Medicare's policy on therapy is challenged

Five national health care advocacy groups are suing the federal government, saying Medicare benefits are being cut for people with Parkinson's disease, Multiple Sclerosis and stroke.  The class action lawsuit is the first to mount a broad challenge to a controversial Medicare policy requiring patients achieve demonstrable improvements in functioning to qualify for physical, speech or occupational therapy. 

The Center for Medicare Advocacy filed the lawsuit with Vermont Legal Aid, on behalf of the National Multiple Sclerosis Society, Parkinson's Action Network, Paralyzed Veterans of America, National Committee to Preserve Social Security and Medicare and the American Academy of Physical Medicine and Rehabilitation.

Under current law, Medicare is obligated to provide therapy that is "reasonable and necessary for the diagnosis and treatment of illness and injury."  The complaint states that if a patent's condition is stable, benefits can be reduced or the person found ineligible for the care.  The suit further contends the standard has never gone through an official federal rule-making process and is denying therapy to thousands of chronically ill Americans.

According to a spokesperson, the Department of Health and Human Services has not yet reviewed the complaint and will not comment until they've had an opportunity to do so.

Healthcare buzzwords for 2011

With rapid changes in healthcare comes a new vocabulary with terms and phrases every provider should know. According to the Healthleadersmedia.com website, these phrases will be heard many times in 2011:

• EHR-EMR-HIT - these acronyms are among the most important to know and understand.  Using technology to connect providers and patient data will be the number one issue in 2011.
• Creative destruction - this oxymoronic phrase is derived from the economic theory that in order to create a new system, the old one will have to be torn down.  The next few years will see our current health care delivery system transformed into a system where strong incentives for efficient, coordinated care become commonplace.
• Teachback - Many patients do not understand much about what they've been told during their healthcare experience.  To ensure they comprehend what they need to know to continue their recovery and care, patients given any instructions should be encouraged to "teach it back"  to the provider. 
• SAT scores - Increasingly heard in physician offices is whether the patient will give a positive answer when asked if the healthcare experience was satisfying. Soon, federal payments will be based on satisfaction (SAT) scores.
• Alignment - standardizing equipment, procedures, programs, policies
• Checklists - step by step protocols to prevent adverse events and infections.
• Medical Loss Ratio - the amount that can be spent by insurance carriers on executive salaries, overhead & marketing as compared to the amount that must be spent on patient care and/or quality improvement.

For the complete list of hot buzzwords for 2011, go to:  www.healthleadersmedia.com