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CT Center for Patient Safety Newsletter
 May 2012

Observation Status:  a new money making ploy


The Center for Medicare Advocacy and co-counsel, the National Senior Citizen Law Center, filed a class action lawsuit against Kathleen Sebelius, the Secretary of Health and Human Services, on behalf of seven individual plaintiffs who represent a nationwide class of individuals harmed by an increasingly common practice. The plaintiffs are Medicare beneficiaries who received inpatient hospital services, but were improperly classified as outpatients, often referred to as "observation status," and therefore deprived of Medicare Part A coverage for their hospital stay and after care.   The misapplication of "observation status" deprives Medicare beneficiaries of their coverage rights and may cause them to absorb significant hospital costs that otherwise would be paid for under Medicare Part A. Additionally, they may be forced to forego critical post-hospitalization skilled nursing facility (SNF) care or pay exorbitant out-of-pocket costs for it because Medicare requires a minimum of three consecutive days as a hospital inpatient to qualify for SNF care.

"We've turned to the courts for fairness because 'observation status' harms thousands of Americans receiving Medicare each year, nationwide," said Judith Stein, Founder and Executive Director of the Center for Medicare Advocacy, one of the nation's leading legal advocates for the more than 48 million older and disabled Americans enrolled in Medicare. "It causes severe financial problems for beneficiaries and their families, and deprives them of nursing home coverage altogether."  "Worse yet, without advocates, Medicare recipients have virtually no way of challenging their denial of benefits," said attorney Gill Deford, the Center for Medicare Advocacy's Director of Litigation. "Without a class action lawsuit, it may be impossible to stop the government from misusing 'observation status' in the first place."


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Dear Members,


The Connecticut Center  for Patient Safety is launching a new area of interest focused on the unique healthcare needs of Connecticut's Seniors.  This year, two new volunteers have come forward to provide their expertise to our efforts.  As a result of their personal family experiences, Maureen Foley and Paul Caron have a wealth of knowledge that we want to share with you.  Our website, www.ctcps.org has recently expanded our Nursing Home and Home Health Care information.  As always, the problem is how can we encourage the health care consumer to be proactive.  We do not want everyone to learn the hard way, which is the way most of us began to figure out the enormity of a patients' or families responsibilies to optimize their care.


Shortly, we will be circulating a survey to you.  Please take the time to fill it out and return it to us.  Your insights and experiences have driven our mission.  We want new stories of your experiences to ground us in our future efforts.



Doctors Fall Short In Helping Many Seniors
One third of older adults said that their doctors did not review all their medications even though problems with prescription and over the counter drugs are so common that seniors make 177,000 emergency room visits each year because of their medications.

Falls cause over 2 million injuries in people age 65 and older annually.  It was found that more than 2/3 of the time doctors and nurses did not ask older patients whether they had fallen or tripped recently nor did they review what they might do to decrease falls.

Depression can cause isolation and lead to an individual not taking care of him or herself.  Yet doctors did not ask if their patients were sad, depressed or anxious.

For those who can, seniors need to become more responsible for their own health care.  It is not just up to doctors.  Only 2.3 million seniors out of 35 million with traditional Medicare coverage took advantage of covered wellness visits last year.

Another grim statistic, found by the Rand Corporation, is that only 30 percent of older adults get care that is supported by medical evidence compared to 55 percent of the general population.

Hip and Knee Replacement Registries are Needed

Registries for hip and knee replacements procedures are a world wide reality with growing importance - particularly as our society ages.  Some countries such as Norway and Denmark, Australia and New Zealand have over ten years of experience.  These registries are growing in complexity and often include the date of surgery, diagnostic treatments, implant information, surgeon and hospital identifiers.  Most significantly, these registries can guide important clinical decision making.  These registries can detect significant risks to patient health associated with a particular procedure.  And the patient, doctor and hospital can be notified if there is an increased risk using a particular medical device.

Why don't we have a knee and hip registry in our country?  My guess is that industry does not want one.  Evidence documents the value of this data.  Action is needed now to avoid unnecessary injury to patients and to facilitate the most cost effective use of limited healthcare resources.

Treatment of Dimentia in the Elderly with Antipsychotics


Nursing homes are treating dementia sufferers with powerful antipsychotics despite FDA advice to the contrary, according to a Health and Human Services report.  The FDA began requiring antipsychotics to carry warning labels in 2005 stating the increased death risk they pose for dementia patients. But 88% of 1.4 million Medicare claims for the drugs in 2007 were for those diagnosed with dementia. Drug companies are pushing the drugs to nursing home doctors for such treatment even though off-label marketing like that is illegal, the department's inspector general said in a statement.

"Despite the fact that it is potentially lethal to prescribe antipsychotics to patients with dementia, there's ample evidence that some drug companies aggressively marketed their products towards such populations, putting profits before safety," he said. The report also slaps Medicare and Medicaid administrators for lax monitoring of nursing homes' use of the drugs. In the first half of 2007 alone, the US paid $116 million for claims  despite the fact those claims violated Medicare rules, the report finds.

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