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MGH Community News |
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MGH Community News |
| November 2012 | Volume 16 • Issue 11 |
Highlights
Sections
Social Service staff may direct resource questions to the Community Resource Center, Lindsey Streahle, x6-8182. Questions, comments about the newsletter? Contact Ellen Forman, x6-5807. |
The RIDE Issuing Transitional Approvals Until A version of the following was e-mailed to the Department and Health Centers earlier this week. Community Resource Center staff recently assisted with a The RIDE application that was approved "transitionally", meaning approved until January, by which time the applicant will need to complete an in-person assessment. A The RIDE customer service staffer said that they still do not have an official start-date for in-person assessments, but expect that they will begin during December. It appears that The RIDE will be issuing this transitional approval for new applicants until the in-person assessment process is up and running (we expect with the exception of the groups exempt from in-person assessment: those with visual disabilities, mental health disabilities and seizure disorders). We encourage you inform new applicants to expect this. Customer Service continues to say that there will be a big public education campaign prior to the roll-out of In-Person Assessment, so we expect to know more specifics when that happens. In the meantime please let Ellen Forman know if you learn any additional details or have significant experiences to share (thanks).
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Hospices Trying to Change Image- Get Referrals Sooner People often have one regret about hospice care: that they didn’t get it sooner. Now, hospices across the country are trying to rebrand and reposition themselves to reach patients earlier and erase the idea that turning to hospice is akin to “giving up.” Doctors are referring patients to hospice even later than they did a few years ago, said Gary Gaumer, an associate professor of economics in the department of Health Care Administration at the Simmons School of Management, who has served on hospice boards for two decades. Fundamentally, doctors want to save people, not admit they can’t, he said. |
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But that push to keep people alive at all cost can deprive patients and family members of valuable time to come to terms with the impending death, to work through family tensions, and to say goodbye, said Diane Stringer, president and chief executive of Hospice of the North Shore. Reaching for hospice isn’t giving up hope, she and others said, but instead actively choosing a different route. “It’s really about reframing hope,” she said, “for quality time, to finish uncompleted business of the emotional and spiritual type, to bring closure to one’s life.” Ironically, care that focuses on quality of life — rather than life extension — is also better medicine, recent studies show. -See the full Boston Globe article… Mass. to Offer In-State Tuition to DACA Recipients Governor Deval Patrick will direct state colleges and universities Monday to allow young illegal immigrants to pay the lower resident rate for tuition and fees as soon as they obtain work permits through the new federal Deferred Action for Childhood Arrivals (DACA) program, a senior administration official said. Patrick’s declaration ends five months of anxiety for immigrants who cheered President Obama’s decision in June to temporarily halt the deportations of immigrants age 30 and under. Education Secretary Paul Reville said recently that Obama’s program changed illegal immigrants’ circumstances enough to clear the way for them to pay resident tuition. Though they are not eligible for green cards, they will be allowed to stay for at least two years and, most importantly, obtain work permits. He said immigrants with federal work permits have been allowed to pay resident tuition since 2008. However, US education officials have said that students with deferred deportations are not eligible for federal financial aid. To pay resident tuition in Massachusetts, state officials said, immigrants must meet the same standards as any other student, including fulfilling academic requirements and the minimum length of state residency for that school. -See the full Boston Globe article …
