In Need of Psychiatric Care, and Resisting - The New Old Age Blog - NYTimes.com

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By Paula Span

The patient showed symptoms of severe depression. She hallucinated, seeing her dead father across her room. Her family was having trouble taking care of her.

Dr. Cornelia Cremens, the psychiatrist who saw the woman at Massachusetts General Hospital, suggested an evaluation at McLean Hospital — which as everyone in Boston (and anyone who read “Girl, Interrupted”) knows is a psychiatric facility.

“I could never go there,” the woman objected, appalled. “If anybody found out, I’d be stigmatized for the rest of my life.”

She was 98.
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Grant program announced for services that help older adults | Healthcare Finance News

Up to six one-year grants, worth $500,000 each, will be made to organizations successfully proposing programs that directly benefit older adults.

The grant will be issued by the Aokland, Calif.-based Center for Technology and Aging, which has released application guidelines for the Medication Optimization Diffusion Grants Program. Four or five of the grants will be used to benefit California seniors, while one or two grants may be issued to organizations in other parts of the country.

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Medical News: Docs Feel Stress When Patients Can't Make Own Decisions - in Geriatrics, General Geriatrics from MedPage Today

Aging and Seeking Work in South Korea - NYTimes.com

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By SU-HYUN LEE

SEOUL — At the Coex Convention Center in southern Seoul, a site best known for sleek business exhibitions, Kang Dal-soo, 76, joined the rush to check out the “silver job fair” offering 2,000 private-sector and 4,700 public -sector jobs for retirees.

“It seems I need to learn text-messaging in order to deliver flowers,” Mr. Kang said anxiously after an interview at a courier company’s booth. He wanted to work — even though flower delivery was not his ideal career — but he was worried about having to master a new technology at his age and wondered if he would be able to keep the job even if he got it.

Silver job fairs, established to find jobs for people aged 60 and over, have mushroomed across South Korea in the past year as part of a government effort to assist a rapidly growing population of older Koreans adrift in a changing society.

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The Long Term Living Training Institute of Pennsylvania: Adult Protective Services Collaboration

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September 9, 2009. Boston, MA. In July, 2009, the Institute for Geriatric Social Work (IGSW) at Boston University School of Social Work developed a collaboration with the Long Term Living Training Institute of Pennsylvania and the Pennsylvania Association of Area Agencies on Aging (P4A) to enrich the training of Adult Protective Services (APS) staff across the Commonwealth of Pennsylvania. The training program enables over 2000 APS workers who are located in the 52 Area Agencies on Aging to choose from a course list comprised of the following online courses: Elder Abuse: Clinical Issues Elder Abuse: Policy and the Law Advocacy and Aging Ethics (available February, 2010) Legal Issues in Aging Mental Health and Aging Issues Compulsive Hoarding in Older Adults IGSW's online courses have been shown to be effective for busy professionals, providing convenient, focused training that maximizes the transfer of practice skills and practice-relevant knowledge. Participants can access the training 24/7 from any computer with Internet access, and complete the courses at their own pace. The Institute for Geriatric Social Work (IGSW) at Boston University is dedicated to strengthening the workforce for an aging society through educational innovation. IGSW was established in 2002 with funding from the Atlantic Philanthropies. Website: http://www.bu.edu/igsw

New York City Candidates Beat a Path to Senior Centers - NYTimes.com

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By JULIE BOSMAN
Published: September 11, 2009

At the busy Hamilton Senior Center in Manhattan on Wednesday, there was belly dancing in the morning, strength training in the afternoon and, in between, a visit from yet another politician.
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Gertrude Baines, Oldest Woman in World, Dies at 115 - Obituary (Obit) - NYTimes.com

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LOS ANGELES (AP) — Gertrude Baines, who lived to be the world’s oldest known living person on a steady diet of crispy bacon, fried chicken and ice cream, died here Friday. She was 115.
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TIME GOES BY | REFLECTIONS: Health Care

Pulitzer Prize-winning journalist Saul Friedman (bio) writes the bi-weekly Reflections column for Time Goes By in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation. He also publishes a weekly column, Gray Matters, on aging for Newsday.

In the kind of journalism I have practiced these 50 years, after my by-line, I have mostly stayed out of the story. I don’t much care for celebrity journalists who make themselves the story; they tend to become entertainers who don’t entertain.

