Rule change could save $28M a year, advocates say
HARTFORD — Under Connecticut law, a home health aide can spend all day caring for you, but if you need help taking your pills, you'll need a nurse to come give them to you.
Gov. Dannel P. Malloy next week will recommend changing that, a move his administration says could save the state more than $28 million a year and remove a barrier that keeps people from moving out of nursing homes.
The plan is likely win the backing of advocates of efforts to enable more seniors and people with disabilities to receive care at home, who say that the expenses associated with medication administration have made moving out of nursing homes cost-prohibitive for many people.
But it's also likely to draw opposition from nurses and some home health care agencies, which criticized a similar proposal last year, arguing that the expertise of nurses is needed to safely administer medications to vulnerable patients and identify problems that occur.
"You will find nobody in the state who deals with these patients who is in favor of this, not even if their job depends on the governor's goodwill," Rep. Peter Tercyak, D-New Britain, said Friday. Tercyak, who works as a home care nurse and co-chairs the Human Services Committee, said he would fight the proposal "tooth and nail."
Last fiscal year, the state spent $128.28 million to have nurses administer medication to about 8,500 Medicaid clients, averaging $54 per visit. One client, the heaviest user, received 2,650 nursing visits, costing the state $156,565.24 -- not including the cost of the drugs. Another 12 clients also required more than $100,000 apiece in medication administration fees.
Malloy's proposal will call for alternate methods for people to receive their medication, including allowing trained home health aides to dispense it according to the instructions of a nurse and letting clients use so-called assistive technology such as medication reminders and pill dispensers. The plan assumes that nurses would still administer medication for most clients and would not prevent doctors from requiring that nurses give patients the medication they prescribe.
Allowing for more flexibility in administering medications has been a recommendation of advocates for expanding the use of home-based long-term care. State officials have been working to help people who wish to move out of nursing homes transition to home or community settings through a federal demonstration program called Money Follows the Person. It requires that the cost of community care fall below certain levels that are based on what institutional care costs, and people monitoring the program say the cost of medication administration can stand in the way of people meeting the cost requirement.
"This is turning out to be one of the most significant barriers to success in Money Follows the Person," said Office of Policy and Management Secretary Benjamin Barnes, Malloy's budget director.
Connecticut is one of 44 states participating in Money Follows the Person. But during a recent six-month period, the state had 30 percent of the total cases nationally in which the projected cost prevented a person from moving into the community.
The Malloy administration's plan has four components. They would:
• Expand "nurse delegation" for medication administration, allowing home health aides who are trained and certified to administer oral and topical medications and eye drops. Home health care agencies would have to have specially trained home health aides to do so. Nurses would still be required to administer injections and medications identified by the client's doctor as having to be administered by licensed providers. Nurses would also be responsible for organizing the medications for home health aides and giving the aides individualized instructions. Some state funds would cover training and implementation costs.
• Allow agency-based personal care attendants to administer medications. Currently, independent personal care attendants hired through a Medicaid waiver program are allowed to administer medications if the clients hire and train them.
• Provide Medicaid coverage for the use of assistive technology such as medication reminders and automatic pill dispensers, which could be used in place of having a nurse administer the medications.
• Reduce the rates paid to nurses for administering medication by 10 percent, saving $10.3 million in the coming fiscal year and $11.2 million a year after that.
Altogether, the administration projected that the changes would save $20.5 million in the coming fiscal year, accounting for time to implement the changes, and $28.6 million annually after that.
This article originally appeared in CTMirror.com.
WATERBURY — The Community Health Center (CHC) in Middletown is opening its 13th medical office and first in New Haven County.
The Middletown not-for-profit health care provider, which serves mostly the uninsured or underinsured, is opening a new full service medical center on North Elm Street in Waterbury.
The $1.2 million project consisted of a renovation of the former St. Mary's Family Health Center, located in the heart of downtown. The completed site currently employs ten full-time and one part-time worker, including three primary-care providers, two medical assistants, one dental hygienist, one psychologist and one psychiatric nurse practitioner.
The center offers comprehensive primary medical, behavioral health and dental hygiene services for all ages and provides assistance with application for public insurance and other support programs.
CHC is a Federally Qualified Health Center (FQHC), which means as part of its funding it receives grants from the federal government to provide primary care, including medical, dental and behavioral health services, to people regardless of ability to pay.
NEW HAVEN — Yale University will soon be home to one of three national centers created to study the genetics of rare inherited diseases, thanks to a $48 million grant from the National Institutes of Health, federal officials announced December 6.
Researchers at Yale, the University of Washington, and a center operated jointly by Baylor and Johns Hopkins universities will analyze the genomes of thousands of patients who suffer from more than 6,000 rare diseases — each afflicting fewer than 200,000 Americans but collectively more than 25 million individuals in this country alone.
At Yale, the Center for the Study of Mendelian Disorders, which refers to diseases caused by inherited mutations of a single gene, will receive $11.2 million under the four-year program. DNA sequencing for this project will be performed at the recently established Center for Genome Analysis at Yale’s West Campus in West Haven.
The new center will not only help pinpoint genetic causes and potential treatments for the rare disorders, but also will shed light on common diseases as well, according Richard Lifton, Sterling Professor and chair of the Department of Genetics, one of the principal investigators of the NIH grant.
