Why So Much?

The issue of the local cost of health care gets a good airing in the latest issue of Commmonwealth magazine available on newsstands and online. The article - Cost Unconsious - by David Denison rounds up the usual insurance, hospital and state government executives to agree that the current rate of cost escalation is unsutainable. To see who they blame and what they propose will require reading the article. Hint: there is little "physician heal thyself."

Test Your Health Care Reform Knowledge

If you think you know a lot about about Massachusetts' landmark health care reform legislataion, you may want to test your yourself by taking the health care reform quiz recently posted to WBUR's health care reform Blog CommonHealth. The blog itself is great reading as various parties on all sides in the ongoing debate about the law's intent and value weigh in on a daily basis. It is just what a blog should be - a conersation between interested parties - with an added benefit that we can all listen in.

And, BTW, there will be prizes for the most correct answers - and, I believe, for the best health reform haiku. So all you poets are welcome to play too!

Federal Budget Watch

Home health care once again has a lot at stake as elected officials in Washington debate the FY 08 Federal Budget and two Massachusetts representatives are front and center in the process. At stake is whether home health care will get a planned inflation increase in its Medicare rates - or whether this needed rate reflief will be sacrificed to pay for other Medicare and health insurance expansions, most notably a $50 billion increase for SCHIP - the state children's health insurance program.

Senator John Kerry is a member of the Senate Finance Committe that will be making these funding decisions over the next few weeks. Congressman James McGovern (D-Worcester) has been a primary sponsor of a Congressional Letter - now with more than 100 siganatures to preserve home health funding in this year's budget.

If you care about preserving home care, contact these elected officials and thank them for their support and ask them to hold steady.

Hospice Bad News/GoodNews

This week Brown University published their findings in a major study on patient satisfaction and the timing of referrals to hospice. Nationally, 11% of the more than 100,000 families surveyed said that they felt that referal for hospice care was "too late." (The figure was 12.4% for Massachusetts.) While the median length of service for hospice was 26 days in 2005, data from the National Hospice and Palliative Care Organization (NHCPO) indicates that 30 percent of people served by hospice in the U.S. dying in seven days or less.

More importantly, however, hospice usuage as covered by the federal Medicare program has grown tremednously in the past five years five years. In Massachusetts the number of patinets has increased by 49% between 2001 and 2005 - a good sign that families and most importantly physicians are seeing the benefits of this service - not only for the patients, but for the surviving families. (See work of Nicholas Christakis at Harvard Medical School on this.)

For families who need information about hospice care at End of Life NHCPO has developed a very informative website as a good place to start.

We're Number 8

The Comonwealth Fund has handed Massachusetts a rank of Eighth in its new report Aiming Higher: Results from a State Scorecard on Health System Performance. Generally the areas in which our state scored the lowest are premium costs for employer sponsored insurance and "Avoidable Hospital Use and Costs." In the area of readmissions to hospitals during a home health episode. we were ranked 35, with a rate of 29.0, compared to a national rate of 26.9. Clearly this is not a problem specific to home care as in the category of overall readmisions for Medicare, 40 states did better than us.

Medicare has adopted reducing acute care hospital (ACH) admission from home care as its national quality improvement goal for 2007. The goal for the campaign is to reduce the average ACH rate across all campaign participant home health agencies by a 5% relative improvement from baseline to the end of the campaign. The Home Care Alliance is a designated partner (a LANE) to the federal Medicare program in this QI effort and more than 75 local agencies have signed up as committed partners.

Progress will be tracked through February 2008 and publicly reported in May 2008.

NORC Anyone?

If you haven't read up on it, you might want to check out the new trend in supporting people who want to "age-in-place" without leaving their own home or community. NORCs - or Naturally Occurring Retirement Communities - are neighborhoods or buildings in which a large segment of the residents are older adults and in which a service structure is set up to meet varying degrees of needs. United Jewish Communities has been a leader in establishing NORCs nationally. The local model is Beacon Hill Village whose members are offered access "to social and cultural activities, exercise opportunities and household and home maintenance services, as well as medical care and assisted living at home."

Don't want to move to a retirement community? Consider starting one on your own.

A Whole New World - Maybe

Yesterday I testified at a Massachusetts legislative hearing in support of Senate Bill 680, which would allow home care agencies to use and get paid for monitoring frail, nursing home at-risk patients via telehealth and video visiting. The value of this technology to help patients living with diseases like congestive heart failure has been demonstrated in any number of studies. But it is hard sometimes for state programs like MassHealth in Massachusetts to embrace new approaches even as they contemplate - and seek permission from the federal government - for a new Community First strategy that attempts to reduce the state's reliance on nursing homes for long term care by expanding community program eligibility and offerings. Hopefully the legislature will prompt them by passing this bill.