But I will make an exception here, not to entertain, but to talk about my own health problems and care. And because I am 80, I think my experiences give me some credibility. I’ll get to that later, but along with my years of expertise gathered from writing my column on issues affecting older people, perhaps I can dispel some of the idiotic notions about the health care debate, most of which come from younger people who are grinding axes for the insurance or drug companies, or who are just plain ignorant and believe they will never get sick or old. What is outrageous is that supposedly responsible Republicans remain silent amid the insanity of the kooks.

I don’t think most older people fell for those “death panel” lies. That came from right-wing nuts who are as young as they are ignorant and Republican members of Congress who would just as soon kill Medicare and Social Security, which would kill more of the old. Most older people are not afraid of talking about and planning for their incapacity or death or that of a loved one.

It’s common for hospitals and doctors to ask for and demand to have in their files, a patient’s living will and/or an advance directive. In my late sister-in-law’s community for older people, most of the residents had “DNRs” (Do Not Resuscitate) tacked to their refrigerators in the event they could not speak for themselves.

Most older people I know also have designated friends or children as health care proxies. Most forms for these documents are available online or for little cost. My living will and most others tells doctors and relatives when to pull the plug. Unfortunately, many doctors and relatives are reluctant to have such a responsibility.

Many older people have consulted with and paid good money to lawyers for these end-of-life documents. In one of the health care bills, they could instead consult their physician. Who but ignorant trouble-makers would object and make a death conspiracy out of a section in one of the health care proposals that would authorize Medicare to pay a doctor $75 once every five years to give some advice on these documents and the possible choices? Is the doctor going to order your death for $75?

Who but some ignorant fool would deny a person the information that if he/she or a loved one is suffering from a painful, perhaps terminal illness that hospice or palliative care would be available to deal with pain and suffering?

Did you know that Medicare pioneered in paying for the help of hospice and palliative care for the terminally ill, forcing most insurers to offer the same benefit? Did you know that if you defeat the terminal illness and live, you can get off hospice care without having to give the money back?

But I’ve gotten ahead of myself. Time magazine, among others, report that older people are surprisingly hostile to what has been wrongfully called “Obamacare.” And many have split with AARP because of its seeming support for the reforms. But I believe that’s because President Obama and the AARP went too long before making it clear what precisely they are for in health reform.

The president’s speech to a joint session of the Congress was typically superb, in setting out his proposals for reforming health insurance. But it’s not simply the health insurance industry that needs reforming; I doubt that’s possible. It’s health care that needs a radical overhaul.

On the morning after his speech, I heard a Michigan woman calling in on a Washington, D.C. radio show. Her insurance premium from Blue Cross/Blue Shield for her family of three was going up 33 percent from $1,000 a month because, she said, “the insurance company was going to be forced to cover pre-existing conditions.” Does anyone believe the insurance industry will agree to lower profits and executive salaries?

What remains on the table, despite Obama’s words, are cumbersome, top-heavy confusing sausages called health care reform ground out by five different committees. Obama made a strong case for liberal, activist government, but a weaker case for a non-profit activist government plan among the insurance choices.

I still don’t know what the president will fight for. Obama has already made unseemly deals with drug companies that will allow them continued profits and power. And the president rarely mentions that what he calls reforms won’t go in effect until 2013 or as late as 2023. Medicare went into effect 11 months after its passage.

As this site has said many times, Medicare for All, which gradually covered all Americans would have been the simplest, most straightforward health care reform. But Obama has said he feared the consequences for the insurance industry and charges of a government take over of health care. But everything I’ve read indicates that most people (and businesses) would give up paying through the nose for their shaky insurance if they had a chance to sign up for Medicare.

I will wager that if Americans were told that health care reform would give them the deal I have - original Medicare plus a private plan – things would be less confusing all around. Ronald Reagan was smart enough to leave Medicare alone, years after denouncing it as socialistic. Even the rabid right would have a more difficult time attacking Medicare as government control of health care. It is. And too many older people and their kids know it and like it.

I always thought it was a mistake to call the reform I favor “single-payer.” Why not call it after one of the most popular health insurance programs we have – “Medicare For All?” I was calling it that in my column as early as a dozen years ago. And Dr. Marcia Angell, then editor of the New England Journal of Medicine, has for years called for the gradual inclusion of all Americans into Medicare.

As I wrote, Medicare’s finances would be enhanced by enlarging and strengthening the risk pool with younger, healthier people (paying taxes and premiums). Otherwise Medicare could die of old age. And that would be a tragedy.

