to remain in their homes and communities.” (phinational.org)

The temporary stay on the ruling will be in effect until January 15^th to hear the remainder of the plaintiffs’ argument regarding “companionship services” and why they do not qualify for overtime pay. The Court will hold a hearing regarding a preliminary injunction on Friday, January 9^th.

New Benefits, Rights and Protections in the Affordable Care Act

ObamaCare offers many new benefits, rights and protections. Some of the Benefits of ObamaCare are all ready here, more ObamaCare benefits are coming 2014 and beyond. Let’s take a look at some of the advantages of our new health care reform law and how its new benefits, rights and protections affect you, your family and your business.

Benefits of ObamaCare: A Quick Summary of ObamaCare’s Benefits, Rights and Protections

ObamaCare offers you and your family many new benefits rights and protections on all new plans. Health plans that started after 2010 will have to switch you over to a plan that offers these benefits in 2014.

Plans signed before 2010 may have grandfathered status. Learn more aboutGrandfathered Health Plans. Here is a quick overview of the different benefits, rights and protections which are all covered in detail below and discussed in-depth on the site.

• New Health Insurance Marketplaces (AKA Exchanges) allow shoppers to compare Health Plans that include all new benefits, rights and protections.

• Cost assistance to individuals, families and small businesses through the marketplace.

• Medicaid eligibility is expanded in 26 states to 138% of the federal poverty level giving millions of Americans access to healthcare.

• No annual or lifetime limits on healthcare.

• All major medical insurance is guaranteed issue, meaning you can’t be denied coverage for any reason.

• Insurance companies can’t drop you when you are sick or for making a mistake on your application.

• You can’t be denied coverage for pre-existing conditions.

• You have the right to quickly appeal any health insurance company decision.

• You have the right to get an easy-to-understand summary about a health plan’s benefits and coverage.

• Young Adults can stay on their parent’s plan until 26.

• A large improvement to women’s health services.

• Reforms to the healthcare industry to cut wasteful spending.

• Better care and protections for seniors.

• New preventative services at no-out-of pocket costs.

• Essential health benefits like emergency care, hospitalization, prescription drugs, and maternity and newborn care must be included on all non-grandfathered plans at no out-of-pocket limit.

• You can’t be charged more based on health status or gender.

• Plus many more benefits, rights and protections.

Know the Law. The Affordable Care Act contains 10 titles, each title addresses a different aspect of health care reform. Title I Quality, affordable health care for all Americans addresses most of the new benefits, rights, and protections. Check out our Summary of Provisions of the Patient Protection and Affordable Care Act for a plain English summary of each provision pertaining to the “benefits of ObamaCare”.

Each new benefit, right and protection is part of one of ObamaCare’s provisions. As you can see by the image below some of the most popular Provisions in the Affordable Care Act are the ones that the least amount of people are aware of.

Study: American Seniors Face Health Care Gaps, Despite Medicare

A new study by the Commonwealth Fund published recently in Health Affairs finds that Americans older than 65 are more likely to have chronic illnesses and to struggle to afford health care – despite qualifying for the federal Medicare program – t

November 25, 2014 09:17 AM

A new study by the Commonwealth Fund that appears in the most recent edition of Health Affairs found that American seniors are more likely to have chronic illnesses and to have difficulty affording their healthcare despite receiving Medicare benefits.

On average, beneficiaries with traditional Medicare will end up spending more than $4,000 per year on out-of-pocket health costs, according to the study’s authors. That constitutes a level of cost-sharing much higher than that seen in comparable nations.

According to a Kaiser Health News reporton the study, the research found that:

• 87 percent of U.S. respondents 65 or older indicated having one chronic condition and 68 percent had two or more. Canada was the next highest, with 83 percent having one disease and 56 percent having two or more.
• 19 percent of United States respondents reported cost as an obstacle in getting care last year. The next highest rate was in New Zealand, with 10 percent.
• 55 percent said it “somewhat or very easy” to get care after hours, a figure that was higher in all countries but Sweden, Canada and Australia.
• American respondents were among the most likely to have discussed with a physician healthy lifestyles and end-of-life planning.
• While each nation’s health system had strengths, the survey highlighted room for improvement across the board. The study, which comes in the midst of Medicare’s open enrollment season, may provide beneficiaries with key factors to consider as they review their coverage choices.

The findings, which are based on phone surveys conducted in 11 industrialized countries, highlight gaps in Medicare coverage that should be addressed, said Donald Moulds, one of the study’s authors and executive vice president for programs at the Commonwealth Fund.http://www.nahc.org/NAHCReport/nr141124_12/