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MGH Community News |
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MGH Community News |
| May 2014 | Volume 18 • Issue 5 |
Highlights
Sections Social Ser vice staff may direct resource questions to the Community Resource Center, Lindsey Streahle, x6-8182. Questions, comments about the newsletter? Contact Ellen Forman, x6-5807. |
Regulators Find Arbour HRI Deficient Again Three months after state regulators allowed a Brookline psychiatric hospital to start accepting new patients again, federal investigators found deficiencies with psychiatric evaluations and treatment plans, problems they said may have hindered patients’ recovery. The federal report, based on a February inspection, concluded that Arbour HRI failed to provide active treatment for at least four patients. The patients, whose diagnoses included bipolar disorder and paranoid schizophrenia, spent many hours without structured activity, the report said. Instead of attending group therapy, they spent many hours sleeping or wandering around the hallways, inspectors said. Massachusetts regulators prohibited the hospital from accepting any patients in November, citing unsafe conditions. When they allowed admissions to gradually resume two weeks later, in early December, mental health officials said Arbour HRI was working to bring the “culture of care’’ up to “our high standards.’’ One Tuesday afternoon during the February federal inspection there were 11 patients in a unit for those diagnosed with both mental illness and a substance abuse disorder. Only three were in therapy. Eight were found in bed. Staff members often wrote in the medical records that patients were offered “educational materials’’ as an alternative, but they did not specify what the materials were or how the patients responded. Arbour Health System operates five psychiatric hospitals and 12 mental health clinics in Massachusetts. Its for-profit parent, Universal Health Services, is a publicly traded company that earned more than $500 million last year and has staked its future largely on expanding in the behavioral health care market. Arbour HRI in particular has been very profitable. The hospital earned a 32 percent profit in 2012, compared with an average 9 percent earned by other non-acute care hospitals in Massachusetts, according to the most recent state reports. Nearly 85 percent of patients at the hospital are covered by the federal and state Medicare and Medicaid insurance programs, meaning that many are poor, and that most care is paid for by taxpayers. Frank Barnes, a longtime mental health worker at the hospital and a union representative for 1199SEIU, said the problems at Arbour HRI reflect the culture of the administration. “The emphasis wasn’t on the quality of care,” he said. “It was on increasing income.’’ Staff members have filed numerous complaints with hospital leaders and regulators about a lack of security personnel; inadequate staff; and patients not having enough towels, blankets, and food at night, he said. |
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When asked why the state cleared Arbour HRI in December, only to have federal inspectors find serious deficiencies three months later, state officials said they were working intensely with the hospital during those months to spur improvements. State regulators visited Arbour HRI and met with staff 11 times between Dec. 10 and March 20, they said. Last month, the state allowed the hospital to open all units to new patients — with assurances of adequate staff, medical coverage, and group programming. -See the full The Boston Globe article...
Child Welfare League of America’s DCF Quality Improvement Report Released A report released on May 28 by the Child Welfare League of America, faulted the Department of Children and Families for inadequate staffing and technology and “grossly out of date” policies to protect children, but it said the agency could not have prevented Jeremiah Oliver’s death. Linda Spears, the league’s vice president of policy and public affairs, said at a news conference that the $150,000 state-funded report did not attempt to assign individual blame for Jeremiah’s death but sought to address broader problems at the agency and in the field of child welfare. For example, it faulted state policymakers for failing to pay attention not just to DCF, but to larger issues such as poverty, drug abuse, and mental illness that can lead to violence against children. The Child Welfare League of America is a Washington-based nonprofit that advocates for vulnerable children and families. The report found a range of problems at the agency. It said that many DCF policies are outdated and that its workers lack adequate mobile technology to be able to log home visits from the road, allowing managers to spot missed visits and other problems. It also concluded that DCF needs more money, beyond the funding increases that Patrick and lawmakers have proposed for the upcoming fiscal year. The money would help reduce caseloads, which are at their highest point in 20 years, Spears said. Currently, she said, social workers handle on average about 20 cases each, compared with the recommended level of 15. The secretary of health and human services, John Polanowicz, said that the report will help the administration improve the agency and that he has already taken steps to address some of its key findings. He said, for example, that DCF has added 90 social workers since January and has distributed 2,000 iPads to social workers in the field. Polanowicz also announced the formation of a “kitchen cabinet” of child welfare specialists to advise DCF’s interim commissioner, Erin Deveney, a former state transportation official who has no prior child welfare experience. It was not clear all of the findings would be embraced. Pressed by reporters, Polanowicz would not commit to seeking more funding for DCF, as the report recommended. He said the administration needed to study the issue more closely. That raised some alarms from child welfare advocates. “We largely support the recommendations included in the report but can’t help but ask what comes next,” Erin G. Bradley, executive director of the Children’s League of Massachusetts, a youth advocacy group, said in a statement. “If the Commonwealth truly wants to make improvements to DCF to better protect our children, we are going to have to prioritize finding the money to implement reforms.” -See the full The Boston Globe article...
