Common Alzheimer's Medication Helps Skills Necessary for Safe Driving
June 9, 2010
Cholinesterase inhibitors (ChEI), a type of medication often prescribed for Alzheimer's disease (AD), improved some cognitive skills related to driving in patients with mild AD, a new Rhode Island Hospital study has shown. Findings from the study showed that after being treated with a ChEI, AD patients improved in some computerized tests of executive function and visual attention, including a simulated driving task. The study is published in the June 2010 edition of the Journal of Clinical Psychopharmacology.
The study was led by Lori Daiello, PharmD, a research associate at the Rhode Island Hospital Alzheimer's Disease and Memory Disorders Center. Daiello says, "Because many patients receiving a diagnosis of AD continue to drive in its early stages, it is critical that we assess driving safety among this population and identify therapies that may improve driving abilities. ChEIs are commonly prescribed for AD, yet little is known about how their potential treatment effects might impact a driver's skills."
The researchers studied the performance of 24 outpatients with newly-diagnosed, untreated, early stage AD using tests that simulate typical situations encountered in on-road driving. ChEI treatment was associated with improvement in the ability to accurately maintain lane position during the simulated driving task. ChEI treatment also was associated with improved target detection accuracy in the visual search task and quicker visual search response times in both the pre- and post-treatment comparison and cross-sectional comparisons. After ChEI treatment, subjects completed the computerized mazes faster, although accuracy of completion was not affected.
The study is published in the June 2010 edition of the Journal of Clinical Psychopharmacology. The research was supported by the National Institute on Aging.
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Vast Geographic Differences Found in Drug Spending under Medicare
June 9, 2010
Widespread geographic variations exist in drug spending among Medicare beneficiaries, with some regions spending twice as much as others, according to a University of Pittsburgh Graduate School of Public Health study. Published in the Online First June 9 issue of the New England Journal of Medicine, and the first to explore regional drug spending under Medicare, the study also found that higher spending on drugs was not balanced by lower spending on other medical care services such as hospitalizations and visits to the doctor's office.
"As current health care reform legislation seeks to address inefficiencies in Medicare spending to get costs under control, it is vitally important to look at how spending differs regionally," said the study's lead author, Yuting Zhang, Ph.D., assistant professor of health economics at the University of Pittsburgh Graduate School of Public Health. "One of the key questions is whether Medicare patients who spend more on drugs to control chronic conditions have fewer physician visits and hospitalizations. Without examining drug expenditures, it is impossible to know whether spending in one area may substitute for spending in another."
The authors found that drug spending accounted for more than 20 percent of total medical spending, but varied substantially. For example, the highest region for drug spending under Medicare was Manhattan, N.Y. ($2,973 annually per beneficiary) and the lowest as Hudson, Fla. ($1,854 annually per beneficiary). Non-drug medical spending also varied widely and was twice as high in the highest-spending regions compared to the lowest.
The authors also found that variations in drug spending were only weakly associated with variations in non-drug medical spending.
"Spending more on drugs didn't clearly result in less spending on other medical services," said Dr. Zhang. "Although there was a weak correlation between the two types of spending, high spending in one area was not offset by low spending in the other. This data gives us valuable insight into the use of health care resources and may help guide public policy related to health care reform."
The study was funded by the University of Pittsburgh and grants from the National Institute of Mental Health and the Agency for Healthcare Research and Quality.
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Commonwealth Fund Commission Calls for CMS to Quickly Reform Payments
June 8, 2010
The new Center for Medicare and Medicaid Innovation (CMI) must be inclusive and flexible in developing and implementing payment initiatives, continuously monitor their impact, and rapidly disseminate them if they appear to be successful, in order to realize the potential for improved health care delivery and reduced spending, according to a new Health Affairs article by Commonwealth Fund researchers.
CMI, as described in the Affordable Care Act, is meant to develop innovative ways of providing and paying for health care that have the potential to reduce costs while preserving or enhancing health care quality. CMI will begin full-scale operations as part of the Centers for Medicare and Medicaid Services (CMS) in 2011, and will be responsible for developing at least 18 reform models specified in the new law, including: patient-centered medical homes, promotion of care coordination through salary-based payment; community-based health teams to support small-practice medical homes; use of health information technology to coordinate care for the chronically ill, and salary-based payment for physicians.
Commonwealth Fund President Karen Davis said, "If health reform is to succeed in improving care and curbing spending, this new center must function like a research and development laboratory for health care delivery, designed to discover, support, and disseminate the best and most innovative ideas."
The authors recommend that the CMI:
Adopt a nimble "innovation with evidence development" approach in which new programs are implemented and continued as long as they show they are improving quality and value, and achieving desired outcomes.
