By Caroline E. Mayer

Determine if you qualify financially

Washington state has prepared a guide to buying long-term care insurance

Don’t buy if the out-of-pocket cost for the coverage would be more than you can afford. Consumer Reports advises people that if their net worth, excluding their home, is below $300,000, long-term care insurance is not a good buy for them.

The National Association of Insurance Commissioners also recommends that consumers spend no more than 5 percent of their income on a long-term care policy.

If you need long-term care but have few financial resources, Medicaid should quickly kick in to pay, although that will probably limit your choices for care.

On the other hand, if you have a lot of resources (some financial advisers put that threshold at $2 million), you may be able to self-insure and pay the costs as they arise, thereby eliminating the need to buy a policy.

Shop around.

Unlike car insurance where you can switch carriers easily, it can be expensive to change long-term care policies because the premiums increase as you age and you lose the investments already made. Comparison shopping is critical.

Some companies and associations (such as alumni groups and AARP) offer group policies with relatively liberal eligibility, making it easier to obtain coverage if the policyholder has any health issues.

However, these policies may have more limited benefits than individually purchased plans.

If you are young or in excellent health, a group plan may also be more expensive; you may end up paying more to subsidize your less healthy peers.

And if you are certain you want LTC insurance, the younger you are, the better. Your annual premiums will be smaller, and you have less chance of being denied for health reasons.

Know what’s covered.

Policies differ greatly so know what you are buying:

• What services are covered?
• How long is the disability period before benefits kick in and what happens if you move from one facility to another?
• How much does the policy pay per day for nursing home care, home-health care and assisted living?
• How long will benefits last?
• Is there an inflation adjustment that anticipates rising medical costs as you age?
• How long are benefits extended (one, three or five years, or indefinitely)?
• Who determines benefit eligibility — your doctor, or the insurance company’s doctor — and on what basis?
• Are preexisting conditions excluded?
• Does the policy cover mental or nervous disorders, alcoholism, drug abuse or self-inflicted injuries?

The National Association of Insurance Commissioners advises consumers to look for policies that include at least one year of nursing home or home health care coverage, including intermediate and custodial care; coverage for Alzheimer’s disease; inflation protection; a guarantee that the policy cannot be terminated because you get older or your health deteriorates; no requirement that the beneficiary has to first be hospitalized to receive benefits and a 30-day cancellation period after purchase.

Check out the insurance company.

Review a carrier’s record with your state insurance commissioner’s office. Find out how long it has been in business its complaint record and history of raising rates. Stick with a company that has an A financial rating.

Also, the National Association of Insurance Commissioners and the American Association for Long-Term Care Insurance have consumer guides on their Web sites.

The Department of Health and Human Services provides extensive information on it’s website, longtermcare.gov.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

By Jenny Gold
This story was produced in collaboration with 

On a Monday night in December, Lauretta Martin, 47, visited the sleep lab at the National Rehabilitation Hospital in Washington, D.C. for the second time.

On her first visit, Martin, a heavyset woman whose husband reports she is a loud snorer, was diagnosed with sleep apnea. This time, she was being fitted for a CPAP machine, which helps keep a snorer’s airway open throughout the night.

The sleep lab has six testing rooms, each of which looks just like a room at a Holiday Inn, with striped wallpaper, a floral bedspread, framed prints of the seaside and free wifi.

“They have a brochure that says it’s just like being in a hotel room, and it is,” says Martin, sitting on the edge of her bed wearing a pair of soft grey pajamas and watching a football game on her flat-screen TV.

Aside from the two-dozen colorful electrodes taped to her body to monitor her every motion and the scuba-style mask on her face to enhance her breathing, she looked ready for a cozy night of slumber.

In the tech room a few doors down, a professional sleep technician observed her over a video monitor, testing the electrodes and preparing to listen in to the sounds of her sleep.

Snoring was once considered a simple annoyance for bed partners, but there is a growing awareness in the medical community that the grunts and snorts of noisy sleepers can also be a sign of sleep apnea, a condition shown to increase the risk of numerous serious illnesses, including heart disease, stroke and dementia.

Testing can be a lucrative business, and labs have popped up in free-standing clinics and hospitals across the country. Over the past decade, the number of accredited sleep labs that test for the disorder has quadrupled, according to the American Academy of Sleep Medicine (AASM).

Sleep apnea occurs when the muscles in the back of the throat relax, causing an airway obstruction that can stop a person’s breathing for several seconds or even minutes.  It causes restless sleep and sometimes dangerously-low blood oxygen levels.

The disorder can be diagnosed by monitoring a snorer’s sleep patterns, either in an overnight visit to a sleep lab or at home using a portable testing device. It is then often treated with a CPAP machine, which helps keep a snorer’s airway open during sleep.

