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MGH Community News |
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MGH Community News |
| August 2014 | Volume 18 • Issue 8 |
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. |
Gov. Deval Patrick this month signed into law a bill aimed at combating substance abuse. That bill would require coverage for at least 14 days of inpatient detoxification, prohibit insurers from determining whether any addiction treatment — inpatient or outpatient — is medically necessary, and would remove a requirement for a substance user to obtain “prior authorization” from an insurer before entering treatment. In addition to drug detox programs, the law requires coverage for 21 days of step down detox, a longer-term program where patients continue in intensive treatment following the detoxification period and eliminates prior authorization requirements for these services as well. These rules, which would not take effect until late next year, apply to both commercial insurance and managed care plans in the MassHealth program. Other provisions in the legislation seek to encourage the use of certain kinds of painkillers that are less likely to be used inappropriately by addicts. Unless directed otherwise by a physician, pharmacists would be required to dispense drugs formulated to prevent abuse, such as those that cannot be crushed for injection or snorting. Insurers would be barred from charging higher copayments on those drugs.
The law will also require all insurance carriers to reimburse for substance abuse treatment services delivered by a licensed alcohol and drug counselor. The law also authorizes the commissioner of public health to classify a drug as dangerous for up to a year and impose certain restrictions on it, if the drug poses an imminent threat to public safety. It includes new data reporting requirements related to the state's prescription monitoring program, to drug overdose deaths and to infants born exposed to drugs. Insurance companies oppose the requirements on insurers, arguing that they will establish a standard of care giving all patients 14 days of inpatient treatment, even where there is no evidence that is the best medical practice. Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, a trade group representing insurance companies, said the group is disappointed that Patrick signed the bill, and that national policy leaders will now look at it as a model. "What we know is doctors will practice this standard and patients will demand they get 14 days, and there's no medical evidence to suggest this is the correct treatment for opioid addiction," Pellegrini said. "We believe you need to take each patient individually and look at their full medical history and determine coverage needs." |
Commissioner of the Massachusetts Department of Public Health Cheryl Bartlett said the elimination of preauthorization removes something that "has been a huge barrier for people to get treatment." Bartlett said the bill allows for a review of the treatment after seven days. "We think it will be reasonably used and used to the benefit of treatment and the person's outcome," Bartlett said. Sources/More Information
New State Domestic Violence Law Gov. Deval Patrick signed the a new Domestic Violence law (Chapter 260 of the Acts of 2014) on August 8 which then immediately became effective. The effort to strengthen existing law was sparked in part by the case of Jared Remy, who had a long record of assault cases before he killed his girlfriend Jennifer Martel last August. Key provisions of the wide-ranging law:
Under the new law, police must not include domestic violence incidents and arrests on the public daily log and may not inform the public until the suspect is arraigned in court. The arraignment and all court proceedings will be public, but the police report on the incident will no longer be a public record. Referring to these provisions, state Rep. Garrett Bradley, D-Hingham, said, "We listened to the advocates, who believed it would encourage people to come forward." State law has long sealed police reports in cases of attempted rape, rape, attempted sexual assault, and sexual assault. The new measure adds domestic violence to the list. These provisions have stirred some controversy. Some say the measure will shield abusers, and the police who investigate them, from scrutiny. The bill, they add, will also deprive residents of important information about key players in their communities. “If a teacher, if a coach, if a guidance counselor — any number of public officials — is arrested under these circumstances, that’s something the public has a right to know,” said Robert Ambrogi, executive director of the Massachusetts Newspaper Publishers Association, an industry group that represents newspapers across the state, including The Boston Globe. Sources/More Information
The RIDE In-Person Assessment May be Deterring Elders A move by the MBTA to crack down on fraud in The Ride, the transit service for the disabled and elderly, has led to a sharp drop in the number of older users, according to figures kept by the transportation authority. Nearly two years ago, the Massachusetts Bay Transportation Authority began to require that all applicants for The Ride attend an in-person evaluation at a Charlestown office, rather than mailing a lengthy application and a doctor’s note. Since the interview requirement began, only 22 percent of applicants have come from the oldest age brackets. In 2010 and 2011, before the change, people over the age of 80 accounted for 39 percent of Ride users, according to numbers kept by the MBTA. “What we have seen and heard is a lot of fear,” said Carolyn Villers, executive director of the Massachusetts Senior Action Council. “The frailest