CMS Says New Technology Will Better Detect Medicare Fraud
July 12, 2011
The Centers for Medicare & Medicaid Services (CMS) has begun using predictive modeling software to help identify potentially fraudulent Medicare claims on a nationwide basis, Dr. Peter Budetti, Deputy Administrator and Director for Program Integrity at CMS, told the Senate Homeland Security Subcommittee on Federal Financial Management on July 12.
“All claims across the country are now being screened before they are paid,” Budetti told the panel. The goal is to halt fraudulent claims before they are paid, instead of first paying a claim and they checking for fraud. Medicare fraud is estimated to cost the program more than $60 billion a year. Medicare pays out on 4.5 million claims a day because it is required by Congress to pay claims within two to four weeks of receiving them.
The new predictive modeling approach will allow CMS to use data to predict the probability of fraud in a particular claim. The software looks at the likelihood that the beneficiary received the services and the likelihood that the provider was able to deliver the service, and then creates a risk score for each claim. CMS then examines high-risk claims looking for fraud. It can then stop fraudulent payment before it goes out.
With the predictive modeling technology, CMS can now check Medicare's data against enrollment records, and stolen provider and beneficiary identification numbers. In a pilot study, CMS said it was able to link to public information from court records, addresses, medical licenses and lists of providers and suppliers excluded from federal health care programs.
“Technology is not a silver bullet,” Lewis Morris, the OIG’s Chief Counsel, told the subcommittee. “It is important to be mindful that as program integrity efforts become more technology-driven, so will health care fraud, and we must adapt to this evolving environment. Additionally even the best fraud prevention technologies will be of little value if not effectively implemented and appropriately overseen.”
“Further complicating matters,” Morris continued, a claim may initially meet all the conditions for payment but subsequently be revealed as improper. “For example, an outpatient laboratory test may appear payable when initially submitted by the hospital. But under Medicare rules, separate payments for nonphysician outpatient services rendered within 72 hours of the day of an inpatient admission are not permitted. When the hospital later submits a claim for an inpatient stay that began within that 72-hour window, the claim for that laboratory test is improper.” In addition, CMS also needs to determine medical necessity.
“This is a very different scenario from a credit card company stopping someone who attempts to buy a jet ski in Galveston with a credit card issued to a long-time resident of New York City,” Morris added. “Health care is very complex and it is difficult to predict and prevent health care fraud relying solely on data analytics.”
###
July 8, 2011
The U.S. Department of Health and Human Services today announced three new initiatives to help states improve the quality and lower the cost of care for the approximately nine million Americans who are eligible for both Medicare and Medicaid (Medicare-Medicaid enrollees).
Today, HHS announced:
For details, go to: http://www.hhs.gov/news/press/2011pres/07/20110708a.html
###
Challenges for Hospitals: Payment, Governance, Expanding Access, and Delivery System Transformation
July 7, 2011
Four papers in the July 2011 issue of Health Affairs examine key topics for hospitals, including the extent to which hospitals "cost shift" to private payers; the success of efforts to reduce avoidable rehospitalizations; new responsibilities for hospital boards of trustees as a consequence of the Affordable Care Act; and expanding access to low-income populations.
A brief summary of each of the four papers follows:
Go to www.healthaffairs.org.
###
Letter to Congress on Older Americans Act
June 8, 2011
The Leadership Council of Aging Organizations (LCAO) has sent a letter to House and Senate appropriators seeking additional funding for Older Americans Act programs.
“As your Committees consider the FY 2012 Labor/HHS appropriations bills in the coming months, the undersigned members of the Leadership Council of Aging Organizations urge you to make investments in the Older Americans Act (OAA) a top priority,” the letter states.
Since FY 2004, OAA appropriations have lagged behind the rising costs of fuel, commodities and wages, while demand to serve older Americans has increased, leading to a substantial and growing shortfall, it says.”In order for OAA funding to simply catch up with the growth in the senior population and the costs of services over the past decade, it would have to increase by at least 12%.”
In addition to an overall increase needed to address inflation and the growth of the aging population, LCAO supports:
###
Groups Urge Protection for Low-Income Programs
June 30, 2011
The National Council on Aging, National Low Income Housing Coalition and other national organizations are calling on Congress and President Obama to protect programs for low-income people. In an open letter to policymakers, the groups portray budgets as "moral documents" and express support for six principles, including making programs efficient without cuts and considering tax revenues.
Meanwhile, Families USA issued a new report showing the impact of budget cuts on enrollees, states and jobs. Go to: that cuts to Medicaid would be devastating not only to enrollees, but also to state economies and jobs. Go to http://www.familiesusa.org/resources/publications/reports/medicaid-cuts-hurt-states.html
###
CMS Seeks Comments about Dual Eligible "Alignment Opportunities"
The Centers for Medicare and Medicaid Services (CMS) is seeking information on opportunities for alignment of benefits and incentives under Medicaid and Medicare. The request was published in the May 16 Federal Register. Comments are due by 5 p.m. July 11, 2011.
An estimated 9.2 million low-income Americans were eligible for both programs in 2008. Two-thirds of dual eligible beneficiaries are over age 65.
Under the Affordable Care Act, the CMS is identifying and addressing conflicting requirements between Medicaid and Medicare that potentially create barriers to high quality, seamless, and cost-effective care for dual eligible beneficiaries (known as the “Alignment Initiative”). The goal is to create and implement solutions in line with three goals:
1) better care for the individual,
2) better health for populations, and
3) lower costs through improvement.
The effort will advance dual eligible beneficiaries’ understanding of, interaction with, and access to seamless, high quality care that is as effective and efficient as possible.
CMS is seeking comments on:
• How can the Medicare and Medicaid programs better ensure dual eligible individuals are provided full access to the program benefits?
• What steps can CMS take to simplify the processes for dual eligible individuals to access the items and services guaranteed under the Medicare and Medicaid programs?
• Are there additional opportunities for CMS to eliminate regulatory conflicts between the rules under the Medicare and Medicaid programs?
• How can CMS best work to improve care continuity and ensure safe and effective care transitions for dual eligible beneficiaries?
• How can CMS work to eliminate cost-shifting between the Medicare and Medicaid programs? How about between related health care providers?
Click here to view the Federal Register notice.
###
World Elder Abuse Awareness Day
June 15, 2011
Today is the 6th Annual World Elder Abuse Awareness Day -- an international effort in support of the United Nation's International Plan of Action on Ageing, which acknowledges the significance of elder abuse as a public health and human rights issue.
