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by Stephen Schinnagel
Wed, Dec 21st 2011 12:00 am

Today's healthcare market seems to change by the day. From advances in technology to providing care to an aging population, changes to the healthcare industry are occurring at a historical pace, reshaping not only the nature of healthcare, but also the methods and location of its delivery.

Perhaps one of the principal drivers fueling this transformation is the necessity of cost containment, particularly in publicly funded programs such as Medicaid and Medicare. Facing spiraling costs and declining reimbursements, tomorrow's healthcare providers will need to become more efficient - placing greater emphasis on reducing over-utilization, promoting preventative care, and advancing home based services as opposed to long term institutionalization.


Planned changes on both the federal and state levels will forever change how patients and their practitioners experience and deliver healthcare. In New York State a variety of reforms are being considered intended to reduce costs, enhance access and improve medical outcomes. One strategy that appears to have gained considerable traction is the promotion of managed long term care (MLTC) programs. Managed long term care helps people who are chronically ill or have disabilities and need health and long-term care services, such as home care or adult day care. With the goal of keeping individuals in their homes for as long as possible, an MLTC arranges and pays for a variety of services through an interconnected network of providers. In exchange for care coordination, the MLTC is paid a capitated rate for each enrollee. What that means is that the medical provider (MLTC) is given a set fee per patient (by an HMO) regardless of treatments required.


On the state level, the budget predictability that comes with capitated payments has great appeal. On a service level, MLTC programs provide comprehensive coverage to its members, while controlling costs by emphasizing preventive care and limiting unnecessary or low-priority services. However, it is now more important than ever for patients to become their own advocates.


The first step is to learn how you want to be taken care of now and as you age, and then make sure you have designated a health care proxy and discussed your health care wishes with that person. When selecting an MLTC program, know what services are covered and who provides the service. You may not have the freedom of choice that you may have enjoyed in the past.


When considering end of life care (and we should all be thinking about this before the need arises), hospice care has been called the gold standard. In fact, a 2007 Duke University study found that people with a terminal illness that choose hospice care live longer than those who do not choose hospice. Hospice provides what the majority of Americans say they want at the end of life: excellent pain management, comfort, and support for the patient and family caregivers. Most Americans know that hospice professionals care for people at the end of life. But there's so much more to know.


Ten more things you should know about hospice:

·         Hospice is not a place but a special kind of care.

·         A hospice care team is made up of doctors, nurses, social workers, counselors, spiritual care providers, aides, homemakers, trained volunteers and other skilled professionals who provide high-quality, compassionate care.

·         Hospice care is available to people of all ages with any kind of life-limiting illness including cancer, advanced Alzheimer's disease, heart disease, lung disease, kidney disease, HIV/AIDS and other life-limiting illnesses.

·         Hospice care is fully covered by Medicare, Medicaid, and most private insurance plans and HMOs.

·         Hospice provides all medications and medical equipment needed to keep a person safe and comfortable. 

·         There's no limit to the amount of hospice care a person can receive; it's available as long as a doctor believes a patient is eligible.

·         Most care is provided at home but hospice is also available in nursing homes, assisted living and long term care facilities and hospice inpatient units. 

·         Hospice care can include complementary therapies such as massage, music and art to bring additional comfort to patients.

·         Hospice programs offer grief support to the families they care for as well as to others in the community who are grieving.

·         More than 1.5 million people receive hospice care every year. 


One of the most common sentiments shared by families who have been helped by hospice care is, "We wish we had known about hospice sooner." To find out if hospice might be right for you or a loved one, or to learn more, contact Niagara Hospice at 439-4417 or visit www.NiagaraHospice.org.


As we attempt to predict tomorrow's health care landscape and how it will affect Niagara Hospice, only one thing remains certain: the environment in which we operate today will in no way resemble the environment of tomorrow. Our ability to navigate these waters will be dependent upon our willingness to consider new opportunities while aggressively embracing innovation. But as in the past, the true measure of our success will be defined by our unyielding commitment to patients and families, and staunchly maintaining the organizational values that have carried us for the last twenty-four years.

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