folks will never apply, because that trip into Charlestown is just going to be too much.” The interviews are part of an effort to crack down on misuse, a major concern for a transportation service that is heavily subsidized; the T estimates that each trip on The Ride costs the agency $45. Users pay $3 for a trip. But the policy’s impact on The Ride’s oldest users highlights the hard-to-convey challenges facing the elderly — fear of the unfamiliar, discomfort on long car rides, the need to drag around oxygen tanks — as well as larger debates over the core function of The Ride and how far the system should go to accommodate mobility-impaired residents. “Ultimately, The Ride is a form of public transit,” said Michael J. Lambert, MassDOT deputy administrator for transit, “not a medical service.” “If someone is so frail that he is not able to go to an in-person assessment for an evaluation,” said James White, chairman of the Access Advisory Committee to the MBTA, “maybe he’s too frail even to be on the system in the first place.” In-person interviews for paratransit have become standard at almost every major US transportation agency. The trip to the evaluation is free; applicants may bring a companion. The interviews are not simply meant to weed outmisuse, Lambert said. They are also an opportunity for people to learn about the service and find out about other transportation resources, such as free hospital shuttles, he said. Applicants also learn about accommodations on the T’s fixed-route system — buses equipped with wheelchair lifts, newly installed train station elevators — that could help them travel solo. By the end of this year, the T will offer free bus and subway passes to all Ride users. Pushing customers to use fixed-route transportation saves the agency money, but Lambert said it is also good for customers: People who learn to comfortably use buses and subways can reach their destinations faster and more cheaply. Some applicants expect the interview to be an interrogation: Instead, customers are met in the lobby and brought to cheerful offices, answer questions about their abilities and routine, complete a balance test, then proceed through a half-mile course featuring uneven pavement, a ramp, and a small set of stairs. People are rarely rejected. From February to June, monthly rates of interviewees deemed ineligible ranged from 0 to 6 percent. Yet advocates who work with seniors say many find the process daunting, fearing a bewildering government building, incomprehensible questions, or a fatiguing obstacle course. Karen Schneiderman, senior advocacy specialist at the Boston Center for Independent Living, said the T should consider establishing other interview sites. “It would be nice if somebody 85 years old didn’t have to go to a building that was 35 or 40 miles away,” she said. -See the full Boston Globe article... Heirs Rights When Homeowner had Reverse Mortgage Reverse mortgages can be a big help to seniors needing extra cash, but heirs who don't know their rights may be faced with large bills or threats of losing the house. Fortunately, there are some protections for heirs. Reverse mortgages allow homeowners who are at least 62 years of age to borrow money on their house. The homeowner receives a sum of money from the lender, based largely on the value of the house, the age of the borrower, and current interest rates. The loan does not need to be paid back until the last surviving homeowner dies, sells the house, or permanently moves out. When the homeowner dies, the house passes to the homeowner's heirs, and the heirs have the following options:
If the value of the house is less than the amount of the loan, the bank cannot go after the estate or the heirs for the remainder of the money. If the value of the house exceeds the loan, heirs can sell the house, pay off the loan, and keep the remaining amount. The heirs have 30 days to decide what they want to do with the house and up to six months to arrange financing. Unfortunately, according to The New York Times, many lenders aren't notifying heirs about their rights and are instead immediately beginning foreclosure proceedings or bogging heirs down in paperwork. Many heirs aren't aware that if they want to keep the house, they can either pay off the loan or buy the house for 95 percent of the appraised value. This can be very beneficial to the heir if the value of the house has gone down significantly since the loan was purchased. Read the New York Times article. For more information about reverse mortgages. -From Reverse Mortgages Can Pose Problems for Heirs, Margolis & Bloom, August 26, 2014. Medicare Star Ratings Allow Nursing Homes to Game the System An examination of the Medicare five-star rating system, Nursing Home Compare, by The New York Times has found that many top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes. The Medicare ratings, which have become the gold standard across the industry, are based in large part on self-reported data by the nursing homes that the government does not verify. Only one of the three criteria used to determine the star ratings — the results of annual health inspections — relies on assessments from independent reviewers. The other measures — staff levels and quality statistics — are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value. The ratings also do not take into account entire sets of potentially negative information, including fines and other enforcement actions by state, rather than federal, authorities, as well as complaints filed by consumers with state agencies. Federal officials say that while the rating system can be improved — and that they are working to make it better — it gives nursing homes incentives to get better. “We have seen improvements,” said Dr. Patrick