BOOMER'S GUIDE VOLUME 4 ISSUE 5 MAY 2011
THE BOOMER'S GUIDE TO PLANET RETIREMENT
DR. MARILYN BRUNO VOLUME 4 ISSUE 5 MAY 2011 WWW.GYNOSAPIENS.COM
IN THIS ISSUE: Page 1: The Art of Persuasion
Page 3: FYI - U.S. Healthcare Expenditures
Page 4: Medicare Fraud Attacked!
Page 8: Prevention is Worth a Pound of Cure
Page 10 : Diabetes Prevention
Page 10 : Back Pain Prevention
Page 11: Thyroid Disease Prevention in Women
Page 11: Heart Disease Prevention
Page 12: Indigestion (Or Worse) Prevention
Page 12: Alzheimer's Prevention
Page 14: Community-Based Care Transitions
Page 14: You Non-Renewable Resource: Time
Page 16: Start up you own Website/Update on FaceBook
QUOTE OF THE MONTH:
”No act of kindness, no matter how small, is ever wasted."
-- Aesop
THE ART OF PERSUASION
Like all arts, persuasion requires perspective, practice, patience, and perseverence.
This cutsie alliteration has something to it. Few things are more frustrating than trying to reason with someone who thinks he knows it all, doesn't respect anyone else's opinion, or just doesn't want to be bothered. With a small child, the threat of being "grounded" may be a training tool. With a spouse, there is the threat of being banished to the couch. But for most adults, like your boss or co-workers, and especially Seniors, threats and force not only do not work, but are punished or even criminalized as harrassment, bullying, battery, and abuse.
I highly recommend the negotiator's guide, Getting to Yes. This small book speaks volumes on the art of persuasion.
-- remain as objective as possible and put emotions aside
-- make your adversary see that his plan or idea has had unexpected negative impacts (e.g., being hurtful or annoying)
-- make your adversary see that your plan or idea is in his interest
-- better, convince your adversary that your idea was actually his idea with different wording.
-- let your adversary think that he is in control
The result of this approach is that your adversary's self esteem rises and reason dominates emotion. Communication channels are cleared and progress can be made.
But, dealing with ornery Seniors takes the art of persuasion to another level. Uncooperative elders are usually of two types:
-- the one who thinks that he knows everything and is perfectly capable of taking care of himself;
-- the one that doesn't care and doesn't want to be bothered.
Here is where patience comes in. Undoubtedly the #1 challenge for a caregiver is to keep cool and not blow your stack. I am admittedly not consistently good at this and blow my stack periodically. But, if I realize that the ornery behavior is a defense mechanism, generated by insecurity, I can understand that adding to the insecurity will just make things worse. Not being a total glutton for abuse, I try to go back to the patience method.
This does not come easily, so I have to practice a lot to remember the following:
-- Seniors' brains may not be working in tip top condition
-- Seniors' poor hearing distorts input, so you cannot expect rational output
-- Seniors are very emotional and easily made insecure, unhappy, and depressed
-- Seniors see and feel everything as relating only to themselves
The reason many caregivers burn out and/or get seriously ill is because Seniors never learn and never improve. Their behavior never changes. You have to really be in it for the long haul and expect nothing in return. This is the perseverence part. When there is occasional gratitude, is all the sweeter.
So, to become a great artist, keep up the perspective, patience, practice and perseverence!
FYI -- U.S. HEALTHCARE EXPENDITURES
This budget item is under attack, so let's see what the story really is:
The Annual Report on National Health Spending states that health care spending in the United States grew "only" 4.0 percent in 2009 to $2.5 trillion, or $8,086 per person, the slowest rate of growth in the 50-year history of the National Health Expenditure Accounts (NHEA). The report, prepared annually by the Centers for Medicare and Medicaid (CMS) Office of the Actuary summarizes trends in health spending based on the most current data sources -- which appear to be 2 years in arrears.
Key stats for 2009 on the growth of health care spending in the new report include:
· Hospital spending increased 5.1 percent to $759.1 billion in 2009, compared with 5.2 percent growth in 2008.