For more information, go to: http://ncea.aoa.gov/NCEAroot/Main_Site/About/Initiatives/Join_Us_Campaign.aspx
###
New Report: Most Aging Baby Boomers Will Face Poor Mobility Options
June 14, 2011
By 2015, more than 15.5 million Americans ages 65 and older will live in communities where public transportation service is poor or non-existent, a new study shows. That number is expected to continue to grow rapidly as the baby boom generation “ages in place” in suburbs and exurbs with few mobility options for those who do not drive.
A new report, Aging in Place, Stuck without Options, ranks metro areas by the percentage of seniors with poor access to public transportation, now and in the coming years, and presents other data on aging and transportation. The analysis by the Center for Neighborhood Technology (CNT) evaluates metro areas within five size categories.
By 2015, 66 percent of seniors living in suburban Chicago will have poor transit access, while only 6 percent of seniors living in the City of Chicago will face poor transit options. The total number of seniors with poor access is projected to increase by 153,550 by 2015.
Metro Chicago ranks among the best for metro populations of 3 million and more. Atlanta ranks worst, followed by Riverside-San Bernardino, CA, Houston, Detroit and Dallas. In smaller areas such as Hamilton, OH will have 100 percent of seniors without access to public transportation.
Daunting Challenge to Local Communities
These conditions present a daunting challenge to local communities as a larger share of their population ages, increasing the demand for mobility options. Research shows that without access to affordable travel options, seniors age 65 and older who can no longer drive make 15 percent fewer trips to the doctor, 59 percent fewer trips to shop or eat out, and 65 percent fewer trips to visit friends and family, than drivers of the same age. As the cost of owning and fueling a vehicle rises, many older Americans who can still drive nonetheless are looking for lower-cost options.
“The baby boom generation grew up and reared their children in communities that, for the first time in human history, were built on the assumption that everyone would always be able to drive an automobile,” said John Robert Smith, president and CEO of Reconnecting America and co-chair of Transportation for America. “What happens when people in this largest generation ever, with the longest predicted lifespan ever, outlive their ability to drive? That’s one of the questions we set out to answer in this report.”
Transportation Is Second Highest Expense
“Transportation is typically the second highest expense for people, especially for those living in areas where driving is the only way to get around,” said Jacky Grimshaw, vice president of policy at CNT. “Poor transit access not only reduces independence for seniors, it also forces them to spend a large portion of their fixed incomes on transportation costs that could instead be paying for food and medicine.”
“For older individuals, access to safe, affordable and reliable public transportation is critical, said Bob Gallo, AARP Illinois Senior State Director. “But in Chicago, a growing number of older adults lack access to the transportation options they need. AARP commends Illinois PIRG and the rest of the Transportation for America coalition for raising awareness of this issue, and starting a conversation with Congress and other stakeholders aimed at generating solutions for the transportation needs of older Americans.”
“The transportation issues of an aging America are national in scope, and cash-strapped state and local governments will be looking for federal support in meeting their needs,” Smith added. “As Congress prepares this summer to adopt a new, long-term transportation authorization, [the report,] Aging in Place, Stuck without Options outlines policies to help ensure that older Americans can remain mobile, active and independent.”
Policy recommendations include:
To view Aging in Place, Stuck without Options, go to: http://t4america.org/resources/SeniorsMobilityCrisis2011
###
Reducing Avoidable Rehospitalizations Among Seniors
June 13, 2011
The rehospitalization of senior patients within 30 days of discharge from a skilled nursing facility (SNF) has risen dramatically in recent years, at an estimated annual cost of more than $17 billion. A new study from Hebrew Rehabilitation Center (HRC), an affiliate of Harvard Medical School, demonstrates improvements in discharge disposition following a three-pronged intervention that combines standardized admission templates, palliative care consultations, and root-cause-analysis conferences.
The study, published in the June issue of the Journal of the American Geriatrics Society, compared patients' discharge disposition from HRC's Recuperative Services Unit (RSU) in Boston, a skilled nursing facility, before and after implementation of the intervention. The rate of patient rehospitalization fell from 16.5 percent to 13.3 percent, a drop of nearly 20 percent. Discharges to home increased from 68.6 percent to 73.0 percent, and discharges to long-term care dropped to 11.5 percent from 13.8 percent.
"The change in discharge disposition observed between the two periods, we believe, reflects an improvement in patient outcomes," says lead author Randi E. Berkowitz, M.D., a geriatrician at Hebrew Rehabilitation Center and medical director of the RSU. "Specifically, a lower acute transfer rate likely reflects improved processes of care in the SNF."
One out of five Medicare beneficiaries was rehospitalized within 30 days of hospital discharge, costing an estimated $17.4 billion, according to recent estimates. In addition, hospitalized patients admitted to a skilled nursing facility have a high rate of early, unplanned rehospitalization. There are many risk factors that correlate with future hospitalization, says Dr. Berkowitz, such as recent hospitalization, specific diagnoses (such as congestive heart failure), acute medical illnesses, depression, and other factors.
From the older patient's perspective, hospital readmission can lead to a steady decline in functional status, ending in disability. As a result, these seniors must often trade their independent living for a long-term care facility.
As part of national health-care reform legislation, Medicare will stop paying hospitals for preventable readmissions for conditions such as heart failure and pneumonia, beginning in October 2012. Two years later, the list will expand to include additional medical conditions.
"Reducing rehospitalization has become a national target of health-care reform," says Robert J. Schreiber, M.D., HSL's chief medical officer. "Readmissions have a significant impact on the nation's health system and are often preventable."
###
Medicaid Block Grants Mean Low-Income Older Adults Could Lose Benefits
April 26, 2011
Based on of its long experience ensuring that states do not limit eligibility and benefits, the National Senior Citizens Law Center says that the result of block granting Medicaid would mean taking health care coverage away from millions of low-income older adults and people with disabilities.
"Our experience has shown that states, if given free rein, intend to serve fewer people by restricting access and benefits," said NSCLC Executive Director Paul Nathanson. "We have fought for years to ensure that states do not ignore Medicaid law."
In a new policy issue brief, NSCLC shows that the courts were needed to stop state attempts to cut costs through changing eligibility or benefits mandated by federal Medicaid law. To prove the point, NSCLC cites several cases that show how states, even when subject to legal constraints, have sought to circumvent Medicaid law.