That possibility (if the wingnuts get their chance) and my hope for Medicare For All, brings me to my personal history with health care and Medicare, for I was fortunate to be struck with serious, life-threatening problems after I became eligible for Medicare, which meant I never had to check first to see if I was covered.

On the eve of April Fool’s Day, 2003, just as I had finished a column and was playing solitaire, my right hand suddenly lost control of the mouse. A call to 911, a trip to the emergency room and by morning I had had a partly paralyzing stroke affecting my right side and my speech. Fortunately it was not worse.

I had eight weeks of intensive rehabilitation at a top hospital and was permitted to stay another several weeks because my wife, during one of her frequent trips to and from the hospital, had a serious auto accident and was herself hospitalized.

To sum up: Medicare paid for all our medical bills, supplemented by my wife’s secondary insurance, similar to what is available to all federal employees including members of Congress. Indeed, a range of choices similar to the Federal Employees Health Benefits are what would be offered in one of the bills pending in Congress.

On Valentine’s Day, 2005, came another blow: I was diagnosed with esophageal cancer in its early, curable stage. But here was my initial fear: Would the best surgeon at Johns Hopkins Medical Center take on a Medicare patient in his seventies who was partly paralyzed by a stroke?

I learned, to my relief, that the young surgeon, Dr. Stephen Yang, specialized in cases involving older people. There was no question that Medicare would cover the radiation, the chemotherapy, the 12 hours of surgery, the follow-up surgery and every checkup since.

Contrast that with the private Medicare Advantage policies that can nickel and dime you to death even though they make great profits and get $10 billion a year in subsidies from you and me. I reported on a recent position paper by UnitedHealth, recommending that Medicare could save money if patients shop for less expensive care, or consider alternatives to surgery for certain cancers at certain ages.

Rationing, of course, is what helps private insurers earn profits and pay high salaries for their CEOs. Never has Medicare told me, “You’re too old.”

One of the several health care proposals before the Congress comes closest to Medicare for All. It was approved by the Democratic majority on the Senate Health, Education, Labor and Pensions Committee (HELP) without a single Republican vote. It was Senator Edward Kennedy’s bill.

Why didn’t Barack Obama put his actions where his fine words were and tell the Democratic Congress to pass the Kennedy bill?



TIME GOES BY | REFLECTIONS: Health Care

Statement from Karen Davis: New Census Data on Uninsured Americans - The Commonwealth Fund

Today, the Census Bureau released the latest data on the number of Americans without health insurance. The number of uninsured individuals rose from 45.7 million in 2007 to 46.3 million in 2008. This increase of 0.6 million would have been much worse without a growth in government-provided insurance of 4.4 million, including a 3.0 million increase in coverage under Medicaid. In contrast, employment-based coverage declined by about 1.1 million, from 177.4 million in 2007 to 176.3 million in 2008.

Today's data release shows the importance of the nation's safety net insurance system--Medicaid and the Children's Health Insurance Program (CHIP). The major bright spot in these new data was the fact that the rate of uninsured children is at its lowest rate since 1987 – at 9.9 percent. This improvement was a reflection of increased coverage for children under government health insurance programs, which rose from 31.0 percent in 2007 to 33.2 percent in 2008. However, more than 7.3 million children remain uninsured, which highlights the importance of the reauthorization and expansion of the CHIP program to 4 million more uninsured low-income children earlier this year.

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Upcoming Medicare Change is an Opportunity to Enroll Eligible Low-Income Seniors in Food Stamps — Center on Budget and Policy Priorities

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The Medicare Part D Low-Income Drug Subsidy (LIS), Medicare Savings Programs (MSPs), and Food Stamps[1] can play important roles in improving the health and well-being of low-income seniors and people with disabilities. Together, these programs can provide several thousand dollars a year in benefits and can significantly increase a low-income Medicare beneficiary’s ability to make ends meet.

Unfortunately, all three programs suffer from very low participation rates among Medicare beneficiaries who are low-income, but not so poor that they qualify for Supplemental Security Income (SSI) and Medicaid. Many low-income Medicare beneficiaries do not know that they can qualify and receive substantial benefits from these programs. For others, the complexity of the eligibility rules and difficulties in enrolling, the differences between program requirements, or the stigma associated with seeking help all serve as barriers.

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Statement: Greenstein on Census’ 2008 Health Insurance and Poverty Data — Center on Budget and Policy Priorities

Today’s grim Census Bureau report shows the nation lost substantial ground in 2008 on poverty, median income, and the number of people who are uninsured. Several aspects of the Census report stand out.

