Category: SOS Blog

As many of you know, I have spent much of the past year taking care of my elderly mother. While she had lived with us since Katrina flooded her home in New Orleans in 2005, this past year has required the greatest amount of hands-on caregiving. Mom died on May 6, and I find myself thinking a great deal about her personal experience of the process of dying…and how we treat the elderly in this country. This is a huge area worthy of many a dissertation; this will certainly not be an exhaustive take on this topic and may be very subjective.

First, I should state pretty clearly my basic assumption: I believe we have not done ourselves any favors by extending human life for as long as we have without providing the elderly with a meaningful and satisfying place within our communities and our homes. Secondly, in this article, I am talking about the very elderly and those in significant decline. Even those who have stayed healthy and active well into their eighties are frequently shunted into custodial care and isolated from their families and their communities when they approach death. I think this is an unconscionable shortcoming of U.S. culture. Life without a meaningful role is not worth much; life in poverty and isolated from others for no reason but ‘being old’ is a crime. Below are a few thoughts about five areas I consider important.

Places to live

In Florida where I live, and in many other places with a large senior population, older adults have isolated themselves in communities for active, over-55 residents. These communities have the reputation of feeling like a resort…at least, until debilitating illness strikes or infirmity makes continued independent living difficult. Then these retirement communities have the same problems as any other neighborhood in which a person might choose to live. Doctors’ offices are a drive away and transportation and drivers are limited. Houses are built with no thought to canes and walkers and wheelchairs; doorways are too narrow, stairs are too frequent, bathtubs are impossible to step into or get out of, counters and appliances are too high. And in many communities there is often an additional problem; the elderly residents are far away from their children or other closely connected people who are able and willing to assist them. In 2011, almost half (47%) of women over 75 lived alone. In 2009, 14.3% of adults 85 or older lived in an institutional setting rather than in their own home. A small percentage live in some other kind of community-based residence ranging from communal farms to Continuing Care Retirement Communities (CCRC’s). Even so, there are not yet enough good choices.

Activities/jobs/functions that maintain involvement and contribute to the community well-being

One of the biggest problems we encountered when Mom moved into our home was that she had been displaced and no longer had a community of her own. Most of her dear friends and family were still loving somewhere in Louisiana. She was in shock because of the loss of her home and her community and was unwilling and unable to undertake the work needed to develop friendships here. At 85, the effort to build a new community was outside her capabilities. I would venture a guess the same might be true for many people at that age.

Respectful care

Doctors in Florida believe they are the best at taking care of the elderly. They have lots of experience at it and often do a very good job. Our overwhelming experience was of very good care; my experience was that the amount of and complexity of care was overwhelming. Without me or someone equally knowledgeable as an advocate, it is my hunch that Mom would have floundered when faced with the choices with which she was presented.

The right to receive and to refuse treatment

Even given the high quality of the care she received, the tendency of physicians and the system is to provide a great deal of care…many medicines, recommendations for procedures and surgeries, frequent visits. Part of my job was to support her in her decisions about her care, especially when she decided “no” to something. Even given her leaning toward little care, the number of medications prescribed for her was high. The pressure to accept treatment is significant. Early on in her stay with us, one doctor told me that declining an endarterectomy (a high risk procedure with little upside for an 86 year old) was irresponsible; we were certainly inviting stroke. We did not return to that physician.

To their credit, physicians are charged with curing/helping/fixing their patients…even if their patient is over 85; but is this what we really want? And how is a compliant patient who is used to doing what her doctor recommends supposed to turn down what is offered and even expected? How much do we actually have a right to refuse treatment?

The right to die at home with excellent care

And then we get to the biggest, final question…how does one arrange to be taken care of and to die at home while also having excellent care? Fortunately, there is an answer to that question…hospice care.  When cure is no longer the focus, when an elderly person has begun a significant decline and is failing to thrive, hospice care may be the kindest, most satisfying way to be comfortable, to be cared about, and to be cared for respectfully. One of the largest benefits to the person dying is the support provided to the primary caregiver, making it possible for them to continue providing care and to remain loving during the process. It certainly was one of the most helpful things Mom and I experienced in the last three months of her life. Warm, cheerful, supportive caregiving assistants taught me how to lovingly allow her to die.

Many of you have privately shared some of your own caregiving experiences. I hope you and others will weigh in here. I am sure you have thoughts we can all benefit from. Just enter your comments below.

 

NOTE: Trish Merchant, our SOS Business Development Manager, stepped up to my request for guest bloggers. Hope you find her information useful.

 

Recently, we’ve had a few customer support calls asking about PQRS. I thought it would be a good subject to share on the SOS blog.

PQRS or Physician Quality Reporting System is a voluntary reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality measures for services in the covered Physician Fee Schedule (PFS) by eligible professionals. While the program is considered voluntary, starting in 2015, eligible professionals who do not satisfactorily submit data on quality measures will see a payment adjustment in their Medicare claims.

According to the CMS website, the PQRS program provides an incentive payment to practices with eligible professionals who provide and report on certain services. Eligible professionals are identified on the claim by their NPI or Tax ID number. SOS customer organizations with eligible professionals can choose to report data via their Medicare Part B claims. Other ways to report include using a registry; reporting directly to CMS via qualified EHR system; or using a qualified PQR data submission vendor.

Participating in this program where eligible professionals satisfactorily submit quality measures data, via one of the above mentioned reporting vehicles, will qualify a provider to earn a PQR incentive payment. The percentage of the payment is based on Medicare Part B Physician Fee Schedule and is an estimate of allowed charges for a covered professional service that was rendered during the same reporting period. Percentages and documents for this incentive vary from year to year so it is important to verify the correct documents are reviewed.