It lists eight ways a block grant could harm older adults:
1. It Could be Harder to Qualify for Benefits
2. Coverage for Long Term Services and Supports Could Be Threatened
3. Access to Nursing Home Care Could Be Lost
4. Availability of Essential Services Could Be Eliminated
5. Those with Both Medicare and Medicaid Could Be At Risk
6. Spouses of Medicaid Nursing Home Residents Could Be Impoverished
7. Nursing Home Consumers Would Lose Protection
8. Getting Medical Equipment and Supplies Could Become Difficult
To view entitled "Medicaid Block Grants: Attacking the Safety Net for Low-Income Older Adults," go to: http://www.nsclc.org/about-us/nsclc-in-the-news/Issue%20Brief%20-%20Medicaid%20Block%20Grants%20April%202011.pdf
###
April 26, 2011
Members of minority groups, especially black Americans, are more willing than their white counterparts to exhaust their personal financial resources to prolong life after being diagnosed with lung or colorectal cancer, according to a University of Alabama at Birmingham study.
This revelation should inform the treatment plans and help physicians design state-of-the-art cancer care that reflects patient wishes, said lead author Michelle Martin, Ph.D., assistant professor in the UAB Division of Preventive Medicine and a scientist with the UAB Comprehensive Cancer Center.
"As new cancer-treatment options emerge, patients are asked to make complex decisions that often involve tradeoffs between quality and quantity of life," Martin says. "A key tenet of delivering high-quality, patient-centered care is understanding and respecting patients' treatment decisions. Our results highlight the fact that personal finances can influence the decisions patients make about their treatment."
Martin and her colleagues compared the willingness of 4,214 participants in the Cancer Care Outcomes Research and Surveillance (CanCORS) study — a multi-center observational study of patients with newly diagnosed lung or colorectal cancer — to use their personal financial resources to extend their lives.
Among other questions, patients were asked, "If you had to make a choice now, would you prefer treatment that extends life as much as possible, even if it means using all of your financial resources, or would you want treatment that costs you less, even if it means not living as long?"
The researchers found that 80 percent of blacks were willing to spend all of their personal finances to extend life, while 54 percent of whites, 69 percent of Hispanics and 72 percent of Asians were willing to do so.
After accounting for a number of factors, including income, disease stage, quality of life, age, perceived time left to live and other medical illnesses, blacks were 2.4 times more likely to expend all personal financial resources to extend life than whites. Hispanic patients were 1.45 times more likely and Asian patients were 1.59 times more likely to expend all personal financial resources than white patients.
The availability of insurance had no statistical effect on the results, by race.
The study was published April 26, 2011, online in Cancer, the journal of the American Cancer Society.
###
Depression Levels Among Caregivers More Than Two Times National Average April 26, 2011
With the economy continuing to struggle and rising prices impacting Americans from coast to coast, caregivers are facing the increased burden of providing financial and emotional support to their loved ones. Caring.com has released the results of a new study, in which 86 percent of caregivers said that caregiving impacted their work situation because they had to take time away from their jobs, quit, retire early, reduce hours, or take a leave of absence (this excludes those who were already not working). The findings were released at the annual conference of the American Society on Aging.
Twenty-five percent of respondents also stated that they suffer from depression, well above the national figure of 9 percent cited in a 2010 study by the U.S. Centers for Disease Control and Prevention. To find support beyond family and friends, caregivers are turning to their churches, synagogues, mosques, or other religious organizations (31 percent). Family caregivers are also seeking support online (25 percent) via discussion forums, chat rooms, and through social networks such as Facebook.
Additional findings include:
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Geriatric Assessment Program Outlines Tailor-Made Treatments
April 22, 2011
Some seniors may need help getting around town, while others may need assistance getting around the house. Regardless of the degree of need, Geisinger Health System utilizes a systematic approach through its Geriatric Assessment Program to identify the medical and social needs of a geriatric patient to design a custom course of treatment to help seniors and their families successfully manage the aging process.
“Sometimes it can become difficult for seniors to realize they have more difficulty handling tasks that were once simple,” said Robb McIlvried, M.D., internal medicine, Geisinger Health System. “As is the case with most seniors, physical capacities change with age, and this can be challenging to cope with.”
Geisinger’s Geriatric Assessment Program at both Geisinger Medical Center (GMC) and Geisinger Wyoming Valley Medical Center (GWV) is designed for those ages 65 and older to receive geriatric care within the hospital, allowing for easily accessible follow-up testing and subspecialty consultation.
“The Geriatric Assessment Program helps seniors promote good health by indentifying and overcoming obstacles and evaluating the need for nursing home placement or assisted living,” Dr. McIlvried said. “All this can be done in two visits, one with the patient and one with his or her family, after which all will leave with a detailed treatment plan that outlines steps to more successfully manage a time in a senior’s life that can be significantly more difficult without proper guidance.”
The Geriatric Assessment Program begins with an initial visit when patients consult with a board-certified geriatric physician, a registered nurse, a social worker and a pharmacist. The group reviews the patient’s health history and medications, conducts a physical exam and performs a social assessment with the patient’s family. At the visit’s conclusion, patients and their families will review a presentation of referrals and recommendations for proper medical and social support.
“After completing the Geriatric Assessment Program, seniors and their families will be able to correctly determine whether the patient is better suited for their current living situation or a higher level of care,” Dr. McIlvried said. “With the patient and his or her family, we will discuss a detailed plan that can address any issues and help ease the transition into elderly living.”
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Alzheimer's Diagnostic Guidelines Updated for First Time In Decades
April 19, 2011
For the first time in 27 years, clinical diagnostic criteria for Alzheimer’s disease dementia have been revised, and research guidelines for earlier stages of the disease have been characterized to reflect a deeper understanding of the disorder.
The National Institute on Aging/Alzheimer’s Association Diagnostic Guidelines for Alzheimer’s Disease have outlined some new approaches for clinicians and provide scientists with more advanced guidelines for moving forward with research on diagnosis and treatments. They mark a major change in how experts think about and study Alzheimer’s disease. Development of the new guidelines was led by the National Institutes of Health and the Alzheimer’s Association.
To reflect what has been learned, the National Institute on Aging/Alzheimer's Association Diagnostic Guidelines for Alzheimer’s Disease cover three distinct stages of Alzheimer's disease:
Preclinical — The preclinical stage, for which the guidelines only apply in a research setting, describes a phase in which brain changes, including amyloid buildup and other early nerve cell changes, may already be in process. At this point, significant clinical symptoms are not yet evident. In some people, amyloid buildup can be detected with positron emission tomography (PET) scans and cerebrospinal fluid (CSF) analysis, but it is unknown what the risk for progression to Alzheimer’s dementia is for these individuals. However, use of these imaging and biomarker tests at this stage are recommended only for research. These biomarkers are still being developed and standardized and are not ready for use by clinicians in general
practice.
