Veterans Affairs Community Care Network Update

For those contracted with TriWest to serve veterans in VACCN Region 4, the claims processor had a programming issue that is causing some claims to be paid at 75% of the billed amount. The HCAOA VA Advisory Council is in contact with TriWest leadership, and the claims processor, PGBA, is implementing a fix. We understand the frustration these payment issues cause. Members are recommended to watch payment records for July and August claims carefully to ensure any underpaid claims are rectified over the coming weeks.

For those serving veterans in the VACCN in any state, this is a reminder that TriWest and Optum need to verify the current credentials (re-credential) for all network providers every third year around the anniversary of the provider's contract. Email from Optum or TriWest should not be considered spam. The re-credentialing process will require submission of a current W-9, insurance, biographical info and, if applicable, a current home care license. This is standard procedure to maintain a current provider network for the VA.

 Exclusive: CMS Study Sabotages Efforts to Bolster Nursing Home Staffing, Advocates Say

Kaiser | By Jordan Rau
 
The Biden administration last year promised to establish minimum staffing levels for the nation’s roughly 15,000 nursing homes. It was the centerpiece of an agenda to overhaul an industry the government said was rife with substandard care and failures to follow federal quality rules.
 
But a research study the Centers for Medicare & Medicaid Services commissioned to identify the appropriate level of staffing made no specific recommendations and analyzed only staffing levels lower than what the previous major federal evaluation had considered best, according to a copy of the study reviewed Monday by KFF Health News. Instead, the new study said there was no single staffing level that would guarantee quality care, although the report estimated that higher staffing levels would lead to fewer hospitalizations and emergency room visits, faster care, and fewer failures to provide care.
 
Patient advocates said the report was the latest sign that the administration would fall short of its pledge to establish robust staffing levels to protect the 1.2 million Americans in skilled nursing facilities. Already, the administration is six months behind its self-imposed deadline of February to propose new rules. Those proposals, which have not been released, have been under evaluation since May by the Office of Management and Budget. The study, dated June 2023, has not been formally released either, but a copy was posted on the CMS website. It was taken down shortly after KFF Health News published this article.
 
“It’s honestly heartbreaking,” said Richard Mollot, executive director of the Long Term Care Community Coalition, a nonprofit that advocates for nursing home patients in New York state. “I just don’t see how this doesn’t ultimately put more residents at risk of neglect and abuse. Putting the government’s imprimatur on a standard that is patently unsafe is going to make it much more difficult for surveyors to hold facilities accountable for the harm caused by understaffing nursing homes.”
 
For months, the nursing home industry has been lobbying strenuously against a uniform ratio of patients to nurses and aides. “What is clear as you look across the country is every nursing home is unique and a one-size-fits-all approach does not work,” said Holly Harmon, senior vice president of quality, regulatory, and clinical services at the American Health Care Association, an industry trade group.
 
Nursing home groups have emphasized the widespread difficulty in finding workers willing to fill existing certified nursing assistant jobs, which are often grueling and pay less than what workers can make at retail stores. Homes say their licensed nurses are often drawn away by other jobs, such as better-paying hospital positions. “The workforce challenges are real,” said Katie Smith Sloan, president and CEO of LeadingAge, an association that represents nonprofit nursing homes.
 
The industry has also argued that if the government wants it to hire more workers it needs to increase the payments it makes through state Medicaid programs, which are the largest payor for nursing home care. Advocates and some researchers have argued that nursing homes, particularly for-profit ones, can afford to pay employees more and hire additional staff if they forsake some of the profits they give investors.
 
“Certainly, facilities haven’t put all the dollars back into direct care over the years,” said David Grabowski, a professor of health care policy at Harvard Medical School. “But for certain facilities, it’s going to be a big lift to pay for” higher staffing levels, he said in an interview last week.

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“Am I Going to Die Today?”

Barbara Karnes, RN

When doctors and healthcare professionals place a number on how long someone has to live, they are doing that person a disservice.  

We have the right to be told about our disease, its progression, and the options of care and their expected outcomes. We need to know what the probability of our being cured is vs. the disease just controlled. If controlled, what does that mean? What kind of quality (physical and mental activity) will we have?

We also have the right to be told if we can’t be fixed, if our disease has progressed to the point it is not fixable. This knowledge gives us the opportunity to live and die in a manner of our own choosing, to address end of life issues, to put our house in order.

About the “not fixable” part; no one can be so specific as to say exactly how long someone has to live—with or without treatment. There are too many personal variables. When a number is given (6 months, a year) patients and their families end up carrying that number with them over the course of their illness. From that point forward the specific number will become a guide to how life unfolds.

Why do I say this? I’ll tell you a personal story. Even though it is personal, many people will have a similar story to tell if they think about it. 

My mother was diagnosed with cancer of the lung: it was not fixable. The doctor told her if she didn’t have treatment, which she declined, she would be dead in six months. His bedside manners were clearly lacking. 

When the sixth month arrived, she was sure she was going to die —during the ENTIRE month. “The doctor said six months, it’s been six months, I am going to die.”

At the end of the sixth month she agreed that maybe he was wrong. She lived 18 months after diagnosis. BUT think of the needless emotional turmoil, and yes, emotional fear that the doctor’s statement created.

Because people don’t have accurate role models on what it is like to die they think they are going to be alive one minute and dead the next. They don’t know there is a process so they often think that at the six month or year point mentioned they will suddenly die.

Imagine the fear of waking up every morning and wondering if you are going to die that day. When a number is put on how long life will be, that question is ever present.

When I think that is happening to a person with a life threatening illness, I respond, “If you can ask yourself, ‘Am I going to die today,’ then you most probably are not. The day that you die, you won’t ask and you won’t care.” Think of the fear that this simple statement reduces.

Study: How Cardio Fitness, Exercise Counteract Cognitive Decline

The University of Texas at Dallas | By Stephen Fontenot

New research from The University of Texas at Dallas’ Center for Vital Longevity (CVL) supports the idea that the brains of older adults who maintain physical fitness by engaging in regular strenuous exercise more closely resemble those of younger adults.

Dr. Chandramallika Basak, associate professor of psychology in the School of Behavioral and Brain Sciences, is the corresponding author of a study published online April 27 and in the June print edition of  Neuroscience that describes how strenuous physical activity and cardiorespiratory fitness help the brains of older adults compensate for age-related changes by improving their ability to perform complex cognitive tasks.

The results demonstrate the importance of maintaining physical fitness and regular strenuous exercise to prolong neurological health.

“Age is just one marker for cognitive health, and fitness can be a significant modifying factor,” said Basak, who directs the Lifespan Neuroscience and Cognition Lab in the CVL. “The brain activation patterns of high-fit older adults in our study resemble those of the young adults during a complex cognitive task that requires switching attention focus and updating memory rapidly. This suggests that physical fitness can significantly modify age-related changes in the brain.”

The researchers used functional MRI to measure fluctuations in blood oxygen level-dependent signals as the 52 study participants performed tasks involving several varieties of cognitive control. Limited research exists on contributions of physical activity and cardiorespiratory fitness to cognitive functions like those tested in the study, including switching, updating and event anticipation, Basak said.

“Our findings suggest that a lifestyle involving moderate to strenuous physical activity may help maintain cognitive processing in the prefrontal cortex of older adults that matches that of younger adults, while cardiorespiratory fitness may preserve neurovascular health of posterior brain regions,” Basak said. “What we mean by strenuous physical activity is a level of physical activity that actually gets your heart rate up and increases your lung capacity.”

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