AlwaysConnected Solutions

In an article published in the NY Times, a company has found a method to analyze a person’s habits, livingconditions and other factors as a way to predict which patients are at risk of medication non-adherence. The message is clear and strong: medication non-adherence is a public health problem and we must find ways to identify and help those who are prone to mis-manage their medications.

Skipping or forgetting doses, taking pills at the wrong time a just a few of the contributors of the 125,000 patients deaths related to medication non-compliance in this country.

The data cites 80 plus year olds as a group most likely to fall into the non-adherence category; likely because of the number of medications they need to manage.

Something as simple as a monitored medication dispenser and optional reminder service can greatly decrease the incidents of non-compliance.

So, if you have a family member who needs timely medications and might have a problem managing them, think about something like RxAlert which will dispense at the right time, remind when the time to take them medicine is at hand and that will also alert other family members if there is an incident of non-compliance.

Medicare has a very specific guidelines when it comes to payments for follow up care.

When you go into the hospital, you must be in inpatient status for 3 consecutive days for Medicare to pay for follow up care related to your hospital stay.

Many times when you are admitted to the hospital, you are in for observation. During this period, you are technically not a patient as the hospital is determining the severity of your condition and if you need to be admitted as a patient. Medicare’s guidelines specify this decision should take no more than 24 to 48 hours.

In one case, a patient at a Maryland hospital stayed at that hospital for 6 days after breaking four ribs. She was tested daily by doctors and nurses and was given oxygen to help her breathe. After she left the hospital, she went to a nursing home for follow up care. To the surprise of her husband and family, they received a bill for over $10,000 for her three week stay. Medicare denied payment because she did not spent the pre-requisite 3 days as an inpatient.

Make sure you ask about your status the minute you are admitted.

If you have questions about your hospitalization or nursing home coverage:

Call Medicare at 1-800-MEDICARE (800-633-4227) or e-mail extendedobservation@cms.hhs.gov.

Medicare has a pamphlet about observation care that is available online.

Can by costly for senior citizens finding Medicare won’t pay follow-up for observational hospital stays

By Susan Jaffe

This story was produced in collaboration with

Sept. 7, 2010 – After Ann Callan, 85, fell and broke four ribs, she spent six days at Holy Cross Hospital in Silver Spring. Doctors and nurses examined her daily and gave her medications and oxygen to help her breathe. But when she was discharged in early January, her family got a surprise: Medicare would not pay for her follow-up nursing home care, because she did not have the prerequisite three days of inpatient care.

“Where was she?” asks her husband, Paul Callan, 85, a retired U.S. Army colonel. “I was with her all the time. I knew she was a patient there.”

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But Holy Cross had admitted her only for observation. Observation services include short-term treatment and tests to help doctors decide if the patient should be admitted for inpatient treatment. Medicare’s guidance says it should take no more than 24 to 48 hours to make this determination.

Yet some hospitals keep patients under observation for days, and that decision can have severe consequences. Medicare considers observation services outpatient care, which requires beneficiaries to cover a bigger share of drug costs and other expenses than they would when receiving inpatient care.

And, unless patients spend at least three consecutive days as an inpatient, Medicare will not cover follow-up nursing home expenses after discharge.

The Callans owe $10,597.60 to Renaissance Gardens, the Silver Spring nursing home where Ann Callan spent three weeks.

“I’m going to fight this,” Paul Callan says. “I don’t care how long it takes, because I don’t think it’s right.”

The Callans have since retained an attorney to pursue the matter, and hospital officials would not discuss details of the case “in anticipation of possible legal action,” a spokeswoman said.

However, Karen Jerome, a physician who is an adviser on care management at Holy Cross, said in a statement that the hospital has a policy of informing patients when they are in observation care and that patients receive a thorough review to determine their status.

While patients generally stay in observation status for no longer than 48 hours, she said, it is the patient’s condition and need for medical care that doctors have to consider most, not the clock. Sometimes the patient does not meet criteria for inpatient care after 48 hours but hasn’t improved enough to go home. When that happens, the hospital will keep the patient until he or she has “a safe discharge plan.”

Conflicting Mandates

Claims from hospitals for observation care have grown steadily and so has the length of that care, says Jonathan Blum, deputy administrator at the Centers for Medicare and Medicaid Services (CMS), the federal agency that runs Medicare. The most recent data show claims for observation care rose from 828,000 in 2006 to more than 1.1 million in 2009. At the same time, claims for observation care lasting more than 48 hours tripled to 83,183.