Mild Cognitive Impairment (MCI) — The guidelines for the MCI stage are also largely for research, although they clarify existing guidelines for MCI for use in a clinical setting. The MCI stage is marked by symptoms of memory problems, enough to be noticed and measured, but not compromising a person’s independence. People with MCI may or may not progress to Alzheimer's dementia. Researchers will particularly focus on standardizing biomarkers for amyloid and for other possible signs of injury to the brain. Currently, biomarkers include elevated levels of tau or decreased levels of beta-amyloid in the CSF, reduced glucose uptake in the brain as determined by PET, and atrophy of certain areas of the brain as seen with structural magnetic resonance imaging (MRI). These tests will be used primarily by researchers, but may be applied in specialized clinical settings to supplement standard clinical tests to help determine possible causes of MCI symptoms.
Alzheimer's Dementia — These criteria apply to the final stage of the disease, and are most relevant for doctors and patients. They outline ways clinicians should approach evaluating causes and progression of cognitive decline. The guidelines also expand the concept of Alzheimer's dementia beyond memory loss as its most central characteristic. A decline in other aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment may be the first symptom to be noticed. At this stage, biomarker test results may be used in some cases to increase or decrease the level of certainty about a diagnosis of Alzheimer's dementia and to distinguish Alzheimer's dementia from other dementias, even as the validity of such tests is still under study for application and value in everyday clinical practice.
To read more, go to http://www.nih.gov/news/health/apr2011/nia-19.htm.
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Effective Pain Management Crucial to Older Adults’ Well-Being
April 11, 2011
Improved management of chronic pain can significantly reduce disability in older adults, according to the Gerontological Society of America (GSA).
Based largely on presentation highlights from GSA’s 63rd Annual Scientific Meeting in November 2010, the current issue of GSA’s WHAT’S HOT examines the impact of pain in older adults, strategies for managing pain and preserving function, and methods to improve the assessment and management of pain for residents in long-term care facilities, including those who have dementia. Support for this publication was provided by McNeil Consumer Healthcare.
“Under-treatment of chronic pain in older adults is common, contributing to unnecessary suffering,” said Deborah Dillon McDonald, RN, PhD, of the University of Connecticut School of Nursing, who served as an advisor for the issue. “Older adults and practitioners need to work together to find optimal multi-modal pain management plans that reduce pain and avoid adverse events.”
The newsletter points out that pain is a signal that something is wrong, and that reports of pain should not be dismissed simply because the patient is older. Furthermore, the issue demonstrates that chronic musculoskeletal pain is associated with numerous problems such as increased disability and sleep difficulty in older people. The research and national initiatives presented therein underscore the importance of good pain management in older adults and explore strategies for optimizing patient well-being.
Among the most successful methods for pain treatment are physical activity, pain protocol interventions, and medication use. Additional topics raised in the newsletter focus on ongoing activities to support safe selection and use of analgesics (including appropriate acetaminophen dosage), which is important to communicate to multiple stakeholders, including patients, caregivers, health care providers, policymakers, and researchers.
An electronic version of the newsletter is available for purchase at www.geron.org/WhatsHot.
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CR Cuts AoA, Older Worker Program; Creates Medicare Vouchers
April 12, 2011
The FY 2011 continuing resolution (CR) pending before Congress (H.Con.Res. 34) would reduce the AoA budget by $124 million below the President’s request (which was $1,624 million) and $16 million below the FY’10 level. The CR did not specify where the $16 million would come from.
The measure also reduces the Community Service Employment for Older Americans program to $450 million — which is $150 million below the president’s request and $375 million below the $825 million in FY’10.
While Medicare benefits will be preserved for those in and near retirement, future generations will receive a “premium support” payment and choose among guaranteed health coverage options.
According to the National Committee to Preserve Social Security and Medicare (NCPSSM),
“The House budget plan privatizes Medicare and achieves savings by shifting costs to Medicare beneficiaries. Future beneficiaries would lose Medicare's guaranteed benefits and would be given vouchers to purchase private health insurance. The amount of the voucher would grow less rapidly than health care costs meaning seniors would end up paying much more for their health care under the voucher plan than under the current Medicare program. Seniors are already paying on average nearly 30 percent of the Social Security benefits for Medicare Part B and D cost sharing. With half of Medicare beneficiaries living in households with incomes below $20,000, they cannot afford to pay more for health care.
“Further concerns are that benefits and premiums could vary from one private plan to another, and it is unclear whether or not private plans would choose to participate in the Medicare voucher program. In the past private insurers did not want to enroll older people – or would ration care if they did participate in order to increase their profit margins. Finally, it is questionable how much this proposal would save due to private health insurance plans' higher administrative costs compared with Medicare.”
The House budget plan also includes reductions to Medicaid funding that would affect low-income seniors. According to NCPSSM:
“Older adults and people with disabilities account for two-thirds of all Medicaid spending, and Medicaid pays for about 62 percent of all long-term services and supports. The proposed changes to Medicaid –- turning it into a block grant program to the states — would affect older Americans by jeopardizing the availability and quality of long-term care both in nursing homes and in the community, and impairing low-income seniors' ability to receive assistance through the Medicare Savings Programs to help pay their Medicare out-of-pocket costs.
The CR would cut all non-defense programs by 0.2% across the board.
FY 2011 Funding for Aging & Health Programs
(budget authority)
|
FY2010 |
FY2011 request |
FY’11 CR |
ADMINISTRATION ON AGING |
$1,516,073,000 |
1,624,733,000 |
1,500,073,000 |
Alzheimer’s disease demonstration |
11,462,000 |
11,464,000 |
Not specified |
Lifespan Respite Care |
2,500,000 |
5,000,000 |
Not specified |
Meals, congregate |
440,718,000 |
445,644,000 |
440,783,000 |
Meals, home delivered |
217,644,000 |
220,893,000 |
217,676,000 |
National family caregiver support |
154,197,000 |
202,220,000 |
Not specified |
Native American caregiver support |
6,388,000 |
8,389,000 |
Not specified |
Native Americans nutrition/supportive |
27,704,000 |
29,708,000 |
27,708,000 |
Network support activities |
44,276,000 |
44,179,000 |
Not specified |
Nutrition services incentive program |
160,991,000 |
161,015,000 |
Not specified |
Preventive health services |
21,023,000 |
21,026,000 |
Not specified |
Program administration |
19,976,000 |
22,508,000 |
Not specified |
Program Innovations |
19,020,000 |
13,049,000 |
Not specified |
Protection for vulnerable elders |
21,880,000 |
23,290,000 |
Not specified |
Supportive services and centers |
368,294,000 |
416,348,000 |
Not specified |
OTHER HHS |
|
|
|
Low-Income Home Energy Assistance |
5,099,223,000 |
3,300,000,000 |
4,710,000,000 |
DEPARTMENT OF LABOR |
|
|
|
Community Services Employment for Older Americans |
825,425,000 |
600,425,000 |
450,000,000 |
Source: House Appropriations Committee and House Rules Committee
###
Census Bureau Survey Shows Poor Older Adults Stay that Way Longer March 16, 2011
Adults 65 years and over are least likely to be in poverty, but once poor, they were as likely to remain in poverty as children under 18 years, the age group most at risk to be in poverty, a new Census Bureau report looking at 2004-2006 data concludes.
