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U.S. launches plan to prevent Alzheimer’s and improve care

KaiserHealthNews — Wed, 16 May 2012 16:20:35 +0000

By Christian Torres

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.

Weekend Reading: Why we’re losing the fight against obesity, the big profits of non-profit hospitals . . .

KaiserHealthNews — Sat, 12 May 2012 14:56:54 +0000

By Shefali S. Kulkarni

Every week, Kaiser Health News reporter Shefali S. Kulkarni selects interesting reading from around the Web.

ABC News: Early Burdens: Eldercare Falls on Young Shoulders

At 30, Suzette Armijo cares for her widowed 86-year-old grandmother, a retired National Park Service ranger in the final stages of Alzheimer’s disease, while holding down a fulltime job, a part-time job and raising a 4-year-old son. “This was nothing that I had planned for,” says Armijo, who moved her grandmother Elizabeth Armijo into a nearby six-bed assisted living home because veterans’ benefits “wouldn’t pay for her to live with me.” … Armijo is among a generation of young adult caregivers, the majority of whom are women, navigating tough turf without a roadmap. … As they try to tap into resources to help an ailing grandmother, Mom or Dad, these 20-somethings and 30-somethings are often on a lonely road (Jane E. Allen, 5/4).

The Atlantic: Can a Sense of Purpose Slow Alzheimer’s?

Medical professionals have also found correlations between a person’s sense of purpose and their physical health and survival. As far back as 1946, the Austrian psychiatrist Victor Frankl, who spent several years in concentration camps during WWII and lost his entire family in the Holocaust, found that the people who survived the concentration camps best were those who believed they had a reason, mission, or purpose that required their survival … [But now] it appears that a sense that your life has purpose, and that what you do matters, may actually protect your brain from the clinical effects of Alzheimer’s disease (Lane Wallace, 5/9).

Photo: PET scan by Jens Langner

Newsweek: Why The Campaign To Stop America’s Obesity Crisis Keeps Failing

Most of my favorite factoids about obesity are historical ones, and they don’t make it into the new, four-part HBO documentary on the subject, The Weight of the Nation. … the government efforts to curb obesity and diabetes avoid the all-too-apparent fact, as Hilde Bruch pointed out more than half a century ago, that exhorting obese people to eat less and exercise more doesn’t work, and that this shouldn’t be an indictment of their character but of the value of the advice (Gary Taubes, 5/7).

The Root: On Blacks And Fat: Will Allen

Obesity is more common in African Americans than in other ethnic groups. But when it comes to black people and weight, that’s where the agreement seems to end. Is food the culprit? Is exercise the solution? Is there even a real problem to begin with, or should we be focusing on health — or even self-acceptance — rather than the number on the scale? Against the backdrop of the first lady’s mission to slim down the nation’s kids, black celebs getting endorsements after shedding inches and a booming weight-loss industry, The Root will publish a series of interviews with medical professionals, activists and fitness enthusiasts that reveal the complexity of this issue and the range of approaches to it. For the fifth in the series, The Root talked to Will Allen, author of the Good Food Revolution: Growing Healthy Food, People and Communities (Jenée Desmond-Harris, 5/9).

Charlotte Observer: Nonprofit Hospitals Thrive On Profits
(5-part series/major investigation)

Hospitals in the Charlotte region have margins among the highest in the U.S. They also have billions in investments and real estate. Experts say they could do more to lower patients’ costs. …To understand what’s happening nationally, one need look no farther than Charlotte’s Dilworth neighborhood, where North Carolina’s largest hospital system got its start. Carolinas HealthCare System began in 1943 with a 325-bed hospital called Charlotte Memorial, which struggled financially for decades. Its leaders decided they needed to grow to survive. They built a system that could attract paying patients while continuing to care for the uninsured. It worked. Over the past 30 years, they have transformed it into a juggernaut (Ames Alexander, Karen Garloch and Joseph Neff, 4/21).

Medscape: New AMA Head on Membership, the ACA, and Medicine’s Future

Dr. [James] Madara: We support coverage for the uninsured; health insurance reforms, which include allowing children to remain their parents’ plans until age 26; and eliminating the lifetime cap on insurance policies. But, like any complex law, the Affordable Care Act is not perfect. For example, the Independent Payment Advisory Board, a nonelected board that could set Medicare pricing independently without accountability, is something we would not encourage (interviewed by Dr. John Reed, 5/9).

