Most Connecticut hospitals will lose a portion of their Medicare reimbursement payments over the next year as penalties for having high rates of patients being readmitted, new data from the Centers for Medicare & Medicaid Services (CMS) show. Statewide, 27 of the 29 hospitals evaluated—or 93 percent—will be penalized in the 2019 fiscal year that began Oct. 1, according to a Kaiser Health News analysis of CMS data. The Medicare program has penalized hospitals since the 2013 fiscal year for having high rates of patients who are readmitted within a month of being discharged. Nationally, hospitals will lose $566 million in penalties, which were instituted as part of the Affordable Care Act to encourage better health care delivery.
Three years ago, Meredith Phillips’ mother, Georgia Svolos, fell and broke her kneecap, setting off a downward spiral that landed her in nursing homes on and off for a year. In one facility, she fell and broke her knee again, necessitating more surgery. All of the facilities were noisy and chaotic, and one smelled of feces. So, when Phillips learned recently about moves by the Trump administration to ease regulations and fines on nursing homes, she was alarmed. “I’m horrified and frightened,” says Phillips, who lives in Westbrook.
Inside the 60 West nursing home in Rocky Hill, two residents played solitaire to the sound of soul music. Others sat in wheelchairs beneath a simulation of rolling clouds, while one got a haircut in a barbershop decorated with Red Sox posters. From the outside, the 95-bed, single-story facility set back from the road looks like any other nursing home. But many of the elderly and ill residents are actually paroled prisoners, and the home is being watched nationally as a potential game-changer for states grappling for ways to care for their aging inmate populations. 60 West is the first facility in the country to win approval from the Centers for Medicare & Medicaid Services (CMS) for federal nursing home funding—a designation that has national significance, experts say, because it’s a new option for cash-strapped states looking for ways to care for growing populations of older and sicker inmates.
At the Fresh River Healthcare nursing home in East Windsor, the chance that a short-stay patient will end up back in the hospital within 30 days of arriving at the facility is less than eight percent. Meanwhile, 12 miles away at the Greensprings Healthcare and Rehabilitation nursing home in East Hartford, more than a third of patients who came from hospitals will be readmitted in 30 days. The wide swing in nursing home patients’ re-hospitalization rates has a lot to do with the condition patients are in when they are discharged from inpatient stays, as well as the planning that goes into the transition to other care. The federal government has been penalizing hospitals since 2012 for high rates of patients returning within 30 days of discharge. But now, nursing homes (or skilled nursing facilities) also are being held accountable for hospital readmissions.
Connecticut has a high prevalence of Medicare beneficiaries living with Alzheimer’s disease or other dementias, often placing an enormous financial strain on caregivers who are spending thousands of dollars a year on care, reports show. “Alzheimer’s is the most expensive disease in America,” said Jennifer Walker, vice president of communications and advocacy for the Connecticut chapter of the Alzheimer’s Association. “The cost of care is very high.”
Medicare covers most fees for doctor visits, and some hospitalization, if needed; but other costs associated with care—including home health services, transportation, diapers for incontinence—are not covered. People with Alzheimer’s often suffer from other chronic illnesses such as diabetes, heart and hypertension, which add to the out-of-pocket costs for care. The financial burden is forcing families who rely on Medicare to tap into retirement savings, cutback on food and medical care for themselves, reduce work hours or quit work altogether to be caregivers, according to the Alzheimer’s Association report Alzheimer’s Disease Facts and Figures.
Dozens of Connecticut doctors accepted six-figure payments from drug and medical device manufacturers in 2015 for consulting, speaking, meals and travel, with six of the 10 highest-paid physicians affiliated with academic institutions, new federal data show. The top 10 doctors – less than 0.1 percent of the 11,000 who received payments – took in $3.6 million, or nearly 15 percent of the total $24.9 million paid out. Among them is the dean of the Yale School of Medicine, Dr. Robert Alpern, who received $445,398 in 2015 from two companies – Abbott Laboratories and AbbVie – in consulting fees, meals and travel expenses for serving on the boards of both companies. In 2014, he received $458,194 from the two companies. The Yale medical school began a research partnership with AbbVie in 2013, after the pharmaceutical company spun off from Abbott Laboratories.
Connecticut still ranks high among states in the use of antipsychotic drugs for elderly nursing home residents, but its rate of use has dropped 33 percent since 2011 – a bigger decline than the national average — new government data show. The data released in June by the Centers for Medicare & Medicaid Services (CMS), show that nursing home residents in Connecticut, many with dementia, are still more likely to be given antipsychotics than their counterparts in 31 other states. But the state’s usage has fallen in the last 4 ½ years at a greater rate than the average drop of 27 percent, and it is now about the same as the national average — 17.4 percent. That’s down from 26 percent in 2011. CMS has been working with states for the past five years to address the overuse of antipsychotic medications in nursing homes.
Ten Connecticut prescribers, including a Derby nurse practitioner who is under investigation by the state, were responsible for more than 22 percent of the state’s Medicare spending on potent narcotics in 2013, new federal data show. More than 4,300 Connecticut clinicians, mostly physicians, wrote Medicare prescriptions for oxycodone, morphine and other Schedule II drugs, which have a high potential for abuse and addiction, at a total cost of $40 million. But a handful of those providers accounted for the largest share of those prescriptions, an analysis of the data show. Topping the list, in both the number of prescriptions and cost, was Heather Alfonso, an advanced practice registered nurse (APRN) at the Comprehensive Pain & Headache Treatment Centers, LLC, in Derby, who wrote out 8,523 prescriptions, at a cost of $2.7 million. Statewide, the average number of prescriptions per clinician was 104, and no other prescriber had more than 5,000 Schedule II claims. The average cost per prescriber was $9,138; the next closest individual cost was $1.8 million.
A Derby nurse practitioner was among the top 10 prescribers nationally of the most potent controlled substances in Medicare’s drug program in 2012 – an anomaly in a state where Medicare records show nurse practitioners rarely prescribe such drugs, which have a high potential for abuse. Heather Alfonso, an advanced practice registered nurse (APRN) at the Comprehensive Pain & Headache Treatment Centers, LLC, wrote out 8,705 prescriptions for opioids and other Schedule II drugs in 2012 – the most prolific prescriber among all Connecticut practitioners, including pain specialists and other physicians, according to Medicare data compiled by ProPublica. She wrote out more prescriptions for the opioid Exalgo than any other Medicare provider in the country, and was the seventh highest prescriber nationally of Oxycontin, writing out more than twice as many prescriptions for that narcotic as the next highest prescriber in Connecticut. She also was the 10th highest prescriber nationally of Avinza, a morphine product. There is no indication that Alfonso’s unusual prescribing frequency drew scrutiny from state or federal officials.
Next year, seniors with private Medicare Advantage insurance policies whose doctors leave their plan may be able to leave, too, under a new Medicare rule. The Centers for Medicare & Medicaid Services (CMS), which oversee Medicare Advantage programs, will create a special three-month enrollment period in any state where insurers make network changes “considered significant based on the affect or potential to affect, current plan enrollees,” according to an update to Medicare’s Managed Care Manual. The special enrollment period – if granted by CMS – would allow Medicare Advantage members to switch out of their plans and join traditional Medicare or another Medicare Advantage plan whose provider network includes their doctors. The mid-year special enrollment period wasn’t an option in 2013 when more than 32,000 UnitedHealthcare Medicare Advantage members in Connecticut were affected by the company’s decision to drop thousands of doctors from its network of providers. The Fairfield County Medical Association sued the company to stop the terminations but was ultimately unsuccessful.