Mail Gall…

Good morning, ProviderNation.

Our California brethren got some nasty-grams in the mail this week. CalPERS, the state employees’ insurance company, told its customers that it was jacking up long-term care insurance premiums by 85 percent over the next two years.

But take heart: Customers can avoid the bill shock by “electing” to trim their insurance coverage. Oh, and they’ve got until next week to make up their damned minds.

Elsewhere, psychologist Suzsanne Singer has died. Singer, who was 88, might have been the kind of person George Eliot was talking about—Singer “lived faithfully a hidden life,” training volunteers to go into nursing home to comfort those who had no visitors. Death be not proud and all that.

A New York man practices yoga to keep Alzheimer’s at bay.

And the fine folks at Fox Business News have some thoughts on having The Talk with one’s folks.

Dance Macabre…

Good morning, ProviderNation.

The House Way & Means Committee will meet in a few minutes to talk Medicare overhaul. When politicians mention “bipartisan” and “reform” in the same sentence, you should be afraid. Be very afraid.

Awaiting word on how long term care folks fared in the most recent awfulness out of Oklahoma. Speaking of Oklahoma, though, the state recently passed a law that allows nursing home residents to install remote-monitoring devices in their rooms as long as they pay for it.

Finally, news from the great ballroom of the Alzheimer’s Totentanz: British researchers believe they’ve found the molecular culprit behind dementia. Your fugitive’s name is oligomer.

“There are no disease-modifying therapies for Alzheimer’s and dementia at the moment, only limited treatment for symptoms,” says lead author Tuomas Knowles. “We have to solve what happens at the molecular level before we can progress and have real impact. We’ve now established the pathway that shows how the toxic species that causes cell death, the oligomers, are formed. This is the key pathway to detect, target, and intervene—the molecular catalyst that underlies the pathology.”

Baby steps, for sure. But as our Sufi brethren like to say, “Whoever walks one step toward the grace of Allah, the Divine mercy walks forward 10 steps to receive him.”

 

Oldest (Folks’) Profession…

Good morning, ProviderNation.

The Oregon House has voted to increase provider taxes. The revenues had been taxed for at least a decade, but under the new bill, they would be extended to nursing homes through 2020. It would also force 25 nursing homes that had been exempt from paying to start ponying up.

The revenue eventually comes back to providers, but it creates some $1.3 billion in federal matching funds for Oregon’s Medicaid coffers. The bill now heads to the state Senate; Republicans have promised to block the measure, hoping to obtain some cuts in public pensions.

In other news, there are some worries about a senior living bubble; And, New Jersey cops are all for boosting ADLs and all, but this ain’t what they had in mind.

Alzheimer’s: Notes from a Stricken Land…

Good morning, ProviderNation.

There’s (kinda) good news after (a lot) of bad news from that rogue state known as Alzheimer’s disease.

First, the (kinda) good. The Salk Institute says that it has developed a drug that “reverses memory deficits and slows Alzheimer’s disease.” The drug, which the Salk folks are calling J147, appears to have made some headway in demented mice after what they’re calling “short term” treatments.

Then, there’s ReXceptor, a Cleveland startup that just won a license to repurpose anti-cancer drugs. They’ll begin Phase I trials later this year. Similar treatments, which tried to get patients’ bodies to get rid of poisonous beta amyloid plaques, have already reached Phase III before tanking, but ReXceptor says they’re taking a slightly different approach.

“We’re not trying to take [beta amyloid] out of the body entirely; we’re trying to restore a natural function,” CEO Michael Haag told MedCityNews.com. “Everyone produces a certain amount of amyloid beta which can be shuttled out of the brain, but as you age, you have less and less of those carrier proteins. We want to give the brain back these carrier proteins.”

Those hoping for regime change in Alzheimer’s can’t draw much cheer from these developments, because they’ve been there before. But for those living (and, mostly, dying) from it maybe there’s no such thing as worse news.

By the by, for those of you interested in the Senate immigration bill, I recommend the verbiage of my ole pal, Alan Gomez, at USA Today.  He’s @alangomez for you Twitterati.

