Medicare paid $5.1B for poor nursing home care

Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found. The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions. One out of every three times patients wound up in nursing homes that year, they landed in facilities that failed to follow basic care requirements laid out by the federal agency that administers Medicare, investigators estimated. By law, nursing homes need to write up care plans specially tailored for each resident, so doctors, nurses, therapists and all other caregivers are on the same page about how to help residents reach the highest possible levels of physical, mental and psychological well-being. Not only are residents often going without the crucial help they need, but the government could be spending taxpayer money on facilities that could endanger people's health, the report concluded. The findings come as concerns about health care quality and cost are garnering heightened attention as the Obama administration implements the nation's sweeping health care overhaul. "These findings raise concerns about what Medicare is paying for," the report said. Investigators estimate that in one out of five stays, patients' health problems weren't addressed in the care plans, falling far short of government directives. For example, one home made no plans to monitor a patient's use of two anti-psychotic drugs and one depression medication, even though the drugs could have serious side effects. In other cases, residents got therapy they didn't need, which the report said was in the nursing homes' financial interest because they would be reimbursed at a higher rate by Medicare. In one example, a patient kept getting physical and occupational therapy even though the care plan said all the health goals had been met, the report said. The Office of Inspector General's report was based on medical records from 190 patient visits to nursing homes in 42 states that lasted at least three weeks, which investigators said gave them a statistically valid sample of Medicare beneficiaries' experiences in skilled nursing facilities. That sample represents about 1.1 million patient visits to nursing homes nationwide in 2009, the most recent year for which data was available, according to the review. Overall, the review raises questions about whether the system is allowing homes to get paid for poor quality services that may be harming residents, investigators said, and recommended that the Centers for Medicare & Medicaid Services tie payments to homes' abilities to meet basic care requirements. The report also recommended that the agency strengthen its regulations and ramp up its oversight. The review did not name individual homes, nor did it estimate the number of patients who had been mistreated, but instead looked at the overall number of stays in which problems arose. In response, the agency agreed that it should consider tying Medicare reimbursements to homes' provision of good care. CMS also said in written comments that it is reviewing its own regulations to improve enforcement at the homes. "Medicare has made significant changes to the way we pay providers thanks to the health care law, to reward better quality care," Medicare spokesman Brian Cook said in a statement to AP. "We are taking steps to make sure these facilities have the resources to improve the quality of their care, and make sure Medicare is paying for the quality of care that beneficiaries are entitled to." CMS hires state-level agencies to survey the homes and make sure they are complying with federal law, and can require correction plans, deny payment or end a contract with a home if major deficiencies come to light. The agency also said it would follow up on potential enforcement at the homes featured in the report. Greg Crist, a Washington-based spokeswoman for the American Health Care Association, which represents the largest share of skilled nursing facilities nationwide, said overall nursing home operators are well regulated and follow federal guidelines but added that he could not fully comment on the report's conclusions without having had the chance to read it. "Our members begin every treatment with the individual's personal health needs at the forefront. This is a hands-on process, involving doctors and even family members in an effort to enhance the health outcome of the patient," Crist said. Virginia Fichera, who has relatives in two nursing homes in New York, said she would welcome a greater push for accountability at skilled nursing facilities. "Once you're in a nursing home, if things don't go right, you're really a prisoner," said Fichera, a retired professor in Sterling, NY. "As a concerned relative, you just want to know the care is good, and if there are problems, why they are happening and when they'll be fixed." Once residents are ready to go back home or transfer to another facility, federal law also requires that the homes write special plans to make sure patients are safely discharged. Investigators found the homes didn't always do what was needed to ensure a smooth transition. In nearly one-third of cases, facilities also did not provide enough information when the patient moved to another setting, the report found.