There are many ways to measure poverty. The official annual poverty rate, based on the Current Population Survey Annual Social and Economic Supplement (CPS ASEC), captures a snapshot of well-being at a single time period. These data have generally shown a decline in elderly poverty rates since the 1960s, the Census Bureau says.
But the new Census Bureau report looks at poverty data based on information collected in the Survey of Income and Program Participation (SIPP). It describes patterns of poverty using measures with different time horizons and provides a dynamic view of the duration of poverty spells and the frequency of transitions into and out of poverty. It further examines how poverty dynamics vary across demographic groups.
The SIPP data provide a more complex picture of the dynamics of poverty for adults 65 years and over. While children had the highest chronic poverty rate, adults 65 and over in poverty at the beginning of the 2004 Panel were the most likely to remain in poverty for the entire 3 years. About 38 percent of elderly adults in poverty in January and February 2004 were poor in all 36 months while the comparable rates for children and working-age adults were 27.5 percent and 18.1 percent, respectively.
The elderly were least likely to be poor for 2 or more months, but their poverty exit rate was not statistically different from that for children.
To view report, Dynamics of Economic Well-Being: Poverty, 2004–2006, go to: http://www.census.gov/prod/2011pubs/p70-123.pdf.
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Dr. Allan Anderson to Head the American Association for Geriatric Psychiatry
March 1, 2011
The American Association for Geriatric Psychiatry (AAGP) has announced that Allan A. Anderson, MD, of Cambridge, Maryland, will become president. He succeeds Jeffrey M. Lyness, MD, as president at the conclusion of the AAGP’s 24th annual scientific meeting, to be held March 18-21 in San Antonio, Texas.
The association will continue to focus efforts in advocating for increased research funding, incentives for physicians to choose a career in geriatric mental health, and fair and reasonable reimbursement for clinical care.
Anderson will focus on growing the association’s membership, bringing in additional psychiatrists who practice geriatric psychiatry and non-psychiatric clinicians and researchers in the arena of geriatric mental health. “By bringing together a broader base of clinicians, educators and researchers in geriatric mental health, the association will have a stronger voice as we push for legislative and policy changes that will guarantee better care for older adults,” Anderson explained.
Anderson is the medical director for the Samuel and Alexia Bratton Memory Clinic at William Hill Gardens in Easton, MD, which is operated by the Episcopal Ministries for the Aging and associated with the Copper Ridge Institute and the Department of Psychiatry at Johns Hopkins University School of Medicine. Dr. Anderson holds the title of assistant professor at Johns Hopkins.
“Allan is widely admired as a clinician and teacher, and brings great experience with real-world practice, including the relationship of community-based practice with academia and clinical investigation,” said outgoing AAGP President Jeffrey M. Lyness, MD. “He also is highly skilled and knowledgeable regarding public advocacy for our patients and our field.”
###
CDC Releases Issue Brief on American Indian End-of-Life Care
Feb. 20, 2011
The Centers for Disease Control and Prevention’s Healthy Aging Program and the National Association of Chronic Disease Directors have released a new Issue Brief, Moving Beyond Paradigm Paralysis: American Indian End-of-Life Care.
The Issue Briefexamines end-of-life beliefs of American Indian and Alaska Native (AI/AN) elders and concludes that health care and social services professionals may need to re-examine their assumptions about end-of-life care.
Conventional wisdom has long held that Indian elders—especially those couched in traditional belief systems—will not openly discuss issues related to death and dying. But, in light of changing culture and demographics and recent successes with new end-of-life care models for AI/AN populations, these long-held but increasingly unjustified assumptions may no longer apply.
The Issue Brief presents four case studies of successful programs providing end-of-life and palliative care in Indian Country. Their work shows that this need can be met in ways that appropriately address the wishes of the patient and family.
The Issue Brief will be posted online shortly at:
http://www.chronicdisease.org/i4a/pages/index.cfm?pageid=3838
Click here to view the Issue Brief.
###
FY 2012 Budget Request for AoA
Feb. 14, 2011
From Department of Health and Human Services: (dollars in millions)
|
FY’10 |
FY’11 |
FY’12 |
‘11/’12 |
Health and Independence |
|
|
|
|
Home & Community-Based Supportive Services. |
368 |
368 |
416 |
+ 48 |
Nutrition Services |
819 |
819 |
819 - - |
-- |
Preventive Health Services |
21 |
21 |
21 - - |
-- |
Native American Nutrition & Supportive Services |
28 |
28 |
28 |
-- |
Aging and Disability Resource Centers |
24 |
24 |
13 |
-10 |
ACA Mandatory Funding (non-add) |
10 |
10 |
10 |
-- |
Aging Network Support Activities |
8 |
8 |
8 |
-- |
Subtotal, Health and Independence |
1,268 |
1,268 |
1,306 |
+ 38 |
Caregiver Services |
|
|
|
|
Family Caregiver Support Services |
154 |
154 |
192 |
+ 38 |
Native American Caregiver Support Services |
6 |
6 |
8 |
+2 |
Alzheimer's Disease Supportive Services Program |
11 |
11 |
11 |
-- |
Lifespan Respite Care |
3 |
3 |
10 |
+8 |
Subtotal, Caregiver Services |
175 |
175 |
222 |
+ 48 |
Protection of Vulnerable Older Adults |
|
|
|
|
Adult Protective Services |
-- |
-- |
17 |
+17 |
Native American Elder Rights (non-add) |
-- |
-- |
2 |
+2 |
Long-Term Care Ombudsman Program |
17 |
17 |
22 |
+5 |
Prevention of Elder Abuse & Neglect |
5 |
5 |
5 |
-- |
Senior Medicare Patrol Program |
13 |
13 |
13 |
-- |
Elder Rights Support Activities |
4 |
4 |
4 |
-- |
Subtotal, Protection of Vulnerable Older Adults |
39 |
39 |
60 |
+21 |
State Health Insurance and Assistance Programs................... |
47 |
47 |
47 |
-- |
Community Living Assistance Services and Supports.............. |
-- |
-- |
120 |
+120 |
Senior Community Service Employment Program l |
825 |
825 |
450 |
-375 |
Chronic Disease Self-Management Programs |
-- |
-- |
10 |
+10 |
Medicare Enrollment Assistance2 |
30 |
-- |
-- |
-30 |
Program Innovations |
28 |
28 |
12 |
-16 |
Earmarks (non-add |
6 |
6 |
-- |
-6 |
Program Administration. |
20 |
20 |
25 |
+5 |
Total, Program Level |
2,432 |
2,402 |
2,251 |
-181 |
Less Funds from Other Sources |
|
|
|
|
Aging and Disability Resource Centers |
- 10 |
-10 |
-10 |
-- |
Health Care Fraud and Abuse Control2 |
- 4 |
- 3 |
-3 |
-- |
Medicare Enrollment Assistance 2 |
- 30 |
-- |
-- |
+30 |
Subtotal, Funds from Other Sources - |
- 44 |
- 13 |
- 13 |
+30 |
Total, Budget Authority |
2,388 |
2,389 |
2,238 |
-151 |
Full Time Equivalents (FTE) (staff)3 |
100 |
111 |
176 |
+ 76 |
1 The Budget proposes to transfer this program from the Department of Labor to HHS in FY 2012. The FY 2010 and FY 2011 funding for this program is displayed comparably.