Social workers have been jumping ship at Massachusetts’ embattled child welfare department this year faster than the agency has replaced them, suggesting DCF is barely treading water in its struggle to safeguard the state’s most vulnerable children, according to state data and union officials representing DCF staffers. At a time when the agency is trying to increase staffing, the Department of Children and Families “actually lost the equivalent of three full-time social workers” between December and the end of March, the most recent time frame available, according to a memo circulated to state senators by SEIU Local 509, which represents state social workers. Meanwhile the Patrick administration has boasted about a slew of hires at the agency, which as of May 21, 2014 stood at 200 new caseworkers, according to the agency. DCF admitted that 81 caseworkers have left this year, and said new hires aren’t counted as fully functioning front-line staffers for at least four months because they don’t take on any new cases for the first two months as they steadily build toward a full caseload. “We are seeing a larger percentage who are just saying, ‘This is too much, the caseloads are too high, the cases are too complex, and this is something we can’t do right now,’” said Peter MacKinnon, president of SEIU Local 509, explaining the staff exodus. “The morale is too low. They’re saying, ‘It isn’t worth it to stay here.’” Union officials also point out that caseloads — already at overwhelming levels in some areas — have risen by nearly 15 percent systemwide, which has helped drive retirements and early departures. “Some of these retirements are demographically driven. Others are driven by the recent furor around the agency. But we’ve got to have some sort of smart recruitment strategy that anticipates (departures) and still gains ground.” said State Sen. Michael Barrett (D-Lexington), the Senate chairman of the Committee on Children, Families and Persons with Disabilities. -See the full Boston Herald article... Cited in/Linked from: MASSterList, Mike Deehan, May 22, 2014.
The Homeless Court Program (HCP) is a program established in partnership with the West Roxbury Division of the Boston Municipal Court Department, the Suffolk County District Attorney’s Office, the Lemuel Shattuck Hospital, Pine Street Inn, Shelter Legal Services, and the Committee for Public Counsel Services. The HCP seeks to expand access to the criminal justice system and reduce legal barriers faced by homeless men and women and those at risk of homelessness by establishing an alternative court session designed to expeditiously resolve outstanding warrants for misdemeanor offenses and non-violent felonies, with the goal of stimulating full and fast social reintegration and the transition to a self-supporting and sustainable life. HCP court sessions are held on the third Thursday of each month and alternate between two locations – Pine Street Inn in Boston, and the Shattuck Hospital in Jamaica Plain. Eligibility
Referral To refer, contact The Committee For Public Counsel Services (CPCS) . They will speak with the client and screen for eligibility: Elizabeth Condron, Pine Street Inn : (617-892-7897), Jeff Garland, CPCS: (617) 209-5548, Christie Charles and Bill Lane, CPCS: (617) 989-8100. If a client is determined eligible, they will ask you to write a letter of advocacy that documents the participant’s accomplishments and supports the recommendation for resolution of the case. Clients should know that CPCS defense attorneys will be sharing these advocacy letters with the District Attorney’s Office, Probation Department, and the Court in order to advocate for the client’s participation in the program and for a resolution of the client’s case. They ask that providers accompany participants to the HCP court sessions if at all possible, and speak about the participants’ accomplishments when the cases are called. More information – HCP Information Sheet for Providers
Experts Call 70 the REAL Retirement Age A recent briefing from the Center for Retirement Research at Boston College says that, in effect, 70 has become Social Security's new retirement age, due to increases in the Delayed Retirement Credit that mean the highest monthly benefits are available for those claiming benefits beginning at that age. In the 1930s, the retirement age was set at 65, which coincided with the age used by many private and public pension plans. In the late 1950s and early 1960s, Congress changed the law to enable workers to claim benefits as early as 62. But benefits claimed before 65 were actuarially reduced, so that those who claimed at 62 and those who claimed at 65 could expect to receive about the same total amount in benefits over their lifetimes. In the early 1970s, Congress introduced the Delayed Retirement Credit, which increased monthly benefits for those who claimed after the so-called Full Retirement Age of 65. That credit, which was modest at first, now fully compensates for delayed claiming. As a result, lifetime benefits are roughly equal for any claiming age between 62 and 70, and the highest monthly benefits are available at 70. In that regard, 70 has become the new 65. An enormous amount of evidence, both for the United States and other developed countries, shows that richer, better-educated people live longer than poorer, less-educated people. According to calculations from the National Longitudinal Mortality Survey, which tracks the mortality of people originally interviewed in government surveys, men whose 1980 family income fell in the top 5 percent had a life expectancy at all ages that was about 25 percent longer than those in the bottom 5 percent.Moreover, the discrepancy in life expectancy between those with high and low socioeconomic status is getting larger with each cohort. The Boston College researchers caution that vulnerable workers who are forced to claim early will have low benefits and will be particularly harmed by any further cuts. They say that policymakers should inform those who can work that 70 is the new retirement age, while devising ways to protect those who cannot work (such as directly changing the benefit formula). The authors also note that most people do not understand how the age when they begin claiming benefits affects the amount they will receive. Read the full Social Security's Real Retirement Age is 70 briefing report. -Adapted from Aging In Stride eNews and the briefing report linked above. Advance Directives- Keep them Safe Accessible and Up-to-Date Keep Them Safe, But Accessible Many people understandably want to keep their advance directives and health care power of attorney forms in a secure place. But if these documents are locked away in a safe deposit box, they won’t be much help if you’re unexpectedly hospitalized. Here are some people who should have copies of your advance directives and some other places where they should be filed.
