Posts Tagged ‘Medicare’

Study reveals “staggering” statistics on Medicare patients who will die or be readmitted within one year of stroke

Wednesday, December 22nd, 2010

Today I came across an excellent post in entitled “Death and readmission rates after stroke “staggering” for Medicare Patients.” As a general comment, if you are not familiar with this online journal, I would strongly recommend you register (it’s free). They post a number of excellent pieces on a consistent basis.

Dr. Gregg Fonarow and colleagues did a study examining the outcomes for 91,134 Medicare patients, who had suffered an ischemic stroke between April 1, 2003 and December 31, 2006. The researchers themselves described their findings as “staggering.” Here is the essential finding:

Almost two-thirds of Medicare beneficiaries discharged from the hospital after suffering an ischemic stroke die or are readmitted within a year.

Does the type of hospital make a difference?

While ostensibly not the major focus of the study, Dr. Fonarow’s research team did examine data to determine if the outcomes were significantly better if the patient was seen for the initial acute ischemic stroke at an academic center versus a non-academic (e.g. community hospital). The finding in this regard was not what I expected.

Rates were only slightly lower for academic hospitals than nonacademic centers. “That was surprising,” said Fonarow. “Whether a hospital was academic or bedside or, more important, a joint commission primary stroke center really did not make a large difference in outcomes.”

The impact on the healthcare system is obvious and alarming

I don’t claim to have any expertise in statistical analysis or application of such data to a system-wide root cause analysis. That being said, does it really take a statistician or mathematician to grasp the import of this “staggering” data? If you or someone you know is on Medicare and has suffered an acute ischemic stroke, there is a 2 out of 3 chance you (or the person you know) will be readmitted or die within one year of suffering that stroke!

The big questions: Why and What can be done?

Dr. Fonarow readily admits that the data he collected does not lend itself to the ultimate answers. What he does note, however, is that while further studies are clearly warranted, since more than one-half of the cases for readmission analyzed involved non-cardiovascular causes, “there’s room for better secondary-prevention efforts.”

“When you looked at causes of readmission, in many cases it was not a recurrent stroke or cardiovascular event but other comorbid conditions, such as pneumonia, falls, and GI bleeds,” he said. “It shows you that when caring for someone after a stroke, managing these comorbid conditions and related risks is going to be critical.”

He added that the period after discharge for an ischemic stroke offers a “window of opportunity” for interventions to reduce the burden of post-ischemic stroke morbidity and mortality.

The information shared by Dr. Fonarow is unequivocally “staggering.” One can only hope that further system-wide studies are performed soon to identify what improvements can and need be made in the delivery of health care to this population to reduce such loss of life and burden on the healthcare system secondary to readmissions.

What’s your reaction to Dr. Fonarow’s study? Are you aware of any data that is known for death and readmission rates in the non-Medicare population? If there is a significant difference in death and readmission rates between Medicare and non-Medicare patients, what is being done in the non-Medicare population that can be adopted for all patient populations?

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A Sticky Wicket No Doubt – study suggests unnecessary screening of advanced cancer patients being done.

Wednesday, October 13th, 2010

An article published today in JAMA reports a case-control study regarding the efficacy of continued surveillance through screening of patients with advanced cancer. The conclusion of the researchers: “A sizeable proportion of patients with advanced cancer continue to undergo cancer screening tests that do not have a meaningful likelihood of providing benefit.”

The study, according to a synopsis provided in an email alert we received from Physician’s First Watch, “used the Surveillance, Epidemiology and End Results (SEER) cancer registry to identify roughly 88,000 patients aged 65 or older diagnosed with advanced lung, colorectal, breast, gastroesophageal, or pancreatic cancer (median survival after diagnosis, 4–16 months). The researchers then examined whether patients were screened for other cancers.”

What the synopsis didn’t mention was that these were “fee-for-service Medicare enrollees.” For those of you having to deal with Medicare issues (which we do all the time in light of the super lien issues affecting our clients who receive Medicare and Medicaid benefits), one wonders just how big a role this “payor” issue played in the reason for the study and its conclusion.

It is common knowledge that Medicare’s solvency remains a major issue in our politically charged financial landscape. On August 5, 2010, U.S. Department of HHS Secretary, Kathleen Sebelius, joined Treasury Secretary Tim Geithner, Hilda Solis, Secretary of Labor, and the Social Security Administrator, Michael Astrue (the latter being also Trustees of the Social Security and Medicare Trust) in releasing the 2010 Annual Social Security and Medicare Trustees Report. In essence, they announced that the solvency of the Trust Fund would be extended by 12 years until 2029.” A “Fact Sheet” has been published by the Centers for Medicare and Medicaid Services (CMS) for those interested in reviewing the substance of the report. While the actual statistical findings are readily available in the JAMA abstract, here is a more concise version of the study’s findings:

  • Overall, cancer patients were screened between one third and one half as often as cancer-free controls.
  • Roughly 9% of women with cancer underwent mammography, and 6% had Pap tests.
  • Some 15% of men with cancer underwent prostate-specific antigen testing.
  • About 2% of cancer patients had lower GI endoscopy.
  • Putting aside the issue of financial expediency, how do you feel about avoidance of screening for “other cancer” in such patients? Is it worth the cost? Not worth the cost? Should we restrict such testing to avoid its apparent financial impact on our Medicare system?