· Physician and clinical services spending increased 4.0 percent in 2009 to $505.9 billion, a deceleration from 5.2 percent growth in 2008.
· Retail prescription drug spending grew 5.3 percent in 2009 to $249.9 billion, after 3.1 percent growth in 2008.
· Spending for freestanding nursing care facilities and continuing care retirement communities increased 3.1 percent in 2009 to $137.0 billion, a deceleration from growth of 5.0 percent in 2008.
· Spending for home health care services provided by freestanding facilities grew 10.0 percent to $68.3 billion following growth of 7.5 percent in 2008.
· Total health care spending by health insurance payers, which includes the Medicare and Medicaid programs, increased 5.1 percent in 2009, a slight deceleration from 5.3 percent growth in 2008.
· Private health insurance premiums grew 1.3 percent in 2009, a deceleration from 3.5 percent growth in 2008 and the slowest rate of growth in the history of the NHEA.
· Out-of-pocket spending grew 0.4 percent in 2009 compared to 3.1 percent growth in 2008.
To read the complete report, visit http://www.cms.gov/NationalHealthExpendData/
02_NationalHealthAccountsHistorical.asp#TopOfPage. To read more studies and reports by the CMS Office of the Actuary, visit http://www.cms.gov/ActuarialStudies/01_Overview.asp.
MEDICARE FRAUD ATTACKED!
The only good news coming out of the CMS is that the new tools provided in the Obama Affordable Care Act to fight fraud, waste and abuse in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) are meeting with some success.
HHS Secretary Kathleen Sebelius and U.S. Associate Attorney General Thomas J. Perrelli announced a report showing that the government's health care fraud prevention and enforcement efforts recovered more than $4 billion in taxpayer dollars in fiscal year (FY) 2010. This is the highest annual amount ever recovered from people who attempted to defraud Seniors and taxpayers, but is obviously a drop in the multi-trillion dollar bucket.
Needless to say, Miami is considered ground zero for healthcare fraud and has benefited from the Strike Force teams' use of advanced data analysis techniques to identify high-billing levels in fraud hot spots. Interagency teams have targeted emerging or migrating schemes along with chronic fraud by criminals masquerading as health care providers or suppliers.
Here is a Medicare Fraud Alert that was circulated a few weeks ago showing that a fraud scheme regarding a phony drug prescriptions that is now popping up nationwide:
Summary
Medical clinics in the West Hollywood area of Southern California have been submitting fraudulent prescriptions for high-cost medications under the Part D program. A partial list of these medications include: Abilify, Advair, Aricept, Celebrex, OxyContin, Effexor, Lipitor, Nexium, Prevacid, Protonix, Tricor, Zetia, and Zyprexa.
Compromised/stolen beneficiary identification numbers (Health Insurance Claim Number [HICN]) have been used in conjunction with compromised/stolen physician identification numbers (National Provider [NPI] and Drug Enforcement Administration [DEA]) numbers to submit the fraudulent prescriptions.
Beneficiaries have become a primary reporting source of physicians whose identities have been compromised. Calls taken from Medicare beneficiaries reporting this activity should be recognized as having a high fraud potential.
How the Scheme is Perpetrated
• An individual representing a medical clinic will visit a pharmacy to set up a drop-off and pick-up arrangement for the prescriptions identified above, indicating they will deliver the filled prescriptions to the beneficiaries.
• An unusually high number of patients are prescribed high-cost drugs and/or the anti-psychotic medications, Zyprexa and Abilify.
• Although prescriptions will be submitted outside of the Los Angeles area, often the beneficiaries have addresses in the Los Angeles area. In some cases the prescriptions are being submitted at locations over 100 miles from the medical clinic location.