Medicare trustees predict funding will fall short by 2024 – updated

KaiserHealthNews — Mon, 23 Apr 2012 20:08:09 +0000

Trustees: Aging population, costs worsen Medicare’s long-term prognosis

By Marilyn Werber Serafini and Phil Galewitz
KHN Staff Writers

Trustees of the Medicare program today forecast increased financial troubles as a result of an aging population and rising health care costs, increasing the visibility of an issue that is already proving divisive in the 2012 presidential and Congressional campaigns.

“Both programs took a turn for the worse this year,” trustee Charles Blahous III, a senior research fellow at George Mason University in Virginia, said of Medicare and Social Security.

Treasury Secretary Tim Geithner discusses the trustee reports in Washington today, as Health and Human Services Secretary Kathleen Sebelius and trustee Charles Blahous listen (Photo by Win McNamee/Getty Images).

Overall, the outlook for the Medicare program which covers nearly 50 million elderly and disabled people was only slightly worse than findings from last year.

Once again, trustees forecast that Medicare’s hospital fund would begin to run out of money beginning in 2024, but many experts place little importance on the trustees’ projection since the program’s insolvency has been forecast from as little as two years away to as many as 28 years since 1970.

Today’s report emphasized that Medicare costs in both the short term and long term would rise higher than previously reported, but that these costs would be offset by 2 percent cuts to the program agreed to in last year’s deficit reduction agreement, unless Congress passes an alternative cost-cutting plan.

“The reported long-term financial outlook has grown worse,” said Robert Reischauer, a trustee and former Congressional Budget Office director, who recently stepped down as head of the Urban Institute.

This year, trustees said, the hospital fund will pay out $38 billion more in benefits than it collects in taxes and premiums from seniors and the disabled.

The trustees stressed the need to look beyond the exhaustion date for Medicare to the toll health care costs are already taking. “A more immediate issue is the growing burden that the programs places on the federal budget well before exhaustion of the trust funds,” the report said.

AARP Executive Vice President Nancy LeaMond said the report “underscore[s] the need for an open, national conversation focused on strengthening retirement security for today’s seniors and future generations.”

In a politically charged campaign season, however, both sides attempted to use the report to their advantage.

Treasury Secretary Tim Geithner, who is the program’s managing trustee, said the 2010 health care law had strengthened Medicare by beginning to rein in costs.

“One of the most important things we can do right now to preserve Medicare is to implement the Affordable Care Act fully and effectively.” Geithner said. “Still, more needs to be done.”

Hours before the release of the report, the Obama administration issued its own analysis, saying the health law would save over $200 billion in Medicare spending through 2016 and that beneficiaries in the traditional, government-run program would save nearly $60 billion through lower payments.

Those savings would come from ending extra payments to private health plans in Medicare, cracking down on fraud and “changing provider payment policies to reflect improvements in productivity,” according to the report from the Centers for Medicare and Medicaid Services.

Lanhee Chen, policy director for GOP presidential hopeful Mitt Romney, disputed such savings, however, saying the report shows the president “has no serious plan” to strengthen Medicare.

Tom Saving, professor of economics at Texas A&M University and a former trustee, and John Goodman, president of the National Center for Policy Analysis, a conservative think tank, also painted a more dire scenario.

The trustees must base their projections on current law, they said, but it is unrealistic to think that Congress will allow reductions to providers to stand in the long term, or that changes to reimbursements based on better performance and coordination of care will help much with costs.

“The financial picture will be worse than the trustees say,” said Saving. The health care law reduces Medicare payments to hospitals and other medical providers.

“For how many years can that happen before the pressure mounts to rescind them? These reimbursements are not sustainable, so eventually Congress will raise them,” he said.

Moreover, the trustees based their findings on demonstration projects in the law, and Goodman says there is no solid evidence that they will save money. “All this about pay-for-performance and coordinated care and integrated care, none of it is working,” said Goodman. “They are trying all this out, and there’s no reason to believe there will be large savings here.”

Medicare’s Chief Actuary Richard S. Foster also said he was skeptical that some projected savings, from provider cuts to improved productivity, would materialize.

The program’s two trustees who represent the public’s interest urged Washington lawmakers to address Medicare’s financial challenges soon to maximize options and allow ample time to phase in changes. “

Earlier action will also help elected officials minimize adverse impacts on vulnerable populations, including lower-income workers and people already dependent on program benefits,” said Reischauer and Blahous in a joint written statement.