Conway, the chief medical officer at the Centers for Medicare and Medicaid Services. As evidence, he pointed to a decrease in the use of physical restraints by nursing homes and in the number of homes reporting bedsores among patients at a high risk of developing them. But some nursing homes are not truly improving. Instead, they have learned how to game the rating system, according to interviews with current and former nursing home employees, lawyers and patient advocacy groups. Nationally, the proportion of homes with above-average ratings has risen steadily. In 2009, when the program began, 37 percent of them received four- or five-star ratings. By 2013, nearly half did. The Times analysis shows that even nursing homes with a history of poor care rate highly in the areas that rely on self-reported data. Of more than 50 nursing homes on a federal watch list for quality, nearly two-thirds hold four- or five-star ratings for their staff levels and quality statistics. The same homes do not fare as well on the sole criterion that is based on an independent review. More than 95 percent of the homes on the watch list received one or two stars for the health inspection, which is conducted by state workers. “These are among the very worst facilities, and yet they are self-reporting data that gives them very high staffing and very high quality measures,” said Toby S. Edelman, a senior policy lawyer with the Center for Medicare Advocacy, a nonprofit organization that helps patients. “It seems implausible.” -See the full New York Times article... Women Committed Under Section 35 May Go to Prison Massachusetts’ opiate addiction crisis, which has ravaged families and upended lives, has had another, less-noted consequence: women who are committed by the courts for detoxification often face repercussions significantly different from those that men face. A portion of state law known as Section 35 allows judges to commit people involuntarily who are shown to be at risk of “substantial harm.” In practice, these are often people brought to the courts by doctors, parents, or desperate relatives. Men are typically sent to a facility on the campus of MCI-Bridgewater, where they receive comprehensive treatment under medical supervision. Some women are sent to a private treatment center in New Bedford. But if there’s no room at that center, women can be sent to a general prison instead. A lawsuit filed this summer by the ACLU and the law firm WilmerHale seeks to end that practice, charging that it violates due process and discriminates based on disability. ACLU lawyers estimate that, over the past three years, about 540 women have been sent to MCI-Framingham, a medium-security women’s prison, without having committed a crime. In the early stages of withdrawal, they charge, women committed to MCI-Framingham don’t have access to medications that are typically used in medically monitored treatment. Instead, they’re given a bucket and over-the-counter drugs such as Tylenol and Tums. Once the detox process is over, these women are kept separate from the prison population, with little opportunity for exercise and no access to the prison’s library or education programs. The law allows for them to be committed for up to 90 days in these conditions, though records show that the average time spent is two weeks. Massachusetts is the only state that undertakes this practice, which could have unintended consequences of its own: In addition to creating cruel conditions, it serves as a disincentive for people to seek treatment for their loved ones. Governor Deval Patrick has, in fact, spoken out against civil commitments to prison, and his staff says the recently passed state budget includes enough additional funding for treatment beds to meet the need. Still, the administration favors keeping the prison option open, as a safety valve that would prevent women in the throes of addiction from being let out on the streets. -See the full Boston Globe article...
Hospitality Homes places patients’ families with Boston area volunteer host families. They do not charge a fee, but do suggest a $25 per night donation. Eligibility
The program is designed to serve the families and friends of patients. However, they do accept patients as guests as long as they are accompanied by a friend or family member and are medically independent. The program generally provides short-term accommodations (1-14 days); however, they may be able to accommodate longer stays, up to three months, depending on the needs of the guest(s) and host availability. Application Process Guests can fill out an application on the website: www.hosp.org. Applications take about 20 minutes to complete and are designed to ensure that an appropriate guest/host placement is made. Additionally, a reference is required for each guest 18 years and older. Guests provide contact information for the reference and Hospitality Homes contacts the references by phone. Acceptable references include employers, former employers, co-workers, a member of the clergy, a social worker that has been working with the guest for more than one month, and doctors. Friends, family members, and neighbors are not appropriate references. It generally takes several days to make a placement. While turning an application around same-day is difficult, it may be possible depending on host availability and the time it takes to clear references. Applying about 2-3 weeks ahead of time is ideal. More Information More information is available in the fact sheet Things to Keep in Mind When Referring a Family to Hospitality Homes, by calling (888) 595-4678 or visiting the website www.hosp.org. Hospitality Homes is included in the MGH Accommodations List. -Thanks to Elyse Levin-Russman for reminding us about this valuable resource.
