Gentiva provides in-home care for patients, most of whom are elderly. Odyssey provides hospice care for those in their last days.

The merger suggests convergence and consolidation across the wide spectrum of care for aging Americans.  The spectrum includes home health care, assisted living, long-term health care, nursing home care and hospice, says Bill Buhr, an analyst with rating firm Morningstar.

The Gentiva acquisition of Odyssey, pulling two of those elements into one organization, is “a transaction that can overnight change other industry player strategies,” he said.

Sophia Snyder, an analyst with market research firm IBISWorld, agrees. The Gentiva-Odyssey deal is an important diversification for a provider of home health care, she says.

It’s a wise strategy as Medicare and Medicaid restrain and even reduce payments to providers of health services. Most patients with in-home care, long-term care, nursing homes and hospice are under the umbrellas of Medicare and Medicaid.

Improvements in coverage won’t kick in until 2014, she notes. “By merging with other providers, industry operators are able to spread costs, such as administration, marketing and purchases, over more locations.”

Gentiva’s Odyssey Buy Sector Game Changer

The best part of the website is the government disclaimer of how SSA determines Medicare, but that it isn’t administered by them:

Although Social Security determines entitlement to Medicare benefits, the Medicare program is administered by a different agency, the Centers for Medicare & Medicaid Services (CMS). There also is a Medicare Web site, and CMS has several publications about Medicare prescription drug coverage.

I find this circular thought process quite funny…

The reason I’m posting on her today, though, is due to her stance on Long Term Care Insurance.  She believes that Long Term Care Insurance is an essential part of good financial health and really hit it hard during her presentation.  She threw up pictures of Christopher Reeves, Michael J. Fox, Annette Funicello and Ronald Reagan and talked about how each of these individuals could have benefited from Long Term Care Insurance.  She told the audience that the cost of needing long term care is NOT covered by Medicare or Medicare Supplemental.  It IS covered by Medicaid, but only in Medicaid Nursing Homes.

She said that even though it is expensive, she recommended that the audience look at purchasing policies in their 50s – while it is less expensive and while you are still healthy.  You can check out her past column on Long Term Care Insurance to get more information from her.

The Medicare Payment Advisory Committee is proposing changes to Medicare reimbursement to skilled nursing facilities that could lower payments to those facilities performing a high-volume of therapy related services. 

The report recommends lower payments made by medicare based upon the efficiencies of scale that the Council has stated that any high volume provide should have achieved by technology and standardization processes.  Is the council recommending punishing quality providers by reducing their payments?  This could be a big blow to long term care for those who need to use these facilities.

The report criticizes that the current medicare system does not provide the best delivery and the use of private sector physicians and facilities is necessary to cope with the growing needs of the system.  The council should recognize that private physicians are not government employees or programs and have every right to run their business as they see fit from an operational and financial perspective.  The good news for those in private practice is that the proposal could be years from enactment and is contradictory to previous statements that it believes that highly efficient facilities are better for the long-term health of the medicare program (yeah, but if you cut their margins….).  Additionally, Congress has routinely ignored the suggestions of this PAC.

For more information on the recommendations of the commission, click here.

The annual reports for Social Security and Medicare are out and what does that mean?  Some are predicting some debating among presidential candidates and others are predicting not much difference from last year, but whatever the predictions, the fact remains that to be sure you have enough to retire and for your long term care, you had better have your own plans.

It looks as though there aren’t many changes between last year’s Social Security report and this year’s.  The news release claims that the “Trustees Report shows improvement in the projected long-term financial status of the Social Security program”, but admits that these improvements are “the result of methodological changes for projecting certain aspects of immigration.”  Key dates remain unchanged.  These dates include the fact that tax revenues are still estimated to fall below program costs in a very short 9 years.   Trust Funds are still estimated to become “exhausted” by 2041.

The full report  on Social Security is rather lengthy, but the news release is worth a quick view.

Social Security seems to be treading water, but Medicare is not faring as well.  Their report states that based on projections and no changes, the fund will be exhausted by 2019.

What does this mean for us?  As we’ve discussed in past postings: making your own plans are your best bet for retirement and long term care.  Knowledge is power…start researching long term care insurance, reverse mortgages, private funds, etc.  

A couple of good articles on the released reports can be found on MSNBC and Forbes.com.

So with all this disparity in Medicaid, what is being done?  As you can imagine, with the primaries due to hit Texas on March 4th and with Hillary already campaigning down there, the THCA is trying to push this to the forefront of the political scene.  They have had marginal success with it making local news as well as Fox Business News.
One article out on this topic states that there is a reform plan available in detail at www.ahca.org, although I could not find anything in a quick search of the website.

Others talking about this subject:

FierceHealthcare

International Journal of Health Care Finance and Economics

The Public Citizen