The number of people living in poverty jumped by 2.6 million to 39.8 million — the highest since 1960. The poverty rate — the percentage of people living in poverty — also rose, to 13.2 percent, which is its highest level since 1997. Similarly, real median household income fell by $1,860 to $50,303, its lowest level since 1997.

These figures are particularly grim because they come after the disappointing record of the 2001-2007 expansion. Poverty was actually higher — and median income for working-age households lower — at the end of that expansion than during the 2001 recession. Such a dismal record during an expansion has never occurred before, since the nation began collecting these data.

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Podcast: Examining the New 2008 Census Data on Poverty, Income, and Health Insurance Coverage — Center on Budget and Policy Priorities

Robert Greenstein discusses the grim Census Bureau data that shows the nation lost substantial ground in 2008 on poverty, median income, and the number of people who are uninsured. Several aspects of the Census report are highlighted.

Listen to Podcast (11:59)

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Private Health Coverage Declined, Became Less Secure in 2008 — Center on Budget and Policy Priorities

The Census Bureau reported today that 46.3 million U.S. residents lacked health insurance in 2008, an increase of 632,000 over the previous year. [1] Nearly 6.6 million more people were uninsured in 2008 than in 2001, when the previous recession hit bottom. The proportion of the population without health insurance climbed to 15.4 percent in 2008, slightly above (but not statistically different from) the 15.3 percent rate in 2007 and considerably above the 14.1 percent figure in 2001.

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Reforming Long-Term Care in the United States: Findings from a National Survey of Specialists - The Commonwealth Fund

Synopsis

Long-term care specialists—including consumer advocates, providers, public officials, and policy experts—who participated in a national survey generally agreed on the need for long-term care reform. Despite some differences, key constituent groups supported the establishment of government-sponsored financing strategies, a shift toward home- and community-based care, offering payment incentives to improve quality, and more effective regulation of nursing homes, home health care agencies, and assisted living facilities.

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September is Recovery Month

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Updated Poverty Data

US Census Bureau
Poverty: 2008


Highlights

The data presented here are from the Current Population Survey (CPS), 2009 Annual Social and Economic Supplement (ASEC), the source of official poverty estimates. The CPS ASEC is a sample survey of approximately 100,000 household nationwide. These data reflect conditions in calendar year 2008.
Highlights

* The official poverty rate in 2008 was 13.2 percent, up from 12.5 percent in 2007. This was the first statistically significant annual increase in the poverty rate since 2004, when poverty increased to 12.7 percent from 12.5 percent in 2003.
* In 2008, 39.8 million people were in poverty, up from 37.3 million in 2007 -- the second consecutive annual increase in the number of people in poverty.
* In 2008, the poverty rate increased for non-Hispanic Whites (8.6 percent in 2008 -- up from 8.2 percent in 2007), Asians (11.8 percent in 2008 -- up from 10.2 percent in 2007) and Hispanics (23.2 percent in 2008 -- up from 21.5 percent in 2007). Poverty rates in 2008 were statistically unchanged for Blacks (24.7 percent).
* The poverty rate in 2008 (13.2 percent) was the highest poverty rate since 1997 but was 9.2 percentage points lower than in 1959, the first year for which poverty estimates are available.
* Since 1960, the number of people below poverty has not exceeded the 2008 figure of 39.8 million people.[1]
* The poverty rate increased for children under 18 years old (19.0 percent in 2008 -- up from 18.0 percent in 2007) and people 18 to 64 years old (11.7 percent in 2008 -- up from 10.9 percent in 2007), while it remained statistically unchanged for people 65 years and over (9.7 percent).[2]

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HHS and USDA Unveil New Food Safety Consumer Web Site at www.foodsafety.gov

Health and Human Services (HHS) Secretary Kathleen Sebelius and Agriculture (USDA) Secretary Tom Vilsack, the co-chairs of the Obama Administration's Food Safety Working Group, unveiled a new consumer Web site today at www.foodsafety.gov. The site is designed to help consumers and families get all the latest information on food safety and food recalls in one convenient place.

The new site will feature information from all the agencies across the federal government that deal with critical food and food safety information, including preventive tips about how to handle food safely, alerts on life-saving food recalls, and the latest news from the key agencies.

