Panel on Comprehensive Health Care, moderated by Kathy Gordon, RN

Kathy Gordon, RN, is retired from Providence Little Company of Mary Hospital in San Pedro, where she supervised compliance with State and Federal regulations and Medicare guidelines.  She enjoyed teaching and being an advocate for patients and their families after hospital discharge to Home Care and Hospice.

Debrah Wonder, RN, described Medicare Fee-For-Service and hospital Diagnosis-Related Groups (which involve a lump sum paid to the hospital for an illness episode), and requirements of the new Health Care Reform in which Managed-Care plans will be required to send in itemized statements to Medicare just like for Fee-For-Service plans, for assessing value received.  You can look at the Medicare website (http://www.medicare.gov/) for patient information and resources related to Medicare.  You can find patient satisfaction and performance ratings of providers, hospital readmission rates, hospital mortality rates and other parameters.  The new Accountable Care Organizations are being organized by providers to more completely coordinate their care, for bundled combined payments to the hospital and doctors.  New Medicare plans are becoming available in the market, including high-deductible, self-funding, etc.

Diane Blagojevich, RPT, a physical therapist, reviewed Home Healthcare services.  An example would be an elderly person injured from falling, going to the hospital for acute care and then receiving Physical Therapy and Occupational Therapy at home rather than going to a nursing home for rehabilitation; this is more comfortable for the patient and has lower cost.  There are federal guidelines for Medicare coverage, including admission to the program from a hospital by a doctor’s order and being homebound with limited independent mobility.  Coverage is for skilled services (not custodial), and can include wound-care and other nursing services, intravenous medications, and blood draws for lab tests.  The goal is to avoid complications (such as pneumonia or blood clots), teaching activities of daily living and using modified utensils as needed, home safety assessment, and social workers for help with completing application forms and obtaining Meals on Wheels.

Lisa Kats, RN, discussed Hospice care, a philosophy of care and not just a place.  Eligibility includes an expectation of less than 6 months to live (but no one is kicked out for exceeding their predicted time!).  Patients and family members are helped with providing physical and emotional comfort in dealing with the complexities of preparation for death, rather than high-tech uncomfortable and frightening medical interventions that would not change the outcome.  Palliative Care is an intermediate level of care not requiring terminal illness, but it also helps with comfort care and does not need to be located in the home.  Payment for Hospice is by assigning Medicare A benefits to the Hospice for a specific related diagnosis.  Patients can still be admitted to the hospital if needed for comfort, such as care for breathing difficulty, nausea or pain.  The program also provides help and relief for stressed caregivers at home.