Sleep apnea has likely gotten more common as the population has grown older and more obese, two major risk factors for apnea, and the National Institutes of Health estimates that more than 12 million Americans suffer from the disorder.  Many are never diagnosed.

“I think the medical community is sort of dropping the ball” on apnea, explains Dr. David Gross, medical director of the sleep lab at the National Rehabilitation Hospital. “It’s just sad when you walk through the hospital and you see these patients with heart failure—the person might be 35 years old, he’s 350 lbs — but no one’s thinking that he has sleep apnea, which he statistically does.”

Dr. David Gross, director of the sleep lab at the National Rehabilitation Hospital in Washington, D.C., analyzes a sleep test (Photo by Jenny Gold/KHN)

He says more than three-quarters of the patients who come to the lab are diagnosed with apnea.

But the testing isn’t cheap: each night at a hospital sleep lab can cost $1,900 and is usually mostly covered by a patient’s health insurance. Some patients, including Martin, end up spending two nights at the lab – one to test for apnea, and the second to try the CPAP machine.

Dr. Fred Holt, an expert on fraud and abuse and the medical director of Blue Cross Blue Shield in North Carolina, says some patients aren’t having basic exams done first and are therefore being prescribed expensive tests they don’t need. Not everyone who snores has a chronic disorder, he notes.

In other cases, Holt says the labs prescribe CPAP machines right away without first suggesting other strategies like losing weight of sleeping on your side, which can also reduce apnea.

“We are spending more and more money on sleep testing and treatment, and like anything else in health care, there are unscrupulous people out there who are more than happy to do testing and treatment that might be of questionable value,” says Holt. “This might be because of naiveté on the part of the physician, or unfortunately, it could be done for the sake of improving the cash flow of one’s business.”

It’s no secret that the sleep business can be lucrative for physicians. A website for Aviisha, a sleep testing company, has a section for physicians showing a picture of a doctor with a stack of money in his lab coat pocket.  And in February, the AASM is offering a seminar on the “business of sleep medicine for physicians” at a golf resort in Arizona.

Dr. Nancy Collop, president of the AASM, says that while many sleep centers offer comprehensive care for sleep disorders, others are largely focused on overnight sleep testing.

“A lot of people have gotten into the sleep business specifically to do that procedure,” she explains. The goal of the AASM’s accreditation process, she says, is to make sure sleep labs are offering more because “many patients may not even need a sleep study.”

Helen Darling, president of the National Business Group on Health, which represents large employers offering health insurance to their workers, says the tests are driving up the cost of premiums.

“This is a good example of something where we have technology, we have financial incentives to use more of it then we have historically done, you have enough problems including a growing obesity epidemic, and you sort of put together the so-called perfect storm for driving up overuse and health care cost,” Darling says.

She says doctors should focus instead on common-sense approaches to sleep apnea, like losing weight, before turning to expensive testing and medical devices.

Another option are home sleep tests, which costs less than a fifth of the cost of a lab test, and are considered effective for most patients. Medicare began paying for home sleep tests in 2008, but the tests have had only modest growth.

“I believe lab tests, as opposed to the home tests, are being wildly overprescribed,” says Mike Backus, senior vice president of American Imaging Management, a subsidiary of Wellpoint.

Right now, he says, 99 percent of the sleep tests given to Wellpoint patients are done in the lab, but “it should be 70 percent at home and 30 percent in the lab.”

Backus adds that the majority of patients who are diagnosed with apnea and then given CPAP machines stop using them within the first year.

Some insurers, including Wellpoint, are changing the way they pay for sleep testing to curb the costs. Many now require a special pre-authorization. They also ask the doctor whether a patient qualifies for a home sleep test instead of one at the lab.

Those changes are now widespread among Massachusetts insurers and are having an effect on the sleep industry in the state.

Dr. Lawrence Epstein, the chief medical officer of Sleep Healthcenters in Massachusetts, says the labs have already experienced a 20 percent drop in the number of patients coming in for testing.

While the past decade was focused on industry growth, he says it’s “now going to be about consolidation and provision of better quality, more efficient care.”

Sleep Healthcenters has shut down three of its 15 sleep labs, and more closures may be on the way. Epstein says the company is focusing more on “sleep wellness,” including treating and managing sleep disorders, and less on testing.

The key, he explains, is to become more efficient without decreasing access to care for patients who need it.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Zocalo Public Square: How Doctors Die

Photo: Hanspeter Klasser

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. … He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible.

Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little (Dr. Ken Murray, 11/30).

Photo courtesy of Hanspeter Klasser

Health Affairs: An MS Patient Loses Trust When She Finds Out Her Doctor Is Paid By Drug Companies’

Last year, four years after showing initial symptoms of multiple sclerosis (MS), I walked out the door of one neurologist’s office and, after several months of searching, switched to a different doctor.