Consumers can sign up in one easy place to receive email and RSS alerts on recalled or potentially unsafe food and hear from the top scientific experts across the government on food safety. Later phases of the site to be launched will include recall feeds for texting and mobile phones. The site will also feature a foodsafety.gov widget that the public and the media are encouraged to download and promote on their Web sites and social networking sites. The widget will instantly update viewers with the latest food safety recalls and will be a valuable public health and safety tool.

Leaders from HHS and USDA praised the new site and said it would be a valuable tool in their efforts to keep our food supply safe and consumers healthy.

"The highest mission of any government is keeping its citizens safe. In this administration, we see public health as an essential part of that mission and this new website as an essential way we will can help keep people safe from unhealthy food and food handling practices and up-to-date on critical food recalls," Secretary Sebelius said. "Consumers no longer will have to search around in different places trying to figure out which agency manages which food product. All the information that they will need will be one easy place at foodsafety.gov."

"Protecting the health and well-being of the American people is a fundamental responsibility of the federal government. Our new and innovative approach to connecting consumers to food safety information in an easy and timely manner is a critical improvement in this effort," said Agriculture Secretary Tom Vilsack.

"This site focuses on prevention by highlighting the steps both businesses and consumers can take to avoid illness," said Food and Drug (FDA) Commissioner Margaret Hamburg. "It also will be a clearinghouse for information on the latest FDA rules and guidance."

"Health departments and the Centers for Disease Control and Prevention (CDC) rely on information from many places, including consumers, when it comes to tracking food-borne illnesses across the country and the world," said CDC Director Dr. Tom Frieden. "With this new Web site, consumers will quickly know who to contact if they believe they became ill from eating a certain food. Those reports of illness can help us identify potential outbreaks sooner and strengthen our efforts to protect Americans from unsafe food and food-borne illness."

"Protecting the American people from food-borne illness is a critical mission of the U.S. Department of Agriculture. Our work is designed to prevent outbreaks of food borne illness from occurring and to react quickly and decisively to contamination in the food supply," said Jerry Mande, Deputy Under Secretary for Food Safety at USDA. "The new foodsafety.gov site will provide families with a one-stop online shop for all the latest information they need to reduce the danger of food-borne illnesses."

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National Planning Grants and Indian Tribes Planning Grants

National Planning Grants Public or private nonprofit organizations, including labor organizations; faith-based and other community organizations; institutions of higher education; government entities within states or territories (e.g., cities, counties); Indian Tribes; or partnerships or consortia operating in more than one state are eligible. Community-based organizations, including faith-based organizations and intermediary organizations operating in more than one state are encouraged to apply for planning grants. Indian Tribes Planning Grants Indian Tribes are eligible to apply. Indian Tribe is defined as a federally recognized Indian Tribe, band, nation, or other organized group or community, including any Native village, Regional Corporation, or Village Corporation, as defined under the Alaska Native Claims Settlement Act (43 U.S.C. § 1602), that the United States Government determines is eligible for special programs and services provided under federal law to Indians because of their status as Indians. Indian Tribes also include tribal organizations controlled, sanctioned, or chartered by one of the entities described above.

The purpose of planning grants is to support the development of AmeriCorps programs so applicants are better prepared to compete for a multi-state AmeriCorps grant in the following grant cycle. These grants are awarded for 12 months. They may not be used to support AmeriCorps members. National Planning Grant applicants must not have previously received a multi-state AmeriCorps grant and must be interested in applying for AmeriCorps funding for a program that will operate in two or more states. Indian Tribes Planning Grant applicants must not have received an AmeriCorps grant in the past and must be an Indian Tribe.

Link to Full Announcement

Eligibility
State governments
County governments
City or township governments
Special district governments
Independent school districts
Public and State controlled institutions of higher education
Native American tribal governments (Federally recognized)
Public housing authorities/Indian housing authorities
Native American tribal organizations (other than Federally recognized tribal governments)
Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education
Nonprofits that do not have a 501(c)(3) status with the IRS, other than institutions of higher education
Private institutions of higher education
Individuals

Additional Information on Eligibility:

National Planning Grants Public or private nonprofit organizations, including labor organizations; faith-based and other community organizations; institutions of higher education; government entities within states or territories (e.g., cities, counties); Indian Tribes; or partnerships or consortia operating in more than one state are eligible. Community-based organizations, including faith-based organizations and intermediary organizations operating in more than one state are encouraged to apply for planning grants. Indian Tribes Planning Grants Indian Tribes are eligible to apply. Indian Tribe is defined as a federally recognized Indian Tribe, band, nation, or other organized group or community, including any Native village, Regional Corporation, or Village Corporation, as defined under the Alaska Native Claims Settlement Act (43 U.S.C. § 1602), that the United States Government determines is eligible for special programs and services provided under federal law to Indians because of their status as Indians. Indian Tribes also include tribal organizations controlled, sanctioned, or chartered by one of the entities described above.