    Pursuing an Injury Claim as a Medicare Beneficiary; so what’s the big deal?

    Wednesday, June 16th, 2010

    Potential clients come to our office seeking information about different types of injury claims – primarily medical malpractice cases, which often sadly include a catastrophic injury or death of a loved one.  After listening to the family or injured victim tell their story and taking pages upon pages of detailed notes, we then start to ask questions.  One of the first questions we ask is:  ”Are you on Medicare, Medicaid, or do you receive any other type of government benefits?” Sound shallow or irrelevant to the conversation? We can assure you that question is asked with the potential client’s best interests in mind. It also allows our attorneys to offer some initial guidance and cautions to the prospective client – all before putting pen to paper to sign our contract for representation (the contingent fee agreement).

    There are many rules, regulations, and procedures that are in place for individuals (we’ll call them ‘claimants’ – although I am not crazy about that word, it will make it easier to remember for purposes of this article) who are making what are called ‘third-party claims’ (pursuing an insurance company, person, or other entity for compensation) and have Medicaid or Medicare coverage.  In addition to issues for those receiving Medicare or Medicaid benefits come concerns for claimants who are receiving benefits through Supplemental Security Income (SSI) or Social Security Disability (SSD).  We could fill an entire book with all of the ramifications involved with the different types of benefits one could experience when making a third party claim.  For present purposes, we will focus on what we see as the most common type of coverage that causes our ‘legal antenna’ to be activated: Medicare.

    Let’s start at the end and work our way back to the beginning of a personal injury claim that involves Medicare coverage/payments.  I say ‘work our way back’ because I cannot tell you how many clients have rightfully asked me the question when their case settles: “When do I get my money?”  The seemingly obvious point in time is immediately after the case settles; however, that would not be correct.  I call this time “the beginning of the case after the case”.  Whenever an attorney represents a Medicare beneficiary and settles their case, the lawyer/law firm is required by law to hold the settlement funds in trust until Medicare is reimbursed the amount of their lien. The lien is the amount of the related medical expenses paid over the course of one ‘s injury claim by Medicare.  While our lawyers take steps throughout the process to submit information to Medicare early and throughout the process to minimize the payout time delay, Medicare does not give a final lien amount for reimbursement until after a case is resolved through settlement or trial. This final lien amount usually takes quite a bit of time to obtain from Medicare and can only be obtained once the case is settled. How much time does it take?  It can take months, although I have seen it (albeit rarely in present time) to take more than a year, and that was with diligent follow-up through letters and phone calls.

    Why does it take so long?  Well, we could write yet another entire book on that topic as well. Suffice to say that we believe Medicare has gotten better over the last few years and has really worked diligently to streamline the process.  What clients need to keep in mind (and we as layers do too for that matter) is that Medicare is really given a daunting task: to file, document, maintain, itemize, and finalize files on every claimant in the Unites States making an injury claim where Medicare is involved, I mean, think about it.  That’s A LOT of people and a lot of work.  On top of all of this, you have the appeals process and also have to factor in what a difficult job it is for Medicare to have to ‘figure out’ what treatment paid by Medicare is causally related to the injury claim.  Heck, even the doctors cannot do this sometimes.  How is a claims representative without a medical license sitting in an office somewhere a thousand miles away from the treatment site supposed to do this?! … but I digress.

    Our lawyers always try to have our prospective clients understand that when their claim involves Medicare is involved, there is going to be a delay – plain and simple; it is the nature of the beast. What we sometimes have to explain to prospective clients is that it will sometimes not be feasible for a law firm to represent them in a personal injury claim where there is a substantial Medicare lien and the claimant is in a jurisdiction (such as Maryland, Virginia and a host of other jurisdicitons) where there is a cap on the amount of monetary damages one can receive.  A good illustration of this scenario is featured in a prior blog by Brian Nash.  Check it out.

    Thinking about ignoring or not paying Medicare back?  Not a good idea.  There are serious civil penalties for not reimbursing Medicare the amount that they are owed.  These penalties extend to the claimants and the lawyers who represent them.  Again, we cannot stress the importance of being 100% in compliance with the Medicare reporting and reimbursement system that is in place.  Medicare also has a system in place for those who think that the law does not apply to them.  You do NOT want to be in that group of people.

    So, moving back from the end to the beginning of a claim where Medicare is involved, don’t be surprised if a lawyer tells you that you have a case, or may have a case, but elects not to take your claim.  At our office, we look at a variety of factors when determining whether or not to invest the tens of thousands (and sometimes hundreds of thousands) of dollars needed to vigorously pursue a claim. The reality of a Medicare lien can substantially affect what you can receive in net recovery – the amount you receive after fees, costs and lien reimbursement. As lawyers, we have to look at both the best and worst case scenarios when it comes to the probabilities of recovery, as well as everything in between, when determining which cases are feasible to pursue.  Are there claimants out there who have legitimate cases that come to us that we regrettably have to decline?  Absolutely. Frankly, that is one of the hardest decisions we have to make at times.

    If you are someone who believes you have a claim for injuries caused by the negligence of another person and you are receiving benefits through SSI, Medicare, SSD or Medicaid, you simply must discuss with the lawyer with whom you are meeting what this means to you and your potential recovery. Since you can not ignore it, you should deal with it early in the process.

    Edited by: Brian Nash