UM Panel: Rethink End-of-Life Priorities - Health - MiamiHerald.com

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As people live longer with the help of technological advances, end-of-life care will take an increasingly large bite out of the nation's healthcare budget -- unless we change the way we treat dying patients and their families, according to a panel Thursday at the University of Miami's Global Business Forum. Three medical doctors, a CEO and a professor of religious studies debated the economics and ethics of end-of-life decisions, warning that the care model historically used by the medical establishment needs to be improved in a world where there are more elderly people with more chronic illnesses. The emphasis, they agreed, should be on a team-oriented holistic approach tailored to the patient and his or her last wishes.
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HCBS / More Info:Achieving Better Chronic Care at Lower Costs Across the Health Care Continuum for Older Americans

Summary

A conference was held to inform potential solutions to improve the cost and quality of care across the health care continuum for older Americans. Synthesizing the conference, this report addresses many of the challenges facing individuals with chronic conditions and functional impairments, and identifies new opportunities for the integration of medical services and social supports tailored to older Americans and supported by new payment designs.

Available Files

• Report PDF (723K, 14 pages)
• Report Off-site link (14 pages)

Lawmakers Urge Swifter Launch Of Home Health Care Demo

From Medical News Today

Democratic lawmakers are pushing the Obama administration to launch a Medicare home health demonstration project as soon as possible.

"The so-called Independence at Home (IAH) program, included as part of the Democrats' new health reform law, is scheduled to take effect no later than Jan. 1, 2012, but Sen. Ron Wyden (D-Ore.) and Rep. Edward Markey (D-Mass.) warn that waiting that long would threaten the health of one of the country's most vulnerable populations," The Hill reports. "The lawmakers are pressing the Centers for Medicare and Medicaid Services (CMS) to install the program 'sooner rather than later,' with a target launch within six months." The push may also have a political incentive. "With many seniors wary of the Medicare cuts contained in the Democrats' new health reform law, party leaders are eager to prove that those cuts won't harm the quality of care... It was CMS that, leery of potential complications surrounding implementation, had pushed lawmakers to delay the required launch of the IAH program until 2012" (Lillis, 6/29).

Congressional Quarterly: "Under the three-year demonstration project, people with chronic conditions such as Alzheimer's disease would have primary care provided in their home by teams of providers directed by physicians and nurse practitioners. Seniors with chronic conditions account for 85 percent of Medicare spending and often receive disjointed and badly managed care through the current Medicare system, Wyden and Markey said" in a letter to Medicare administrators. "Organizations that contract to participate are held accountable for producing 5 percent savings in the cost of the beneficiaries' care, but at the same time improving the quality of care and satisfying family members and caregivers. In return, the organization gets a share of the savings beyond 5 percent" (Norman, 6/29).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

Lawmakers Urge Swifter Launch Of Home Health Care Demo

Better Together - The New Old Age Blog - NYTimes.com

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By PAULA SPAN

Their doctor calls Carrie and Tulane Howard “the ‘Rear Window’ couple.” They spend hours sitting by the bay window, in the house they bought in Northwest Washington, D.C., in 1951, looking out at their garden and beyond it to Rock Creek Park.

“My dogwoods and my azaleas have just finished blooming, and I think this year was the most beautiful,” Mrs. Howard said recently. She’s “90 and one-half,” a retired R.N. who worked in many Washington hospitals, now taking care of her 86-year-old husband, once a biochemist at the National Institutes of Health.
The Howards have between them so many health challenges that they could easily have been among those seniors who constantly revolve in and out of emergency rooms, hospitals and rehab facilities en route to nursing homes.

He’s had Alzheimer’s disease for years, plus an underactive thyroid; for a while, he was overmedicated, lost his appetite and shed an alarming amount of weight. He’s been hospitalized for a blood clot and for hernia surgery. She has survived colon cancer, has developed hypertension and kidney disease, and works to keep her diabetes under control — and of course, she has the stress of caring for her husband. “It’s very taxing, very hard work,” she acknowledged.

But they’re doing rather well, it seems. “They’re enjoying a little renaissance in their 60th year of marriage because they’re a little healthier,” said their doctor, Eric DeJonge, director of geriatrics at Washington Hospital Center. (Actually, it’s their 64th year.)

And part of the reason, Dr. DeJonge is convinced, is that both spouses see the same physician. He visits them at home, with follow-up visits by nurse practitioners and, when necessary, social workers. (I’ll say more about housecalls, an old idea made new again, in a future post.) “It really helps me care for each individual by caring for the whole. They almost become a single unit,” he said in an interview.
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Online Social Networks Bridge Gaps for Chronically Ill - NYTimes.com

By CLAIRE CAIN MILLER

A former model who is now chronically ill and struggles just to shower says the people she has met online have become her family. A quadriplegic man uses the Web to share tips on which places have the best wheelchair access, and a woman with multiple sclerosis says her regular Friday night online chats are her lifeline.

