[Congressional Record (Bound Edition), Volume 145 (1999), Part 8]
[Extensions of Remarks]
[Pages 11549-11551]
[From the U.S. Government Publishing Office, www.gpo.gov]



INTRODUCTION OF THE MEDICARE'S ELDERLY RECEIVING INNOVATIVE TREATMENTS 
                          (MERIT) ACT OF 1999

                                 ______
                                 

                            HON. JIM RAMSTAD

                              of minnesota

                    in the house of representatives

                         Thursday, May 27, 1999

  Mr. RAMSTAD. Mr. Speaker, I rise today to introduce legislation to 
promote the coverage of frail elderly Medicare beneficiaries enrolled 
in innovative Medicare+Choice programs.
  This bill will exempt certain innovative programs specifically 
designed for the frail elderly living in nursing homes from being 
impacted by the new risk-adjusted payment methodology designed by the 
Health Care Financing Administration (HCFA) during its phase-in period.
  While the concept of a risk-adjusted payment methodology would 
actually be beneficial for such programs, the interim methodology is 
limited in scope and is primarily based on hospital encounter data. 
This focus on hospitalizations will put programs that are designed to 
provide care in non-hospital settings, thus reducing the need for 
expensive hospitalizations, at a distinct disadvantage.
  One such program is EverCare, an innovative health care program for 
the frail elderly in Minnesota and other states. A recent study by the 
Long Term Care Data Institute (LTCDI) has concluded that EverCare's 
revenue alone will decrease 42% under this new methodology. The program 
could not continue with such dramatic cuts.
  Recognizing that EverCare and programs like it may be adversely 
impacted by the new

[[Page 11550]]

methodology, HCFA granted certain programs limited exemptions. However, 
HCFA acknowledged that additional steps may be necessary by stating 
they would also be ``assessing possible refinements to the risk 
adjustment methodology'' as it relates to these programs and was 
considering developing a `hybrid' payment methodology for them.
  I appreciate HCFA's understanding of the uniqueness of the programs 
and the need to treat them differently than traditional Medicare+Choice 
plans. However, I am concerned that over four months have passed and we 
have not seen action on the part of HCFA to develop such a methodology. 
In addition, I am concerned that they have not applied the exemption to 
other similar programs specifically designed for the frail elderly 
living in nursing homes.
  Along with the bill and statement today, I am submitting some 
testimonials I have received from those involved with this critical 
program. I believe they will do a better job than I could of explaining 
the uniqueness and importance of these programs.
  Mr. Speaker, the risk adjusted payment methodology is intended to 
ensure reimbursements which reflect the health care status and needs of 
Medicare beneficiaries, not deny access to pioneering new programs.
  That's why I urge my colleagues to cosponsor this legislation to 
ensure cost-effective and care-enhancing programs like these are not 
unintentionally and fatally impacted as HCFA gradually moves into an 
appropriate, comprehensive methodology. I urge my colleagues to 
cosponsor this MERITorious bill.

     The EverCare Story--Clinical Success Stories Submitted by Site


                              Phoenix Site

       Sara Roth was a 75 year old EverCare resident of Shadow 
     Mountain Care Center. Sara's primary diagnosis was S/P 
     frontotemporal craniotomy for a massive subdural hematoma. 
     She was now essentially bedridden and as a result had 
     pressure sores complicating her current medical status. Less 
     than 9 months prior to her enrolling with EverCare, she had 
     been essentially alert and dependent. Sara's family was 
     pursuing legal interventions with her previous health care 
     providers.
       Sara's family felt isolated, tremendously frustrated and 
     out of control prior to her enrolling in EverCare. Sue was 
     able to help this family who had unrealistic expectations, 
     make difficult, but informed decisions. Ultimately, Sara was 
     able to die with compassion and dignity. The family was 
     comforted and supported by the team during this difficult 
     time, as their attached letter attests.
       This example truly represents the unique aspects of the 
     EverCare model in action--protecting the quality of life, and 
     when this is no longer possible, creating the most 
     therapeutic environment to protect life's end.


                                                Scottsdale, AZ

                                                    July 20, 1998.
     Re Ms. Sue Freeman, nurse practitioner.

     Ms. Kathryne Barnoski,
     Clinical Director,
     EverCare, Phoenix, AZ.
       Dear Ms. Barnoski: I write this letter to express our 
     family's deep appreciation for all of Ms. Freeman's help in 
     regard to our mother, Sara Roth, who passed away on July 1 at 
     the Shadow Mountain Nursing Home in Scottsdale.
       Prior to EverCare, our family felt alone and frustrated in 
     dealing with all Sara's medical needs at Shadow Mountain. It 
     was difficult reach a doctor or getting answers from her 
     nurses regarding her condition or explanation of medications. 
     EverCare became like a fairy godmother who orchestrated a 
     wonderful team approach to caring for our mother. 
     Communication between Dr. Sapp, Ms. Freeman and myself was 
     excellent and that in itself did wonders for my peace of 
     mind.
       I would like to take this opportunity to thank one of your 
     shining stars--Ms. Sue Freeman. What a wonderful woman! She 
     is articulate, highly skilled, organized, professional, and 
     has a great heart! I always felt like Sara was a top priority 
     with Sue and for that, we will always be grateful.
       EverCare works. That is important for you to know. God only 
     knows what would have happened to Sara's quality of life 
     without Dr. Sapp and Ms. Freeman.
       Thank you from the bottom of our hearts.
           Sincerely,
                                                   Eleanor Shnier.

