A New Medicare Proposal Would Cover Training for Family Caregivers

Even with extensive caregiving experience, Patti LaFleur was unprepared for the crisis that hit in April 2021, when her mother, Linda LaTurner, fell out of a chair and broke her hip.

LaTurner, 71, had been diagnosed with early-onset dementia seven years before. For two years, she’d been living with LaFleur, who managed insulin injections for her mother’s Type 1 diabetes, helped her shower and dress, dealt with her incontinence, and made sure she was eating well.

In the hospital after her mother’s hip replacement, LaFleur was told her mother would never walk again. When LaTurner came home, two emergency medical technicians brought her on a stretcher into the living room, put her on the bed LaFleur had set up, and wished LaFleur well.

That was the extent of help LaFleur received upon her mother’s discharge.

She didn’t know how to change her mother’s diapers or dress her since at that point LaTurner could barely move. She didn’t know how to turn her mother, who was spending all day in bed, to avoid bedsores. Even after an occupational therapist visited several days later, LaFleur continued to face caretaking tasks she wasn’t sure how to handle.

“It’s already extremely challenging to be a caregiver for someone living with dementia. The lack of training in how to care for my mother just made an impossible job even more impossible,” said LaFleur, who lives in Auburn, Washington, a Seattle suburb. Her mother passed away in March 2022.

A new proposal from the Centers for Medicare & Medicaid Services addresses this often-lamented failure to support family, friends, and neighbors who care for frail, ill, and disabled older adults. For the first time, it would authorize Medicare payments to health care professionals to train informal caregivers who manage medications, assist loved ones with activities such as toileting and dressing, and oversee the use of medical equipment.

The proposal, which covers both individual and group training, is a long-overdue recognition of the role informal caregivers — also known as family caregivers — play in protecting the health and well-being of older adults. About 42 million Americans provided unpaid care to people 50 and older in 2020, according to a much-cited report.

Read the full article from KFF Health News.

Feds Move to Rein In Prior Authorization, a System That Harms and Frustrates Patients

When Paula Chestnut needed hip replacement surgery last year, a pre-operative X-ray found irregularities in her chest.

As a smoker for 40 years, Chestnut was at high risk for lung cancer. A specialist in Los Angeles recommended the 67-year-old undergo an MRI, a high-resolution image that could help spot the disease.

But her MRI appointment kept getting canceled, Chestnut’s son, Jaron Roux, told KHN. First, it was scheduled at the wrong hospital. Next, the provider wasn’t available. The ultimate roadblock she faced, Roux said, arrived when Chestnut’s health insurer deemed the MRI medically unnecessary and would not authorize the visit.

“On at least four or five occasions, she called me up, hysterical,” Roux said.

Months later, Chestnut, struggling to breathe, was rushed to the emergency room. A tumor in her chest had become so large that it was pressing against her windpipe. Doctors started a regimen of chemotherapy, but it was too late. Despite treatment, she died in the hospital within six weeks of being admitted.

Though Roux doesn’t fully blame the health insurer for his mother’s death, “it was a contributing factor,” he said. “It limited her options.”

Few things about the American health care system infuriate patients and doctors more than prior authorization, a common tool whose use by insurers has exploded in recent years.

Prior authorization, or pre-certification, was designed decades ago to prevent doctors from ordering expensive tests or procedures that are not indicated or needed, with the aim of delivering cost-effective care.

Originally focused on the costliest types of care, such as cancer treatment, insurers now commonly require prior authorization for many mundane medical encounters, including basic imaging and prescription refills. In a 2021 survey conducted by the American Medical Association, 40% of physicians said they have staffers who work exclusively on prior authorization.

So today, instead of providing a guardrail against useless, expensive treatment, pre-authorization prevents patients from getting the vital care they need, researchers and doctors say.

“The prior authorization system should be completely done away with in physicians’ offices,” said Dr. Shikha Jain, a Chicago hematologist-oncologist. “It’s really devastating, these unnecessary delays.”

In December, the federal government proposed several changes that would force health plans, including Medicaid, Medicare Advantage, and federal Affordable Care Act marketplace plans, to speed up prior authorization decisions and provide more information about the reasons for denials. Starting in 2026, it would require plans to respond to a standard prior authorization request within seven days, typically, instead of the current 14, and within 72 hours for urgent requests. The proposed rule was scheduled to be open for public comment through March 13.