To learn more about this program and how to get started, please visit the CMS website. For questions on how to set up SOS Office Manager for these services, SOS customers with current support agreements can contact the SOS Support Desk.

 

Several times in the past few of years, I have mentioned that I am the primary caregiver for my almost 93 year old mother. Last week, she took a fall that has left her in terrible pain and needing a great deal more assistance.

In addition to getting help from others, I am trying to implement some of the suggestions that I have read about. While resources are available, many of us do not find them in time to be of real assistance to us.

One decision I have made is that it is time to set priorities and to follow through on them. I will be going to the medical equipment store today to look at hospital beds. On Thursday,  we will get an order from the doctor for home health care assistance. Hopefully, on Friday I will be able to get input about sitters and the like.

In the meantime, I will need to put this blog on hiatus. If I can get some of my co-workers to do a post, there will be something here. If I get inspired and have some found time, I will do a post. Otherwise, I will leave you until things quiet down on the home front.

Thanks for reading. Hope to talk to you again soon.

I know you thought that all your HIPAA policies and procedures were in place and that you were finished with learning about how this law affects you. I am sorry to say that you were wrong.

The HIPAA Omnibus Rule has finally been released. According to FierceHealthIT, HHS released the Omnibus Rule to simplify compliance actions that must be taken by affected entities.

The four rules that combine to create the omnibus final rule include:

• Modifications to the HIPAA Privacy, Security, and Enforcement Rules mandated by the Health Information Technology for Economic and Clinical Health Act, and certain other modifications to improve the rules, which were issued as a proposed rule on July 14, 2010.
• Changes to the HIPAA Enforcement Rule to incorporate the increased and tiered civil money penalty structure provided by the HITECH Act, originally published as an interim final rule on Oct. 30, 2009.
• A final rule on Breach Notification for Unsecured Protected Health Information under the HITECH Act, which replaces the breach notification rule’s “harm” threshold with a more objective standard and supplants an interim final rule published on Aug. 24, 2009.
• A final rule modifying the HIPAA Privacy Rule as required by the Genetic Information Nondiscrimination Act (GINA) to prohibit most health plans from using or disclosing genetic information for underwriting purposes, which was published as a proposed rule on Oct. 7, 2009.

Read more: HHS unveils final HIPAA omnibus rule - FierceHealthIThttp://www.fiercehealthit.com/story/hhs-unveils-final-hipaa-omnibus-rule/2013-01-17#ixzz2JZe5a824

Ascertaining the impact of this Omnibus rule could be a while in the making, but HIPAA commentators have begun their assessments. I will be attending a webinar hosted by IDExperts on February 6 in an attempt to start to understand just what has been changed and to try to get an idea about how that affects us and our customers.

On January 30, FierceHealthIT indicated that providers must attend to at least four areas:

Monetary penalties aside, four areas of the rule that will have a significant impact on providers are:

• A change that makes business associates and their subcontractors liable for breaches of personal health information
• An enhanced right for patients to obtain electronic copies of their records
• An enhanced right for individuals to request restrictions regarding disclosure of their PHI
• A change to the breach notification rule in which any disclosure of PHI is presumed to be a breach

Read more: Handling HIPAA: 4 new provisions providers must know - FierceHealthIT http://www.fiercehealthit.com/special-reports/handling-hipaa-4-new-provisions-providers-must-know#ixzz2JZmdjFI7

That fourth area, the breach notification rule, is one that could affect anyone who handles PHI. Any disclosure of PHI is presumed to be a breach.

When the Interim Final Rule was released in 2009, the notion of assessing whether any significant “harm” had occurred to those whose data had been lost or viewed inappropriately was introduced. David Harlow, author of HealthBlawg discussed the current change in FierceHealthIT. The bottom line for Mr. Harlow is this:

… the default assumption is that any irregular release of PHI is a breach, with no subjective standard of harm getting in the way. The covered entity or business associate unfortunate enough to have suffered this breach may either (a) immediately acknowledge that it is, in fact, a breach, and rev up the notification machinery (notice to data subjects, the federales–possibly for posting on the Wall of Shame–and the press, as appropriate, based on the size of the breach) or (b) decide that a risk assessment is necessary, and begin its assessment of at least the four factors highlighted in the regulation.

Read more: Uncertainties surround new HIPAA breach notification rule – FierceHealthIThttp://www.fiercehealthit.com/story/guest-commentary-uncertainties-surround-new-hipaa-breach-notification-rule/2013-01-29#ixzz2JZiJrwSa

What impact will this have on you and your organization? If you allow PHI to be released contrary to your policies and to the law, how will you proceed? Do you know? Who is your Privacy Officer? Do they know?

Time to wake up the HIPAA education machinery again! …or for the first time if you do not have such machinery in place.

 

Last week when I wrote about violence in our lives, I mentioned my concern that the immediate focus after mass shootings is so often the mental health of the shooter. I also mentioned that the mentally ill are no more likely than the public at large to commit acts of violence.

This morning, my partner Seth mentioned his concern that the focus on the possible mental health issues of individuals who want to own and carry guns potentially presents a whole raft of HIPAA concerns. After all, how do we define mental illness? And who has a right to know what diagnoses have been applied to which people? How do background checks access this information?

Also this morning, a feminist therapist friend shared a link that I had to pass on to you. The speech to which this link will direct you is written by Paula J. Caplan, Ph.D. Dr. Caplan is an articulate and often entertaining psychologist who frequently points her sharp and well-focused eye on the inequities of our culture. She too has concern about how we utilize the issue of so-called mental illness to divert ourselves from the issues of violence in our culture.

Please take a look at her speech on stopping gun violence given yesterday. I would love to hear your comments.