KHN wants to hear from you: Contact Kaiser Health News

Medicare now covers annual depression screening

LocalHealthGuide — Sun, 08 Apr 2012 15:11:51 +0000

Bette Davis in The Little Foxes

By Michelle Andrews

Bette Davis, who had breast cancer and suffered a series of strokes before her death in 1989 at age 81, famously remarked that old age is not for sissies.

Many people assume that as health problems multiply and loved ones die, it’s inevitable that the elderly become depressed.

Not true, say experts. Older people have lower rates of depression than younger groups.

But depression often goes undiagnosed in the elderly, who feel the stigma of mental illness more acutely than younger people and are often less likely to seek help.

At the same time, older people are more likely to have multiple chronic conditions that consume their primary-care provider’s attention in the limited time available during a typical office visit.

The situation may be changing. In October, Medicare began to cover annual depression screening in primary-care settings with no cost sharing for beneficiaries.

Paying doctors to screen for depression — Medicare’s going rate is $17.36 per person — may well increase how often they do it, say experts.

“Doctors are trying to do the right thing, but how do you prioritize what to do in 21 minutes with a complex person?” asks Ken Duckworth, medical director for the National Alliance on Mental Illness, [www.nami.org] an advocacy group. “If they get paid for it, they structure it into their practices.”

Medicare covers 60 percent of the treatment for mental health problems, including depression. (Under a 2008 law, that figure is scheduled to rise to 80 percent in 2014.)

A Rapid Test

Most primary-care practices that screen for depression use a tool called the patient health questionnaire. The PHQ-9, as it’s called, asks people to describe how frequently during the past two weeks they have felt down or hopeless or taken little interest or pleasure in doing things. It also asks about sleep patterns, appetite and concentration, among other things. Although the test can be taken in just a few minutes, a 2001 study indicated it identifies depression and pinpoints its severity nearly 90 percent of the time.

Nearly 17 percent of people will have a major depressive disorder during their lifetimes, according to 2007 data from the National Comorbidity Survey of mental health disorders. For people 60 and older, however, the lifetime prevalence is much lower, 10.7 percent. “It’s the survivor factor,” says Michael Friedman, an adjunct associate professor at Columbia University’s schools of social work and public health. “You’re more likely to die young if you have depression.”

The lower figures don’t tell the whole story, say experts. Older people are much more likely to suffer from chronic conditions such as diabetes and heart disease, which can complicate diagnosis and treatment of both depression and other medical problems.

“Depression worsens the effect of other illnesses,” says Charles Nemeroff, a geriatric psychiatrist at the University of Miami. “People with depression are more vulnerable to [disease], and once it happens, it’s worse.”

People with depression often don’t take very good care of themselves. They don’t exercise or eat right. They don’t take their medications or get their blood work done to make sure their blood pressure, blood sugar and cholesterol levels are under control. And people with multiple chronic conditions probably take multiple medications that may interact with each other.

In addition, diabetes and heart disease can actually cause a late-life form of depression called vascular depression, which may occur when blood vessels harden, reducing blood flow to the brain.

All of these factors present a challenge for primary-care providers. There’s no point in screening for depression, after all, if you don’t have the resources to help people get the treatment they need.

An Encouraging Trial

Mental health experts point to a model called collaborative care as one that has shown good results. In one trial conducted at 14 primary-care clinics in Washington state, patients who had poorly controlled diabetes and/or heart disease as well as depression received help from a nurse to improve their efforts to control their diseases over a 12-month period.

The nurse worked closely with a psychiatrist, primary-care physician and psychologist to track patient progress and adjust medications as necessary.

Patients who received the intensive team approach showed significantly more improvement in both their depression and other medical conditions compared with patients who received usual care, according to a study published in the New England Journal of Medicine in December 2010 about the trial. Lead author Wayne Katon, a professor of psychiatry at the University of Washington School of Medicine, said the clinics saved an average of $600 per patient over a two-year period.

Most primary-care practices don’t provide that kind of comprehensive, coordinated care, Katon says.

But as policymakers and insurers increasingly offer incentives to primary care physicians to transform their practices into medical homes for their patients and reward providers for better disease control rather than simply running tests and doing procedures, the landscape should change.

Depressed people are more likely to receive diagnoses and be treated in primary-care settings than elsewhere. Research shows that elderly people, in fact, prefer to deal with their primary-care provider on mental health issues. In that context, coverage of depression screening may help more Medicare beneficiaries get the help they need.