In a report to Congress in March, the Medicare Payment Advisory Commission said the increase may be explained by hospitals’ heightened worries of more-aggressive Medicare audits of admissions and Medicare’s decision in 2008 to expand criteria that allow patients to be placed in observation status. Yet the number of people admitted to inpatient status remained stable, the report said.

The trend is emerging as hospitals cope with increasing constraints from Medicare, which is under pressure to control costs while serving more beneficiaries. In addition to more stringent criteria for inpatient admissions, hospitals face more pressure to end over-treatment, fraud and waste.

In this environment, doctors have to make difficult judgments about their elderly patients, says Steven Meyerson, medical director for care management at Baptist Hospital of Miami.

Resources

Related Content What To Do If You’re In Observation Care

If you have questions about your hospitalization or nursing home coverage:

Call Medicare at 1-800-MEDICARE (800-633-4227) or e-mail extendedobservation@cms.hhs.gov.

Medicare has a pamphlet about observation care that is available online.

“Under a set of rather arbitrary definitions, which are very vague and difficult to understand and apply, we have to decide who’s an inpatient and who’s an outpatient when sometimes the distinction can be two or three points in their sodium level or the amount of IV fluids they are receiving,” he told CMS officials at an information-gathering session Aug. 24.

If the distinction isn’t always clear to doctors, it’s even more elusive for patients.

Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy in the District, has received dozens of complaints from seniors who assumed they would have the fuller coverage provided to inpatients.

“People have no way of knowing they have not been admitted to the hospital,” says Edelman. “They go upstairs to a bed, they get a band on their wrist, nurses and doctors come to see them, they get treatment and tests, they fill out a meal chart – and they assume that they have been admitted to the hospital.”

Setting a patient’s status is complicated. More than 3,700 U.S. hospitals use a tool created by McKesson Health Services to guide the decision. It provides criteria for medical conditions and treatment based on scientific evidence to identify “over 95 percent of all reasons for admission to any level of care,” Rose Higgins, McKesson’s president for care management, said in a statement.

Higgins said that hospitals can tell patients the criteria used to assess their status, but the company’s recent filing with the Securities and Exchange Commission describes the decision-making tool, called InterQual, as a trade secret.

Many patients are not told by hospital officials that they haven’t been admitted. (Medicare does not require such notification.) And the designation can change during a person’s hospital stay. Sometimes a physician who hasn’t seen the patient will determine that the case does not merit inpatient status; Medicare requires that patients whose status is downgraded must be informed.

‘No Man’s Land’

Ed Timmins, 88, has been in a nursing home in Springfield since he was discharged from Inova Fairfax Hospital after falling in a restaurant parking lot in June. The Defense Department retiree was an observation patient during his four days at the hospital, where he was treated for extreme back pain and received an MRI and other treatment. But without the three-day inpatient stay, Medicare will not cover his nursing home bill, which reached $23,864 through the end of August.

On his first day in the hospital, Timmins, who has Alzheimer’s disease and was taking powerful painkillers, received a notice saying he was being “placed into an outpatient status for Outpatient Observation or Extended Recovery. You are still considered an ‘outpatient’ but are being cared for on a nursing unit for further evaluation of your symptoms by your physician. Within 24 hours, your physician should make a decision to either . . . Admit you for inpatient treatment or Discharge you for continued outpatient follow-up care.”

“For him to be treated at an Inova hospital for four days and then be considered an outpatient is ludicrous,” says his daughter, Lynn Hollway. She was in his room – on the phone updating her mother – when he received the notice but assumed they could deal with the issue once his condition stabilized.

Hospital officials say status decisions are often not in their hands. “Medicare rules require us to make sure that a patient meets what’s called medical necessity to be in an inpatient status,” says Linda Sallee, vice president for case management for the Inova Health System. A hospital spokeswoman said Inova physicians would not discuss details of Timmins’s care.

Even if patients know they are observation patients, there is little they can do to change their status. Medicare has covered their care on an outpatient basis, so they have not been refused benefits.

“There’s no official appeal,” says Edelman. “Medicare has not denied coverage. You’re in no man’s land.”

Following The Rules

Hospitals officials say they pay a price if they give inpatient status to a Medicare patient who should only be under observation. When that happens, the hospital is overcharging Medicare and can be required to refund some of the money the government paid.

During a three-year pilot project in six states, Medicare auditors, who received commissions based on overcharges they uncovered, forced hospitals and other health-care providers to return $1 billion in improper payments. The program is being expanded every state this year.

Pressure to increase the use of observation status may also come from the new federal health law, which includes penalties for hospitals that have unusually high rates of preventable readmissions. Because observation patients have not officially been admitted, they wouldn’t count as readmissions if they need to return.

