Flu, You and Update on Pre-Claim Review

By: Melody Rabor-Dizon

 

WHY SHOULD I GET THE FLU SHOT?

• As recommended by Centers for Disease Control (CDC), a yearly flu vaccination is the first and most important step against flu viruses.

• It does not only reduce flu-related illnesses but prevent any missed days from work or school, as well as keep you from unnecessary doctor’s visits or worse hospitalizations.

• Vaccination of high-risk persons is especially important to decrease their risk of severe flu illness including young children, pregnant women, people with chronic health conditions like asthma, diabetes or heart and lung disease and people 65 years and older as well as health care workers, and other people who live with or care for high risk people to keep from spreading flu to them.

WHAT PREVENTIVE ACTION CAN I TAKE TO STOP THE SPREAD OF GERMS?

• Washing of hands is the single most effective way of preventing spread of illnesses. If soap and water are unavailable, an alcohol-based hand rub is a good alternative.

• Avoid close contact with sick people as much as possible. If you are sick with flu-like illness, CDC recommends staying home for at least 24 hours until your fever is gone, except to get medical care or for other necessities. (Your fever should be gone for 24 hours without the use of a fever-reducing medicine).

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

• Avoid touching your eyes, nose and mouth. Germs spread this way. • Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.

TAKE THE FLU ANTIVIRAL DRUGS IF YOUR DOCTOR PRESCRIBES THEM

• Antiviral drugs can make illness milder and shorten the time you are sick. They may also prevent serious flu complications.

• Studies show that flu antiviral drugs work best for treatment when they are started within 2 days of getting sick, but starting them later can still be helpful, especially if the sick person has a high-risk health condition Note: For the 2016-2017 season, CDC recommends use of the flu shot (inactivated influenza vaccine or IIV) and the recombinant influenza vaccine (RIV). The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used during 2016-2017.

UPDATE ON PRE-CLAIM REVIEW

Considered as a last resort, NAHC’s VP for law, Bill Dombi, has stated, we’re left with no other choice. Filing a lawsuit against CMS will be a grueling case but it is intended to provide an injunction for Illinois’s Pre-claim Review Demonstration. Now on its 11th week, contradicting data from CMS claims higher affirmation rates of either partially affirmed or affirmed at 78%, while many home health agencies claim a 0% affirmation rate. There is a wide disparity with what kind of data is being gathered. Though, CMS has implemented a program that provides education and direct contact to home health agencies and helping them identify what documents are needed with a given time frame before being given a partial affirmation. So, somewhat, there is progress on CMS’ side. The Alliance for Home Health Quality and Innovation (IHHQI) and the Visiting Nurse Associations of America (VNAA) are the other two organizations who have joined efforts with NAHC, who also has been very passionate about the adverse effects of PCRDS. “It is not only harmful to the home health care industry, causing punishing administrative burdens delaying care in Illinois but harmful to the patients as well creating a negative impact on patient access to high quality home health care.”

Since CMS’ non-reply over the legislation letter from our two Illinois Congressmen and the rest of the 18 representatives, it appears that the demonstration will be implemented in the other pilot states in the future, per NAHC. The association plans to lead a tour of Illinois to “publicize the damage pre-claim is doing to home care patients and providers in the state so that it can be brought to an end and not extended to anywhere else in the country.”

It’s all political at this point, with the last=concluded election and Congress on recess till November 14th, the Pre Claim Undermines Seniors’ Health (PUSH) Act (HR6226) has since been pending from the time the bill was introduced. Per Val Halamandaris, President of NAHC, this will be a “grueling case”. “Sometimes they think they can kick us around. They’re wrong. They need to understand that some of the toughest people you will come across are those who have devoted their lives to caring for the sick and the dying.” You got that right, Mr. Halamandaris. Let’s spread the word.

VT/CPRTV staff at the 22nd annual Chicago Filipino Asian American Hall of Fame gala night, from left to right, Teri Cruz, Janet Guinsatao, Lou Cabalona, James dela Cruz, Maria Girlie Pascual, Melody Dizon, Mar Lapena, and Ryan Tejero.

(1),Veronica, Emcees Girlie Pascual & Nick Vera Perez; (2)
Veronica and Committee Chairs Jovie Calma and Ryan Tejero.

From left to right: Elsa Castillo, Neneth Miranda and Amy Cheboub enjoying the line dance music of awardee Richie Gil.