For many people, social networks are a place for idle chatter about what they made for dinner or sharing cute pictures of their pets. But for people living with chronic diseases or disabilities, they play a more vital role.

“It’s really literally saved my life, just to be able to connect with other people,” said Sean Fogerty, 50, who has multiple sclerosis, is recovering from brain cancer and spends an hour and a half each night talking with other patients online.
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Calif. Budget Cuts Will Hit Adult Day Care Centers, Prison Health Care; Texas And Kansas Weigh Medicaid Cuts

from Medical News Today

The Los Angeles Times, on adult day care centers in California: "Under the most recent cost-saving budget proposals, 327 adult day healthcare centers throughout California would be eliminated. Cuts could save the state $135 million in fiscal 2011, state projections show. But advocates and center operators said care for many of the 37,000 low-income participants -- who suffer from diabetes, brain injuries, dementia and other chronic conditions -- would cost the state even more money if the centers close. More than 40% of participants would end up in nursing homes, said Lydia Missaelides, executive director of the California Assn. for Adult Day Services. Others would be hospitalized" (Gorman, 2/11).

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Medical News: Tailoring Trumps Targeting for Cholesterol Control - in Cardiovascular, Dyslipidemia from MedPage Today

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By Peggy Peck, Executive Editor, MedPage Today

Lipid control is more than a simple matter of "knowing your numbers," according to a computer model that found tailoring statin therapy to fit an individual's five-year risk of heart attack or stroke is a better prevention strategy than treating to preset goals.

In the model, patients who whose five-year coronary artery disease risk was 5% to 15% received 40 mg of simvastatin (Zocor), while those whose risk was greater were given 40 mg of atorvastatin (Lipitor).

In every scenario, the tailored approach was preferable, Rodney A. Hayward, MD, of the University of Michigan and the Veterans Affairs Ann Arbor Healthcare System, and colleagues wrote in the Jan. 19 Annals of Internal Medicine.

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Medical News: Rising Costs -- the Real Heartbreak of Psoriasis - in Dermatology, Psoriasis from MedPage Today

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By Michael Smith, North American Correspondent, MedPage Today

The heartbreak of psoriasis used to be the disease itself. Now it's the skyrocketing cost of treatment.

From 2000 through 2008, the cost of brand-name drugs increased 66% on average, according to Vivianne Beyer, MD, and Stephen Wolverton, MD, of the Indiana University School of Medicine in Indianapolis (Beyer is currently at St. Vincent Hospital in Indianapolis).

The cost of several of the drugs "greatly outpaced" both general inflation and the overall increase in cost of prescription medicines, the researchers reported in the January issue of Archives of Dermatology.

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The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions

Author: Richard G. Kronick, Melanie Bella, Todd P. Gilmer

While creating better systems of care for aged, blind, and disabled beneficiaries is a priority within Medicaid, it is a challenge given the vast heterogeneity of this complex population. The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions provides insights for targeting efforts to improve care and control spending for the program's highest-need, highest-cost beneficiaries.

Building on the 2007 Faces of Medicaid II report, this subsequent analysis examines two data sets -- pharmacy claims and five years of diagnostic data -- to further refine what is known about Medicaid beneficiaries with multiple chronic conditions. Researchers Rick Kronick, PhD, and Todd Gilmer, PhD, both from the University of California, San Diego, found that by looking at pharmacy data in addition to claims:

* The proportion of Medicaid beneficiaries with disabilities who are diagnosed with three or more chronic conditions increases from 35 percent to 45 percent;
* The frequency of psychiatric illness among Medicaid beneficiaries with disabilities increases from 29 percent to 49 percent, and the prevalence of cardiovascular disease increases from 32 percent to 44 percent; and
* Costs for beneficiaries with three or more chronic conditions increases from 66 percent to 75 percent of total spending for beneficiaries with disabilities.

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The Health Care Blog: Health 2.0: Beneath the Hype, There's Cause for Real Hope

By MICHAEL MILLENSON

Health 2.0 is a trend accompanied by both buzz and buzzwords. That worries some advocates for the poor, underserved and just plain old and sick. Will those groups be left behind in the latest information revolution?
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H.R. 3830: To direct the Secretary of Health and Human Services to develop an individual chronic disease... (GovTrack.us)

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To direct the Secretary of Health and Human Services to develop an individual chronic disease prevention and wellness achievement matrix.

Sponsor: Rep. Jeffrey Fortenberry [R-NE1]

Text

Status:

Introduced Oct 15, 2009
Referred to Committee on Energy and Commerce

Updates

S. 1781: A bill to provide for a demonstration program to reduce frequent use of health services by... (GovTrack.us)

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A bill to provide for a demonstration program to reduce frequent use of health services by Medicaid beneficiaries with chronic illnesses by providing coordinated care management and community support services.