It was the final act in a series of events that had gradually eroded my trust in the first neurologist’s judgment, which I believe was colored by his financial relationships with drug companies who manufacture and market medicines for MS patients. … Given my background in medical ethics, I was familiar with the potential conflicts of interest that exist for physicians participating in clinical pharmaceutical trials.

Assuming that my neurologist was being compensated for running the trial, in addition to his earnings from seeing patients in his neurology practice, I’d asked him if that was the case, and he confirmed that it was (Maran Wolston, December 2011).

The New Republic: More Health Care Heresy From Newt

Newt Gingrich

Newt Gingrich’s past endorsement of an individual mandate has drawn fire from conservatives. But that’s not his only health care heresy.

In 2008, Gingrich made the case for another idea that became part of Obamacare and, in due time, the focus of right-wing attacks.

Worse still, at least from the standpoint of conservatives, he did so by writing an op-ed for The New York Times. Oh, and did I mention he had some help? Gingrich had a co-author: John Kerry, the Democratic senator and former presidential nominee. … they also acknowledged that ultimately the private sector couldn’t solve this problem on its own.

More action was necessary, they said, and that action had to come from government … That’s the problem for Gingrich when it comes to improving the delivery of health care. He isn’t crazy. But plenty of influential conservatives are (Jonathan Cohn, 12/13).

Photo by Gage Skidmore

Newsweek: Could This Be The End Of Cancer?

By all rights, Shari Baker should have said her final goodbyes years ago. In 2005, more than a year after three doctors dismissed a lump under her arm as a harmless cyst, she was diagnosed with stage IV (metastatic) breast cancer … In May 2006, she traveled to the University of Washington.

The (cancer) vaccine was injected into her upper arm; she got five more shots over the next five months. Today, with scans detecting no cancer anywhere, Baker seems to have beaten some extremely stiff odds. …

By “cancer vaccine,” scientists mean something that will stimulate the immune system to attack malignant cells (Sharon Begley, 12/12).

The Atlantic: The Top 10 Health Stories Of 2011

Photo by Jean Scheijen

Coffee is good for you. And coffee is bad for you. Cell phones cause cancer. And cell phones don’t cause cancer.

Like any other year in health, 2011 was one of conflicting studies. In the end, we’re not always sure how to act or what to drink or when to exercise, but we do know more about ourselves and the world we live in thanks to researchers everywhere and the work that they do.

However broad or specific their conclusions, however small or large their sample size, medical studies do contribute to our wellbeing simply by existing and, if nothing else, by making us think twice about the things we eat, say, and do on a daily basis (Nicholas Jackson, 12/14).

Photo courtesy of Jean Scheijen

The Daily Show: Ed Gillespie

Jon Stewart talks health care with Republican political strategist Ed Gillespie (12/8).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Viewers will be able to watch a deep brain stimulation surgical procedure, accompanied by a live web chat led by Drs. Ryder Gwinn and Ron Young of the Swedish Neuroscience Institute.

Essential tremor is a common condition whose cause is unknown. It is more common in the elderly but can occur at any age. The tremor sometimes runs in families, in which case it is called familial tremor.

In some cases, essential tremor can occur with other brain and nervous system disorders, such parkinsonism.

Essential tremor usually consists of small, rapid movements that typically affect the hands but can also affect other parts of the body, including the head and face.

The shaking can cause serious disability, making it impossible, for example, to perform such simple tasks as writing and eating.

In deep brain stimulation surgery, an electrode is placed in part of the brain called the thalamus and then connected to a pacemaker-type device that is implanted under the skin.

When successful, electrical stimulation from the device stops the tremor. The pacemaker device can be turned on and off, as needed, by the patient with a hand-held magnet.

Viewers of tomorrow’s live stream will be able to submit questions about essential tremor and deep brain stimulation surgery and any other essential tremor treatment options, during the live stream using an embedded chat feature or via Twitter using the hashtag #SwedishDBS.

Dr. Jennifer Witt, a movement disorders neurologist with the institute, will also be joining the conversation to discuss the medical management of essential tremor.

WHEN:

Friday, Dec. 16, 2011, 9 a.m. to 12 p.m.

WHERE:

The webcast can be viewed online at www.Swedish.org/DBSLive.

Those interested may also join the conversation via Twitter by using the hash tag #SwedishDBS.

To learn more:

• Visit the National Institute for Neurological Diseases and Stroke’s webpage on tremor.

• Visit the National Library of Medicine’s Medline Plus page on deep brain stimulation.

Heather Kirkwood, a HPS patient who stars in the film and serves as Director of Outreach/VP for the HPS Network, will facilitate our discussion and take questions following the film.

When:

• Tuesday, December 13, 5:30 to 7:30 P.M.

Where:

• 415 Westlake at Kakáo Chocolate & Coffee, Seattle.

Cost: 

•  $10 at the door

Note: Attendance by RSVP

Click here to RSVP or call 206-957-3337×306,