There are 2.6 million elderly New Yorkers who receive Medicare, the public health insurance program for the elderly. But one in three patients — nearly 900,000 — are enrolled in Advantage, Medicare HMOs run by private insurers.
Dr. Jonathan Leibowitz, who serves 30 patients under Medicare Advantage at his Brooklyn practice, said he was blindsided by UnitedHealthcare’s decision to give him the boot.
“A patient can’t see his doctor? What are they doing!” he asked.
UnitedHealthcare told Leibowitz that because of “significant changes and pressures in the health-care environment,” he’d be getting the ax on Jan. 1.
From the New York Post.
The old age provisions of the Medicaid program were designed to insure poor retirees against medical expenses. However, it is the rich who are most likely to live long and face expensive medical conditions when very old…We find that retirees with high lifetime incomes can end up on Medicaid, and often value Medicaid’s insurance features the most, as they face a larger risk of catastrophic medical needs at old ages, and face the greatest consumption risk.
“We saw it happen almost overnight,” [State Senator Diane J. Savino] said, describing programs that sprang up in sites like former auto-shops and part-time banquet halls in neighborhoods like Brighton Beach and Manhattan’s Chinatown, siphoning off low-income immigrant seniors from regular senior centers, “and basically stealing Medicaid dollars to do it.”
“We’re dealing with the unintended consequences of a very good initiative,” she added, referring to the Cuomo administration’s Medicaid redesign, which has rapidly transferred tens of thousands of elderly and disabled people from a fee-for-service system to managed care, in an attempt to reduce Medicaid spending and nursing home use.
Under the new system, managed care plans get roughly $3,800 a month for each eligible person they enroll in New York City, regardless of what services are provided. The plans contract with the social adult day care centers to provide services to their members. But advocates for the elderly and for people with disabilities have warned state officials that some plans were “cherry-picking” healthy seniors by using the new day care centers as marketing tools, while shunning the people who needed hours of costlier home care.
Joan Pastore, director of Amico, a city senior center in Dyker Heights, Brooklyn, said members of the center told her that they were not only signed up by new centers with enticements like $100 in cash and $50 for bringing a friend, but “coached on how to lie to qualify for home care.” (NYT)
Researchers at the Georgia Institute of Technology have developed Cody, a robotic nurse the university says is “gentle enough to bathe elderly patients.” There is also HERB, which is short for Home Exploring Robot Butler. Made by researchers at Carnegie Mellon, it is designed to fetch household objects like cups and can even clean a kitchen. Hector, a robot that is being developed by the University of Reading in England, can remind patients to take their medicine, keep track of their eyeglasses and assist in the event of a fall.
The technology is nearly there. But some researchers worry that we are not asking a fundamental question: Should we entrust the care of people in their 70s and older to artificial assistants rather than doing it ourselves? (NYT)
In Bensonhurst, Brooklyn, at the new R&G Social Adult Day Care Center, known locally among elderly immigrants for luring clients with cash and grocery vouchers, most people there for lunch did not stay to eat. Instead, many walked briskly toward the subway carrying bags stuffed with takeout containers, and two elderly men rode away on bicycles with the free food.
Not a wheelchair or walker was in sight at these so-called social adult day care centers. Yet the cost of attendance was indirectly being paid by Medicaid, under Gov. Andrew M. Cuomo‘s sweeping redesign of $2 billion in spending on long-term care meant for the impaired elderly and those with disabilities.
Such centers have mushroomed, from storefronts and basements to a new development in the Bronx that recently figured in a corruption scandal. With little regulation and less oversight, they grew in two years from eight tiny programs for people with dementia to at least 192 businesses across the city.
Of the 1.1 billion claims submitted to Medicare in 2010 for hospitalizations, nursing home care, doctor’s visits, tests and physical therapy, 117 million were denied. Of those, only 2 percent were appealed.
More from Susan Jaffe from the Kaiser Health News.
In the 19th Century, it wasn’t unheard of for politicians to pay constituents for votes with cash payments, livestock and even whiskey. Although election-day gifts of pigs, chickens and whiskey have long since gone by the wayside, modern day political parties have other ways of buying votes — at least that’s what Republican Rep. Darrell Issa, is alleging. Issa, the chairman of the House Oversight and Government Reform Committee, is accusing the Department of Health and Human Services of using an $8 billion program that pays bonuses to Medicare Advantage plans to “buy” the election.
His office wants to investigate whether they bonus payments are designed to temporarily hide the detrimental effects of the Affordable Care Act from seniors until after the election. The ACA, the federal health care law signed into law by President Obama, is slated to cut about $716 billion from the Medicare program over the next decade. Of this, $156 billion is due to be cut from Medicare Advantage plans. Issa has threatened to subpoena the documents on the Medicare Advantage bonus program if the Department of Health and Human Services does not willingly turn them over.
More about this issue from Fox News.
[A]ccording to the Congressional Budget Office, for every $500 the law spends on preventive services and prescription drugs, it cuts the rest of Medicare by $7,385. That’s a cut-to-spending ratio of nearly 15 to 1.