DPH Strongly Encourages Health Institutions to Implement Medical Orders for Life-Sustaining Treatment (MOLST) In 2010, the Patient-Centered Care and Human Mortality Report issued by the Massachusetts Expert Panel on End of Life Care promoted the implementation of Medical Orders for Life-Sustaining Treatment (MOLST) in health care institutions statewide. After a successful MOLST demonstration in 2010 in the Worcester area, the Department of Public Health and the Executive Office of Elder Affairs are collaborating with Commonwealth Medicine at the University of Massachusetts Medical School to (implement) expand MOLST statewide, and strongly encourage all health care institutions to implement MOLST. MOLST, a voluntary process, helps seriously ill patients translate their individual preferences for receiving - or foregoing - life-sustaining treatment into valid medical orders. By discussing goals of care and completing a standardized form with their health care providers, patients nearing the end of life can decide and document how much medical treatment and which life-sustaining treatments (interventions) they want or do not want. MOLST orders are honored across all health care settings. MOLST is currently being implemented in hospitals, managed care practices, nursing homes, and home health care and hospice services, as well as by organizations providing emergency medical services. More Information See the promotional flyer and the MOLST website: www.molst-ma.org. -From Medical Orders for Life-Sustaining Treatment (MOLST), MA Health Care Training Forum, November 28, 2012. Weatherization Assistance Program Faces Cuts The federal Weatherization Assistance Program (WAP), now in its thirty-fifth year, is slated for a 95% cut from American Recovery and Reinvestment Act (ARRA) funding, a 66% cut from pre-ARRA funding, for the fiscal year beginning April 1, 2013. A new report from the National Consumer Law Center (NCLC), Low-Income Weatherization: Stimulus-Funded Program Shines but Storm Clouds Are on the Horizon, found that ARRA funding spent over the past three years resulted in WAP weatherizing 775,000 low-income homes nationwide, exceeding the government’s initial goal of 593,000 homes. “State and local weatherization agencies throughout the nation really came through in delivering the goods. Not only are over three-quarters of a million low-income families now living in healthier, more energy-efficient homes, saving an average $437 annually per household, but the program created 14,400 skilled jobs at its peak, and enabled many small U.S. businesses to grow while laying the foundation for a more vibrant green economy,” said National Consumer Law Center Attorney Charlie Harak, author of the report. “It’s unbelievable that on the heels of such a tremendous success, this cost-effective program is now in imminent danger as it faces a 66% cut from pre-Stimulus funding. The need is great as only 20% of eligible homes have been weatherized.” More Information See the executive summary, full report, charts, press release and videos at: http://www.nclc.org/issues/low-income-weatherization.html Dog Protected by Restraining Order Under New Mass. LawAn eight-year-old lab mix named Panzer is the "poster dog" for a new Massachusetts law recognizing a link between domestic violence and animal abuse, CBS Boston reports. Panzer's owner fled to a shelter herself to escape abuse, then, under the new state measure, filed a restraining order to protect her pet. The new law “An Act Relative to Domestic Violence and Animals” was signed by the Governor on August 2, 2012 and became effective October 31, 2012. Panzer is now safe with a foster family. "Animals are often used as a tool for emotional abuse," says Marshfield Police Chief Phil Tavares. "The batterer, the abuser will use an animal to seek revenge on or try to control one of the victims." According to CBS Boston, more than 70-percent of abused women say their abuser either threatened their pet or actually hurt the animal. One study found that up to 48% of battered women will not leave, or will return to a violent relationship due to fear of what might happen to the animal if left behind. The hope is the new law will change that, empowering victims to leave and giving their pets a safe haven. CBS Boston reports Panzer's owner couldn't stay in Massachusetts because all of the state's domestic violence shelters were full. Once she and her son find permanent housing, they expect to be reunited with their pet. See the original article: Dog Protected by Restraining Order Under New Mass. Law, CBSnews.com
We want to remind staff about an important resource for those with limited informal social supports (or overwhelmed social networks). Neighbor Brigade is a non-profit organization dedicated to helping communities quickly mobilize to help their neighbors during times of crisis. Chapters consist entirely of neighborhood volunteers who step in to help where immediate family and friends just can’t do it all. Services include:
Help is completely free of charge. Current chapters:
For More Information
-Thanks to Katie Binda for the reminder about this important program.
