Questions

The Medicare 2013 Annual Election Period

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Medicare 2013

Beneficiaries can switch from their Medicare Advantage plan back to Original Medicare starting Oct. 15. Changes are effective Jan. 1, 2014.

I’m enrolled in a Medicare Advantage plan but I want to go back to Original Medicare. How can I do that?

The Medicare 2013 Annual Coordinated Election Period (ACEP) – more commonly referred to as Medicare Open Enrollment – starts October 15. This is the period during which Medicare beneficiaries can enroll in, and change or disenroll from Part C Medicare Advantage plans as well as Part D prescription drug plans, with any change effective January 1, 2014.

Some Medicare Advantage plans may have used deceptive marketing practices to lure patients into making the switch when it wasn’t necessarily in their best interest, according to the Department of Health and Human Services/Office of Inspector General reportBeneficiaries Remain Vulnerable to Sales Agents’ Marketing of Medicare Advantage Plans.” Read more


How can we improve patient outcomes in regard to surgical site infections?

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Preventing Infection after Hip and Knee Surgeries
Source: Institute for Healthcare Improvement (www.ihi.org)

Surgical site infections (SSIs) following hip or knee arthroplasty can be catastrophic for the patient —- leading to multiple surgeries, prolonged periods of medical and physical therapy, use of a wheelchair or walker, months of recuperation, significant pain, and substantial out-of-pocket expenses, reports the Institute for Healthcare Improvement , not to mention increased costs to providers.

Preventing Infection after Hip and Knee Surgeries

Three common practices reduce surgical site infections, reports the IHI.

 

With over 1.1 million procedures done in 2008 (the most recent numbers available), knee and hip replacements are two of the most commonly performed surgeries in the U.S. Depending upon patient risk, it is estimated that between 6,000 and 20,000 SSIs occur annually after these types of surgeries and the number is predicted to rise substantially in coming years due to an aging population staying more active, as published in Healthcare Executive. Read more


Do patients with mental illness qualify for home health care?

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Medicare Services for Psychiatric Patients

Obstacles to care management include inadequate discharge planning and medication non-adherence.

Patients are eligible for home health services if they present with acute psychiatric symptoms and meet the qualifications for homebound.

Mental health disorders comprise four of the top 10 causes of disability in the U.S. and include clinical depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder.

Depression alone affects more than 6.5 million Americans age 65 and older. It’s the single most significant risk factor for suicide in the elderly population.

Obstacles in Care Management

Increasingly shorter hospital and facility stays aren’t meeting the needs of patients struggling with mental illness. Hospitalized psychiatric patients often end up being readmitted after discharge, largely due to:

  • Inadequate discharge planning
  • Medication non-adherence
  • Lack of systems to ensure outpatient behavioral health follow-up
  • Impairment to patients’ ability to care for themselves
  • Lack of access to community services and family support
  • Substance abuse

Source: Agency for Healthcare Research and Quality Read more