Read the full article from KHN.

Want a Clue on Health Care Costs in Advance? New Tools Take a Crack at It

Need medical treatment this year and want to nail down your out-of-pocket costs before you walk into the doctor’s office? There’s a new tool for that, at least for insured patients.

As of Jan. 1, health insurers and employers that offer health plans must provide online calculators for patients to get detailed estimates of what they will owe — taking into account deductibles and copayments — for a range of services and drugs.

It’s the latest effort in an ongoing movement to make prices and upfront cost comparisons possible in a business known for its opaqueness.

Insurers must make the cost information available for 500 nonemergency services considered “shoppable,” meaning patients generally have time to consider their options. The federal requirement stems from the Transparency in Coverage rule finalized in 2020.

So how will it work?

Patients, knowing they need a specific treatment, drug, or medical service, first log on to the cost estimator on a website offered through their insurer or, for some, their employer. Next, they can search for the care they need by billing code, which many patients may not have; or by a general description, like “repair of knee joint,” or “MRI of abdomen.” They can also enter a hospital’s or physician’s name or the dosage amount of a drug for which they are seeking price information.

Not all drugs or services will be available in the first year of the tools’ rollout, but the required 500-item list covers a wide swath of medical services, from acne surgery to X-rays.

Once the information is entered, the calculators are supposed to produce real-time estimates of a patient’s out-of-pocket cost.

Starting in 2024, the requirement on insurers expands to include all drugs and services.

These estimator-tool requirements come on top of other price information disclosures that became effective during the past two years, which require hospitals and insurers to publicly post their prices, including those negotiated between them, along with the cost for cash-paying or uninsured patients.

Still, some hospitals have not fully complied with this 2021 disclosure directive and the insurer data released in July is so voluminous that even researchers are finding it cumbersome to download and analyze.

The price estimator tools may help fill that gap.

The new estimates are personalized, computing how much of an annual deductible patients still owe and the out-of-pocket limit that applies to their coverage. The amount the insurer would pay if the service were out of network must also be shown. Patients can request to have the information delivered on paper, if they prefer that to online.

Read the full article from KHN.

A Review of 62 Studies Finds Few Big Differences Between Traditional Medicare and Medicare Advantage on a Variety of Measures

Enrollees in Medicare Advantage Were More Likely to Get Routine Check-ups and Immunizations, While Those in Traditional Medicare Were More Likely to Receive Care in the Highest-Rated Hospitals. Rates of Satisfaction Were Similar Among Both Groups.

With the Medicare open enrollment period set to begin Oct. 15, a perennial decision faced by Medicare beneficiaries is whether to get their coverage through traditional Medicare or the private plans known as Medicare Advantage.

A new KFF review of 62 studies published since 2016 that compares Medicare Advantage and traditional Medicare on measures of beneficiary experience, affordability, utilization, and quality finds few differences that are supported by strong evidence or have been replicated across multiple studies. For example, beneficiaries in both coverage types reported similar rates of satisfaction with their care and overall measures of care coordination.

Notably, relatively few studies specifically examined specific subgroups of interest, such as beneficiaries from communities of color, living in rural areas, or dually eligible for Medicare and Medicaid, making it difficult to assess the strength of the findings or how broadly they apply.

In some areas, however, the research identified noteworthy differences between Medicare Advantage and traditional Medicare, including:

Medicare Advantage:

  • Medicare Advantage enrollees were more likely than those in traditional Medicare to report having a usual source of care. They were also more likely to receive preventive care services, such as annual wellness visits and routine checkups, screenings, and flu or pneumococcal vaccines.
  • Medicare Advantage enrollees reported better experiences getting needed prescription drugs than traditional Medicare beneficiaries overall. However, among beneficiaries with diabetes, cancer, or a mental health condition, findings were mixed.
  • Most studies found that utilization of home health services and post-acute skilled nursing or inpatient rehabilitation facility care was lower among Medicare Advantage enrollees than traditional Medicare beneficiaries, but were inconclusive as to whether that was associated with better or worse outcomes.