Comcast Will Forgive Outstanding Bills for Low-Income Families
Comcast Corp., a provider of Internet, cable TV, and other services, is highlighting an amnesty program for certain low-income families who might otherwise qualify for Internet Essentials, the company’s effort to help young students bridge the so-called digital divide. That program offers low-cost Internet access, discounted computers, and free digital literacy training. In addition to amnesty, this year’s program is offering up to six months of complimentary service for any new family in Boston that has not yet applied for the program (must be approved by September 20).
After that, eligible households can receive broadband service for $9.95 a month, plus tax, and have the option to purchase an Internet-ready computer for under $150. More at Internet Essentials. -See the full Boston Globe article... Boston University Program Allows Kin to Consent to Donation of Skeletal Remains Most staff are familiar with whole body donations programs. As we know, some patients find it meaningful and comforting to plan to make this contribution to the training of the next generation of doctors. There are some situations where one cannot donate a whole body, but in which a new program to donate the skeletal remains may be appropriate. Now in its first year, the Boston University Donated Osteological Collection is creating a collection of skeletons to be kept at the Boston University Medical school for use in the Forensic Anthropology Master’s Degree program as well as by medical/dental classes and by the State Police. Whole body donation requires the patient to plan ahead and give consent by pre-registering. Under this program, next of kin may consent to the donation after death. The Boston University Donated Osteological Collection program can also accept donations that have been autopsied, have had extensive surgery or have donated organs for transplant. Frequently Asked Questions
For More Information or to Donate Please contact:
-Thanks to Sue Streeter for sharing this resource. A SNAP Cookbook: Good and Cheap by Leanne Brown As the subtitle “Eat Well on $4 a day” suggests, the recipes in this cookbook are designed to meet the budgets of the estimated 46 million Americans receiving SNAP assistance. SNAP benefits are roughly $4 per person, per day. The free online book includes tips for eating well and shopping on a budget. Download Good and Cheap -Thanks to Melanie Cohn-Hopwood for sharing this resource.
Medicare to Start Covering MD Coordination of Care Services for Chronically Ill Beneficiaries Last year, the Centers for Medicare & Medicaid services (CMS) finalized a policy to begin paying Medicare physicians for non-face-to-face services intended to manage care for those with multiple, chronic conditions. CMS recently announced the proposed payment rate for these chronic care management services. According to CMS, in January 2015, Medicare will begin paying doctors who coordinate the care of patients with two or more chronic conditions. Reporting on the proposed payment rule, the New York Times provided details on this new policy. Patients with chronic conditions who wish to have a doctor manage their care must sign up in writing, and their doctor will then draw up and help execute a plan to manage the patient’s chronic conditions. The doctor, or someone on the doctor’s staff, will also be available 24 hours a day and seven days a week to help with any “urgent” needs of the patient, related to their chronic condition. For each patient, the doctor will be paid $42 per month by Medicare to perform these services. Care for chronically ill patients often requires a variety of specialists, procedures, and medications. Coordinating the care for these patients should benefit them considerably by streamlining the management of their condition and reducing medical errors. According to CMS, this policy should be cost-neutral for the Medicare program, since it will keep patients healthier and out of the hospital.
-From Immigrants Help to Strengthen Medicare, Medicare Watch, The Medicare Rights Center, August 21, 2014.
MA ACA Implementation: Those Temporary Coverage, Commonwealth Care and Qualified Health Plans Will Need to Reapply During Open Enrollment Nearly 400,000 people in Massachusetts will need to reapply for health insurance before the end of the year, and many of them probably do not even know it. Due to the poor performance of the state’s Health Insurance Exchange website, more than 200,000 households whose eligibility couldn’t be verified have been placed in temporary Medicaid coverage. Those in Temporary coverage along with those currently receiving extended coverage (Commonwealth Care existing members- an additional 100,000 people), and those in Qualified Health Plans through the Health Connector, will need to complete new applications this fall in order to transition into ACA plans starting in 2015. Open Enrollment begins November 15, 2014.