If you have a do not resuscitate order (DNR), remember that you or your health care agent may be required to produce a signed form, or you may have to wear a special bracelet identifying that decision. If a lawyer drew up your advance directives, ask whether he or she will keep a copy, and for how long. And Up to DateIf you decide to change something in your advance directives or health care power of attorney, the best thing to do is create a new one. Once the new document is signed and dated — in front of appropriate witnesses, and notarized if necessary — it supersedes your old directive. The American Bar Association Commission on Law and Aging suggests that you re-examine your health care wishes whenever any of the following “five d’s” occurs:
Make sure anyone with a copy of your old directive returns it to you so you can destroy it. Then distribute the new one. Take the time to discuss these changes with your doctor and your health care agent to be sure everyone is clear on the changes. If you enter a nursing home or assisted living facility, make sure a copy of your revised advance directive gets filed in your medical records. A growing number of states are creating medical registries in which you may record your directive so that it will be directly available to health care providers when needed. If you move to another state, check that your living will is still valid. Although states may be legally required to honor any advance directive that clearly conveys your wishes, it’s best to verify that your form meets the requirements specific to that state. Massachusetts for example, is one of only three states that recognizes Health Care Proxies but does not recognize Living Wills. While Massachusetts considers this kind of document good evidence of a patient’s wishes, it’s not legally binding in the Commonwealth. -Adapted from:
With additional information on Living Wills in Massachusetts from Massmed.org: Important Differences Between Health Care Proxies and Living wills and Facing End-of-Life Issues. Bridgewater State Hospital Under Scrutiny Lawyers from the Disability Law Center, designated under federal law to investigate complaints about the abuse of disabled people, launched an investigation in April into the alleged abuse and neglect of inmates at Bridgewater State Hospital, interviewing staff and inmates about reports that guards and clinicians are illegally putting mentally ill men into physical restraints and isolation cells. The center’s investigation follows a series of Globe articles highlighting the increasingly discredited use of restraints and seclusion at Bridgewater. The facility houses about 340 men, including a wide range of mental health patients, all of whom have had some contact with the criminal justice system Some are dangerous convicted criminals referred from other prisons, but others have been accused of only minor offenses and have never been criminally convicted. In 2009, a 23-year-old mental health patient, Joshua K. Messier, who was accused of assaulting a staff member in a psychiatric facility died as prison guards were strapping his wrists and ankles to a small bed. In a 2007 lawsuit against the state prison system, the center said the isolation of mentally ill inmates exacerbates their illnesses. It also said that, while social isolation and sensory deprivation would be difficult for any inmate, “for prisoners with mental illnesses, they exceed the limit of human endurance.” The suit was settled two years ago, after the department agreed to minimize use of isolation for mentally ill inmates and provide specialized housing units for mentally ill inmates who may be violent. The settlement also followed a Globe Spotlight Team investigation, which found that inadequate care for mentally ill prisoners often resulted in suicides. The Globe’s recent reporting noted that Bridgewater’s use of seclusion and restraints increased 27 percent since Messier’s death. If Disability Law Center officials conclude they have found wrongdoing, they could file a federal lawsuit against the state to force changes. In early May Governor Deval Patrick and a large group of senior staff members visited Bridgewater State Hospital and announced that the administration will bring in a nationally recognized specialist to help reduce the medium-security prison’s overreliance on restraining mentally ill men, strapping their wrists and ankles to a bed, or isolating them in small cells for days or weeks at a time. During a meeting of about two dozen officials that included top Bridgewater administrators and advocates for the mentally ill, Patrick asked for a report outlining short-, medium-, and long-term solutions to the issues confronting the facility, ranging from the excessive use of seclusion and restraints to whether patients and inmates treated at Bridgewater should be under the care of the Department of Mental Health, rather than the Department of Correction. After Patrick’s meeting with advocates and Bridgewater staff members, Cabral said the administration will retain Joan Gillece to help reduce the use of seclusion and restraints at the prison. Gillece, project director for the National Association of State Mental Health Program Directors, has played a leading role in training staff at mental health facilities to reduce their reliance on such measures through a program known as the “Six Core Strategies.” The program focuses on techniques designed to reduce violence and the factors that cause violence to escalate into situations in which staff members believe use of seclusion or restraints is the only way to guarantee the safety of patients and clinicians. The Disability Law Center’s executive director, Christine M. Griffin, attended the meeting and praised Patrick’s selection of Gillece. “She’s a wonderful choice and has experience working in prisons,” she said. “She can help them reduce the use of restraints and, frankly, eliminate it. It can be done.” Under state law, mental health patients may be secluded or restrained only in cases of emergency where they are committing or threatening to commit acts of “extreme violence.” -See the full Boston Globe articles: Watchdog Group for Disabled Launches Investigation and Patrick and Top Aides Visit Troubled Bridgewater State Hospital
Watch for Fake Utility Bill Collector Scams and How to Report Such Fraud The Federal Trade Commission, state and local consumer protection agencies, and utility companies have gotten a slew of complaints from consumers about utility bill scams. Here are a few signs you may be dealing with a scammer:
So if you get a call from someone threatening to shut off your utility service:
Reporting Fraud
-Adapted from and for more information: Lights Out for Fake Utility Bill Collectors, Federal Trade Commission (linked from Utility Network Listserv, Charlie Harak, May 09, 2014), and Aging in Stride eNews.
Ruling Gives Detained Immigrants Right to Bail Hearings Bay State immigrants in federal custody cannot be held for more than six months without a chance at a bond hearing under a recent court ruling, a decision that “changes everything,” according to lawyers who have for years been waiting for the law to be revised. U.S. District Judge Michael Ponsor in Springfield ruled that allowing U.S. Immigration and Customs Enforcement to indefinitely detain Bay State immigrants without an opportunity for a bail hearing violates their due process rights. He said a federal law, which permits the detention of certain immigrants, allows all immigrants to eventually be heard. “This changes everything,” said Rachel Rado, a immigration attorney in Boston not involved in the case. “Before, I would tell them there’s no hope. Now they would be eligible to post a bond.” An immigration court will determine whether detained immigrants are a danger to society or a flight risk before allowing them to rejoin the public. If immigrants are released and skip a court date, they can be immediately deported, according to Rado. The decision will affect “about 40” immigrants who are currently being detained but will also extend to many others who will eventually be held by ICE, according to Nicole Hallett, an attorney for the plaintiffs. Many immigrants in ICE custody have already served their criminal sentences, and some have only been on probation, according to Hallett. ICE can detain certain immigrants pending a deportation hearing under federal law. Ponsor ruled that ICE “shall immediately cease and desist” holding immigrants indefinitely without a bail hearing. ICE spokesman Daniel Modricker said the agency does not comment on ongoing litigation. -See the full Boston Herald article... Cited in/linked from MASSterList, Mike Deehan, May 30, 2014.
