Industry Updates

Industry trends and legislative changes that affect seniors and the medical professionals providing their care.

The Cost of Treating Different Diseases

Industry Updates, Uncategorized
Spending grew fastest for ill-defined conditions (such as preventive care, and cold and flu treatment, and slowest for circulatory conditions.

Spending grew fastest for ill-defined conditions (such as preventive care, and cold and flu treatment, and slowest for circulatory conditions.

Circulatory conditions had been the largest contributor to health spending, for at least a decade, until 2012 when they were surpassed in total spending by ill-defined conditions (a category including check-ups, follow-up appointments, preventive care, and treatment of minor conditions such as colds, flus, and allergies), according to Peterson-Kaiser Health System Tracker.

In 2012, about $250 billion was spent on ill-defined conditions, and $243 billion went toward the treatment of circulatory conditions.

Go here for a listing of total expenditures in $billions by disease category, 2012.

The report concludes that the top five disease-based spending categories (ill-defined conditions, circulatory, musculoskeletal, respiratory, endocrine, and nervous system conditions) account for roughly half (51%) of all medical services spending by disease category. Circulatory and ill-defined conditions each represent about 13% of overall health spending by disease and musculoskeletal, respiratory, and endocrine conditions represent 10%, 8%, and 7% respectively.

Spending grew fastest for ill-defined conditions and slowest for circulatory conditions from 2000 to 2012.

Among major disease categories, the cost per case grew fastest for infectious diseases.

Read Full Report here.


Home Health Care Jobs on the Rise in 2014

Industry Updates

Health Care Jobs are set to boom, with home health leading the charge. 

Home Healthcare Jobs

An increasing demand for home health care for aging adults leads the trend in health care jobs, according to U.S. News and World Report.

Among the top trends in health care jobs in the coming year, an increasing demand for home health care options for aging adults makes the top three, according to annual rankings based on data compiled by U.S. News and World, reports Home Health Care News.

The three trends include an increasing demand for home health care for aging adults, a need for tech staff to assist top-tier employees, and a focus on preventative and wellness care, U.S. News and World Report writes.

  • There is going to be a lot more community care that is going to be needed as we move forward,” Deborah Rowe, senior director of Genesis HealthCare, told U.S. News and World Report. Further, she said, the emphasis will be on caring for aging adults who wish to remain in their homes. “There is an increasing demand as [senior citizens] are getting older and managing their chronic diseases and living with them,” Rowe told the publication.
  • According to U.S. News and World Report’s rankings this year, health care fell to the No. 2 spot for jobs in demand, second to the tech sector. However, health care jobs are still trending up with opportunities abound.
  • Take your pick of the 38 health care jobs, and you’ll find the same story: There are more openings than applicants to fill them,” U.S. News wrote in late January.

View the U.S. News and World report.

Source: Home Health Care News


Improvement Standard Update: New Medicare Policy Manuals Released

Industry Updates, Referring to Home Health
Regulations under Affordable Care Act has led to 130,000 fewer 30-day Medicare hospital readmissions in the first 8 months of 2013.

Regulations under Affordable Care Act has led to 130,000 fewer 30-day Medicare hospital readmissions in the first 8 months of 2013.

CMS has revised its Medicare policy manuals to ensure coverage for skilled maintenance care, reflecting the “Jimmo vs. Sebelius” settlement, reports the Center for Medicare Advocacy.

The Jimmo settlement ends a longstanding practice denying Medicare coverage to people who had “plateaued,” or were “chronic,” or “stable,” or “not likely to improve.” The Manual revisions, which clarify that improvement is not required to obtain Medicare coverage, were published by the Centers for Medicare & Medicaid Services (CMS) on Friday December 6, 2013. They pertain to care in Inpatient Rehabilitation Facilities (IRF), Skilled Nursing Facilities (SNF), Home Health care (HH), and Outpatient Therapies (OPT).

As CMS states in the transmittal announcing the Jimmo Manual revisions:

“No ‘Improvement Standard’ is to be applied in determining Medicare coverage for maintenance claims that require skilled care. Medicare has long recognized that even in situations where no improvement is possible, skilled care may nevertheless be needed for maintenance purposes (i.e., to prevent or slow a decline in condition). The Medicare statute and regulations have never supported the imposition of an ‘Improvement Standard’ rule-of-thumb in determining whether skilled care is required to prevent or slow deterioration in a patient’s condition. Thus, such coverage depends not on the beneficiary’s restoration potential, but on whether skilled care is required, along with the underlying reasonableness and necessity of the services themselves. The manual revisions now being issued will serve to reflect and articulate this basic principle more clearly.”

Per the Jimmo Settlement, CMS will now implement an Education Campaign to ensure that Medicare determinations for SNF, Home Health, and Outpatient Therapy turn on the need for skilled care – not on the ability of an individual to improve. For IRF patients, the Manual revisions and CMS Education Campaign clarify that coverage should never be denied because a patient cannot be expected to achieve complete independence in self-care or to return to his/her prior level of functioning.

“As with components of all settlement agreements, the Jimmo revisions are not perfect,” says Judith Stein, Executive Director of the Center for Medicare Advocacy. “But they do make it absolutely clear that skilled care is covered by Medicare for therapy and nursing to maintain a patient’s condition or slow decline – not just for improvement.”

Read revisions and “MLN Matters” article.