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

We want to hear from you: Contact Kaiser Health News

Weekend Reading: A doctor and the right to die, med students shun primary care and other stories

KaiserHealthNews — Sat, 17 Mar 2012 13:00:55 +0000

Every week, KHN reporter Jessica Marcy selects interesting reads from around the Web.

Time: Peter Goodwin: The Dying Doctor’s Last Interview (Video)

Dr. Peter Goodwin, a family physician and right-to-die activist, took his own life on March 11, 2012, at age 83. He did it legally, with the blessing of his family and doctors, under the Oregon law allowing physician-assisted suicide — the first such law in the country — that Goodwin was instrumental in creating. … He did not look like a dying man; he was chirpy and alert … However, as a result of his fatal disease — a Parkinsons-like condition called coritcobasal degeneration — he could not use his right hand or do much reliably with his left. … “I can no longer eat in public,” Goodwin said. “My balance is gradually deteriorating. My three doctors agree that I’m within six months of dying. My attending physician has given me a prescription for medication to end my life and I have had it filled” (Belinda Luscombe, 3/14). – Subscription required to view the full interview.

The Atlantic: The Doctor Is Out: Young Talent Is Turning Away From Primary Care

Couple the lifestyle and the training experience with the huge debt burden that U.S. medical students accrue, and deciding on a hospitalist career becomes a rational choice. Dr. Wachter of UCSF compares hospital medicine to site-based specialties that came before it: emergency medicine and critical care. All of these specialties represent a convergence of high-complexity and high-cost care in a single location, where it makes sense to have well-trained specialists who handle the specific set of problems encountered there (John Henning Schumann, 3/14).

American Medical News: How Selling A Practice Kept It In The Family

For the past 30 years, Domingo Ngo, MD, has loved being a gastroenterologist owning a solo practice and the small, one-story building it occupies on a tree-lined street in Stuart, Fla. His wife, Josefina Ngo, RN, was the practice’s nurse. … If Dr. Ngo retired and was unable to find another physician to take his place, there was a chance it would have closed. He hoped it would be able to continue if his son (Benjamin Ngo, MD) joined him. They wanted to work together, but the son … didn’t want to be a solo-practice physician. … Dr. Domingo Ngo did what many other practices have done, or are considering doing — he contacted a local hospital to see whether it would buy the practice (Victoria Stagg Elliott, 3/12).

The Atlantic: Daddy Issues

Recently, a colleague at my radio station asked me, in the most cursory way, as we were waiting for the coffee to finish brewing, how I was. To my surprise, in a motion as automatic as the reflex of a mussel being poked, my body bent double and I heard myself screaming: “I WAAAAAAAANT MY FATHERRRRRR TO DIEEEEE!!!” … let us begin by considering A Bittersweet Season, by Jane Gross. A journalist for 29 years at The New York Times and the founder of a Times blog called The New Old Age, Gross is hardly Kafkaesque. An ultra-responsible daughter given to drawing up to-do lists for caregivers and pre-loosening caps on Snapple bottles, Gross undertook the care of her mother in as professional a way as possible. … What could go wrong? (Sandra Tsing Loh, March 2012).

AARP Bulletin: Hospitals May Be The Worst Place To Stay When You’re Sick

Today, more than a decade into the fight against medical errors, there’s little reason to believe the risks have declined substantially for the 37 million people hospitalized each year. In fact, recent studies suggest a problem that’s bigger and more complex than many had imagined. A report released in January on Medicare patients found that hospital staff did not report a whopping 86 percent of harms done to patients. If most errors that harm patients aren’t even reported, they can never be tracked or corrected (Katharine Greider, 3/1).

Columbia Journalism Review: Should Health Journos Use Hospital Safety Data?

In a highly touted effort to improve the quality of hospital care, the federal government has started disclosing data that ostensibly reveals which hospitals are best (and worst) at keeping their patients safe. But a few weeks ago, Kaiser Health News presented some not entirely unexpected news that turned conventional wisdom about patient safety data into, well, not-so-conventional wisdom. A piece by Jordan Rau raised serious questions about the efficacy of the federal government’s efforts to turn patients into savvy shoppers. The data, it seems, may not be ready for prime time. I rang up Rau, a veteran health journalist and an expert in these matters, for a Q and A to help all of us who may be tempted to use the data in ways we probably shouldn’t (Trudy Lieberman, 3/12).