The state is promising they will outreach to consumers to encourage existing members to submit new applications and attract the remaining uninsured to sign-up during Open Enrollment. To reach them, the Connector plans to place 2 million robocalls and knock on 200,000 doors, along with making personal phone calls, sending mail, buying print and broadcast advertisements, and holding community meetings and enrollment fairs. “We know who they are,” said Robin Callahan, deputy Medicaid director, referring to the people in the temporary program. “We generally know where they are. We have to move them through a new application process.” The campaign is estimated to cost $15 million to $19 million, money the state will seek from the federal government. The state does not know how many of these people will ultimately qualify for MassHealth and how many will instead have to buy private insurance with state and federal subsidies. But a check of their income found only 43 who would not qualify for any kind of assistance. Additionally, some 34,000 people who bought private insurance through the Connector will have to reapply, instead of simply renewing their plans, to update their information in the new system. The Connector also hopes to reach out to 50,000 people who did not sign up last year but might qualify, for a total outreach goal of 450,000. The state has renewed a $2 million contract with the advocacy group Health Care for All to visit 200,000 households, as well as provide written materials in seven languages, organize meetings, and run a telephone help line. The Connector is also spending $1.6 million of state money for 15 community-based agencies to work as navigators, educating the hardest to reach populations on how to sign up for insurance. Additionally, the technology company Dell is receiving $4.1 million to answer questions by phone at its call center and $3.9 million to conduct outgoing automated calls (robocalls), as well as make live phone calls. Sources and for More Information
-Thanks to Matt Silvia-Perkins for forwarding this information. State Chooses hCentive as Health Insurance Exchange Website for Fall 2014 Open Enrollment The state announced this month that the Patrick Administration has decided, with support from the Centers for Medicare and Medicaid Services (CMS), to use hCentive for the state’s Health Insurance Exchange (HIX). By proving hCentive’s IT readiness for Fall 2014 Open Enrollment (beginning November 15), the Commonwealth can remain a state-based Marketplace, stop its contingency planning to join the Federally Facilitated Marketplace (FFM) and focus exclusively on expanding access to affordable health insurance through hCentive. The hCentive system promises to offer a streamlined, single-point-of-entry shopping experience this fall and a solution that meets – and in some instances exceeds – current FFM Exchange capabilities. Unlike the FFM, hCentive now supports State Wrap, the unique Massachusetts program that offers additional state premium assistance to help make health insurance more affordable for thousands of residents. The State Wrap program is one of the main drivers behind the Commonwealth’s 97% rate of insurance. Additionally, hCentive has automated its interface with Dell, the Health Connector’s billing and enrollment vendor responsible for conducting transactions between insurers and consumers. Health plans and consumer advocates cited this connection and State Wrap as their top concerns with migrating to the FFM. -See the full press release. -Thanks to Matt Silvia-Perkins for forwarding this information.
Increasing Inpatient Psychiatric Facilities in MA Steward Health Care System is spending millions to open new psychiatric units in its Massachusetts hospitals, filling a gap in mental health care and marking a reversal from the recent years in which hospitals had little interest in expanding these services. Psychiatric care has long been considered a drain on hospital finances, but Steward executives said sweeping changes in the way health care is paid for are shifting that calculation. The for-profit company, which owns 10 hospitals in Massachusetts, has added 40 beds for adults with mental illness or substance abuse disorders in the past nine months, and plans to expand by another 30 beds this year — a total increase of 21 percent. Suddenly, enhancing mental health services is not only good for patients but makes financial sense, too. Under new payment models, if large providers such as Steward can better coordinate care and keep patients healthier, reducing their long-term use of medical services, the hospitals may also see their bottom lines improve. “A significant number of the patients we serve need behavioral health care, and that’s why we are making this investment,’’ said Dr. Mark Girard, president of Steward Hospitals. Many patients arrive in emergency rooms in crisis, he said, “and can’t get out because there are no beds available’’ in hospital behavioral-health units. Steward’s strategy is part of a broader enhancement of mental health services across the state. Partners HealthCare, one of the largest providers of psychiatric care in Massachusetts, is embarking on a significant expansion that includes adding 53 beds, mostly at McLean Hospital, a psychiatric hospital in Belmont, and at a planned mental health facility in Lynn. MetroWest Medical Center has asked regulators for permission to open a 14-bed psychiatric unit at its Natick campus. Partners and MetroWest said their expansion plans are not motivated by the new payment models. But they are among the growing number of providers realizing that it will be difficult to improve the health of large numbers of patients, a goal of the federal Affordable Care Act, also known as Obamacare, without addressing mental health and addiction problems. A report released last month from the state Department of Public Health found the state has a total of 2,431 psychiatric beds for acutely