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Senate Dems' bill light on deficit cuts in 2013

White House-backed legislation in the Senate to replace $85 billion in across-the-board spending cuts would raise the deficit through the end of the budget year by tens of billions of dollars, officials said late Wednesday as the two parties maneuvered for public support on economic issues. The nonpartisan Congressional Budget Office said that under the Democratic measure, deficits also would rise in each of the next two years before turning downward. Democratic officials had said earlier in the day their bill would spread one year's worth of anticipated savings — $85 billion — over a decade in an attempt to avoid damaging the shaky economic recovery. The legislation would cancel across-the-board cuts due to begin on Friday. Instead, it would eliminate payments to some farmers, enact defense reductions beginning in two years and impose tax increases, mostly on millionaires. White House spokesman Jay Carney recently told reporters at the White House the administration supports the measure. The Senate is expected to vote on Thursday on rival Democratic and Republican plans to replace the spending cuts, known in Washington-speak as a "sequester." Both bills are expected to fail. In an indication that across-the-board cuts are inevitable, President Barack Obama has set a meeting with congressional leaders for the day they take effect. While the administration has warned of severe cuts in government services as a result of the reductions, few, if any, are likely to be felt for several weeks. That could give the administration and lawmakers breathing room to negotiate a replacement, although Senate Republican Leader Mitch McConnell said during the day there were limits to what could be negotiated. "We can either secure those reductions more intelligently, or we can do it the president's way with across-the board cuts. But one thing Americans simply will not accept is another tax increase to replace spending reductions we already agreed to," he said. Democrats said their proposal to replace across-the-board cuts was designed with the economy in mind. It "seeks the same amount of savings in a more responsible way" as the $85 billion in cuts that will otherwise take effect, said Adam Jentleson, a spokesman for Senate Majority Leader Harry Reid. "The impact on the economy is much better. Sequestration as constituted would hurt economic growth and destroy jobs," he added. Over a decade, the bill would cut deficits by an estimated $110 billion, half from higher taxes and half from the defense and farm program cuts. That is in keeping with Obama's call for a balanced approach that combines selected spending cuts with closing tax loopholes. Senate Democrats have been reluctant to spell out the details of their measure, although it is not clear if that results from its relatively small impact on the deficits through the end of the current budget year. Across the Capitol, though, the party's leaders have talked openly of their desire to spread the cuts in their replacement measure over a longer period. "It is entirely intentional," said Rep. Chris Van Hollen, D-Md., and the party's senior member on the House Budget Committee. "The whole idea is to achieve the equivalent deficit reduction without hurting jobs and having disruption in the economy. You do that by having targeted cuts and eliminating tax loopholes over a longer period of time," he added. He said the Democrats' approach is the same as Federal Reserve Chairman Ben Bernanke's recommendation, which is to help the recovery gain strength before beginning to make cuts. In the Senate, Republicans have yet to disclose their own sequester replacement measure. Most of the rank and file favors an alternative that lets Obama adjust the cuts to minimize any impact on the public, but that approach has its critics among lawmakers who fear giving the White House that much authority.

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As budget cuts loom, is government shutdown next?