2 Funding from Medicare Trust Funds.
3 FY 2010 and FY 2011 FTE figures do not include staff working on the Community Living Assistance Services and Supports Program, the Senior Community Service Employment Program, the State Health Insurance and Assistance Program, or Adult Protective Services. The FY 2012 FTE figure includes 55 FTE for these programs.
###
From Office of Management and Budget (GPO): (dollars in millions)
Obligations by Program Activity:
|
FY2010 |
FY2011 |
FY2012 |
ADMINISTRATION ON AGING |
$1,523 |
$1,526 |
$2,248 |
Aging & Disability Resource Centers |
10 |
10 |
13 |
Adult Protective Services |
— |
— |
17 |
Alzheimer’s disease demonstration |
11 |
11 |
11 |
Chronic Disease Self-Management Program |
— |
— |
10 |
CLASS Program Administration |
— |
— |
120 |
Community Service Employment for Older Americans |
— |
— |
450 |
Elder abuse/neglect prevention |
5 |
5 |
5 |
Elder Rights Support Activities |
— |
— |
4 |
Lifespan Respite Care |
3 |
3 |
10 |
Long-term care ombudsmen program |
17 |
17 |
22 |
Meals, congregate |
441 |
441 |
441 |
Meals, home delivered |
218 |
218 |
218 |
National family caregiver support |
154 |
154 |
192 |
Native American caregiver support |
6 |
6 |
8 |
Native Americans nutrition/supportive |
28 |
28 |
28 |
Network support activities |
44 |
44 |
8 |
Nutrition services incentive program |
158 |
161 |
161 |
Preventive health services |
21 |
21 |
21 |
Program administration |
20 |
20 |
24 |
Program Innovations |
19 |
19 |
12 |
Senior Medicare Patrol Program |
— |
— |
10 |
State Health Insurance Assistance Program (SHIPs) |
— |
— |
47 |
Supportive services and centers |
368 |
368 |
416 |
*The FY 2011 levels may be reduced by the continuing resolution for FY 2011 appropriations that has yet to be passed by Congress.
Highlights from HHS documents:
Elder Justice. The budget proposes increases of +$21.5 million to support an enhanced focus on elder rights and elder justice, including +$16.5 million for State Adult Protective Services (APS) demonstrations. Authorized by the Elder Justice Act of 2010, these resources will allow AoA to provide leadership and program coordination as well as develop and disseminate best practices across State and local APS agencies. Of these funds, +$1.5 million will be targeted for coalition building, training and technical assistance, elder rights program development, and research for preventing and addressing elder abuse within Tribal nations. In addition to these APS improvements, the budget provides an additional +$5 million to improve resident advocacy to elders and adults with disabilities who live in long-term care settings through increased support to the Long-Term Care Ombudsman Program.
Family Caregiver Support. AoA’s FY 2012 request provides an additional +$95.5 million for programs that provide caregivers with services, supports and respite. The request proposes an additional +$40 million for the National Family Caregiver Support Program (including +$2 million for Native American caregivers) to provide information, assistance, counseling, training, and respite care support to family and informal caregivers; as well as an additional +$48 million for Home and Community-Based Supportive Services such as adult day care, transportation assistance, and minor home modifications that help caregivers to care for their loved ones at home.
CLASS. The request also includes $120 million in administrative funding for the Community Living Assistance Services and Supports (CLASS) Program. program. This voluntary insurance program for participating adults that will allow participants to prepare themselves financially to be able to afford the services and supports that they may one day need to remain independent and in the community
Older Workers. The FY 2012 budget also proposes to shift the Senior Community Service Employment Program (SCSEP), authorized under Title V of the Older Americans Act, from the Department of Labor to AoA. The FY 2012 request for SCSEP is $450 million, a reduction of -$375 million, of which -$225 million reflects a one-time special appropriation in response to the economic downturn. This proposal reflects the recognition that the SCSEP program can be at its most effective when its services are closely integrated with the supports that are provided by AoA’s existing aging services programs. The wages earned by participants while in this program and after finding unsubsidized employment, will be key to allowing more seniors to remain independent and in their communities.
Ombudsmen. The Budget includes $22 million, an increase of $5 million, to support long-term care ombudsmen in their role as advocates for residents of nursing homes and other adult residential care facilities.
###
House Appropriations Panel’s CR Has Largest Spending Cuts in History
Feb. 11, 2011
The House Appropriations Committee has introduced a FY 2011 Continuing Resolution (H.R. 1) to fund the federal government for the last seven months of the fiscal year. It includes spending cuts of over $100 billion from the President’s fiscal year 2011 request. A committee press release calls the CR legislation “the largest single discretionary spending reduction in the history of Congress.” The current continuing resolution for FY’11 expires in early March.
The proposal would provide $70,750,000 less for AoA than the FY’10 level by removing “program efficiency reductions” due to the Affordable Care Act ($65 million) and earmarks ($6 million). H.R. 1 would fund AoA at $1,445,323,000, compared to the FY’10 appropriation of $1,516,073,000, and the FY 11 request of $1,624,733,000.
The committee’s bill would also cut the Senior Community Service Employment Program by $525 million compared to the FY’10 level ($825 million) and $300 below the president’s FY’11 request of $600 million. Below are proposed cuts of interest to aging policy and public health.
