All posts by Mathieu Uber

Governator Terminates IHSS for Those in Need

Gov. Schwarzenegger’s budget butchery cuts services from IHSS recipients.  After November 1, 2009, people with an overall functional index score below 2 will no longer qualify for IHSS.  People who receive a functional index ranking below 4 for any domestic service will no longer receive that particular service.

Functional index ranking is how the county determines the level of needs people have.  As part of the assessment for services, the county determines the person’s ability to complete certain tasks, such as housework, laundry, shopping and errands, meal preparation and cleanup, eating, bathing and grooming.  Also they assess the person’s control over respiration, memory, bowel, bladder, orientation and judgment.

Now, in addition to assessing need, the “functional ranking system” is being used to take away services from the people that need them.  Let’s take, for example, an individual who has a “3” ranking for sweeping floors, a “4” for changing bed linens, and a “5” for cleaning bathrooms.  Under the new law, the individual would no longer receive service for sweeping floors because the ranking for this service is “3” and therefore too low.  The individual would continue to receive service for changing bed linens and cleaning bathrooms.  

There is also a “functional index score” (as opposed to the functional ranking index just mentioned) which is now being used as a line drawn to sever services from those who need them.  After a social worker assesses a person’s needs, the county gives a “functional index rank from “1” to “6” for each of the tasks.  This ranking is then averaged out.  The result is called the “functional index score.”  Effective November 1, 2009, the new law eliminates IHSS services entirely for individuals with a functional index score below level 2.    

On October 1, 2009, Disability Rights California and other organizations filed a lawsuit to stop these cuts.  We are hopeful and hard at work to reverse this dark ideology as soon as possible.  

This narrow vision couldn’t come at a worse time.  At a time when the State should be preparing for growth nothing is being done to prepare for the exponential rate of growth in the populations of people who rely on these services to live from day to day.  Instead of alleviating the pressures that the future burdens us with, the Governor shoots holes in the bucket that he asks us to fill.

However, we are happy to say that persons who receive protective supervision or paramedical services will not have their IHSS services cut regardless of their function index rankings or score.

California State Plan on Aging

(Thanks for the update. – promoted by Brian Leubitz)

The California State Plan on Aging estimates the population of seniors, over 85 years of age, will increase 172% over the next 20 years.  The most recent draft of the plan finds that “California’s older adult population will increase by 90 percent as members of the Baby Boomer cohort reach 60.” The Plan outlines the major areas of concern for seniors in the next four years.

EDIT By BRIAN: See the flip for more on the Plan on Aging.

The first goal of this plan is to make it easier for older Californians and their caregivers to access local information about services and programs available in their communities. One step to achieving this goal is currently underway. CalCareNetwork is being developed to provide a single searchable web site of information about home, community based and institutional long-term services.

To “enable older Californians, adults with disabilities and their caregivers to be active and supported in their homes and communities” is another stated goal of the state plan. Transportation issues are a major barrier to independence in many communities. Of note in the report is the acknowledgement that transportation planners have not worked with members of human services agencies to integrate the needs of seniors and those with disabilities.  California now has representatives from the Department of Transportation on the California Olmstead Advisory Committee to address transportation concerns from both the individual need and infrastructure perspectives. The Department of Motor Vehicles is developing a Three-Tiered Driver Assessment program. The goal is to keep drivers safely on the road for as long as possible, however this assessment could lead to more adults relying on alternative transportation.

One of the most dramatic changes to the health of seniors has been in the last century is the shift in the causes of death from infectious diseases and acute illnesses to chronic diseases and degenerative illnesses. Californians may live many years with diseases that need to be managed to maintain health. Californians have increased their use of preventive health screenings however significant racial health disparities persist in the treatment of chronic health concerns.  Alzheimer’s disease and other forms of dementia continue to be a substantial concern for individuals and their families. The third goal of the state plan is to promote the health of seniors through increased participation in health  initiatives and expanding  the availability of programs for family caregivers.  Additionally the promotion of early intervention and treatment for mental health issues is a stated goal.

The final goal is to protect the rights of older Californians through the Long-Term Care Ombudsman Program and Health Insurance Advocacy and Counseling Program (HICAP).  Updates to these programs and tools to improve communication and recognize fraud are part of the state plan.

The State Plan on Aging is clear in its anticipated funding from the state, noting: “The Department considers increases in State funding unlikely even though the population of older adults and adults with disabilities will continue to increase.” Interestingly over three pages of the State Plan draft is dedicated to the “opportunities for volunteerism and civic engagement.” This is due to the fact that many services are provided within the Aging Network through volunteers. The California Department of Aging (CDA) notes it is difficult to recruit and retain volunteers. The CDA will work to encourage increased volunteerism among older adults for their peers and those with disabilities.