Traumatic Brain Injury States Grant Program, Implementation Partnership Grants

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In July 1996, Congress enacted Public Law 104 166 to provide for the conduct of expanded studies and the establishment of innovative programs with respect to traumatic brain injury, TBI. Under the Law, the Health Resources and Services Administration, HRSA, Maternal and Child Health Bureau, MCHB, is charged with implementing a State Grants Program, formerly called the TBI State Demonstration Grant Program, to improve access to health and other services for individuals with TBI and their families. The National Institutes of Health and the Centers for Disease Control and Prevention, CDC, have also been delegated responsibilities in the areas of research, and prevention and surveillance respectively. The Federal TBI Program was reauthorized as part of the Childrens Health Act of 2008. Through this program States and Territories are eligible to receive two types of TBI Grants. This announcement solicits competitive applications for one type, State Implementation Partnership Grants. These grants are to be used by states to establish an infrastructure for the delivery of TBI related services and to improve the States ability to make system changes that will sustain the TBI service delivery infrastructure. This is the first of a four year project period. (The second category is TBI Protection and Advocacy, P&A, grants to the Governor designated State Protection and Advocacy organizations. These grants provide information and referral services, training in self advocacy, advocacy, and litigation services to individuals with TBI and their families. Since FY 2006, the Federal Program office has only two categories of grants, and the phrase Federal TBI Program is currently an umbrella for 2 components, State Implementation Partnership Grants and Protection and Advocacy Grants.)

Link to Full Announcement

Eligibility - As cited in 42 CFR Part 51a.3 (a), any public or private entity, including an Indian tribe or tribal organization (as those terms are defined at 25 U.S.C. 450b), faith based and community based organization are eligible to apply for this federal funding opportunity that can document previous experience to address and fulfill review criteria in guidance.

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Medical News: Older Americans Worried about Healthcare - in Public Health & Policy, Health Policy from MedPage Today

By Cole Petrochko, Staff Writer, MedPage Today

More than half of Americans 50 and older are worried that there will not be enough doctors and nurses to provide care in the near future, according to a nationwide survey.

And two-thirds of the 1,001 seniors polled said they are very or somewhat concerned that the current system limits their ability to see the doctor of their choice.

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Medical News: Aggressive Prostate Cancer Linked to Trichomonas - in Urology, Prostate Cancer from MedPage Today

By Crystal Phend, Senior Staff Writer, MedPage Today

The sexually transmitted infection Trichomonas vaginalis increases risk of clinically-relevant, aggressive prostate cancer, researchers affirmed.

Men with antibodies to T. vaginalis were more than twice as likely to develop tumors that spread outside the prostate and that ultimately led to bony metastases or prostate cancer-specific death, Jennifer R. Stark, ScD, of the Harvard School of Public Health, and colleagues found.

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MEDICARE PART D RECONCILIATION PAYMENTS FOR 2006 AND 2007

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The DHHS Office of Inspector General found that Part D sponsors owe a net total of $18 million to Medicare
for the 2007 Part D payment reconciliation, which is significantly less
than the net total of $4.4 billion that sponsors owed for 2006. Despite
this improvement, sponsors continue to submit inaccurate bids and make
large unexpected profits.

CMS makes monthly prospective payments to sponsors for providing
prescription drug coverage to Medicare beneficiaries. These payments
are based on estimates that sponsors provide in their bids prior to the
beginning of the plan year. After the close of the plan year, CMS
reconciles these payments with the sponsors' actual costs to determine
whether sponsors owe money to Medicare or Medicare owes money to
sponsors.

More specifically, sponsors owe Medicare a net total of $600 million
because of unexpected profits or losses that triggered risk sharing for
2007. Many of these sponsors overestimated the costs of providing the
benefit in their bids. As a result, Medicare payments to sponsors and
beneficiary premiums were higher than necessary. Medicare recoups a
portion of these higher payments. However, beneficiaries do not
directly recoup any of the money that they paid in higher premiums. At
the same time, sponsors will receive a net total of $406 million from
Medicare for the low-income cost-sharing subsidy and a net total of $186
million for the reinsurance subsidy because they underestimated these
costs in their bids.