FY 2011 CONTINUING RESOLUTION REDUCTIONS
(in millions of dollars)
Program |
Compared to FY10 Enacted |
Compared to FY11 Request |
Administration on Aging |
|
|
Program Efficiency Reduction due to ACA (aka ObamaCare) |
(65.0) |
(65.0) |
Earmarks |
(6.0) |
|
Community Service Employment for Older Americans |
(525.0) |
(300.0) |
HHS |
|
|
Community Health Centers |
(1000.0) |
(1290.0) |
State Health Access Grant Program |
(75.0) |
(75.0) |
CDC |
|
|
Public Health Preparedness and Response |
(269.1) |
|
Earmarks |
(20.6) |
|
General Reduction |
(850.0) |
(850.0) |
CMS: |
|
|
Centers for Medicare and Medicaid Services |
|
|
Underexecution of Personal Pay |
(26.0) |
(26.0) |
Program Efficiency Reduction due to ACA (aka ObamaCare) |
(340.0) |
(360.7) |
Research, Demonstration and Evaluation |
(32.5) |
(37.7) |
Medicare contracting reform |
(56.5) |
(56.5) |
Earmarks |
(3.1) - |
|
Administration on Children and Families |
|
|
Low Income Home Energy Assistance Program - Contingency Fund |
(390.3) |
(590.0) |
Community Services Block Grant (Grants to States) |
(305.0) |
(305.0) |
Community Services Block Grant (Economic Development) |
(36.0) |
(36.0) |
Office of Secretary |
|
|
Eliminate no-year flu funding |
(276.0) |
|
Social Security Administration |
(625.0) |
(997.6) |
Legal Services Corporation |
(70.0) |
(85.0) |
Corporation for National and Community Service |
(1024.0) |
(1288.6) |
The CR will be considered on the House floor next week.
To view H.R. 1, click here.
To view a summary of the bill, click here.
A list of program cuts can be found here.
Meanwhile, the House Energy and Commerce Committee, chaired by Rep. Fred Upton (R-MI), will hold a vote on Feb. 15 on the committee’s oversight plan. The plan states that the committee will examine, among other topics, issues related to the Department of Health and Human Services implementation of Public Law 111-148, The Patient Protection and Affordable Care Act (ACA), including:
The oversight plan can be viewed by clicking here.
Older Adults Often Excluded From Clinical Trials, UM Study Finds
Feb. 2, 2011
Clinical trials and research evidence guidelines used to treat older adults could be improved by eliminating upper age limits for study inclusion, by reducing the use of eligibility criteria that disproportionately affect older patients, and by encouraging adherence to recommended analytical methods for evaluating treatment effects by age. Those are the recommendations of a new study led by Donna Zulman, M.D., the lead author and a Veterans Affairs scholar with the Robert Wood Johnson Foundation (RWJF) Clinical Scholars at the University of Michigan Health System.
Consider this:
"These findings are concerning because it means that doctors cannot be confident that clinical trial results apply to their older patients," says Donna Zulman, M.D., "Health care providers and patients need better evidence about treatment strategies that improve the health and quality of life of seniors."
The study also found that trials rarely assess how treatments affect function and quality of life, outcomes that are often of great importance to older individuals.
"It is rarely appropriate to exclude people from clinical trials based on their age alone," argues Jeremy B. Sussman, M.D., a study co-author and a Veterans Affairs scholar with the RWJF Clinical Scholars program at the U-M. "This is especially true in trials investigating conditions that are common in older adults."
The study, "Examining the Evidence: A Systematic Review of the Inclusion and Analysis of Older Adults in Randomized Clinical Trials," was published online in the Journal of General Internal Medicine on February 2, 2011.
###
New Report Shows Dramatic Increase in Reliance on Social Security among Seniors
Jan. 27, 2011
New research from the Institute for Women’s Policy Research (IWPR) finds that reliance on Social Security for retirement income has increased dramatically since 1999—particularly among men. Contributing factors include loss of assets during the most recent recession, as well as shifts toward higher risk retirement plans.
“Social Security is more needed than ever,” said Heidi Hartmann, President of IWPR and lead author of the report, Social Security Especially Vital to Women and People of Color, Men Increasingly Reliant. “It has served as the bedrock of retirement income for several generations of Americans. Now, as a result of the Great Recession and with the value of assets down— including homes, pension accumulations, and savings—Social Security serves as our Rock of Gibraltar. Social Security is the one income stream that is secure and does not fluctuate with the marketplace.”
Between 1999 and 2009, the number of men aged 65 and older relying on Social Security for at least 80 percent of their incomes increased by 48 percent (from 3.8 million to 5.7 million) to equal more than a third of all men aged 65 and older in 2009. The increase for comparable women was 26 percent (from 8.2 million to 10.3 million) to equal half of older women in 2009.
Minorities tend to be more reliant on Social Security than whites are, as they are considerably less likely than whites to have asset or pension income. Women benefit disproportionately from Social Security because the program is designed to pay proportionally higher benefits to lower earning workers and women tend to earn less than men. Women also benefit from the program’s family benefits.
In 2009, Social Security helped more than 14 million Americans aged 65 and older stay above the poverty line. Without access to Social Security, 58 percent of women and 48 percent of men above the age of 75 would be living below the poverty line.
The study is based on IWPR analysis of data from the 1978 to 2010 Current Population Survey Annual Social and Economic Supplements collected jointly by the Census Bureau and the Bureau of Labor Statistics.
###
AAHSA Becomes LeadingAge
Jan. 25, 2011
As of Jan. 25, 2011, the American Association of Homes and Services for the Aging (AAHSA) officially becomes LeadingAge. LeadingAge reinforces its not-for-profit members’ commitment not only to providing services and care, but also to leading the charge for change in the way our country views aging.
The organization said LeadingAge and its members are committed to innovative practices to transform how we serve our aging population, to cutting-edge initiatives that develop services that meet older adults’ needs and preferences, and to advocacy that expands the world of possibilities for aging.
The website is still http://www.aahsa.org/.
###
HHS/DOJ Fraud Prevention/ Enforcement Recovered $4 Billion
January 24, 2011
The government’s health care fraud prevention and enforcement efforts recovered more than $4 billion in taxpayer dollars in Fiscal Year (FY) 2010, according to a report released today by U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and U.S. Associate Attorney General Thomas J. Perrelli. That is the highest annual amount ever recovered from people who attempted to defraud seniors and taxpayers, according to the annual Health Care Fraud and Abuse Control Program (HCFAC) report.
“Our aggressive pursuit of health care fraud has resulted in the largest recovery of taxpayer dollars in the history of the Justice Department,” said Perrelli. “These actions are in large part because of the great work being led by the Health Care Fraud Prevention and Enforcement Action Team (HEAT). Through this initiative, we are working in partnership with government, law enforcement and industry leaders, and the public to protect taxpayer dollars, control health care costs, and ensure the strength and integrity of our most essential health care programs.”