The stepped-up audits and the new law’s financial incentives are intended to control skyrocketing Medicare costs and to reward better care. That could be jeopardized by an increase in costly inpatients. Easing the standard for inpatient status would also raise the agency’s nursing home spending.

“We’ve asked them to change it,” says Sallee. “But I would be very surprised if they did, because it would cost a lot of money.”

Blum says that many factors are involved in the increasing use of observation care. “It’s not clear to us whether or not this trend is due to financial incentives,” he says. “There could be lots of other things going on.”

For example, he says, doctors may be “doing the right thing” by keeping vulnerable seniors in the hospital for observation if they lack a support system at home.

Medicare officials are weighing changes to the admissions policy and sent letters to hospital associations in July soliciting suggestions. Among the options are requiring hospitals to notify patients that their stay is considered observation, setting a strict time limit for observation care and changing how the agency pays hospitals for such care, Blum says.

For some, changes may not come soon enough.

“This system is impracticable and just locks up patients in the hospital,” Meyerson told CMS officials last month. “They are not well enough to leave and not sick enough to admit. So what do you do with them?”

We’re coming out of a long hard winter. The inclement weather has given us far too many excuses to exercise less. Eggnog, cookies, cheese quiche many other goodies we consumed during the holidays will take a toll on our bodies. In some cases, it might directly affect our health in the short-term. Our diet might start to produce some symptoms of problems which have been lurking for some time now. What if we start getting those pains or we’re just not “feeling right?”

What do we do? Should we run to the ER? Or do we just wait it out? According to a study published in the Journal of the American Medical Association, lack of health insurance or financial worries contribute to as much as a six-hour delay in seeking emergency treatment. Life-saving treatments to open the blocked artery and restore blood flow are most effective if started within one hour of the start of symptoms. Yet, the study shows that 49 percent of uninsured patients and 45 percent of insured patients with financial concerns delayed seeking care by more than six hours during a heart attack, compared with only 39 percent of insured patients without financial concerns. So what if you are one of those folks who have high-deductible insurance or are under-insured? When you start having unusual symptoms, you don’t want to run to the ER if you are just experiencing a stomach ache. You’ll end up paying hundreds of dollars for what amounts to a dose indigestion medication. But, what if is it something more than achy in your tummy?

Technology can help. For less than a cup of Starbucks, you can connect with a registered nurse who can talk to you about your symptoms and provide you with expert medical advice. Getting this form of advice can either prevent unnecessary time and expense or it could save your life. Our unique medical alert solution, MultiAlert provides two forms of care; traditional emergency response and access to expert medical advice, just by pressing a button. It’s like having a mini walk-in clinic in your living room. When you press the nurse button, you’ll be connected to a nurse triaged center trained to listen to your medical symptoms and questions and prepared to provide you with expert medical advice about what to do. No need to find that 800 number to get connected. Did you know that less than half of those who visit a hospital emergency room actually need critical care? After hours of waiting, and the expense of test, most folks are directed to a lower form of care. When all is said and done, you will be paying a deductible which could be in the hundreds of dollars. So, check out MultiAlert. It could save you time and expense or it could SAVE YOUR LIFE. For more information about MultiAlert, visit our website.

Classified as “the world’s other drug problem”. non-adherence to medication regimens accounts for more than 10% of older adult hospital admissions and one out of four nursing home admissions.

Approximately 200,000 people with treatable ailments die each year in the US because they do not take their medications properly. This could be because thirty to 50% of all patients ignore or otherwise compromise instructions concerning their medication. In the case of our seniors, much of this is due to confusion or forgetfulness. Perhaps this confusion is because more than half of our seniors take 5 or more prescription medications on average. That’s a lot to think about and manage for anyone of any age. This mis-management results in unwanted health consequences.

Any caring family member would (and should) do whatever it takes to see to it that their loved ones are assisted in managing this ever-important part of their lives. Some families hire a private duty nurse to visit and administer these medications. Most families simply cannot afford that luxury. Many take the time to personally manage their loved ones medications. This can be very burdensome and sometimes leads to un-intended mistakes. Let’s face it. We live in a busy world and busy lives. Inevitably, we are faced with delays. Life gets in the way.

Make A List, Check It Twice

Another issue we face are the multiple prescriptions older adults take. Sometimes our elders need to see specialists for different ailments. Doctors usually ask what other medications are being taken but many times, we are not equipped with all of the information. Perhaps a recent visit to another doctor resulted in a new prescription and we’ve failed to remember to tell him. It’s probably time to take a “prescription inventory.” Make a list of every medication, who prescribed it, when and for what condition and bring it to your local pharmacist. He will work with you to make sure there are no serious interactions and also to clarify the need for some of the prescriptions. Often, we are prescribed a medication but our doctors fail to tell us to stop taking it. As habits are formed, many of our older adults simply renew these meds.