Further, sponsors continue to make large unexpected profits. Based on
OIG calculations, the 179 sponsors that had profits large enough to
trigger risk sharing made at least $1.02 billion in unexpected profits
in 2007. These sponsors owe a portion of these unexpected profits to
Medicare based on the risk-sharing requirements. In addition, sponsors
included an estimated $1.07 billion of expected profits in their bids.

Finally, for 2006, CMS collected almost all of the funds that sponsors
owed to Medicare in November and December 2007. However, CMS has not
collected a total of $14 million from five sponsors for 2006.

Based on these findings, OIG recommends that CMS should: (1) ensure that
sponsors' bids more accurately reflect their costs of providing the
benefit to Medicare beneficiaries, (2) hold sponsors more accountable
for inaccuracies in the bids, (3) determine whether changes to the risk
corridors are appropriate, (4) determine whether alternative
methodologies would better align payments with sponsors' costs for the
low-income cost-sharing and reinsurance subsidies, and (5) follow up
with the sponsors that owe funds for 2006. CMS concurred or agreed with
three of the recommendations but did not state whether it concurred with
OIG's second or third recommendations.

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Medicare Hospice Care: Services Provided to Beneficiaries Residing in Nursing Homes

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In 2006, 31 percent of Medicare hospice beneficiaries resided in nursing
facilities. Medicare paid $2.59 billion for their hospice care, at an
average of $960 per week for each beneficiary. Hospices most commonly
provided nursing, home health aide, and medical social services. They
furnished an average of 4.2 visits per week per beneficiary for these
three services combined. They also commonly provided drugs.

The Medicare hospice benefit allows a beneficiary with a terminal
illness to forgo curative treatment for the illness and instead receive
palliative care, which is the relief of pain and other uncomfortable
symptoms. Medicare spending on hospice care and the number of
beneficiaries receiving it have increased significantly in recent years.
Previous Office of Inspector General (OIG) work has raised questions
about the hospice benefit for nursing facility residents. However,
little subsequent research has been done to examine hospice care for
these beneficiaries and almost no beneficiary-specific data exist.

This memorandum report found that hospices provided nursing services to
beneficiaries for 96 percent of claims, home health aide services for 73
percent of claims, and medical social services for 68 percent of claims.
Drugs were provided to beneficiaries for 96 percent of claims. In
addition, nursing services were provided at an average of 1.7 times per
week, home health aide services at an average of 2.2 times per week, and
medical social services at an average of 1.7 times per month.

This memorandum report is one in a series of four reports prepared by
OIG that examine the hospice benefit for nursing facility residents. It
is based on data from a medical record review of a stratified random
sample of hospice claims for beneficiaries in nursing facilities in
2006. The report also uses claims data for all Medicare beneficiaries
who received hospice care in 2006.

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MEDICARE HOSPICE CARE FOR BENEFICIARIES IN NURSING FACILITIES: COMPLIANCE WITH MEDICARE COVERAGE REQUIREMENTS

This report determines the extent to which hospice claims for beneficiaries in nursing facilities in 2006 met Medicare coverage requirements.

Eighty-one percent of claims did not meet at least one Medicare coverage requirement pertaining to election statements, plans of care, services, or certifications of terminal illness. An additional 1 percent of claims were undocumented. Medicare paid approximately $1.8 billion for these claims.
Claims from not-for-profit hospices were less likely to meet Medicare coverage requirements than those from for-profit hospices. Specifically, 89 percent of claims from not-for-profit hospices did not meet Medicare requirements, compared to 74 percent of claims from for-profit hospices.

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Prostate Cancer Overdiagnosis in the United States: The Dimensions Revealed

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More than 1 million additional men have been diagnosed with and treated for prostate cancer since the introduction of prostate-specific antigen (PSA) screening in the 1980s. And the "vast majority of these additional 1 million men did not benefit from early detection," write the authors of a new study published online August 31 in the Journal of the National Cancer Institute.

"Prostate cancer screening has resulted in substantial overdiagnosis and in unnecessary treatment," Otis W. Brawley, MD, medical director of the American Cancer Society, writes in an editorial that accompanies the new study.