Refugee and Immigrant Assistance Center (RIAC) The Refugee and Immigrant Assistance Center is dedicated to promoting cultural, educational, and socioeconomic development in the refugee and immigrant community. They offer the following services:
Counseling Services RIAC’s Community Counseling Services provide clinical staff with expertise in refugee and immigrant mental health issues in a community-based mental health and social support program. The counseling services are offered at the Jamaica Plain office only. Currently they can treat clients in English, Farsi, Ibo, Hausa, Swahili, Spanish, and Somali. RIAC accepts the following types of insurance: Massachusetts Behavioral Health Partnership (MBHP), Boston Medical Center HealthNet Plan (BMC), and Neighborhood Health Plan (NHP). For those with other or no insurance, RIAC may refer to other agencies. Office Locations
Website: http://www.riacboston.org/ -Thanks to Ellen Godena for sharing this resource.
Pilot Program Offers Stable Housing To Homeless LGBT Youth
Approximately 40 percent of homeless young adults in the U.S. identify as lesbian, gay, bisexual or transgender, according to a study from The Williams Institute at UCLA Law. Family Rejection According to the Williams Institute study, the most frequently cited reason for LGBT homelessness is family rejection. “When you boil it down, young adults are homeless for three main reasons and that’s that home doesn’t exist, home isn’t safe, or home isn’t supportive,” says Youth on Fire drop-in-center program manager Ayala Livny. Livny says that not only are gay and transgender youth more likely to be homeless, they’re also more likely to engage in risky behavior. To survive, some turn to sex work — exposing themselves to STDs, HIV and violence. “So whether that is in the shelters where there aren’t safe places for them, whether that’s on the streets in the community, all of these components come together to provide really dangerous situations for young adults who are on the streets,” Livny says. Seeking Stability While young adults can spend their days at Youth on Fire, it is not a shelter — it closes at night. Livny says some of the LGBT youth she sees during the day have been assaulted at night at shelters. But now, the private nonprofit Massachusetts Housing and Shelter Alliance, or MHSA, is introducing a program to house this at-risk population. “It is permanent housing that’s accompanied by services,” explains MHSA executive director Joe Finn. “We are able to make services available to that tenant that are are helpful in supporting that person in their tenancy, depending on what their specific wants and needs are.” Those services could include counseling, job placement and access to health care. The pilot will provide 32 units of housing in Greater Boston and Western Massachusetts. Youth on Fire is one of three organizations coordinating the housing. However, according to Youth on Fire’s Facebook page, the current MA Senate Ways & Means Budget proposal would cuts the funding for the LGBTQ Young Adult Pilot Program, that funds part of the new Housing Program. They are encouraging calls to Senate President Therese Murray (617.722.1500) and Senate Ways & Means Chairman Stephen Brewer (617-722-1540) to express disappointment in their decision to cut this LGBTQ young adult housing pilot program. -Adapted from and for more information: Pilot Program Offers Stable Housing To Homeless LGBT Youth, WBUR, May 5, 2014, the MHSA Press Release, November 7, 2013, and Youth on Fire’s Facebook page.
Deciding If a Reverse Mortgage is a Good Choice Reverse mortgages allow homeowners aged 62+ to use a portion of their home equity and continue living in their home. Federal law requires that anyone considering the FHA Home Equity Conversion Mortgage must receive counseling from a government-approved agency. NCOA is one of nine groups approved by the U.S. Department of Housing and Urban Development (HUD) to provide this service. Search for a HUD approved agency. The National Council on Aging (NCOA) recently announced a new national toll-free number for older homeowners to sign up for counseling when considering a reverse mortgage: 1-855-899-3778. For more information about reverse mortgage, download the National Council on Aging's free consumer booklet. Also available in Spanish. NCOA reverse mortgage counselors do not sell any products. They work with seniors to weigh the pros and cons of a reverse mortgage to decide if this option is right for their situation. NCOA counselors also identify benefits and other supportive community services that can help older adults pay for basic necessities and remain independent in their homes as long as possible. There is a $90 upfront fee for this service. Depending on available funding, NCOA will:
"Thousands of older homeowners use counseling to decide if a reverse mortgage is right for them," said Amy Ford, NCOA's director of home equity initiatives. "We're proud to offer this service as a way to help seniors achieve lasting economic security and independence." Reverse mortgage counseling is one of several resources that NCOA provides seniors to improve their economic security. Other free online tools include EconomicCheckUp (www.benefitscheckup.org/esi-home), which helps with budgeting, debt reduction, and employment; BenefitsCheckUp (www.benefitscheckup.org), which screens for thousands of public and private benefits programs; and My Medicare Matters (www.mymedicarematters.org), an educational site that helps people make the most of their Medicare coverage. -Adapted from Aging In Stride eNews, May 1, 2014.
App Aims to Make Caring for an Ill Loved One Less Onerous Renee Fry was fresh off a stint as deputy chief of staff to former governor Mitt Romney and was settling into a new marketing job in 2008 when she suffered a seizure and learned she had a massive brain tumor. “Your life just changes overnight,” she said. As did the lives of Fry’s mother and sister, who were thrust into the role of caretakers, helping her recover from a successful 14-hour surgery and managing the extensive rehabilitation she needed to regain motor function. From this trying period came the inspiration for Making Care Easier, a startup founded by Fry and her sister, Julie, to help people plan and manage the health care needs of family members. The company’s website (https://www.makingcareeasier.com) and mobile app can store electronic medical records, provide research on health conditions, and help multiple caretakers coordinate schedules. It also offers online shopping for durable medical equipment. Julie Fry knew those responsibilities well. She is a former marketing director for the National Association for Home Care & Hospice, and previously ran a business that remodels homes to accommodate the needs of elderly patients and people with disabilities. But even she admits she was surprised by how hard it was to organize vital information when caring for her sister. “We needed a site to help us create and store our important information like emergency plans, care plans, medicine plans,” Julie Fry said. “It had to be one place everyone could access from anywhere to not only find information, but act on that information. We couldn’t find it, so we created it.” Making Care Easier is free for users. Revenue comes from advertising and fees collected from retailers when users buy medical equipment through the site. -See the full Boston Globe article...