So, once you have culled the list, how do we keep our loved ones on the right schedule? Pill boxes has been a popular choice. There has been an evolution of how pill boxes work. They give you a way to organize your pills by day. Little compartments labeled MON. TUES. …. you get the idea. There are now boxes which will light up on the correct day. A great improvement. However, most pill boxes are still somewhat confusing for seniors. It’s very easy to open the wrong compartment. Lastly, what if a medication is missed? How do you know?

AlwaysConnected Solutions now offers RxAlert which is designed to make medication management simple, secure and to provide a way to know that medications were taken. It is a locked device so that only the scheduled medication can be taken and it prevents tampering. Trays are preloaded with the proper doses and you can schedule up to 4 does a day. A tray will support 4 doses on each day up to 7 days. When it’s time for medication, the correct compartment starts to blink (light). If the compartment door is not opened in 30 minutes, the unit will start to beep. Another 30 minutes and you get a phone call and, finally a notification (email, text) of non-compliance is sent to a family member or some other designated recipient. 

For more information, go to our website for pricing and more information.

Keep your family member safe by providing an affordable and simple way to manage their medications. Try RxAlert.

From an article posted on CNN’s Health website:

This Sunday’s Super Bowl could prove to be a real heartbreaker for some fans of the losing team.

A new study suggests that the emotional stress fans feel after a loss may trigger fatal heart attacks, especially in people who already have heart disease. Stress generates the so-called fight-or-flight response, which causes sharp upticks in heart rate and blood pressure that can strain the heart.

You can read the rest of the article here for more helpful information.

Given the premise, it is important to know when you should be listening to your body and responding responsibly.

If you feel ill effects that COULD be symptoms of a heart attack you have choices: running to the ER to get checked out OR getting expert medical advice before you get to the hospital to find out you have a severe case of indigestion.

A device like AlwaysConnected Solutions‘ MultiAlert can be the perfect way to provide you access to expert medical advice at the push of a button. It is the only PERS device that provides two forms of care in one device. When you push the nurse helpline button, you’ll be connected with an RN who will assess your symptoms to determine the severity of your condition. On one hand, you could save the time an expense of an unnecessary visit to the ER. On the other hand, you could get the help you need without delay. Remember: quick response means better outcomes.

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Let’s break down a 9-1-1 call.

As you can see, there are about ten (10) steps in the 9-1-1 process. Each step means time consumed to get the proper information to dispatch help. With a medical alert systems 10 steps are reduced to 5. Also medical alert systems will insure that all of the information about the caller (location, special needs, special instructions, medication allergies) are on file and need not be asked at the time of the call. This alone can save minutes. The information is communicated to the responders so they know where to go and what to do in the shortest amount of time. Another important step is the medical alert responder also has contact information on file so family members, neighbors or other caregivers can be notified of the incident. There is no need for them to get that information from the caller.

A complex process unfolds when someone calls 9-1-1 for assistance. It takes mere minutes, but here’s what happens between the time you call for help and when the ambulance arrives.

We have color coded certain steps to indicate cause for concern.

Blue text means you should understand the potential for a problem.
Red text means this is a known problem which can contribute to significant delays in receiving help.
Where you see a ➩ symbol, this indicates that a step is NOT NECESSARY with a medical alert solution such as Multi-Alert.

1. ➩ A person calls 9-1-1 to report an incident. A distinction is made on whether the caller is using a landline or cellphone.  Sometimes a call comes in on your cable company’s phone service. Currently this can be a problem because there is information which YOU must provide your cable provider so that your location is know. This is a complicated interaction between the web based phone services commonly known as VoIP (Voice Over Internet Protocol).
2. ➩ The call is answered by a 9-1-1 operator at the closest public safety answering point (PSAP), which is a locally based 9-1-1 centre that helps decide which services are needed to respond to the call. The PSAP will look up the emergency agencies which service your address. Another point of delay (:10).
3. The information provided by the caller determines whether an ambulance is required. If so, the call is forwarded to the ambulance call center. This can take some time(1:00-3:00).
4. ➩ When a landline call comes in, it’s answered by one of the center’s call-takers, who immediately sees the civic address from where the call has originated, and the name of the person to whom the phone is registered pop up on the computer screen. Point of delay is significantly less in this case; provided it is a traditional land line. Many are moving to cell and cable-based (VoIP) lines.
5. ➩ When a cellphone call comes in, the call-taker has to manually input the caller’s information. This can be a significant time delay. (1:00)
6. ➩ The call-taker begins asking the caller a set of standard questions to determine the severity of the problem and how urgent the response should be. Depending on the information, the emergency call falls into different categories that will help the dispatchers and paramedics decide whether to send the ambulance with sirens and lights flashing. Serious problems like a patient not breathing, a patient in a serious car accident, etc. fall into the most urgent categories, and a slight fall, or someone who feels poorly, etc, will fall into the slightly less urgent category. Much of this information is already contained in our customer records. This is a point of much delay. Having quick access to vital information reduces the need to question the patient which reduces the overall stress of the situation. Of course, precious minutes are saves by having this information handy.
7. As the questions are being answered, the call-taker is transferring the information to a dispatcher sitting metres away. The call-taker continues assisting the caller, while the dispatcher quickly identifies the most appropriate ambulance to respond. A dedicated response center has all of the pertinent local emergency numbers for your address up on the screen for an automatic dispatch. (:30)
8. The dispatcher notifies the appropriate paramedic crew of the call by radio and the information is simultaneously sent to their pagers. The ambulance begins the trip to the scene, with sirens and lights flashing if necessary.
9. Paramedics inform dispatchers of the routes they intend to use, or ask for suggestions from the command center that will get them there as quickly as possible. The dispatchers, and sometimes paramedics from other ambulances, will offer advice and guidance about the quickest routes available.
10. As the ambulance arrives on scene, the dispatchers are informed and the patient receives the treatment he or she needs.

In the above process, there is around 2:00 minutes of built-in delays plus various points where delays can occurred. When you are suffering or have an immediate medical need, two minutes might mean the difference between a simple doctor visit or a prolonged stay in a hospital at great cost.

It is essential to understand this process. If you can avoid the delays introduced by a 9-1-1 call, you will improve the chances of a quick response which means a better outcome. Make sure the medical alert solution you have is connected to a response center and is just not a fancy way to dial 9-1-1.

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It is our position the the 911 service has been an indispensable public service since its inception back in 1968.Every day, millions of Americans turn to this system for help. But depending on it as your sole source of help can be a questionable decision.

Unfortunately, the system is overloaded with non-urgent calls which tie up the phone lines and add undo pressure on the responders. Many times, this has tragic consequences. Here’s an article which provides some examples of the abuse of this system. If there is a regional crisis, it could compromise your ability to request help.

That’s why having a medical alert solution is so invaluable. There is a dedicated response center that is not part of the traditional 911 system which responds to your alert immediately. The responders don’t even have to ask who you are or where you live. All of that information plus any other information you provide us is at their fingertips the second you are connected to them. They use this information to help asses your situation and relay that information to emergency responders saving valuable time to get help to you quickly.

Read this the article in the NY Post.

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The incredible technology we have these days can sometimes cause problems because the simplest of considerations have not been addressed. Many cable companies are now offering internet-based telephone service. It is much cheaper than the traditional land lines (cooper wire). But in the case of VOIP (Voice Over Internet Protocol) there are some pitfalls. In the case of VOIP, the cable company does not know where you are located. You must first register your home address with them and have your 911 service associated with that address. It is just the way the system works right now. If you don’t, it can cause problems.

According to the Sun Sentinel news report, an 81 year old woman was preparing for Thanksgiving with her family in 2009 when a piece of the crystal she was using fell on her foot, cutting her and causing severe bleeding. Reiner dialed zero on her phone and spoke to a Comcast operator, who according to the suit, transferred her to the local police dispatcher, but she was unable to speak clearly and give him her address.

The suit alleges the emergency call was disconnected. The dispatcher asked the Comcast operator for Reiner’s address but the operator could not locate it. The AP reports it took 16 minutes to find Reiner’s address and for paramedics to arrive at her home. The Palm Beach County Fire Rescue records reportedly show the paramedics arrived to a silent and locked house and left, after deciding the call was “unfounded.”

This is an unfortunate incident that could have been avoided had the person had a personal emergency response solution (PERS).

Typically, a medical alert system will connect to a response center which knows who you are and where you live. This information along with other information (allergies, contact info for family members, medications, location of extra keys to the house) is kept on file. When you make a call, that information is at the fingertips of the responder and they do not have to ask for it. In the case of this poor woman, standard protocol would have automatically (within minutes) dispatched emergency services even if the person could not communicate with the responder. Most times, the location of a lock box or key holder is also on file and would be communicated to the EMS response team. This would have avoided the extreme delay and probably have saved her life.

If he were asked, the husband of this poor woman would have gladly agreed to pay a couple of dollars a day to have prevented this tragedy.

A medical alert system isn’t just for “old people who fall.” It serves a valuable service whenever there is an accident in the home.

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