In FY 2010, only seven cities had Strike Force prosecution teams. This small enforcement group was responsible for the following successes of the Health Care Fraud and Abuse Control Program (HFAC) according to oig.hhs.gov/publications/hcfac.asp:
-- 140 indictments involving charges filed against 284 defendants who collectively billed the Medicare program more than $590 million
-- 217 guilty pleas negotiated and 19 jury trials litigated, winning guilty verdicts against 23 defendants
-- Imprisonment for 146 defendants sentenced during the fiscal year, averaging more than 40 months of incarceration
-- Federal prosecutors opened a total 1,116 criminal health care fraud investigations as of the end of FY 2010 and filed criminal charges in 488 cases involving 931 defendants. -- 726 defendants were convicted for health care fraud-related crimes during the year.
-- more than $2.5 billion in recoveries under the False Claims Act, which is the largest in DOJ history.
So, while a great record for a small strike force team, we Seniors need to do everything we can to join this fight. Report Medicare fraud that you identify:
By Phone: / 1-800-HHS-TIPS (1-800-447-8477)By Fax: / 1-800-223-2164
(no more than 10 pages please)
By E-Mail: /
By Mail: / Office of the Inspector General
HHS TIPS Hotline
P.O. Box 23489
Washington, DC 20026
-- Review your Medicare Summary Report. Make sure that you received the services claimed. If not, call the Medicare Fraud hotline:
I personally handled the following cases while volunteering at S.H.I.P (SHINE in Florida):
-- a woman noticed that her CMS Summary Statement included a claim for a prosthetic left arm (which she did not need or receive). Going back to earlier Statements, she saw that nine months earlier, she had supposedly received a prosthetic right arm!
-- a woman told me that she was is picked up at her home, driven to a clinic, fed lunch, given $20 and driven home twice a week. Her Medicare Summary Statement showed that she was receiving bi-weekly physical therapy. When pressed, she said that she did not want to release the name of the clinic, because she needed the money.
-- Even if you need the money, you are accomplice to the crimes of fraud and theft if you knowingly receive services that are not medically-necessary. Here is another fraud case that I helped file, that is still under investigation and could happen to any one of us:
-- a woman was wheeling her shopping cart out of a supermarket on her way to her car when she was physically lifted off the ground, strapped to a gurney, put into an ambulance, and brought the Emergency Room of a hospital, where she was held for 3 hours and subjected to tests, despite her strongest protests. When the intake doctor finally released her and called a cab, he instructed the cab to take her home, rather than to the supermarket parking lot where her car was parked. Naturally, she went directly for her car, but her shopping cart of paid-for groceries was gone. Nobody in the supermarket claimed responsibility.
Since the woman was not out of her mind or suffering from a stroke, I call this kidnapping and elder abuse. Someone in the supermarket probably called her cousin who runs the ambulance service. Once in the system, the Senior was not taken seriously without a brain scan and barrage of other tests. Scary to think what we Boomers are in for as we age and Medicare comes under further attack.
Also note, if you or a loved one was in the hospital and acquired a pulmonary infection or infection caused by indwelling medical devices (catheters, etc.), the hospital is responsible for paying for it, not Medicare. Call the Medicare Fraud hotline.
This happened to my Mom, who had no pneumonia when she entered the hospital with a hip fracture last August (as proven by the chest Xray they gave her in the ER). The doctor prescribed oxygen, but Mom did not tolerate the small nose tubes (cannula) or face mask. So, four days later, the hospital gave her a breathing apparatus called a tent (clear plastic collar off the face) attached to a machine that was affixed to the wall with a drainage tube facing the floor to dispose of excess water. A technician checking up on Mom four hours later discovered that the wall apparatus was installed upside down, with the drainage tube facing up. Until this error was discovered, all the water drained into the tent and, therefore, into Mom's lungs. She was then diagnosed with a rampant case of pneumonia. The technicians who installed the apparatus apologized, acknowledging the error, but the hospital insisted that Mom had pneumonia when she entered the hospital and refused to accept liability...
Bottom line, if this outrageous, fatal error happened to my loved one, it can happen to every one of us. I am filing a Medicare fraud claim against the hospital in the hope that it never makes the same mistake again.
We can only hope that the important prosecutions reported in the annual report of the HCFAC are an indication of President Obama's making the elimination of Medicare fraud, waste and abuse a top priority in his administration, following on his creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), as well as the following: