The Obama administration is moving forward with an ambitious, fast-moving agenda to improve the treatment of Alzheimer’s disease and unlock a method to prevent it by 2025.

The final draft of the plan, released today, also sets up a wide-ranging effort to improve the care that Alzheimer’s patients receive and support families.

I am not alone – alzheimers.gov

As many as 5.1 million Americans are diagnosed with Alzheimer’s disease, and that number could more than double in the next few decades, said Health and Human Services Secretary Kathleen Sebelius when she unveiled the plan at a National Institutes of Health summit on Alzheimer’s-related research.

The majority of the plan’s expected funding – $130 million over the next two years – will go toward NIH research, but another $26 million will go toward Alzheimer’s care and public awareness.

Chief among those is a government website, alzheimers.gov, also launched Tuesday. The site serves as a “one-stop shop,” Sebelius said, for patients and their families.

It features information on Alzheimer’s diagnosis, caregiver support, insurance coverage and clinical trials for new treatments.

A radio, TV and print campaign will promote the site beginning this summer and encourage families to plan ahead for the care of their loved ones.

The site will also serve as a resource for health care providers, featuring up-to-date information on how to diagnose and treat Alzheimer’s.

Secretary Kathleen Sebelius

Sebelius noted that the health law requires Medicare providers to check patients for cognitive impairment during annual wellness visits, but it will be increasingly important for all providers to have guidelines for Alzheimer’s diagnosis and to look for signs of illness prior to age 65.

The online resources will complement several on-the-ground initiatives. Grants are being awarded this summer to educational centers that work with geriatricians, nurses and others to develop new curricula and training programs.

Sebelius said that the administration’s goal is to “improve the care, immediately, that people with the disease receive.”

In addition, the administration plans to evaluate how Alzheimer’s patients fare within new health care models, like the medical homes and accountable care organizations being promoted by the health law.

Reviews will focus on changes in patients’ cognitive function and on the efficiency of services provided. Work on that front is projected for completion by the end of this year.

It will take much longer, though, to find new treatments, or even a preventive treatment, for Alzheimer’s. NIH Director Francis Collins said Tuesday that study of the disease is “at an exceptional moment.”

He went on to announce two major research grants: one will evaluate a nasal spray that could improve patients’ brain function; the other will test a preventive medication among a large family in Colombia whose members have a genetic predisposition to Alzheimer’s.

Know where to turn: alzheimers.gov

The national plan for Alzheimer’s has been through several months of development since President Barack Obama signed the National Alzheimer’s Project Act in January 2011.

Funding, however, remains an issue. The administration announced in February it would devote $156 million over two years to the national plan.

Immediately, $50 million of already available NIH funds were transferred to Alzheimer’s-related projects. Another $80 million was requested as part of the president’s Fiscal Year 2013 budget, which has yet to be passed by Congress.

Much of the $26 million going toward Alzheimer’s care and awareness is also awaiting approval.

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.

Huffington Post: Women’s Health Care Is Stronger Thanks To The Health Care Law

In many families, women are the health care decision makers. When children go for their checkups, we are often the ones who make the appointment and sit in the room holding their hand. When elderly parents see a new specialist, we are the ones carrying the folder with all their health information. … In the past, this also meant that many women would take care of their own health last. By the time they got around to it, women found a system stacked against them. But thanks to the health care law, that’s changed (Kathleen Sebelius, 3/20).

The New Yorker: Holding Court

Late last year, a three-judge panel of the D.C. Circuit [Court of Appeals] voted, two to one, to uphold President Obama’s health-care reform, known as the Affordable Care Act (ACA). [Brett M.] Kavanaugh dissented, primarily on the ground that the lawsuit was premature. … “Under the Constitution,” Kavanaugh wrote, “the President may decline to enforce a statute that regulates private individuals when the President deems the statute unconstitutional, even if a court has held or would hold the statute constitutional.” … In other words, according to Kavanaugh, even if the Supreme Court upholds the law this spring, a President Santorum, say, could refuse to enforce ACA because he “deems” the law unconstitutional. That, to put the matter plainly, is not how it works (Jeffrey Toobin, 3/26).

Governing: What Will The Supreme Court Ask About Health Reform?

If the court decides to rule on the lawsuit, a decision is expected by the end of June before the conclusion of the court’s current session. That decision has heavy implications for states. The ACA includes an extensive expansion of Medicaid (expected to add up to 20 million people to the program’s rolls) and asks states to create a health insurance exchange where individuals and small businesses can compare and purchase insurance plans. Market reforms, such as rules for the medical loss ratios that insurance companies must maintain, would also require cooperation from state governments (Dylan Scott, 3/15). Photo: Franz Jantzen

The Atlantic: The Most Scientific Birth Is Often The Least Technological Birth

When I ask my medical students to describe their image of a woman who elects to birth with a midwife rather than with an obstetrician, they generally describe a woman who wears long cotton skirts, braids her hair, eats only organic vegan food, does yoga, and maybe drives a VW microbus. … Many medical students, like most American patients, confuse science and technology. They think that what it means to be a scientific doctor is to bring to bear the maximum amount of technology on any given patient. And this makes them dangerous. In fact, if you look at scientific studies of birth, you find over and over again that many technological interventions increase risk to the mother and child rather than decreasing it (Alice Dreger, 3/20).

TIME: Inside America’s Drug Shortage

Lynn Divers thought she had heard the worst of it when doctors told her that her daughter Alyssa had cancer. … Then came the truly heartbreaking news. In late February, when Divers called the hospital to confirm Alyssa’s upcoming chemotherapy treatment, the nurse informed her that there was a drug shortage. The hospital couldn’t be sure that there would be enough methotrexate — the cornerstone of therapy for some childhood cancers, including leukemia and osteosarcoma — to treat Alyssa, now 10. … How did this happen? How could hundreds, perhaps thousands of cancer patients suddenly find themselves without the drug treatments that could save their lives? (Alice Park, 3/19).

American Medical News: The ABCs Of Health Literacy

One in three patients has “basic” or “below basic” health literacy, meaning he or she struggles with tasks such as completing a health insurance application or understanding a short set of instructions about what liquids to avoid drinking before a medical test. This literacy gap has medical consequences. A wide body of research has found that patients with poor literacy skills have much worse health outcomes than patients who can read well. They make more medication or treatment errors, are less compliant and are 50% likelier to be hospitalized, says the National Patient Safety Foundation. Low-literacy patients with chronic diseases … rack up four times more in annual medical costs than patients with higher reading ability (Kevin B. O’Reilly, 3/19)

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.

Premium Rebates, Coverage Labels, Reduced Medicare Drug Costs Highlight 2012 Health Law Changes

By Michelle Andrews

Two years after its passage, the sweeping health care overhaul remains deeply controversial, with both political parties trying to use it to their advantage in the upcoming elections.

As GOP lawmakers constantly deride “Obamacare” and threaten to repeal it, it’s easy to forget that implementation marches on, and a number of notable changes will take effect for consumers this year.

They will, that is, unless the Supreme Court strikes down some or all of the law, including the requirement that nearly everyone have health insurance beginning in 2014.

If that happens, all bets are off. Provisions that have already taken effect — such as allowing adult children to remain on their parents’ health plans until age 26 and the 50 percent discount on brand-name drugs for seniors who reach the so-called donut hole in their prescription drug plans — could be rolled back, and provisions for 2012 cancelled.

The court will hear arguments in the case later this month and a decision is expected this summer.

If the law stands, here are the major new provisions that will affect consumers this year:

Free Contraception Coverage

Starting in August, the Obama administration’s new rules on contraceptive coverage that have generated such controversy take effect.

That means that women in a new health plan or in an existing one that has changed its benefits enough to not be considered grandfathered under the law will be able to receive contraceptives without an out-of-pocket charge.

In addition, these plans will have to provide a variety of basic women’s health services, including well-woman visits; screening for gestational diabetes; HPV testing; counseling for sexually transmitted infections; counseling and screening for HIV; and screening and counseling for interpersonal and domestic violence.

Religious employers such as churches are exempt from the new requirement. Colleges, hospitals and other employers that are affiliated with religious institutions are not exempt, but employees at those institutions will receive free contraceptive services from their employer’s insurer.

Religiously affiliated employers have a one-year grace period to implement this change, so some employees may not receive the free benefit until August 2013.

Rebates For Consumers

Under the health-care overhaul, insurers have to spend at least 80 to 85 percent of premium revenues on medical claims and quality improvement or else rebate the difference to policyholders. In most group plans, that would mean the employer.

How much consumers can expect to receive remains an open question. An analysis by the National Association of Insurance Commissioners based on 2010 data estimated that insurers would have returned $2 billion to consumers had the provision been in force then.

The analysis said rebates would have gone to 53 percent of people in individual plans, 23 percent in small-group plans and 15 percent of large-group plan members.

In December, the Obama administration estimated that 9 million Americans might receive rebates totaling up to $1.4 billion, also based on 2010 data. The administration says some reports show insurers have been moderating their premium increases to avoid having to pay rebates. But other policy experts aren’t so sure.

“My guess is that rebates will be higher [than the NAIC estimate] in 2011,” says Timothy Jost, a law professor at Washington and Lee University who helped prepare the NAIC report. “Insurers seem to have raised their premiums based on projected increases in utilization that never occurred.”

Clearer Descriptions

Beginning in September, at the start of the open enrollment season, all health plans will have to provide concise, consistent plan information aimed at allowing consumers to easily understand their benefits and compare plans.

Every plan will be required to give people a short summary of coverage and a uniform glossary of terms. It will also have to provide examples of how much the plan would cover if someone had a baby or was managing Type 2 diabetes — two common situations that should make it easier for people to compare plans.

“This is a big deal,” says Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation. “Some of the materials people get explaining their health plan benefits are extraordinarily confusing, and this should make it clearer.” (Kaiser Health News is an editorially independent project of the Foundation.)

Shrinking Doughnut Hole

The health care overhaul is slowly eliminating the doughnut hole. This is the break in Medicare prescription drug benefits that, in a standard plan, begins after total drug spending by the beneficiary and the health plan exceeds $2,930 and continues until the beneficiary has hit the $4,700 out-of-pocket limit.

Last year, Medicare beneficiaries with high drug costs got a 50 percent discount on brand-name drugs once they reached the doughnut hole. This year, they’ll see a 14 percent discount on generic drugs as well.

Drug costs will continue to diminish in coming years, until in 2020 the doughnut hole no longer exists and Medicare beneficiaries with drug plans will simply be responsible for 25 percent of their drug costs.

‘Accountable Care’

Last December, the administration announced that 32 health-care organizations would participate in a three-year Pioneer Accountable Care Organization program aimed at providing better, coordinated care for 860,000 Medicare beneficiaries.

Providers — including hospitals, clinics and physician groups — that work together to improve beneficiaries’ health and to bring costs down will share in the savings that they achieve.

Although Medicare beneficiaries may not realize that their health-care provider is participating in the program, they may start to notice changes in their care this year, says Debra Ness, president of the National Partnership for Women and Families.

She leads the Campaign for Better Care, a coalition of organizations focusing on improving health-care delivery.

“For some of these folks, it may start to feel like they have a team working with them, or like their primary-care provider is developing an individualized care plan,” she says. “Compared to what happens now, it could feel like a pretty big change.”

Please send questions or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.

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.

Mother Jones: Santorum In ’93: More Government Needed in Health Care

Rick Santorum (Photo: Gage Skidmore)

If elected president, Santorum vows, he will end the “tyranny” of President Obama’s Affordable Care Act. Yet as an up-and-coming congressman in the early 1990s, Santorum took a much different line. Then—like now—health care was one of the nation’s most divisive issues. In 1993, Republicans were up in arms about a health care reform bill spearheaded by Hillary Clinton and pushed by President Bill Clinton. … During that fiery debate, Santorum said it would be a mistake to allow the delivery of health care services to be determined only by the market. He asserted that Republicans were “wrong” to let the marketplace decide how health care works. He instead argued that government should play a “proactive” role in shaping the health care marketplace “to make it work better” (Andy Kroll and Tim Murphy, 3/5).

The Atlantic: Making The Best Of What Is Often The Very Worst Time Of Our Lives (Book Excerpt)

As difficult as things are now, these may turn out to be the good old days. How we die is already a public health crisis, and care for people through the end of life is poised to become a generation-long social catastrophe. … Very soon, for the first time in human history, older people will outnumber younger people on our planet. In the United States, one in five adults is 65 or older. … Those of us who are concerned about long-term care have good reasons to worry. The nursing homes of the future — our future! — may make today’s nursing homes look like luxury hotels. It doesn’t have to turn out that way (Ira Byock, 3/7).

American Medical News: Legal Risks Of Going Paperless

System breaches. Modification allegations. E-discovery demands. These issues are becoming common courtroom themes as physicians transition from paper to EMRs, legal experts say. Not only are EMRs becoming part of medical negligence lawsuits, they are creating additional liability. … Studies are mixed about how EMRs will impact liability for physicians. … Whatever the future holds for EMRs, it’s important that doctors reduce their liability risks during system implementation, legal experts say. Being aware of potential legal pitfalls prevents doctors from falling victim to technology intended to do good — not cause hardship (Alicia Gallegos, 3/5).

The Daily Beast: Talking About Sex Is the Only Way To Stop HIV

[The United States has] been stuck at about 50,000 new infections each year for more than a decade. Compared with the challenges facing places like sub-Saharan Africa, our failure is particularly galling: we have plenty of drugs that work, the money and systems to administer them, and effective, if not particularly popular, ways to interrupt the spread (condoms, clean needles, abstinence). So why aren’t we doing better? The answer is blindingly simple: sex. Almost all HIV in the U.S. is spread by sexual intercourse, yet when faced with this fact, we act like a bumbling junior-high-school kid hearing about the birds and the bees for the first time. As a result, we have before us an unabated 30-year epidemic of a sexually transmitted disease (Kent Sepkowitz, 3/5).

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 Mary Agnes Carey
KHN Staff Writer

Now that Congress has passed legislation to avert drastic payment cuts to physicians who treat Medicare patients, attention is turning to what will happen when the temporary solution expires at the end of this year.

For doctors, the nail-biter has become a familiar but frustrating rite. Lawmakers invariably defer the cuts prescribed by a 1997 reimbursement formula, which everyone agrees is broken beyond repair. But the deferrals are always temporary. In 2010, Congress delayed scheduled cuts five times, with the longest patch lasting one year.

While Democratic and Republican leaders say they do not want Medicare physicians’ payments to be cut, there is often disagreement about how to offset the costs of a fix.

With the clock already ticking to the next deadline – Dec. 31, 2012 — we thought we would provide some answers to frequently-asked questions about the doc fix.

Q: How did this become an issue?

Today’s problem is a result of yesterday’s budget panacea – a 1997 deficit reduction law that called for setting Medicare physician payment rates through a formula based on economic growth and known as the “sustainable growth rate” (SGR).

For the first few years, Medicare expenditures did not exceed the target and doctors received modest pay increases. But in 2002, doctors reacted with fury when they came in for a 4.8 percent pay cut.

Every year since, Congress has staved off the scheduled cuts. But each deferral just increased the size – and price tag – of the fix needed the next time.

The formula also reinforces what many experts say are some of the worst aspects of the current fee-for-service system – rewarding doctors for providing more tests, more procedures and more visits, rather than for better, more effective care.

In an Oct. 14 letter to lawmakers, the Medicare Payment Advisory Commission (MedPAC), which advises lawmakers on Medicare payments, called the formula “fundamentally flawed” and said it “has failed to restrain volume growth and, in fact, may have exacerbated it.”

Q. Why don’t lawmakers simply eliminate the formula?

Money is the biggest problem. It would cost about $316 billion to stop the doc fix cuts over the next decade and Congress can’t agree on where to find that kind of cash.

For physicians, the prospect of facing big payment cuts is a source of mounting frustration. Some say the uncertainty led them to quit the program, while others are threatening to do so.

Still, defections have not been significant to date, according to MedPAC. Physician groups continue to lobby Congress to enact a permanent payment fix.

The deal Congress just passed would stop a 27 percent pay cut scheduled to begin March 1 but did not raise the level of Medicare reimbursement to physicians.

Q: What do experts recommend?

Last October, MedPAC recommended eliminating the formula without increasing the deficit by cutting fees for specialists and imposing a 10-year freeze on rates for primary care physicians. That proposal was strongly opposed by health industry groups, as well as the American Medical Association (AMA).

The AMA has recommended a five-year transition fee scale that allows time to test new payment approaches, including several being tested as part of the 2010 health care law.

Several other options have been offered to fix the reimbursement scheme, including proposals by Rep. Allyson Schwartz, D-Pa., and the White House, but none has generated strong bipartisan interest.

Q: What happens next?

The current fix expires on Dec. 31 but lawmakers aren’t expected to have any serious discussions about what to do next until after the November elections. So the “doc fix” is likely to be considered in a lame duck session of Congress later this year.

Proponents of using money saved from winding down the wars in Iraq and Afghanistan to finance a permanent fix are likely to push for that again. While the idea has found favor among Democrats, many Republicans oppose it.

Lawmakers may also turn to ideas they’ve used before to fund another short-term fix, such as reducing Medicare payment rates to hospitals, nursing homes and other providers.

Carol Eisenberg and Lexie Verdon contributed to this report.

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.