     
                                  ____
       Rose Dealba is an 82-year old female resident of Mi Casa, 
     patient of Dr. Greco with a history of cervical myopathy and 
     chronic diarrhea. Mrs. Dealba was essentially bedridden and 
     total care because of her cervical myopathy. Of note--Mrs. 
     Dealba is cognitively intact. Her inability to care for 
     herself had added depression to her problem list. Her quality 
     of life was less than optimal due to her inability to get 
     herself to the bathroom, to feed herself, etc. The patient 
     and her family felt there was not hope for improvement in 
     Mrs. Dealba's condition.
       With slow and progressive/incremental physical therapy, 
     occupational therapy and restorative nursing, Mrs. Dealba was 
     able to feed herself, transfer and ambulate to the bathroom 
     with a walker and assist of one. Her chronic diarrhea has 
     finally been controlled. With another round of PT she has 
     become more independent in her transfers and ability to get 
     to the bathroom. She is now able to go outside with her 
     family.
       Both Mrs. Dealba and her family are thrilled with her 
     progress. With Mrs. Dealba's previous medical carrier, 
     physical therapy had been denied. She has been able to 
     maintain these gains with assistance of the restorative 
     nursing program.

       It is very difficult to report only one success story. Team 
     members report successes in practicing the EverCare model on 
     a daily basis. A recent event leading to a letter of 
     appreciation for Mary Ann Allan is one of many examples. Mary 
     Ann has grown especially close to her residents and their 
     families in a very short time as she joined EverCare in June 
     of 1998.
                                  ____

       Elizabeth DeBruler is an 89-year old resident at the 
     Glencroft Care Center with a primary diagnosis of S/P CVA and 
     Hypertension. Elizabeth is alert, oriented and very 
     functional with no stroke residual. She is up and about daily 
     in the facility ambulating with her walker. Mary Ann and Dr. 
     Kaczar are the Primary Care Team and work together to monitor 
     Elizabeth's blood pressure and medications.
       In December, the nursing staff reported to Mary Ann that 
     Elizabeth was confused with decreased food and fluid intakes. 
     Mary Ann examined her, ordered a workup to rule out a 
     treatable cause, and discussed a treatment plan with Dr. 
     Kaczar. Labs showed a urinary tract infection and 
     dehydration. The BUN was 56, Creatinine 2.4. A family 
     conference was convened with Elizabeth's daughter Arlene 
     Latham, Dr. Kaczar, Mary Ann and the nursing staff. Potential 
     treatments were discussed and Advanced Directives were 
     reviewed. Elizabeth's wishes were considered as well as her 
     daughter's. Everyone agreed on a plan. Antibiotics by mouth 
     would be started and if no improvement in food/fluid intake 
     short term, intravenous fluids for hydration would be given. 
     Elizabeth would remain a do not resuscitate. Intravenous 
     fluids would be given in the care center with full support of 
     the Director of the Nursing and the staff rather than 
     transport to the hospital. Elizabeth did not improve with 
     antibiotics alone and did require intravenous fluids. Mary 
     Ann contacted the Case Manager, Rose Larkin, and it was 
     determined that Elizabeth would qualify for Intensive Service 
     Days for a change in condition and to prevent a 
     hospitalization. As Elizabeth improved, she was moved into a 
     Skilled Nursing benefit. Mary Ann visited Elizabeth daily and 
     updated Arlene on her condition. Elizabeth recovered with the 
     assistance and support of the family, facility staff and the 
     primary care team.


     EverCare,
     2222 E. Camelback Rd, Suite 120, Phoenix, AZ.
       Dear Ms. Barnoski: I would like to express my appreciation 
     for the interest taken and care given to my mother, Elizabeth 
     DeBruler by Dr. Philip Kaczar and Mary Ann Allen. Dr. 
     Kaczar's prompt attention to her recent physical problems 
     have been commendable and the follow-up by Mary Ann has also 
     been impressive. The close attention and efforts to make her 
     comfortable have been very satisfying to me.
       EverCare is to be commended for their foresight in 
     selection of these individuals. I feel they are an asset to 
     Ever Care and Glencroft Care Center.
           Sincerely,
     Arlene Latham.
                                  ____



                               Tampa Site

                               AWAKENING

       Coming ``live'' in a new facility is always an opportunity 
     for everyone involved; the member and family, the facility, 
     facility staff, EverCare staff, and the primary care team. 
     There are many reservations. ``Should I have signed my Mom up 
     for this EverCare?'' The staff is wondering how this will 
     work. The nurse practitioner is thinking ``how will I fit in 
     with this group?''
       One of my new members in a new facility was a 72-year-old 
     woman. She lived there for six months, after suffering a 
     severe CVA, leaving her aphasic, NPO with a feeding tube. She 
     was dependent in all ADL's, and spent a good portion of her 
     day in a geri chair, watching her soaps. She did respond by 
     nodding her head, but it was extremely difficult to assess 
     her level of orientation.
       This member's son had a discussion with the primary care 
     team and all of her medications, including cardiac and 
     seizure, were discontinued, at his request. The member 
     responded to this change, she woke up!
       A team effort ensured. Physical therapy and occupational 
     therapy screened the member and requested an evaluation. 
     Indeed there were documented changes.
       Therapy and the primary care team discussed a plan of care 
     and put it into action. Case management became actively 
     involved. Speech therapy came on board as the member 
     demonstrated gains in other areas. Communication was the key 
     to this plan.
       The member worked very hard and made continual gains. She 
     is now able to assist

[[Page 11551]]

     with bathing and grooming. She can propel her wheelchair 
     throughout the facility and attends activities. She is able 
     to use a pad to communicate some of her needs. She still 
     likes her soaps. Best of all, she is no longer a tube feeder 
     and can feed herself after set-up.
       The member was not just ``the CVA.'' The office staff could 
     visualize our member and truly felt great as she made gains.
       The outcome of this team effort was an increase in the 
     quality of life for our EverCare member.
       EverCare can make a difference!

       

                          ____________________