Medicare Reminder- Medicare D Extra Help -Adapted from What is Extra Help?, Dear Marci, Medicare Rights Center, May 19, 2014.
OneCare Offers Full Dental Services As you are probably aware, MassHealth covers limited dental services for most adults. OneCare is the Massachusetts pilot program that combines benefits for adults 21-64 who are eligible for both MassHealth and Medicare (“dual eligibles”). A new fact-sheet compares the dental benefits available under the program with those under MassHealth Fee-for-Service. Covered services under OneCare include Dentures (including repairs), crowns (including repairs), Periodontal services (root canals) and Endodontic services (gum treatment). As missing teeth can impact nutrition, health and job prospects, this may be important for certain patients to know. Partners Healthcare is currently not participating in OneCare for primary care, so patients who opt for the OneCare program would need to choose a new participating primary care provider. Patients will need to weigh their options to decide what is best for them. More Information Medicare Reminder- Medicare Savings Programs (MassHealth Medicare Buy-In Programs) A Medicare Savings Program (MSP) is an assistance program that can help pay for your Medicare costs if you have limited finances. In Massachusetts these programs area called MassHealth Medicare Buy-In Programs. Some seniors who are over-income for MassHealth will qualify for one of these programs.MassHealth Buy-In allows MassHealth to pay all of the Medicare Part B premium for Massachusetts residents who are not getting other MassHealth benefits. It can also help get Medicare Part B for persons who have only Medicare Part A. There are three MassHealth Medicare Buy-In programs that help pay Medicare expenses:
If you qualify and get a Medicare Savings Program, you should automatically get Extra Help, the federal assistance program that helps pay Medicare Part D prescription drug costs for people with limited finances. A Medicare Savings Program can also act as a way for Medicare-eligible people to automatically enroll in Medicare outside of formal enrollment periods. Medicare Savings Programs also get rid of premium penalties for those who did not enroll in Medicare in a timely manner. To apply: Apply for MassHealth. -Adapted from and for more information:
Medicare Extends Cardiac Rehab Coverage to Certain Heart Failure PatientsMedicare beneficiaries who experience heart failure may now be eligible for cardiac rehab. Initially Medicare only covered 36 rehab sessions for those who had a heart attack, bypass surgery or episodes of chest discomfort resulting from exertion, known as stable angina. Medicare recently extended cardiac rehab coverage to beneficiaries who have procedures like heart valve replacement, stenting or a heart transplant. Now they are expanding coverage for certain people with heart failure. To qualify for cardiac rehab through Medicare, patients still have to meet certain criteria, including left ventricular ejection fraction (a measure of cardiac output) of 35 percent or less and Class II to IV symptoms on the widely used New York Heart Association classification system. Patients also have to be on drug therapy, as most already are. Still, “it’s a fairly big expansion,” said Dr. Joseph Chin, a medical officer in Medicare’s coverage and analysis group. Of the four million Medicare beneficiaries over age 65 estimated to have heart failure, about half will now qualify for rehab. Sources and for More Information
ACA Implementation: State Announces Strategy to Overhaul Health Site The Massachusetts Health Connector recently announced a plan to fix its broken health insurance signup site. The plan calls for the authority to hire a new vendor to build a workable site, with the federal health exchange serving as a backup in case the vendor’s site is not satisfactory. The timeline calls for both sites to be up and running in the fall, in time for the next open enrollment period in November. The cost estimate for the dual-track plan is $121.1 million, and officials are working to determine how much will be funded by federal officials, Sarah Iselin, the insurance executive whom Governor Deval Patrick tapped to oversee repairs to the state’s broken Health Connector website, said. Much of the money -- $55.9 million – is slated to go toward hCentive, a Virginia firm that has helped with similar websites in Kentucky and Colorado. The cost estimate assumes a steady state of 307,000 enrollees. Iselin, who is returning to her private sector post at Blue Cross Blue Shield in early June, cautioned that the cost estimate was based on “best, reasonable guesses.” “There are still things we don’t know,” she said. State officials are seeking to disentangle themselves from CGI, the contractor behind the current, troubled health care site that has frustrated scores of individuals trying to sign up for insurance. Iselin told the Health Connector board that neither of the paths offers an ideal fix, and the federal option, in particular, will probably require the state to design a multistep online process so consumers could get the extra subsidies for health insurance coverage provided by state law. Massachusetts provides more generous subsidies than the federal health insurance program for residents with incomes below 300 percent of the federal poverty level. Iselin said whether the state can retain those unique aspects of its program if it connects to the federal site is still under discussion with the Obama administration. According to the state’s plan, use of the federal website, if necessary, would be for no more than a year, just until hCentive is ready. “Federal officials haven’t made any commitment to what they can do yet,’’ Iselin said. She said Connector hope to be able to make a decision by midsummer about which track to go with for the fall. Health insurers are livid about the prospect of having to build two software systems that could work with the state’s two-track approach, saying the costs to the 10 health insurance companies statewide could run into millions of dollars overall. “It’s a significant challenge that will really strain the resources of the plans,” said Eric Linzer, spokesman for the Massachusetts Association of Health Plans. “That may translate to higher costs for employers and consumers.” Linzer said health plan officials are upset that the Patrick administration has not worked closely with the insurers to fully understand the technology impact on the companies, even though the administration knew its insurance marketplace was in trouble as early as last fall. Massachusetts had the first online health insurance marketplace in the country, created under its landmark 2006 law mandating coverage for most residents. The website worked well until it was revamped last year to meet the demands of the federal Affordable Care Act. The new website was supposed to tell consumers whether they qualified for a subsidized plan, calculate the cost of coverage, and enable them to compare plans and enroll. It has not worked properly since it was launched in October, leading the state to encourage people to fill out paper applications instead. The flaws forced the state to enroll an estimated 160,000 residents in temporary insurance plans through the state Medicaid program. Sources and for More Information:
*Cited in/Linked from MASSter List, Mike Deehan, May 09, 2014.