Health Care Fraud and Abuse Control Program Report
More than $4 billion stolen from federal health care programs was recovered and returned to the Medicare Health Insurance Trust Fund, the Treasury, and others in FY 2010. This is an unprecedented achievement for the Health Care Fraud and Abuse Control Program (HCFAC), a joint effort of the two departments to coordinate federal, state, and local law enforcement activities to fight health care fraud and abuse.
The Affordable Care Act provides additional tools and resources to help fight fraud that will help boost these efforts, including an additional $350 million for HCFAC activities. The administration is already using tools authorized by the Affordable Care Act, including enhanced screenings and enrollment requirements, increased data sharing across government, expanded overpayment recovery efforts, and greater oversight of private insurance abuses.
During FY 2010, HEAT and the Medicare Fraud Strike Force expanded local partnerships and helped educate Medicare beneficiaries about how to protect themselves against fraud. In FY 2010, the total number of cities with Strike Force prosecution teams was increased to seven, all of which have teams of investigators and prosecutors dedicated to fighting fraud. The Strike Force teams use advanced data analysis techniques to identify high-billing levels in health care fraud hot spots so that interagency teams can target emerging or migrating schemes along with chronic fraud by criminals masquerading as health care providers or suppliers. Strike Force enforcement accomplishments in all seven cities during FY 2010 include:
Including Strike Force matters, federal prosecutors opened 1,116 criminal health care fraud investigations as of the end of FY 2010, and filed criminal charges in 488 cases involving 931 defendants. A total of 726 defendants were convicted for health care fraud-related crimes during the year.
View the HCFAC annual report online at: oig.hhs.gov/publications/hcfac.asp.
###
HHS Announces New Anti-Fraud Rules under Affordable Care Act
January 24, 2011
The Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) at Department of Health and Human Services will shortly publish a final rule with comment period implementing portions of the Affordable Care Act designed to prevent and combat fraud waste and abuse under the Medicare, Medicaid, and children’s Health Insurance Program.
The rules will include:
These regulations are effective on March 25, 2011. The rules will be published in the Federal Register shortly Until that time, they may be viewed at: www.ofr.gov/inspection.aspx.
###
New AGS Fall Prevention Guidelines Include Tai Chi, Reduced Meds
Jan. 13, 2011
In the first update of the American Geriatrics Society and the British Geriatric Society's guidelines on preventing falls in older persons since 2001, they now recommend that all interventions for preventing falls should include an exercise component and that a number of new assessments should be used, including; feet and footwear, fear of falling, and ability to carry out daily living activities.
The guidelines, a summary of which are published in the Journal of the American Geriatrics Society, also state that fall screening and prevention should be a part of all healthcare practices for older adults.
The guidelines were compiled by a panel comprising members from the previous panels and new members with substantial knowledge, experience, and publications in fall prevention and care of older patients, and are based on a systematic review of the randomized controlled trials of fall prevention interventions. The literature search included meta-analyses, systematic literature reviews, randomized controlled trials, controlled before-and-after studies, and cohort studies published between May 2001 and April 2008. The panel also reviewed the RCTs published between April 2008 and July 2009 and concluded that the additional evidence did not change the ranking of the evidence or the guideline recommendations.
"Falls are one of the most common health problems experienced by older adults and are a common cause of losing functional independence," said Dr. Mary Tinetti of Yale University School of Medicine, USA, and one of the panel chairs. "Given their frequency and consequences, falls are as serious a health problem for older persons as heart attacks and strokes."
The guidelines now state that doctors and other health professionals should determine whether their older patients are at risk of falling by asking if they have fallen recently or if they are unsteady walking. If so, health providers should look for the presence of known problems such as muscle weakness, poor balance or blood pressure that drops too much on standing. If they have these problems, then older adults should receive the interventions described in the guidelines, but if there is no evidence of gait problems or recurrent falls, they do not require a risk assessment.
The new recommendations for interventions focus on:
"We found that the most effective trials for preventing falls in older people looked at multiple interventions rather than just one; previous studies have indicated that it is more effective to focus on one intervention, but because we looked at not only what recommendations were given, but also which carried out, we're confident that multifactorial interventions is the best course of action," said Tinetti.
"There is emerging evidence that the rate of serious fall injuries, such as hip fractures, is decreasing modestly in areas in which fall prevention is integrated into clinical practice. By making fall prevention part of the clinical care of older adults this trend can continue."
###
Aggressive Care Raises Medicare Costs In End-Stage Dementia
Jan. 10, 2011
A large proportion of Medicare expenditures for nursing home residents with advanced dementia, a terminal illness, is spent on aggressive treatments that may be avoidable and of limited clinical benefit, according to a new study by the Institute for Aging Research, an affiliate of Harvard Medical School, published in the online version of the Archives of Internal Medicine on Jan. 10, 2011.
The study examined Medicare expenditures for 323 nursing home residents with advanced dementia in 22 facilities in the Greater Boston area as part of the Choices, Attitudes, and Strategies for Care of Advanced Dementia, or CASCADE, study. According to the findings, the largest proportion of Medicare expenditures was for hospitalizations (30.2%) and hospice (45.6%). Medicare expenditures rose by 65 percent in each of the last four quarters before death, primarily due to an increase in both acute care and hospice services. Acute care costs were lower among residents who had either a Do Not Hospitalize (DNH) order, lived on a special care dementia unit, or did not have a feeding tube.
"Our study demonstrates that a large proportion of Medicare expenditures in advanced dementia are attributable to acute and sub-acute services that may be avoidable and may not improve clinical outcomes," says senior author Susan L. Mitchell, M.D., M.P.H., a senior scientist at the Institute for Aging Research.
An additional 10 percent of Medicare expenditures were for care in a rehabilitation facility after hospitalization. Dr. Mitchell calls the benefits of skilled nursing or rehabilitative care for these patients "questionable," given that most of them are totally physically functionally and cognitively impaired.
Strategies that promote high-quality palliative care may shift expenditures away from aggressive treatments for dementia patients at the end of life and more toward a comfort care approach, say the researchers.
"The strong association between the lack of a DNH order and higher acute care expenditures supports the notion that advance care planning may be a key step toward preventing aggressive end-of-life care," says Dr. Mitchell, an associate professor of medicine at Harvard Medical School. Among cancer patients, advance planning lowers costs in the last week of life, and lower costs are associated with a higher quality of dying experience.
Both hospice and palliative care focus on quality of life or "comfort care," including the active management of pain and other symptoms, as well as the psychological, social and spiritual issues often experienced at the end of life. Unlike hospice, however, palliative care services do not depend on life expectancy and may be used in conjunction with curative treatments.
###