With big, automatic budget cuts about to kick in, House Republicans are turning to mapping strategy for the next showdown just a month away, when a government shutdown instead of just a slowdown will be at stake. Both topics are sure to come up at the White House meeting Friday between President Barack Obama and top congressional leaders, including Republican House Speaker John Boehner. A breakthrough on replacing or easing the imminent across-the-board spending cuts still seems unlikely at the first face-to-face discussion between Obama and Republican leaders this year. To no one's surprise, even as a dysfunctional Washington appears incapable of averting a crisis over economy-rattling spending cuts, it may be lurching toward another over a possible shutdown. Republicans are planning for a vote next week on a bill to fund the day-to-day operations of the government through the Sept. 30 end of the 2013 fiscal year — while keeping in place the new $85 billion in cuts of 5 percent to domestic agencies and 8 percent to the military. The need to keep the government's doors open and lights on — or else suffer the first government shutdown since 1996 — requires the GOP-dominated House and the Democratic-controlled Senate to agree. Right now they hardly see eye to eye. The House GOP plan, unveiled to the rank and file on Wednesday, would award the Pentagon and the Department of Veterans Affairs with their line-by-line budgets, for a more-targeted rather than indiscriminate batch of military cuts, but would deny domestic agencies the same treatment. And that has whipped up opposition from veteran Democratic senators on the Appropriations Committee. Domestic agencies would see their budgets frozen almost exactly as they are, which would mean no money for new initiatives such as cybersecurity or for routine increases for programs such as low-income housing. "We're not going to do that," said Sen. Tom Harkin, D-Iowa. "Of course not." Any agreement needs to pass through a gantlet of House tea party conservatives intent on preserving the across-the-board cuts and Senate Democrats pressing for action on domestic initiatives, even at the risk of creating a foot-tall catchall spending bill. There's also this: GOP leaders have calculated that the automatic cuts arriving on Friday need to be in place in order for them to be able to muster support from conservatives for the catchall spending bill to keep the government running. That's because many staunch conservatives want to preserve the cuts even as defense hawks and others fret about the harm that might do to the military and the economy. If the automatic cuts are dealt with before the government-wide funding bill gets a vote, there could be a conservative revolt. "The overall sequester levels must hold," said Rep. Tom McClintock, R-Calif. Little to no progress has been made so far between House and Senate leaders and the White House, and given the hard feelings engulfing Washington, there's no guarantee that this problem can be solved, even though the stakes — a shutdown of non-essential government programs after March 27 — carry more risk than the across-the-board cuts looming on Friday. The funding plan for the rest of the fiscal year will be a main topic at the White House meeting on Friday, the March 1 deadline day for averting the across-the-board cuts. Obama, speaking to a group of business executives Wednesday night, said the cuts would be a "tumble downward" for the economy, though he acknowledged it could takes weeks before many Americans feel the full impact of the budget shrinking. The warring sides in Washington have spent this week assigning blame rather than seeking a bipartisan way out. In a glimpse of the state of debate on Wednesday, Republicans and the White House bickered over whether the cuts would be under way by the time Friday's meeting started. A spokesman for Boehner said they would be in place; the White House countered that Obama would in fact have until midnight Friday to set them in motion. The cumbersome annual ritual of passing annual agency spending bills collapsed entirely last year — not a single one of the 12 annual appropriations bills for the budget year that began back in October has passed Congress — and Congress has to act by March 27 to prevent a partial shutdown of the government. By freezing budgets for domestic agencies, the Republican plan would deny an increase for a big cybersecurity initiative, additional money to modernize the U.S. nuclear arsenal and money to build new Coast Guard cutters. GOP initiatives such as more money for the Small Business Administration or fossil fuels research would be hurt as well, but there's little appetite for the alternative, which is to stack more than $1 trillion worth of spending bills together for a single up-or-down vote. But the GOP move to add the line-by-line spending bills for the Pentagon and veterans' programs to the catchall spending bill would give the military much-sought increases for force readiness and the Veterans Administration additional funding for health care. That approach has few fans in the White House, which is seeking money to implement Obama's signature efforts to overhaul financial regulation and the nation's health care system, or within the Democratic Senate, where members of the Appropriations Committee want to add a stack of bills covering domestic priorities such as homeland security, NASA and federal law enforcement agencies like the FBI. "You need balance," said Sen. Charles Schumer, D-N.Y. "We feel as strongly about the domestic side as we do defense." The catchall spending measure, known as a continuing resolution or CR inside Washington, was originally seen as a potential must-pass measure to avert Friday's cuts or make them less severe. But no serious talks to avert the cuts have been under way. On Thursday, Democrats will force a vote on a measure that would forestall the automatic cuts through the end of the year, replacing them with longer-term cuts to the Pentagon and cash payments to farmers and installing a minimum 30 percent tax rate on income exceeding $1 million. But that plan is virtually certain to be toppled by a GOP-led filibuster vote. Republicans in turn are considering offering a measure that would give Obama authority to propose a rewrite to the 2013 budget to redistribute the cuts. Obama would be unable to cut defense by more than the $43 billion reduction that the Pentagon currently faces, and would also be unable to raise taxes to undo the cuts. The GOP plan would allow a resulting Obama proposal to go into effect unless Congress passed a resolution to overturn it. The idea is that money could be transferred from lower-priority accounts to accounts funding air traffic control or meat inspection. But the White House says that such moves would offer only slight relief. At the same time, however, it could take pressure off of Congress to address the sequester. In the House, where Republicans in the past Congress passed legislation to replace the cuts, Boehner has said it's now up to Obama and the Senate to figure a way out. The Senate never took up the House-passed bills, which expired when the new Congress was seated in January.