Hospital Quality Improving, Readmissions Falling for People with Medicare According to new data released by the Department of Health and Human Services (HHS), hospitals around the country are becoming safer places. Incidents occurring in hospitals such as adverse drug reactions, falls and infections decreased 9 percent during 2011 and 2012. As a result, nearly 15,000 deaths and 560,000 patient injuries were prevented and about $4 billion in health spending was saved. 30-day readmission rates are also declining. After holding constant at 19 percent from 2007 to 2011 and decreasing to 18.5 percent in 2012, the Medicare all-cause 30-day readmission rate has further decreased to approximately 17.5 percent in 2013. This translates into an 8 percent reduction in the rate and an estimated 150,000 fewer hospital readmissions among Medicare beneficiaries between January 2012 and December 2013. See the Health & Human Services Press Release. -Adapted from Medicare Watch, The Medicare Rights Center, May 15, 2014.
New Anti-Shackling Law Also Standardizes Treatment of Pregnant Inmates On May 15, 2014 Governor Patrick signed into law a new unified ban on the use of restraints on pregnant inmates in labor, delivery and post-delivery recuperation, except under extraordinary circumstances (defined below).The law also requires more pre-and post-natal medical care for incarcerated women. The bill also provides that female inmates be screened for pregnancy upon admission to a correctional facility and receive non-directive counseling, daily exercise, appropriate prenatal nutrition and medical care if pregnant while also stipulating that the correctional officer present for any medical examination of an inmate be female, if possible, and ensure the privacy of the patient. Although the Department of Correction, which controls state prisons, already prohibits prisoners in labor from being restrained, each county jail has had its own policies. Representative Kay Khan (D-Newton) has filed some version of the Anti-Shackling Bill since 2001. In 2013, Senator Karen Spilka (D-Framingham) filed a companion bill in the Senate. Earlier this year, Governor Deval Patrick filed 90-day emergency regulations to immediately prohibit the practice of shackling pregnant women as a stopgap measure until the legislature passed the Anti-Shackling Bill. Last month, both the State Senate and State House unanimously passed versions of the bill. Since the emergency regulations were filed in February, advocates have heard reports of two incarcerated women who have gone into labor. Both were shackled during transport, and one was not unshackled when requested by medical personnel. Further, one was shackled in the hospital during labor and during postpartum recuperation without an individualized determination that “extraordinary circumstances” justified it. Lauren Petit, staff attorney at Prisoners’ Legal Services, added, “This law is critical because it brings uniformity to the system. Women have different experiences, depending on whether they’re being held at MCI Framingham, Bristol County Jail, or the Western Massachusetts Regional Women’s Correctional Center.” She added, “I spoke with an 18 year old woman who received no birthing classes at all. She had no knowledge of what she was going to experience in childbirth or what she needed to do. She reported being transported in DOC transportation vans, handcuffed and shackled and without seatbelts.” For the purposes of this law “extraordinary circumstances”, which would allow the inmate to be restrained, means a situation in which a correction officer determines that the specific inmate presents an immediate and serious threat to herself or others or in which the inmate presents an immediate and credible risk of escape that cannot be curtailed by other reasonable means. If an inmate is restrained, the restraints shall be the least restrictive available and the most reasonable under the circumstances. Leg or waist restraints shall not be used on a pregnant or postpartum inmate. If the attending physician or nurse treating the pregnant inmate requests that restraints be removed for medical reasons, the correction officer shall immediately remove all restraints. The law does not prohibit the use of hospital restraints requested by a treating physician for the medical safety of a patient. Adapted From and for More Information Full text of the law: An Act to Prevent Shackling and Promote Safe Pregnancies for Female Inmates
Commission Will Study Challenges Faced by Black Males in Boston Activists urged Boston city councilors this month to ensure that a new commission takes concrete steps to help black males make economic and educational gains. “If you didn’t know already, it’s tough being a black man in Boston,” Horace Small, a longtime community advocate, said during a hearing of the City Council’s Committee on Government Operations at Madison Park Technical Vocational High School in Roxbury. The hearing was held to discuss the yet-to-be formed Commission on the Status of Black Men and Boys in Boston, which the council voted to create in February. Small voiced the views of many speakers at the hearing when he stressed the importance of “making sure this commission actually matters, that it has teeth,” rather than being a group “where people come together and blow smoke.” He called for the commission to meet with business and government entities and release an action plan within three years. Councilor Tito Jackson, vice chairman of the operations committee and the author of the ordinance creating the commission and other speakers identified a range of issues the commission will tackle, including high dropout rates and high levels of incarceration among young black men, as well as their access to jobs, skills training, and business ownership. The ordinance calls for 14 members to be appointed to the commission, but that number could grow, Jackson said. The commission members will be appointed by Mayor Martin J. Walsh and serve three-year terms without compensation, according to the ordinance. But Jackson said Thursday that the