Long Distance Non-Emergency Medical Transportation A new type of resource has been brought to our attention: non-emergency medical transportation for long-distance travel. Each vehicle is equipped with a hospital bed, supplies, and a nurse on board. These services are private pay and not covered by insurance. Amenities normally include food, bed, patient care, onboard bathroom, TV, and space for a caregiver or family member. These companies can provide service in the contiguous U.S. Below is a sampling of companies that offer this service:
- Thank you to Lynn Mazur for bringing this resource to our attention.
Family Resource Center (JP and Roxbury) The Family Resource Center is a new program that serves any family with children aged 12 and under in the Jamaica Plain and Roxbury areas. The Family Resource Center provides the following services:
Additionally, staff at the Family Resource Center may provide assistance with filling out housing applications. Every other Friday from 1:30 to 3:00pm a case manager from the Metropolitan Boston Housing Partnership (MBHP) visits the center to provide advocacy for those in need of housing. The Family Resource Center does not turn anyone away. If the staff cannot help you, they will refer you to an organization that will. The center is primarily for families with younger children but families with older children may still receive services. The Family Resource Center is open from 9:00am to 5:30pm Monday through Friday. No referral is needed. Drop-ins are accepted but calling ahead is preferred. For More Information Call 617-522-1018 for more information. The program does not yet have a website. The Family Resource Center
New "Supper Club" for Older LGBTs in JP Sponsored by Ethos, Out4Supper, the first “Supper Club” in Boston for LGBT elders and their friends, is now open. A program of entertainment, speakers and discussion groups accompany the meal. Out4Supper is held on the first Tuesday of each month, from 6:00 pm to 8:00 pm, at the Mount Pleasant Home, 301 S. Huntington Ave in Jamaica Plain. The location is easily accessible by public transportation and includes plenty of on-site and street parking. Suggested Donation: Seniors $5.00 ($10.00 adults under 60). To RSVP, call 617.477.6606 or email out4supper@ethocare.org.
Special Needs Blogs and Websites List The website PhD in Special Education recently compiled a list of 100 special needs resources on the web. The list can be found at: http://phdinspecialeducation.com/special-needs/ and covers sites dealing with Autism, Down Syndrome, Batten Disease and special education. Some of the sites chronicle an individual’s or family’s journey with Down Syndrome or another condition, and some of the sites offer advice or links to other resources about special education or a specific type of special need.
Bromley-Heath to Get Family Education Center Boston officials and education leaders recently broke ground on a $16 million learning center at the Bromley-Heath housing development that aims to teach children, their parents, and other members of their community in the same space. “The more we looked at what really moves the dial for low-income, at-risk kids, we realized we had to focus on the economic stability of the entire family,” said Wayne Ysaguirre, head of Associated Early Care and Education, a Boston nonprofit that is spearheading the project. The core component will be early education. The new facility will have room for about 175 children up to age 8. The facility will be run as a lab school, incorporating the latest research on creative curriculum and teaching methods. More than a dozen other organizations will share resources, including the Thrive in 5 initiative, which is run by the city and the United Way of Massachusetts Bay and Merrimack Valley. The initiative prepares Boston children for kindergarten. Career-focused courses will be offered to about 150 adults. Another 700 can enroll in programs on parenting, financial stability, and nutrition. -See the full Boston Globe article …
Settlement to End Medicare Improvement Standard For about 30 years, home health agencies and nursing homes that contract with Medicare have routinely terminated the Medicare coverage for physical and occupational therapy of a beneficiary who has stopped improving, even though nothing in the Medicare statute or its regulations says improvement is required for continued skilled care. Advocates charged that Medicare contractors have used an unofficial “Improvement Standard" to illegally deny coverage to such patients. Once beneficiaries failed to show progress, contractors claimed they could deliver only "custodial care," which Medicare does not cover. In January 2011, the Center for Medicare Advocacy and Vermont Legal Aid filed a class action lawsuit, Jimmo v. Sebelius, against the Obama administration in federal court aimed at ending the government’s use of the improvement standard. After the court refused the government’s request