ill patients, which puts Massachusetts at the top of states for inpatient mental health services, given its population, said Dr. Madeleine Biondolillo, the agency’s associate commissioner. The number still may not be adequate, however, for specific regions, within individual health care networks, or for certain types of patients. Inpatient beds can be especially hard to find for children and teenagers, dropping from 310 to 250 over the last five years, according to the Massachusetts Association of Behavioral Health Systems, and just a handful of the new psychiatric beds are for kids. Dr. Robert Master, chief executive of Commonwealth Care Alliance, a nonprofit organization that oversees health care for 16,000 disabled adults, said the state desperately needs more mental health services, but inpatient hospital beds probably should not be the top priority. More than 60 percent of hospitalized clients do not need to be in a hospital at all, Master said, and would do better in a less-costly and less-restrictive crisis-stabilization program, usually in a residence with around-the-clock staffing by psychiatrists and social workers. Some patients wait for days in emergency rooms, even when hospital beds are available, because they are aggressive or have other behavioral problems that hospitals do not want to manage, he said. Community-based programs would add more options.
“We are paying for the care in the wrong places,’’ Master said. Partners, which says it annually spends about $50 million generated from other, more-profitable services to subsidize money-losing psychiatric care, is adding residential beds and embedding social workers into primary care practices, said Dr. Scott Rauch, president of McLean and chairman of psychiatry and mental health for Partners. It is also shifting some inpatient substance-abuse treatment to outpatient settings. -See the full Boston Globe article...
SSI For Children Now Outstrips Welfare; Debate Intensifies The Supplemental Security Income (SSI) program provided about $20 billion to low-income families with disabled children over the last two years, quietly eclipsing traditional welfare programs to become the biggest source of monthly cash for the nation’s poorest families, new data shows. The dramatic growth of the use of the program for disabled children has led some researchers to suggest it has simply replaced welfare as a primary source of cash for many families who lost benefits due to the much-touted welfare reforms of the mid-1990s. The expansion also comes amid a growing recognition among lawmakers and policy analysts that children’s disabilities, especially harder-to-assess ones like ADHD, have become a gateway to receive the best government cash benefits available today, and this trend deserves closer study. In 2012, the SSI program for children paid out $9.7 billion, roughly $700 million more than the nation’s welfare programs, which have long given out the most cash for indigent children. Last year, the SSI program distributed even more, paying out about $10 billion, $1.3 billion more than the welfare programs. It started in 1974 as a little-known program that served largely indigent children with severe physical disabilities and cash aid was meant to help parents who were prevented from working because of their disabled child’s needs. The program nearly doubled its rolls in the past two decades, as it accepted broader definitions of what was a qualifying disability and as the nation’s welfare benefits shrunk. Enrollment in the children’s SSI program still does not surpass the number of welfare cases, but because of SSI’s superior cash benefits of up to $720 a month per child, it now distributes more money. Critics say the program, as it now operates, creates perverse incentives for poor families to obtain – and maintain – disability diagnoses for their children even when symptoms may improve. The program, they say, has become an alternate welfare system without the work requirements and time limits that were hallmarks of the 1996 welfare reforms that passed with bipartisan support and hailed as one of President Clinton’s signature achievements. These issues, among others, were detailed in a three-part Boston Globe series in 2010 about the children’s SSI program. Officials from the Social Security Administration, which administers SSI, later approved $1.1 million to fund a study of the program by the Institute of Medicine, the nonprofit health research wing of the National Academy of Sciences. But supporters of SSI say it is a well-managed critical lifeline for poor families raising disabled children. They note that the program rejects more applicants than it accepts and that eligible children must show “marked and severe” limitations. Its current enrollment represents about 2 percent of all American children. Kathy Ruffing, senior fellow at the nonprofit Center on Budget and Policy Priorities, said SSI has introduced programs to encourage parents and teenagers to work and exempt some income when calculating benefit amounts. She said the criticism that SSI discourages parents and teenagers from working is “overstated.” Supporters say the program’s expansion largely reflects the nation’s growing sophistication in detecting disabilities in children, especially behavioral, emotional and mental disabilities. They say indigent parents of disabled children — some struggling to maintain jobs amid their child’s emergencies – need extra income to provide basic needs. SSI payments are higher – and generally longer lasting and more flexible – than welfare. Of the 1.3 million children on SSI, the federal government pays on average $640 in federal funds a month for each child who qualifies, and the overwhelming majority receives the maximum $720 monthly payment per child. Also, more than one child per family can qualify, and parents with disabilities can also receive aid through the adult SSI program. Once recipients are enrolled, disability examiners