Traditional Medicare:

  • A somewhat smaller share of traditional Medicare beneficiaries than Medicare Advantage enrollees experienced a cost-related problem, mainly due to lower rates of cost-related problems among traditional Medicare beneficiaries with supplemental coverage. (But traditional Medicare beneficiaries without supplemental coverage had the most affordability-related difficulties.)
  • Traditional Medicare outperformed Medicare Advantage on measures such as receiving care in the highest-rated hospitals for cancer care or in the highest-quality skilled nursing facilities and home health agencies.

In other areas, though, findings were mixed or showed little difference between Medicare Advantage and traditional Medicare based on multiple studies.

Among the findings:

  • There were generally no differences in the aggregate number of hospital days or average length of stay for common medical admissions.
  • Neither Medicare Advantage nor traditional Medicare consistently performed better across all quality measures.
  • Additionally, two analyses of several measures of beneficiary experience found no differences between the two groups in experiences with wait times and in the share reporting trouble finding a general doctor, being told that their health insurance was not accepted, and being told they would not be accepted as a new patient.

Findings related to the use of other health care services, including hospital care and prescription drugs, and condition-specific quality of care measures varied – likely due to differences in data and methodology across studies.

Interest in how well Medicare Advantage plans serve their growing and increasingly diverse enrollee population has never been higher, as Medicare Advantage, for the first time, is projected to enroll more than half of all eligible Medicare beneficiaries next year, making it the main way that Medicare beneficiaries get their coverage and care. In comparison, just over a decade ago in 2010, 25 percent of the eligible population was in a Medicare Advantage plan.

The Medicare open enrollment period runs through Dec. 7.

The full analysis, Beneficiary Experience, Affordability, Utilization, and Quality in Medicare Advantage and Traditional Medicare: A Review of the Literature, as well as more data and analyses about Medicare Advantage, are available at kff.org.

Hot Weather Safety

Hot weather precautions to reduce the risk of heat exhaustion and heat stroke

  • Stay indoors and in an air-conditioned environment as much as possible unless you’re sure your body has a high tolerance for heat.
  • Drink plenty of fluids but avoid beverages that contain alcohol, caffeine or a lot of sugar.
  • Eat more frequently but make sure meals are balanced and light.
  • Never leave any person or pet in a parked vehicle.
  • Avoid dressing babies in heavy clothing or wrapping them in warm blankets.
  • Check frequently on people who are elderly, ill or may need help. If you might need help, arrange to have family, friends or neighbors check in with you at least twice a day throughout warm weather periods.
  • Make sure pets have plenty of water.
  • Salt tablets should only be taken if specified by your doctor. If you are on a salt-restrictive diet, check with a doctor before increasing salt intake.
  • If you take prescription diuretics, antihistamines, mood-altering or antispasmodic drugs, check with a doctor about the effects of sun and heat exposure.
  • Cover windows that receive morning or afternoon sun. Awnings or louvers can reduce the heat entering a house by as much as 80 percent.

If you go outside

  • Plan strenuous outdoor activities for early or late in the day when temperatures are cooler; then gradually build up tolerance for warmer conditions.
  • Take frequent breaks when working outdoors.
  • Wear a wide-brimmed hat, sun block and light-colored, loose-fitting clothes when outdoors.
  • At first signs of heat illness (dizziness, nausea, headaches, muscle cramps), move to a cooler location, rest for a few minutes and slowly drink a cool beverage. Seek medical attention immediately if you do not feel better.
  • Avoid sunburn: it slows the skin’s ability to cool itself. Use a sunscreen lotion with a high SPF (sun protection factor) rating.
  • Avoid extreme temperature changes. A cool shower immediately after coming in from hot temperatures can result in hypothermia, particularly for elderly or very young people.

If the power goes out or air conditioning is not available

  • If air conditioning is not available, stay on the lowest floor out of the sunshine.
  • Ask your doctor about any prescription medicine you keep refrigerated. (If the power goes out, most medicine will be fine to leave in a closed refrigerator for at least 3 hours.)
  • Keep a few bottles of water in your freezer; if the power goes out, move them to your refrigerator and keep the doors shut.

Visit the Washington State Department of Health for more information.

Omicron COVID-19 variant discovered in three counties across Washington

The Washington State Department of Health (DOH), in partnership with the UW Medicine Virology Lab, has confirmed a total of three cases of omicron variant found in Thurston County, Pierce County, and King County. The patients range in age from 20 to 39, two men, one woman.