to dismiss the case, and the administration lost in similar individual cases in Pennsylvania and Vermont, it decided to settle. As part of the proposed settlement, which the federal judge must still formally approve, Medicare will revise its manual that contractors follow to clarify that Medicare coverage of skilled nursing and therapy services “does not turn on the presence or absence of an individual’s potential for improvement” but rather depends on whether or not the beneficiary needs skilled care, even if it would simply maintain the beneficiary's current condition or slow further deterioration. The policy shift will affect beneficiaries with conditions like multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, ALS (Lou Gehrig’s disease), diabetes, hypertension, arthritis, heart disease, and stroke. In addition, under the settlement more than 10,000 Medicare beneficiaries who were denied claims for skilled services before January 18, 2011, when the lawsuit was filed, will have their claims re-examined. It could be a couple of months before a federal judge approves the settlement, which the New York Times reports she is expected to do. Then it could be a year or more until the Medicare billing contractors get the newly clarified manuals. See the full source articles:
MassHealth Relaxes Breast Prostheses Provider Rules As of November 9, 2012 MassHealth has relaxed their regulations to no longer require that programs that provide breast prostheses and related supplies employ a certified prosthetist. Now programs may offer these services with as long as they
This change should help make breast prostheses more easily available to patients. For example, this may allow MassHealth members to get their prostheses through the MGH Images Boutique. For more information, see the MassHealth Transmittal Letter PRT-24.
Cost Commission Begins Work to Rein-In Health Spending in Massachusetts Governor Deval Patrick recently swore in the board members of the Health Policy Commission, the new agency charged with holding down health care spending in the state. Massachusetts is the first state to set an annual target for total health care spending, passing a law earlier this year calling for costs to rise in line with the growth of the overall economy. The commission is charged with monitoring spending by hospitals and doctors groups. The board will review practices by provider groups whose spending is deemed excessive and may require them to submit a performance improvement plan, which would be open for public review and comment. Those providers who neglect their performance plans, falsify information or otherwise buck the process could face a fine of up to $500,000. The process of holding providers accountable to a state spending target begins in 2014, when the commission will be reviewing performance during the 2013 calendar year. The law says total medical spending next year should grow no more than 3.6 percent . Through 2017, increases will be pegged to the projected growth rate in the state economy. For five years after that, growth in health care spending will be held to a half percentage point less than the overall state growth rate. The commission will have the power to recommend modifications to the target starting in 2018. The commission also must hold annual hearings on health costs, file an annual report on the state’s progress, oversee the Office of Patient Protection now under the Department of Public Health, and develop standards for certifying patient-centered medical homes, a model of primary care in which a team of caregivers collaborate on people’s mental and medical health needs. -See the full Boston.com “White Coat Notes” article… Cited in/Linked from: HEALTH CARE WEEKLY UPDATE, November 21, 2012, from Barbara Roop & John Goodson, Health Care for Massachusetts.
U.S. Set to Sponsor Health Insurance The Obama administration will soon take on a new role as the sponsor of at least two nationwide health insurance plans to be operated under contract with the federal government and offered to consumers in every state. These multistate plans were included in President Obama ’s health care law as a substitute for a pure government-run health insurance program — the public option sought by many liberal Democrats and reviled by Republicans. Supporters of the national plans say they will increase competition in state health insurance markets, many of which are dominated by a handful of companies. The national plans will compete directly with other private insurers and may have some significant advantages, including a federal seal of approval. Premiums and benefits for the multistate insurance plans will be negotiated by the United States Office of Personnel Management , the agency that arranges health benefits for federal employees. -See the full The New York Times article … Cited in/Linked from: HEALTH CARE WEEKLY UPDATE, Barbara Roop & John Goodson, Health Care for Massachusetts, November 02, 2012.