“Many of the most promising therapeutic targets in development for the treatment and prevention of diseases ranging from Alzheimer's to cardiovascular disease were identified from rare Mendelian traits,” explained Lifton, who is also an investigator for the Howard Hughes Medical Institute. “Dramatic improvements in DNA sequencing developed and implemented here at Yale now permit rapid progress in defining and solving thousands of additional Mendelian diseases, and we are thrilled to contribute to this national effort.”
The centers will join the International Rare Disease Research Consortium, which has a goal of developing new ways to diagnose and treat 200 disorders by 2020. The centers have already collected thousands of DNA samples from several hundred people afflicted with rare disorders. The project will engage clinical faculty, patients and families at Yale and around the world to research the inherited basis of these diseases.
The grants to study Mendelian disorders were made by the National Human Genome Research Institute and National Heart Lung and Blood Institute.
NEW HAVEN — The Hospital of Saint Raphael (HSR) is the first hospital in New Haven County and just the fourth in the state to be designated “Baby-Friendly” by an international program to promote breast-feeding and mother-child bonding. The World Health Organization and the United Nations Children’s Fund named HSR a Baby-Friendly Hospital last month under an initiative to recognize hospitals and birth centers that help parents make informed choices about feeding and caring for their babies.
“This designation tells the community that we are completely dedicated to giving babies the best start to a healthy life,” said Annmarie Golioto, MD, a physician at HSR’s Dr. Romeo A. and Lena B. Vidone Birth Center and medical director of the Newborn Intensive Care Unit. “Providing infants with human milk gives them the most complete nutrition possible. Breast milk provides the optimal mix of nutrients and antibodies necessary for a baby to thrive.”
BRIDGEPORT — Primary care physician Daniel T. Kocinsky, MD, received the St. Vincent de Paul Mission Award as St. Vincent Medical Center’s 2011 Physician of the Year in a ceremony held last month at Tashua Knolls in Trumbull before a gathering of physicians, administrators and guests. The award honors the attending physician who best demonstrates the qualities exemplified by St. Vincent de Paul, one who truly lives the mission and values of the Medical Center.
“Dan Kocinsky is an outstanding doctor with superior clinical skills, who also is loved by his patients for his caring manner,” said St. Vincent’s President/CEO Susan L. Davis. Davis quoted from his nominations, which were submitted by employees, nursing staff and patients. One letter called Kocinsky, an internist, a “doctor both modern and old-fashioned,” in that he is extremely knowledgeable on the latest clinical advances yet never loses his compassion for his patients. One longtime patient called every appointment with Kocinsky a “comfort visit.”
Kocinsky is in private practice with PriMed Internal Medicine of Trumbull, and is board-certified in internal medicine.
NEW HAVEN — Most heart attack patients transferred between hospitals for the emergency artery-opening procedure called angioplasty are not transported as quickly as they should be, Yale School of Medicine researchers report in the first national study of “door-in door-out” time for transfer patients.
Fewer than ten percent of heart attack patients transferred from their initial hospital to one offering the life-saving procedure are transferred within the recommended 30 minutes, according to the researchers, who published their findings in the November 28 issue of Archives of Internal Medicine.
For ST-segment elevation myocardial infarction (STEMI) patients, quick response is critical because this type of heart attack is caused by a complete blockage of blood supply to the heart. Angioplasty should be performed as quickly as possible, but many smaller hospitals do not have the staff or facilities to perform the procedure 24/7. Experts agree that the hospitals should send those patients on to a hospital that offers the procedure. The guidelines recommend that the time from arrival at the first hospital until the patient leaves should be no more than 30 minutes.
In 2009, nearly 14,000 heart attack patients were transferred from smaller hospitals to hospitals that offer angioplasty, but fewer than 10 percent of them were sent onto the second hospital within the recommended time. Nearly one third of the heart attack patients were sent more than 90 minutes after arriving at the emergency room.
WALLINGFORD — MidState Medical Center hosted its annual meeting on November 14 at the Connecticut Hospital Association. During the program MidState presented its annual Crystal Obelisk Award, which since 1991 has honored individuals and groups for outstanding contributions to health care. Radiologist Sherwin Borsuk, MD was named as the 2011 recipient.
Borsuk joined the medical staff of MidState predecessor Meriden-Wallingford Hospital in 1978, and for more than 30 years has served the hospital in multiple capacities. Earlier this year he became an active member of the board’s Quality Committee, which sets quality goals, establishes, monitors and assesses measures of performance, quality of care, clinical safety and adverse events.
Borsuk “is a mentor to his staff, is proactive in making things easier for them to be more productive, and is adamant about providing the highest quality services,” said MidState director Bruce Eldridge, who presented the award.
BRIDGEPORT — A report released by HealthGrades, an independent source of physician information and hospital quality ratings, named St. Vincent’s Medical Center a recipient of the Coronary Intervention Excellence Award for 2011. The report found that patients treated at five-star-rated hospitals experience a 73-percent lower risk of mortality and a 63-percent lower risk of complications compared to one-star-rated hospitals.
“This third-party endorsement validates the patient care provided by our excellent cardiologists, nurses, other clinical staff and support team,” said Lawrence Schek, the Bridgeport hospital’s vice president and chairman of cardiology. “St. Vincent’s has a long history of excellent cardiac-care outcomes. We have invested in new technology and expanded and renovated our interventional cardiology area, so we can provide the safest and highest quality care to our patients.”