Wise Leadership

Chris Perna, CEO, The Eden Alternative

Good Afternoon, ProviderNation.

Thousands of books have been written and tens of thousands of articles, lectures, and videos have been used to teach leadership.

At The Eden Alternative, we have a set of 10 core principles that drive everything we do and teach. The 10^th principle, our capstone, says, “Wise leadership is the lifeblood of any struggle against the three plagues” of loneliness, helplessness, and boredom.We believe there can be no substitute for wise leadership when it comes to creating care environments that support culture change and person-directed care. But what constitutes wise leadership? And what makes wise leadership so elusive?

Leadership is about leading… right? Well, not so fast! My experience tells me that wise leadership is actually the effective use of many different tools, such as communication, vision, relationship building, competence, selflessness, and many others in the pursuit of a noble goal. In this case that goal is person-directed care.

Leadership isn’t any one of these tools alone; it is a combination of all of them used at different times and to varying degrees. There is no magic formula that tells you when to apply any particular tool and in what proportion.

I’ll call it the “squishiness factor.” A leader has to decide when and how to apply the tools at their disposal using a combination of experience, discernment, and gut instinct.

A leader needs to understand the context of the situation and be engaged in relationships with the people involved to be most effective.

Some of this can be taught, but much of it comes from within the leader. As if that isn’t hard enough, a leader also has to decide when and how to let others in the organization use their tools. This gets to the issue of empowerment or, in other words, a manager’s willingness to give up their role as the “manager.”

This is a huge challenge for many managers in long term care who have worked hard to climb the corporate ladder in a very hierarchical environment. They have earned their position and the authority that goes along with it, and they often don’t want to give it up.

However, this is exactly what a good leader does. A manager protects their power while a leader learns to share their power.

A leader helps others to grow by allowing them to take ownership and responsibility by giving them the authority, autonomy, resources, and information they need to be successful, not hoarding those things for themselves.

At its core, wise leadership is about helping others to be successful. Wise leaders are comfortable in their own skin and create an environment where others look to them for guidance, not answers.

Wise leaders consistently demonstrate that they have command of their tool set and can use experience, discernment, and their gut to pick the right tool at the right time.

Finally, wise leaders create an environment where power is distributed to all, so everyone can experience growth by taking ownership and responsibility.

Wise leadership is the elusive but essential ingredient for successful culture change and genuine person-directed care.

Cav Id Therapy Caps…

Good morning, ProviderNation.

Providers will have to caveat their emptori from now. The good people over at CMS have issued a memo that they hope will clarify the Advance Beneficiary Notice of Noncoverage (ABNs) requirements of the American Taxpayer Relief Act.

In the good ole days of say, Dec. 31, 2012, providers were merely “encouraged” by CMS to warn patients that there were therapy caps and all that.

Were we ever that young?

“Now the provider/supplier must issue a valid, mandatory ABN to the beneficiary before providing services above the cap when the therapy coverage exceptions process isn’t applicable,” CMS says in the memo.

We’ve got a scintillating write-up with more specifics here.

Washington Week in Preview…

Good morning, ProviderNation.

There’s that old, lame joke about the opposite of progress being Congress, but still… Things are In Motion.

Today, House Ways and Means will hold hearings on the so-called “doc fix.” The witness list shows it to be heavy on the physician and hospital association side, but long term care advocates will probably be listening to make sure none of the magic words (like “offset”) pops up.

Also, we’re hearing that U.S. Rep. Fred Upton (R-Mich.) and Sen. Orrin Hatch (R-Utah) are plotting to launch a bill that would overhaul Medicaid. Among other things, the bill would reduce the provider tax to 5.5 percent and vastly expand managed care in exchange for (or do I mean, “to offset?”) more state flexibility. The lobbying types we’ve talked to say the bill’s chances of becoming law are slim (because the Democrats control the Senate, and bills of this type have usually been non-starters), but it’s worth noting because these ideas (like the snail in that other lame joke) keep coming back at the oddest times.

Finally, the long-awaited national immigration bill looks like it’ll be marked up this week. Long term care advocates have pushed hard on this one, saying that they need fresh workers to brace for that Silver Tsunami that we keep hearing about.