Hospital Medicare Cash Lures Doctors as Costs Increase Doctors are increasingly making the decision to sell their practices to hospital groups, creating a new dynamic that threatens to raise the price of health care, even as the federal government and states strain to keep a lid on costs. Under Medicare’s tangled payment system, hospitals get higher reimbursements than individual doctors for cardiology treatment, as they do for other specialty services, in some cases as much as three times more. At the same time, the added bargaining power gained by controlling more of the heart care in a geographic market has given large hospital systems added leverage in negotiating reimbursements from insurers. “Clearly, in the short run, it raises costs,” said Paul Ginsburg, president of the Center for Studying Health System Change, a Washington-based nonprofit research group. “We have a case where a physician becomes employed by a hospital and now a payer, like Medicare, has to start paying more.” Trade Offs The advantage of more doctors joining large health-care systems is the prospect of higher-quality and more coordinated care for patients, especially in the better hospital systems. In the meantime, the trend continues to push up costs. -See the full Bloomberg.com article … Cited in/Linked from: HEALTH CARE WEEKLY UPDATE, Barbara Roop & John Goodson, Health Care for Massachusetts, November 21, 2012. Opinion: Health Care Cuts Are Coming- Here's Where Liberals Say You Can Slice A liberal think-tank closely allied with the Obama administration is proposing a health care spending plan it says could save hundreds of billions of dollars in entitlement spending without hurting middle- and low-income patients. The plan from the Center for American Progress (CAP) comes as Congress prepares for a battle royal over the so-called fiscal cliff. This new plan is notable not just for potential savings, but for what some of those savings are. They include many things that build on savings included in the Affordable Care Act, like cutting waste and encouraging more efficient care, as well as lowering payments to some providers. But there are also some controversial items. Like asking wealthier Medicare beneficiaries to pay more out of pocket for their care. And limiting the tax-free status of health insurance for people who earn more than $250,000 a year. Some previously suggested options are not included in this proposal. For example, raising Medicare's eligibility age to 67. "We believe raising the Medicare age simply shifts costs to states, seniors and private employers," CAP President Neera Tanden said. Likewise, the plan rejects most cuts to the Medicaid program. Reducing funding for Medicaid right now "would undermine the very strong case the administration is making each and every day for governors to ... do their Medicaid expansions" under the Affordable Care Act, Tanden said. -See the full NPR story … Cited in/linked from: HEALTH CARE WEEKLY UPDATE, Barbara Roop & John Goodson, Health Care for Massachusetts, November 16, 2012.
Exercise Gains Momentum as Psychiatric Treatment The benefits of exercise in nearly every aspect of physical health are well known, but evidence in recent years suggests a unique effect on some psychiatric disorders.
-See the full article summary: Exercise Gains Momentum as Psychiatric Treatment. Medscape. Nov 16, 2012 , including suggestions on how to motivate patients to exercise.
Psychotherapy in Adult Attention Deficit Hyperactivity Disorder Abstract Attention deficit hyperactivity disorder (ADHD) is a risk factor for co-occurring psychiatric disorders and negative psychosocial consequences in adulthood. Previous trials of psychotherapeutic programs for adult ADHD were based on cognitive behavioral psychotherapeutic approaches and showed significant effects. Targets of psychotherapeutic interventions include not only coping with the core symptoms and associated problems such as depression and anxiety, but also probable consequences such as low self-esteem. Improvements in ADHD symptomatology and associated symptoms have been reported after psychotherapeutic treatment. The support of other participants is strongly regarded as helpful by patients in group therapy. This manuscript provides an overview of psychotherapy approaches and results of studies evaluating programs developed to treat adults with ADHD. Finally, the specific requirements of psychotherapy for adult ADHD as well as further research questions will be discussed. -See the full Medscape.com article summary…