language of the document could be changed to give the council some input regarding appointments. He said it was unclear when the members would be selected. -See the full The Boston Globe article... U.S. Mines Personal Health Data to Find the Vulnerable in Emergencies The phone calls were part Big Brother, part benevolent parent. When a rare ice storm threatened New Orleans in January, some residents heard from a city official who had gained access to their private medical information. Kidney dialysis patients were advised to seek early treatment because clinics would be closing. Others who rely on breathing machines at home were told how to find help if the power went out. Those warnings resulted from vast volumes of government data. For the first time, federal officials scoured Medicare health insurance claims to identify potentially vulnerable people and share their names with local public health authorities for outreach during emergencies and disaster drills. The program is just one of a growing number of public and corporate efforts to take health information far beyond the doctor’s office, offering the promise of better care but also raising concerns about patient privacy. “There are a lot of sensitivities involved here,” said Kristen Finne, a senior policy analyst at the Department of Health and Human Services. “When we started this idea,” she said, referring to using Medicare data for disaster assistance, “there was a lot of ‘are you crazy?’ ”Ms. Finne noted that the program was painstakingly designed to comply with privacy laws. Aspects of the Medicare program were tested in New Orleans; in Broome County, N.Y., which includes Binghamton; and in Arizona. The program was presented to state and local public health officials last month. “We are now moving to scale this really across the country,” said Dr. Nicole Lurie, the assistant health secretary for preparedness and response. The health officials’ intention was to be more proactive in finding vulnerable people like those who suffered and died in disasters such as Hurricane Katrina and Hurricane Sandy. About a dozen advocates for people with disabilities who were briefed by officials generally expressed support and appreciation of the concern for their community’s needs in emergencies. Others find the program troubling, however well intentioned. “I think it’s invasive to use their information in this way,” said Christy Dunaway, who works on emergency planning for the National Council on Independent Living, which supports disabled people living at home. Dr. Karen DeSalvo, a former New Orleans health director who helped develop the Medicare pilot program and now leads the Office of the National Coordinator for Health Information Technology, said “We are all going to have to, I’m hoping, come to some consensus with how we’re balancing privacy and security with the need to save somebody’s life,” Dr. DeSalvo said. Respecting the importance of federal and state laws that restrict the disclosure of medical data, the officials found a legal route for Medicare to transfer data on patients’ bills for medical equipment to public health authorities who have systems in place to protect patient privacy. They published a description of it in the Federal Register. “Now every Medicare beneficiary, at least theoretically, is on notice that their information could be shared in this way,” said Kevin Horahan, a policy analyst with Dr. Lurie’s office. -See the full The New York Times article... Cited in/Linked from HEALTH CARE WEEKLY UPDATE, Barbara Roop & John Goodson, Health Care for Massachusetts, May 16, 2014.
$84K Treatment Price of New Hep C Drug “Outrageous” Kaiser Permanente, the biggest U.S. health maintenance organization, said it is using Gilead Sciences' new hepatitis C drug, Sovaldi (sofosbuvir), even though its $84,000 treatment price is "outrageous." Hepatitis C, estimated to infect about 3.2 million Americans, is a blood-borne virus that can cause severe liver damage.The medication is widely viewed as a breakthrough that can cure a majority of hepatitis C patients, often within 12 weeks. Analysts project 2017 sales of $9.1 billion, according to Thomson Reuters Pharma. But Gilead has come under fire, from insurers and Congress, for Sovaldi's $1,000-a-pill price at a time when U.S. healthcare spending is under scrutiny and President Barack Obama's Affordable Care Act aims to make health coverage accessible to everyone. The company says Sovaldi should create huge savings for the healthcare system over time by preventing complications from liver disease and transplants, but declined requests for evidence to back up those claims. A Gilead executive told Reuters last week that it had an agreement to discount the drug for the Kaiser network, based on their recognition of the long-term benefits. In an interview, Kaiser officials disputed that view. Kaiser is using Sovaldi "not because we see this as a high-value, cost-effective approach," said Dr. Sharon Levine, associate director of the Permanente Medical Group. "It's because this is a therapy that represents a substantial improvement over existing therapies ... It's an outrageous price for a therapy that has huge public health implications." She called Kaiser's discount on Sovaldi "modest" and said state Medicaid programs and private health insurers "are going to have to make very serious tradeoffs just based on a single manufacturer's decision on pricing a drug because they can." Gilead officials declined to comment. Lawmakers Seek Pricing Information Democratic lawmakers in the House of Representatives, led by California's Henry Waxman, have asked Gilead to explain Sovaldi's pricing. The company said it met with committee staff in April. Insurers and state officials running the Medicaid health program for the poor fear a multibillion-dollar tab from Sovaldi alone. Kaiser, a nonprofit, said Sovaldi will be a material portion of its drug budget - a cost ultimately born by members and employers who pay insurance premiums. -See the full article: Costs to Public of USD 84,000 Hep C Drug 'Outrageous' - Kaiser. Medscape. Apr 02, 2014.