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About New York - Judge Rules New York State Warehoused Mentally Ill People - NYTimes.com

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Although S. K. was able to care for herself, manage her money and live alone, she wound up in an adult home — privately run facilities that have as many as 400 people under one roof. For nearly 40 years, adult homes have been the subject of scandal, outrage, investigations and promises of reform, much like the state hospitals they were supposed to replace. By now, the largest adult homes have more residents than psychiatric hospitals.

Like many mentally ill people, S. K. was not sent to the adult home for any reason other than to stash her somewhere, off the street.

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State Discriminated Against Mentally Ill, Judge Rules - NYTimes.com

New York State discriminated against thousands of mentally ill people in New York City by leaving them in privately run adult homes, which effectively replaced state-run psychiatric hospitals more than a generation ago but turned out to be little more than institutions themselves, a federal judge ruled on Tuesday.

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Study Estimates Hospital Penalties Generate Few Savings for Medicare - WSJ.com

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The government won't save much from Medicare's year-old policy of refusing to pay hospitals' extra costs to treat hospital-acquired infections and injuries such as bedsores, a new study concludes.

Medicare adopted the policy last year with the goal of saving lives and cutting costs. Each year, about 1.7 million Americans acquire infections while in the hospital, and 99,000 of them die, according to the federal Centers for Disease Control and Prevention.

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Hoyer: Public health plan might have to go - TheHill.com

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House Majority Leader Steny Hoyer said Tuesday that a public option might need to be dropped from the healthcare bill in order to get it passed.

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Data Fuel Regional Fight on Medicare Spending - NYTimes.com

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By ROBERT PEAR

For years, health policy experts have said health care spending is much higher in New York City and Boston because doctors and hospitals there provide more services, practicing medicine in a more intensive way.

But new government data show that Medicare costs per patient in those cities are slightly below the national average when the numbers are adjusted for the cost of living and other factors.

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C-SPAN Video Player - Pres. Obama Speaks at AFL-CIO Picnic in Cincinnati, OH

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C-SPAN Video Player - Pres. Obama Speaks at AFL-CIO Picnic in Cincinnati, OH

Why Reform Survived August | The New Republic

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by Jonathan Cohn

Somehow, though, health reform is not dead. Despite all of the setbacks and all of the missed opportunities--despite this train wreck of a month--the situation remains remarkably similar to what it was before the recess. Significant health care legislation is likely to pass, particularly if Obama manages to give a good speech on Wednesday night. And while the possibilities for what that legislation might accomplish have certainly diminished, mostly for worse, it’s not clear how much they have diminished--and to what extent progressives may yet have the power to change that fact.

Here is where the debate stands, based on interviews with about a dozen key players spanning the administration, Congress, and broader reform community:

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The Health Care Blog: Interview: TR Reid on healthcare reform around the world

TR Reid is a former foreign correspondent with the Washington Post. He spent two years (partly funded by the Kaiser Family Foundation) looking at health care systems across the world and has been featured heavily in many media venues lately asking the simple question, if everywhere else can cover everyone at half the cost, how do they do it?

His book is called The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care and here's an interview he did as part of Frontline's Sick Around The World.

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The Health Care Blog: No Alternative: An Analysis of the GOP Plan

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By HARRIS MEYER

Congressional Republicans have been blasting away all summer at the Democrats’ health reform legislation. But they might face heavy blowback if more Americans took a close look at two ambitious health reform bills sponsored by GOP lawmakers.

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Health Affairs Blog-Fact or Fiction Advance Care Planning in Health Reform

by Chris Fleming

Patients with serious or advanced illnesses would be given more control over their care by language in health reform legislation passed by three House committees that would pay physicians, nurse practitioners, and other providers for counseling Medicare beneficiaries about advance planning for future care decisions.

That was the unanimous opinion expressed by three respected geriatricians at a August 20 conference intended to clarify several issues at the heart of the current health reform debate. The conference, Fact vs. Fiction: Key Issues in Health Reform, was sponsored by Health Affairs. The participants in the panel dealing with end of life issues were Christine Cassel, MD, President, American Board of Internal Medicine; Diane E. Meier, MD, Director, Center to Advance Palliative Care, Mount Sinai School of Medicine; and Jerald Winakur, MD, of the Center for Medical Humanities and Ethics at the University of Texas Health Science Center and author of “What Are We Going To Do With Dad?,” a Health Affairs 2005 Narrative Matters essay.

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Even Mild Infections Hasten Decline With Alzheimer's - Forbes.com

(HealthDay News) -- For people with Alzheimer's disease, even a minor infection can double the rate of memory loss, British researchers report.

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