The patients are:

  • a man in his thirties from Thurston County,
  • a man in his twenties from Pierce County, and
  • a woman in her twenties from King County.

Confirmation came in midday Saturday, and patients are still being informed. Details about their conditions are unknown to DOH. Samples were collected between Nov. 29 and Dec. 1 and confirmed at an in-state lab.

This is early in the investigation, DOH does not believe the cases are related, but the travel history of the patients is unknown.

Little is known clinically about the omicron variant at this time. Researchers are working to learn more about it, but it was found here quickly thanks to increased surveillance efforts; lab specialists have been looking for omicron through PCR testing and genomic sequencing. The state also increased its lab capacity to detect genetic markers associated with new and existing variants.

Sequencing has been prioritized for anyone with travel history or close contact with a confirmed case. Case investigation and contact tracing among those at higher risk for contracting and spreading omicron has been prioritized. Travelers who have been to a country or state with omicron, or anyone identified as a close contact, receives that prioritization.

“We knew that it was a matter of time before omicron was sequenced in our state and so we were anticipating this very news,” said Umair A. Shah, MD, MPH, Secretary of Health. “We strongly urge people to get vaccinated and get their boosters as soon as possible to maximize their level of protection from any variant.”

The best protection from this variant and others comes from getting vaccinated and getting boosters as soon as possible. This is especially important for children and adults with chronic conditions that place them at higher risk for severe disease from COVID-19.

“Even with a highly mutated virus like omicron, we are not going back to square one of the pandemic,” said Dr. Jeff Duchin, Health Officer, Public Health – Seattle & King County. “Omicron may pose new challenges that we will need to respond to, but compared to the early days of the pandemic, we know much more about COVID-19, and we’re better prepared for it. We know layered protections work together to maximally reduce risk, and that will continue to be the case for delta and for omicron if that becomes a dominant strain circulating in our community.”

“If there is room for improvement in how we are using our current tools and strategies, this is a good time to make those improvements, especially vaccination and booster doses when eligible, good-quality masks indoors, improving indoor air quality and avoiding crowded indoor spaces along with other COVID-19 prevention measures,” Duchin said.

“We suspected that the omicron variant was circulating in our region, and now our laboratory has confirmed the first three cases in Washington state by viral genome sequencing in the last 24 hours. Throughout the pandemic, it’s been a huge team effort by the UW Medicine Virology Laboratory, requiring development and implementation of several diagnostic and sequencing assays to detect and confirm the variety of COVID-19 variants that have surfaced in Washington state,” said Dr. Geoffrey Baird, chair of Laboratory Medicine and Pathology at UW Medicine. To date, the laboratory has tested approximately 3.8 million COVID-19 samples.

DDA Issues Air Quality, Wildfire Prevention & Heat Wave Advisory

Information on Air Quality, Wildfire Prevention & Heat Wave Advisory

Air Quality

Washington State is experiencing serious air quality issues due to the wildfires that have been occurring around the state. Unhealthy air quality can impact people who have respiratory and immune system issues.

Below are some resources from the Department of Health website for you to review.  If your health situation becomes worse, we encourage you to contact your health care provider.

See the below links for more information on air quality.

Department of Health– this link provides some guidance on how to protect yourself from wildfire smoke.

Department of Health -this link includes information about health concerns that may impact people with respiratory and immune systems as a result of the wildfire smoke in your area.

The Department of Ecology has a map to show you air quality situations in different areas of the state that are impacted by the wildfires, or check out airnow.gov.

Wildfire Prevention

Wildfires may cause people to evacuate their homes or be without power for days.

Read our Care Provider Bulletin and put a plan in place to protect people you support and yourself when fire danger exists. Check out this link on Washington Wildfire Resources.

Heat Wave Advisory and Cooling Stations

Extreme heat is a period of high heat and humidity with temperatures above 90 degrees for at least two to three days. In extreme heat your body works extra hard to maintain a normal temperature. This exertion can lead to death. In fact, extreme heat is responsible for the highest number of annual deaths among all weather-related hazards. For more information go to ready.gov/heat.

Please take a few minutes to learn what you can do to keep the people you support and yourself safe while enjoying the summer.