High-Skilled Immigrants: On Not Wasting Immigrant Capacity Not to pick on Cleveland, but 15,300 people leave every year. The population has slid from almost one million to 325,000. A recent risk assessment concludes that it might even lose half the current population. Richard Herman writes in the Plain Dealer: "The city needs the fresh optimism and pluck of new immigrants." Urban planning needs an immigrant attraction plan. Herman speaks for all business centers. The Boston Redevelopment Authority recently presented a paper that suggests that for every new visa holder who comes to work in Boston, 3 or more jobs are created! In the face of a scarcity mentality ("they will take our jobs") there comes a new voice that suggests every immigrant builds community, increases consumer spending and is often responsible for generating new jobs. Boston welcomes foreign born leadership and they are visible at the head of the city's institutions of higher education, culture and business. But a major additional concern has been a focus of British and American researchers who have documented the underemployment of immigrants. When I'm in a taxi I take it as a research opportunity to ask drivers what they did before migrating to the US. "I was an engineer." "I taught biology." One refugee acquaintance had 20 years as an orthopedic surgeon and another as a Sarajevo psychiatrist. Both are working in vastly different jobs at a fraction of the pay and potential contribution they were making before being forced away by war. MPI reports that "1.6 million, or 23 percent, of the nearly 7.2 million college-educated immigrants ages 25 and older in the U.S. civilian labor force are affected by brain waste. Brain waste particularly affects the foreign born who earned their bachelor's degrees abroad, with 26 percent in low-skilled jobs or unemployed." Recognizing the economic benefits to the receiving community and the lost human capital of underemployment, what should be done? -Excerpted from IIL News 2.8: Skilled Immigrants, Westy Egmont, May 29, 2014. The Immigrant Integration Lab’s Newsletter will be archived at: http://www.bc.edu/content/bc/schools/gssw/research/research-centers/iil/mailing-list.html
Many Mothers Have Untreated PTSD After Perinatal Death Mothers who lose a child prenatally have extraordinarily high rates of depression and PTSD, and receive limited treatment for these conditions. This is particularly true for black women, who have the worst pregnancy outcomes in the United States. "Moms who were bereaved had much higher odds of depression and PTSD," said Katherine Gold, MD, MSW, MS, from the University of Michigan in Ann Arbor. Dr. Gold presented results from the Michigan Mother's Study here at the American Congress of Obstetricians and Gynecologists 2014 Annual Clinical Meeting. Dr. Gold began her presentation by explaining that there are more perinatal deaths every year in the United States than suicides and homicides put together. Annual perinatal deaths also exceed annual motor vehicle deaths of children and adults. Stillbirth and infant death are traumatic events that leave a lasting mark on families in general, and mothers in particular. Although the problem is significant, until now bereavement research has focused on white, upper-middle class, well-educated mothers. The published studies have also primarily been qualitative. The Michigan Mother's Study is a 2-year longitudinal study that had population-based sampling and attempted to quantify the health effects of perinatal bereavement. The results revealed significant distress 9 months after the loss. Bereaved mothers had 4 times the rate of depression as mothers whose children lived, and 6 times the rate of PTSD. Rates of mental health disorders were the same for mothers who experienced stillbirth as they were for mothers who experienced infant death. The survey revealed a low rate of treatment of bereaved mothers. Moreover, although levels of distress were similar in black and white mothers, black women were significantly less likely to receive treatment. -See the full Medscape summary article: Many Mothers Have Untreated PTSD After Perinatal Death. Medscape. May 06, 2014.
Psych Outpatients Happy to Monitor Mood Via Smartphone Apps Most psychiatry outpatients own smartphones and are open to using them to monitor their mental health, potentially offering clinicians the opportunity to track their patients' mood in real time, preliminary research suggests. "Mood tracking is mostly done only at appointments and is less often done outside the clinic. When it is done, it is often still with paper and pencil," study presenter John Torous, MD, of Harvard University and Beth Israel Deaconness Medical Center in Boston, Massachusetts, told Medscape Medical News. "This is both inconvenient and risks not being accurate if the user 'back fills in' data at a later time. A smartphone application is a much easier tool because it can remind you when to fill out a survey, administer the survey, and automatically time stamp the survey, and securely deliver or store it, all without carrying around anything extra," he added. Dr. Torous and colleagues assessed smartphone use among patients attending 5 outpatient mental health clinics ― 2 in Massachusetts and 1 each in Louisiana, Wisconsin, and California. Initial results of 100 patients at 1 site in Massachusetts revealed that 70% owned a smartphone and more than 50% were willing to download a mobile app to monitor their mental health. "Unfortunately, we do not have data in from all the study sites, but our initial results suggest that psychiatry patients both own smartphones and are interested in using them to monitor their mental health," Dr. Torous said. The patients expressed more interest in using a mobile app than text messaging for mental health monitoring. Dr. Torous noted that most of the apps currently available to track mood have never been studied or tested in clinical studies with patients. His team has created an app called "Mindful Moods" and is in the process of conducting a small study using the app in patients suffering from depression to determine how results of daily mood tracking on a smartphone compare with standard assessments. "The whole field of smartphone app research seems to be rapidly expanding, and there is a push to build a greater evidence base around this," Dr. Torous said. -See the full Medscape summary article... Study Links Antidepressants to Gait Impairment in Older Adults Antidepressant use is independently associated with gait impairment, but depressive symptoms are not, a new study of nearly 2,000 community-dwelling older adults demonstrates. Regression analyses showed that while being on antidepressant therapy was independently associated with gait impairment, having depressive symptoms was not. There are many possible explanations for the observed relationship between antidepressant use and gait impairment, the researchers note. For example, the drugs have a number of side effects that can affect gait, such as muscle rigidity and drowsiness. "Our results suggest that a gait and falls assessment may be a useful addition when assessing older adults with depressive symptoms, especially when antidepressants are prescribed," Dr. Orna Donoghue of The Irish Longitudinal Study on Ageing (TILDA) at Trinity College Dublin and her team state. "This is particularly pertinent given the increased prevalence of antidepressant treatment in recent years." The findings also underscore the importance of exercise interventions to prevent falls and help older adults maintain their independence, the researchers add, noting that these interventions have "both psychological and physiological benefits." -See the full Medscape article summary: Study Links Antidepressants to Gait Impairment in Older Adults. Medscape. May 15, 2014. |