Sponsor: Sen. Jeanne Shaheen [D-NH]
Cosponsors: Sherrod Brown [D-OH], Robert Menéndez [D-NJ]

Text

Status:
Introduced Oct 14, 2009
Referred to Committee on Finance

Updated Information

Large Majority of Drivers 55+ Unaware of Potentially Dangerous Combination of Medications and Driving

According to a new study released today by the AAA Foundation for Traffic Safety, 95 percent of respondents 55 and older have one or more medical conditions and 78 percent use one or more medications, yet only 28 percent indicated some awareness of the potential impact on driving performance associated with those medications.
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How Do You Know If You’re at High Risk for a Heart Attack? - Health Blog - WSJ

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By Jacob Goldstein

If you’re 20 or older and don’t have diabetes or heart disease, you can plug a handful of simple variables — things like age, cholesterol level and blood pressure — into a Framingham risk calculator and find out your chances of having serious heart trouble (a heart attack or coronary death) in the next 10 years.

Still, some 300,000 Americans die every year of sudden cardiac death outside the hospital, and many of those people don’t have classic risk factors for heart disease. Non-fatal heart attacks, too, remain difficult to predict for many patients.So there’s an understandable urge on the part of researchers to find new measures that will better predict who is at risk.

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Cost Savings Adds to Value of Preventing Chronic Disease - Forbes.com

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Avoiding diabetes, high blood pressure can add years to life, researchers say

(HealthDay News) -- Prevention of chronic diseases such as diabetes, obesity and high blood pressure improves the lives of older Americans and also reduces medical costs, study findings show.

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MacArthur Genius Award: Reducing Falls in the Elderly - Health Blog - WSJ

By Jacob Goldstein

For a 75-year-old with high blood pressure, the risk of death or serious disability resulting from a fall is just as high as the risk of death or serious disability caused by a stroke. But a generation ago, doctors thought of falling as an inevitable risk, not something they could do anything to prevent as part of caring for patients.

That’s how Mary Tinetti, a geriatrician at Yale med school, laid things out for us when we got her on the phone to chat about the MacArthur genius grant she just won.
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Structuring, Financing and Paying for Effective Chronic Care Coordination

The text below is an excerpt from the complete document.

Abstract

Growing evidence demonstrates that certain approaches to financing and paying for chronic care coordination for patients are effective not only for improving patient well-being but can also reduce health care spending. However, chronic care approaches should vary for different patient populations and can be carried out effectively by diverse organizations and professionals reflecting the heterogeneity of health care delivery throughout the US. The Report considers the different populations in need of care coordination, summarizes current evidence of effectiveness, describes the various entities that can serve as focal points for coordinating care, and details the possible financing and payment options that can support these approaches.

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IBM and Chinese Deaf Association Launch Real-time, Online Sign Language Interpretation Service | Accessibility News International

First-of-a-kind Internet Service Supports Organization of 2009 Deaflympics

PRNewswire-FirstCall/ — IBM (NYSE: IBM) and the
Chinese Deaf Association announced the launch of an online sign language
interpretation service in Taiwan, aimed to provide video and audio instant
messaging services to the deaf. The service, initially used to support the
organization of the 21st Summer Deaflympics held in Taipei city from September
5 to 15, will benefit over 200,000 deaf and hearing impaired people in Taiwan.

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• A different kind of Olympics (flanderstoday.eu)

The Health Care Blog: Cool Technology of the Week

By JOHN HALAMKA - I attended the New England Healthcare Institute Medication Adherence Expert Roundtable on Thursday July 23rd, 2009. The purpose of the roundtable was to prioritize activities that would encourage patients to be more compliant with the medications, especially those with chronic diseases such as diabetes, congestive heart failure and COPD. One technology that we discussed was an intelligent pill bottle for the home from rxvitality.com and it's my cool technology of the week. Using technology similar to the Ambient Orb, the intelligent pill bottle flashes to indicate when it's time to take the medication inside the bottle. When the bottle is opened it sends telemetry back to a portal which can be used to track patient medication adherence. Read More

H.R. 3340: To establish a Medicare Chronic Care Rapid Learning Network to develop and apply improved... (GovTrack.us)

To establish a Medicare Chronic Care Rapid Learning Network to develop and apply improved practices in care management for Medicare beneficiaries with multiple chronic conditions. Sponsor: Rep. Timothy Johnson [R-IL15] Cosponsors [as of 2009-07-26] - Rep. Thomas Latham [R-IA4] Rep. Patrick Murphy [D-PA8] Rep. Allyson Schwartz [D-PA13] Status: Introduced Jul 24, 2009 Referred to Committee on Ways and Means Read More