It is difficult to know how anyone program will be affected when the state budget is finalized. The concerns highlighted by this report necessitate planning for the increased needs of a rapidly growing population of seniors. Current fiscal concerns are leading to reduction in services as the leading edge of the baby boomers enters the period of greatest need to age well within their communities.

While the recruitment of volunteers is beneficial for these social programs it will not be a sufficient substitute for the dollars needed for transportation, care, and health concerns of the 14.6 million seniors expected to populate California in the coming decades.  

Drug Companies and Doctors Undermine FDA

Improper “off-label promotion” is a form of fraud used by the pharmaceutical industry to increase profits by selling more drugs than necessary.  Before a drug becomes available on the market FDA specifies the uses for which it is safe.  Off-label promotion encourages using a product for non-FDA-approved purposes.  Physicians may lawfully prescribe a drug for an off-label use.  However, manufacturers are prohibited from promoting, or marketing a drug for uses other than FDA-approved uses.

Pharmaceutical manufacturers practice a wide range of abusive activities that provide false and misleading information about the safety or efficacy of products for non-approved uses.  For example, it was found by the U.S. Department of Health and Human Services’ Office of Inspector General that the drug corporations will use so-called “medical science liaisons” that present themselves falsely as scientific experts in a particular disease to promote off-label uses.  

Moreover, manufacturers will pay physicians to “write” advocacy articles about off-label uses of products that are, in fact, written by the manufacturer.  This practice is particularly insidious because the publication of such articles, in medical journals, for example, may be sufficient to qualify the off-label use for reimbursement by taxpayers.

Financial harm to Medicare and Medi-Cal is only one problem caused by off-label promotion.  

Off-label promotion leads physicians to prescribe a product for a non-FDA-approved use based on false, misleading, and erroneous information, thus, patients suffer.  Additionally, Americans rely on the FDA approval process to evaluate the safety and efficacy of pharmaceutical products.  

Off-label promotion strips away this trust.

Rep. Mike Feuer Struggles Against Medical-Error Billing

Assembly Member Feuer has authored a sensible bill with the intention of protecting consumers and it is having a tumultuous time getting passed.  AB 542 is an attempt at protecting consumers and patients from being billed for what are called “never events.”

A never event is a medical error that, frankly should never happen.  The term never event was first introduced by Ken Kizer MD, former CEO of the National Quality Forum (NQF), in reference to particularly shocking medical errors.  These adverse events are preventable, they are clearly identifiable and measurable, and they are serious – they result in death or significant disability.

Currently, operations done on the wrong body part account for most of the never events.  Other errors include dispensing the wrong medication, giving a transfusion of the wrong blood type, and leaving objects in patients.  Unfortunately, patients can still be held responsible for any charge resulting from the commission of the medical error, or actions taken to correct the error.

California passed legislation in 2006 requiring the reporting of all never events.  However hospitals and other providers are still allowed to bill patients for a treatment gone wrong and the treatments caused by their own errors.  A recent nation-wide survey found that at least half of the hospitals involved did not have policies waiving the costs incurred through a never event.  Furthermore, hospitals on average pass on to other payers 70 percent of the cost arising from the medical errors caused by negligence.

Mike Feuer proposes protecting patients as well as consumers.  Patients who have been harmed by medical errors should not be responsible for paying the bill for those errors.  Healthcare providers need to be made financially responsible for the commission of such medical errors; this will help ensure such devastating errors never occur.

Why is this bill having such a hard time passing?  It didn’t pass last year as AB 2146, and this year as AB 542 it’s seeing some opposition.  There are some inane technicalities that patients could get caught up in if the bill passes, which further illustrates how raunchy our healthcare system is.  For example, a patient reports to the Emergency Room and is found to have a sponge left inside that has eroded the biliary duct.  The patient needs to transfer to a hospital with a hepatobiliary specialist to repair this never event.  However, according to the legislation, the patient and her/his insurer cannot be billed for the services required to repair the injury. So, good luck finding a hospital that will accept the patient.

Opposers say that the bill creates precedent for a long list of never events that patients won’t have to pay for.  They are going as far as to say that a patient’s care won’t be reimbursed if they acquire C. diff colitis from antibiotic treatment. This balking is ridiculous because never events are clearly measurable, preventable medical errors that result in severe disability or death, there is no slippery slope.

Mike Feuer has worked hard on bills to oversee our long-term care facilities, regulate hospitals and protect the patients they serve.  He is a leader in the debate over health reform and has worked with advocacy groups to limit the incidence of never events.  Specifically, the Congress of California Seniors (a non-partisan private organization) has been by his side in this fight because never events devastate the health and finances of our seniors.

Mike Feuer has been a strong voice in the fight for a better safety net system to protect seniors and vulnerable families.  AB 542 is another effort to improve the health and well-being of Californians, by protecting consumers from being billed for never events.  Implementation of this bill would improve healthcare practices and protect patients by guarding them from being billed for obscene medical errors.