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Sources: Rockets make deals with Suns, Kings; Morris twins reunited in Phoenix

The Houston Rockets acquired Sacramento's Thomas Robinson, the fifth overall pick in the 2012 draft, in a deal on Wednesday night, league sources told Yahoo! Sports. The Rockets sent Patrick Patterson, Toney Douglas and Cole Aldrich to the Kings. In a separate deal, the Rockets sent Marcus Morris to the Phoenix Suns for a 2013 second-round draft pick. That deal reunites Morris with his twin brother, Markieff. Thomas Robinson (USA Today Sports) The Kings give up Robinson, the power forward out of Kansas, Francisco Garcia and Tyler Honeycutt, sources said. Marcus and Markieff played together at Kansas and were chosen back-to-back with the 13th and 14th picks of the 2011 draft. Marcus started 17 games for the Rockets this season, averaging 8.6 points and 4.1 rebounds in 21 minutes a game. Robinson is off to a slow start in the NBA. In 51 games off the bench, he averaged 4.8 points and 4.7 rebounds in nearly 16 minutes per game. Nevertheless, he's still considered to hold considerable potential as a power forward. The Seattle ownership group, led by Chris Hansen and Steve Ballmer, was notified of the trade before its completion, a source told Y! Sports. The group has agreed to purchase the Kings from the Maloof family and is awaiting approval from the NBA Board of Governors.

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Lakers beat Celtics 113-99 on emotional night

Dwight Howard had 24 points and 12 rebounds in helping the Los Angeles Lakers to an emotional 113-99 victory over the Boston Celtics on Wednesday night in their first game since the death of owner Jerry Buss. Kobe Bryant added 16 points, Steve Nash and Earl Clark had 14 apiece, and Metta World Peace 12 in a game that surely would have delighted Buss, who always loved to win but especially liked beating the Celtics. The Lakers won their most recent NBA championship - and last under Buss - in 2010, defeating the Celtics 4-3 in the finals. Buss died Monday at 80 after an 18-month struggle with cancer that had forced him to watch his team's games on TV or an iPad instead of from his suite above the Staples Center court. Paul Pierce scored 26 points for the Celtics, who fell to 8-17 on the road and lost their third in a row away from home. Courtney Lee added 20 points and Kevin Garnett had 12 on 6-of-14 shooting. Howard's performance in the Lakers' first game since the All-Star break came on the eve of the NBA trade deadline. He has been the subject of rumors, but general manager Mitch Kupchak said this week that Howard wouldn't be going anywhere. He was among seven Lakers in double figures on a night when they shot 51 percent, dominated the paint 54-30 and were 22 of 31 from the free throw line for one of the most complete games they've played in months. Clark had a career-high 16 rebounds, and Antawn Jamison added 15 points off the bench for Los Angeles. The Lakers improved to 26-29 and gained a split in the season series, having avenged a 116-95 loss to the Celtics on Feb. 7 when they trailed by 32 points. Boston trailed by nine at the end of the first two quarters before the Lakers opened up a 75-57 lead early in the third. Typical of their balanced scoring throughout the game, World Peace, Bryant, Nash, Howard and Clark each contributed baskets in the 11-2 run. Nash had seven assists, giving him 10,144 while passing Magic Johnson for sole possession of fourth place on the career list. The Lakers shot 51 percent in the first half and had four players in double figures, helping them to a 64-55 lead. Howard was energetic in scoring 15 points and setting screens reminiscent of his days with Orlando. Bryant had 14 points, Nash 12 and World Peace 10. Pierce carried the Celtics with 23 points on 9-of-15 shooting in the half, when they shot 49 percent. Buss was remembered in a pregame video tribute featuring photos of him as a child all the way through him hoisting trophies marking the team's 10 NBA championships won under his ownership. Bryant fittingly spoke on behalf of the Lakers' players, having been acquired by the Lakers as a 17-year-old. ''He was a brilliant, incredible owner but an even better person,'' Bryant said of Buss. ''His innovation transcended the game and we are all, all spoiled by his vision and his drive to win year after year after year.'' There was a moment of silence in the darkened arena before the crowd broke up the quiet with chants of ''Jerry, Jerry.'' A memorial service for invited guests will be held Thursday at Nokia Theatre across the street from Staples Center. Buss will be buried in a private service on Friday. NOTES: Lakers F Pau Gasol said he hopes to get off his crutches soon and return before the end of the regular season. He had surgery on his right foot after injuring it on Feb. 5. ... The Celtics signed free agent G-F Terrence Williams to a 10-day contract on Wednesday. He had been playing with Guangdong in the Chinese league, averaging 17.9 points, 3.4 rebounds and 4.1 assists in 29 games. ... Jeanie Buss accepted condolences on her father's passing from numerous well-wishers stopping by her seat before the game. ... Jack Nicholson and Dyan Cannon, longtime Lakers fans dating to the team's days at the Forum in Inglewood, were on hand.

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