are supposed to re-evaluate their cases every few years to see if they have improved and no longer qualify, though those reviews are frequently skipped, data show. About 1.6 million households receive welfare benefits under a program known as Temporary Assistance for Needy Families (TANF- called Temporary Assistance for Families with Dependent Children or TAFDC in Massachusetts). Households receive on average about $450 a month, with huge variations state to state that can more than halve or double that amount. And, many states that offer lower welfare payments have higher SSI caseloads for children, underscoring critics’ concerns who say SSI is becoming the alternative welfare. For instance, in Texas, where maximum monthly welfare benefits in 2012 were relatively low at $260 a month for a family of three, there were about 144,000 children receiving SSI, three times as many families receiving welfare payments. (SSI accepts cases per child, while welfare accepts cases by household.) But in Massachusetts, which pays a maximum welfare benefit of about $630 for a family of three, there were about 50,000 households on welfare, more than twice as high as the number of children on SSI. States have an incentive to get a welfare-receiving family, with a disabled child, onto the SSI rolls. If that family drops welfare for SSI, the states save money because SSI is virtually entirely funded by the federal government with no matching state amount needed. -See the full Boston Globe article... Black Infant Death Rates Down, But Gap Persists A new report shows that infant mortality — the measure of how many babies die during the first year of life — has reached a historic low for black children. And the study shows that the persistent gap in infant mortality rates between black and white infants has narrowed significantly over the past dozen years. In 2000, black infants were nearly five times as likely to die as white infants; by 2012, a gap remained, but it had shrunk considerably. In 2012, the most recent year for which data exists, there were 6.5 deaths among every 1,000 black infants born in Boston, the same rate as for Latino babies, according to the report. There were 3 deaths per 1,000 white babies. Infant mortality is regarded as a bellwether of a community’s well-being, making such racial disparities particularly troubling in a city such as Boston, which hosts a range of world-renowned health centers, specialists say. Former mayor Thomas M. Menino once described infant mortality as the most pressing medical problem in Boston. While the gap between black and white infants remains unsettling, the city has made significant strides in addressing infant morality, said Barbara Ferrer, executive director of the Boston Public Health Commission. There was also a reduction in premature and underweight births among black infants. Ferrer said these advances are the result of a new approach that started a few years ago encompassing more long-term and socially conscious efforts. Instead of just focusing on prenatal care, public health care workers now work with women to help them lead healthy lifestyles before their first pregnancy, as well as between pregnancies. Nurses check up on children until the age of 5, following up to make sure they stay healthy. Public health caseworkers, who serve about 2,000 women a year, try to address social stressors as well, referring women to resources that help with housing, food, and finances. Recent research shows that poverty, racism, and isolation may be deciding factors in an infant’s health, Ferrer said. “There’s a new conceptual approach that says that rather than focus on prenatal care, our best opportunity is to discuss the time before pregnancies and [during] inter-pregnancies,” said Brent Ewig, director of policy at the Association of Maternal & Child Health Programs, a Washington, D.C., advocacy group. Building social networks with other pregnant women is critical for mothers-to-be, said Elmer Freeman, a Northeastern University specialist in the study of health care disparities. The city has sought to nurture those networks with support groups known as “women’s circles.” -See the full Boston Globe article... Medicare: Not Such a Budget-Buster Anymore Every year for the last six years in a row, the Congressional Budget Office has reduced its estimate for how much the federal government will need to spend on Medicare in coming years. The latest reduction came in a new report from the budget office released this week. The changes are big. The difference between the current estimate for Medicare’s 2019 budget and the estimate for the 2019 budget four years ago is about $95 billion. That sum is greater than the government is expected to spend that year on unemployment insurance, welfare and Amtrak - combined. It’s equal to about one-fifth of the expected Pentagon budget in 2019. Widely discussed policy changes, like raising the estate tax, would generate just a tiny fraction of the budget savings relative to the recent changes in Medicare’s spending estimates. In more concrete terms, the reduced estimates mean that the federal government’s long-term budget deficit is considerably less severe than commonly thought just a few years ago. The country still faces a projected deficit in future decades, thanks mostly to the retirement of the baby boomers and the high cost of medical care, but it is not likely to require the level of fiscal pain that many assumed several years ago. The reduced estimates are also an indication of what’s happening in the overall health care system. Even as more people are getting access to health insurance, the costs of caring for individual patients is growing at a super-slow rate. That means that health care, which has eaten into salary gains for years and driven up debt and bankruptcies, may be starting to stabilize as a share of national spending. -Learn more about the reasons for the decline, see the full New York Times article...