Documenting Noncompliance Not Enough "If only the doctor had told me how important it was to (get a test, see a specialist, return for a follow-up visit, go to rehab, and so on), then of course I would have done it. But he didn't act like it was that big a deal." Malpractice attorneys and insurance risk managers say that this is a classic allegation they hear from plaintiffs. And it often works with juries. The best defense against this tactic is having meticulous records that document the doctor's rationale of treatment, clear explanations of what he or she wants the patient to do, and whether the patient actually complied with that advice. But merely writing "patient did not comply" is not enough to protect you. How you document noncompliance (or nonadherence) can mean the difference between winning or losing a lawsuit -- and often preventing the suit from being filed at all. Juries place a significant amount of responsibility for follow-up on doctors and what steps they took to remind patients of the need for it. "Juries have created this affirmative duty to tell the patient that there is a specific danger and that they need to be seen." says James Lewis Griffith, Sr., a malpractice attorney in Philadelphia, Pennsylvania Especially in these hard economic times, physicians should ask about a patient's financial circumstances. "Doctors aren't social workers, but they need to go the extra mile to find out what may interfere with good compliance," said Georgette Samaritan, RN, BSN, senior risk management consultant with MAG Mutual, a liability carrier based in Atlanta, Georgia. Every physician needs a reliable clinical tracking system to identify patients who fail to keep scheduled appointments for tests and consultation with specialists. Do you call patients who've missed their appointments? How do you know whether the patient actually saw the gastroenterologist you referred him to? "Failure to maintain reliable clinical tracking systems is one of the most frequently cited problems in malpractice cases where there is an allegation of delay in diagnosis or failure to supervise care," said Samaritan. -See the full Medscape.com article: Documenting Noncompliance Won't Protect You Anymore. Medscape. Nov 12, 2012. Opinion: Keeping Patients Alive a Few Weeks More- Is It Futile Care? Medscape just conducted a survey of 24,000 doctors, and only 25% said they would not provide futile interventions. A very significant percentage, more than 30%, said that they would. The rest of those surveyed said they might, depending on the circumstances. That is a startling finding because the way we understand futility in ethics and in medical practice is "no benefit." So why would you do things that don't benefit the patient? Some people said in the survey that they would provide futile treatments because there is always the possibility of a miracle. That is a troubling way to approach the subject of futility. It is true that miracles can happen, but for people who we know have end-stage lung cancer, liver disease, or pancreatic cancer, miracles don't come. The evidence says that we know what the prognosis is going to be. So, although I certainly understand wanting to offer hope to people and give them emotional comfort, we are not doing them favors by saying, "You know, miracles happen; things happen out of the blue." Maybe that is something that the chaplain wants to say, but it isn't something that the doctor should be saying. Offering small hope instead of providing futile treatments is a more humane way to deal with the reality of death. They have the right to hope, but we ought to give them more short-term, reasonable things to hope for and not continue to give them hope that we absolutely know is futile at this point in their care. The fact that a lot of doctors are still willing to give futile care is probably tied in with another reality, and that is fear about the law. People worry that "if somebody sues me, and I didn't do x, y, or z, then I'm going to be on the wrong end of a malpractice suit." I have never seen it. I have acted as an expert witness. You don't lose those cases. If you say in good conscience, as a physician, as an expert, that I believed that doing something was futile and I didn't do it, and I talked about that with the patient -- anybody can sue you at any time for anything -- you are not going to lose that case because you are following the standard of care and what you believe to be true as the expert. -See the full opinion piece: Keeping Patients Alive a Few Weeks More: Is It Futile Care?. Medscape. Nov 15, 2012. New Autism Toolkit for Pediatricians and Information for FamiliesThe American Academy of Pediatrics (AAP) recently released Autism: Caring for Children With Autism Spectrum Disorders: A Resource Toolkit for Clinicians, the second edition of the toolkit includes the latest AAP guidelines on autism screening, surveillance, diagnosis, treatment, and referral and resources for families. The toolkit includes handouts for families in English and Spanish. There is also a companion website for families where you can also access this information: American Academy of Pediatricians, HealthyChildren.org- Autism Spectrum Disorders. -See the full summary article at New 'Autism Toolkit' for Clinicians Launched . Medscape. Oct 26, 2012.
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