Virtual Therapy Sessions Make Mental-Health Care More Widely Available Since therapists don’t do physical exams, the field is perhaps uniquely suited to transition from face-to-face meetings to online appointments. Despite hurdles related to insurance reimbursement and concerns about whether an interpersonal connection can survive in the virtual world, proponents say that online therapy is an effective solution to bring mental health care to those who might not otherwise get it. “Anyone who’s used Skype, particularly for romantic reasons, knows that you can have very intimate conversations. The extra distance might actually allow more self-revelation,” noted Peter Yellowlees, a professor of psychiatry at the University of California Davis, who conducts research on online consultation services and uses video-conferencing technology in his own practice. “I’ve had many people tell me things on video that they wouldn’t necessarily share in person.” Janet Wozniak, a child and adolescent psychiatrist at Massachusetts General Hospital who is the associate director of the Bressler Program for Autism Spectrum Disorders, is taking part in pilot program for telepsychiatry. Skype and other similar applications aren’t strictly compliant with HIPAA privacy rules and regulations, and so while some practitioners do use Skype, MGH uses its own software. For Wozniak’s patients, mainly children and teens on the autism spectrum with psychiatric disorders, simply coming to the office can be harrowing.The initial goal for the pilot program to include 10 online psychiatry visits has become hundreds, and expanded beyond autism to patients with a variety of psychiatric conditions including depression, anxiety, obsessive-compulsive disorder, and substance abuse. And Wozniak describes unexpected benefits. For one, she’s met family members who are present in the background of the online session. She can see details about where her patients live. And without the stress of getting to the office on time, patients are actually more relaxed and engaged — allowing an interpersonal connection that is just as good as, if not better than, a face-to-face visit. “This is the wave of the future,” she said. But some worry that when it comes to rolling out telepsychiatry services on a larger scale, this future will be stunted. In Massachusetts, telemedicine visits aren’t reimbursed by insurance plans, said Sarah Sossong, the director of telehealth at MGH. That means that outside of pilot programs like the one at MGH, online therapy visits would be accessible only to those able to pay out of pocket. As a result, “we have our foot on the brakes and foot on the gas at the same time,” Sossong said. “We think it’s the right thing for patients but there needs to be a change at a system level if we want to be able to offer this to all our patients.” Does online therapy actually work? That was the question that faced Steven Hyler, who is on the faculty of Columbia University in the Department of Psychiatry, and who previously coordinated New York State Psychiatric Institute’s telepsychiatry consultation program. For about a decade, he worked to arrange virtual psychiatric consultations for patients without easy in-person access, from inmates at maximum security prisons to patients at rural community medical centers. Over the years, Hyler became familiar with the pros and cons of seeing patients through a computer screen. “You can’t touch the patient, or smell the patient. You can’t hand the person a tissue through the screen,” said Hyler, who now serves as a consultant to doctors interested in telepsychiatry. “But on the other hand, there are times and patients and practices where you don’t want to be in the room with someone.” Fueled by his experiences, Hyler published a meta-analysis of studies comparing telepsychiatry with in-person psychiatric assessments, and found the two methods to be equivalent. Other research has described similarly positive comparisons in patients with depression and post-traumatic stress disorder. Ultimately, Hyler notes, regardless of how slick the technology, the success of any treatment — whether online or face-to-face — depends on the relationship between the therapist and the patient. “It’s still up to the practitioner,” Hyler said. “There’s nothing magic about it. It all depends on the person on the other end of the line.” -See the full Boston Globe article...
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