Include among its pilots an array of health care payment models, with the foremost goal being that payments are tied to high quality, efficient care that is patient-centered.
Include private sector payers and public health insurance programs including Medicare and Medicaid in pilot initiatives—the broader the initiative, the greater the impact.
Be open to payment reform approaches led by states or private sector entities, taking into account geographic differences in health care and the environments in which care is provided.
Ensure transparency by developing explicit criteria for selecting new programs and their participants and putting in place a mechanism to inform policymakers and interested parties about ongoing and planned projects.
Guarantee there are systems in place to continuously monitor and identify pilots' successes and failures.
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First of Prescription Drug Rebate Checks to Be Mailed June 10
June 8, 2010
In compliance with the health reform legislation (Affordable Care Act) recently passed by Congress, the government will begin on June 10 mailing out $250 checks to those Medicare beneficiaries who entered the Medicare Part D donut hole, also known as the coverage gap, in the first quarter of 2010 and are not eligible for Medicare Extra Help (also known as the low-income subsidy or LIS).
The donut hole is the period in the prescription drug benefit in which the beneficiary pays 100 percent of the cost of their drugs until they hit the catastrophic coverage. People in the Extra Help program already have assistance with the cost of prescription drugs.
“We are heading into the week when our first tax-free $250 donut hole rebate checks will be mailed out to Medicare beneficiaries who have fallen into the coverage gap,” said Secretary Kathleen Sebelius and Attorney General Eric Holder in a letter to states (see next story.) “Accordingly, we are especially concerned about fraud and increased activity by criminals seeking to defraud seniors – and we are seeking your help to stop it,” they wrote.
The $250 checks will be sent automatically to Medicare beneficiaries who quality for them. The senior does not need to take any action and no one should be contacting them offering assistance with obtaining a check.
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HHS to Double Size of Senior Medicare Patrol Program
June 8, 2010
The Department of Health and Human Services has announced plans to double the size of the Senior Medicare Patrol (SMP) program. Since 1997, HHS and its Administration on Aging have funded Senior Medicare Patrol projects to recruit and train retired professionals and other senior citizens about how to recognize and report instances or patterns of health care fraud.
Close to 3 million Medicare beneficiaries have been educated since the start of the program, and more than 1 million one-on-one counseling sessions have taken place with seniors or their caregivers.
The FY’11 budget request sought $9.4 million for the Administration on Aging for the SMP program. In prior years, AoA has also received about $3 million from HCFAC (the Health Care Fraud and Abuse Control fund) to support infrastructure, technical assistance and the other SMP program support and capacity-building activities designed to enhance the effectiveness of state-wide SMP programs funded under the separate congressional appropriation.
Currently, the Senior Medicare Patrol program funds projects in every state, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands.
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HHS/DOJ Announce Outreach and Education to Combat Medicare Fraud
June 8, 2010
U.S. Secretary of Health and Human Services Kathleen Sebelius and Attorney General of the United States Eric Holder today sent a letter to state attorneys general urging them to work with HHS and federal, state, and local law enforcement officials to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud beginning this summer. The campaign is part of the Health Care Fraud Prevention Enforcement Action Team (HEAT), a cabinet-level initiative launch by HHS and DOJ in May 2009.
The letter outlines education and outreach efforts, including
1) Cutting the improper payment rate, which tracks fraud, waste and abuse in the Medicare Fee for Service program, in half by 2012.
2) Holding a series of regional fraud prevention summits around the country over the next few months. The first summit will take place in Miami on July 16. Other will follow in Los Angeles, Las Vegas, Detroit, Boston, New York, and Philadelphia.
3) Holding regular (generally quarterly) health care fraud task force meetings to facilitate the exchange of information with partners in the public and private sector. All 93 U.S. Attorneys have been asked to put a plan into place and schedule their first meeting by August 16, 2010.
4) Doubling the size of the Senior Medicare Patrol to put more boots on the ground in the fight against Medicare fraud.
5) Launching a new educational media campaign this summer to educate Medicare beneficiaries about how to protect themselves against fraud. It will focus on the importance of staying vigilant about personal Medicare information. The campaign will begin with a $1 million national radio campaign that will run in June through August as $250 tax-free rebate checks get mailed to eligible seniors each month. The Affordable Care Act also contains some important new tools and resources that will directly help law enforcement officials crack down on fraud.
To view the letter, go to http://www.healthreform.gov/ag_letter_hhsdoj06082010.pdf
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Protective Factors Uncertain for Alzheimer's Disease
May 11, 2010
There is not enough conclusive research on risk factors and protective factors for Alzheimer’s disease to make specific recommendations for behavioral, lifestyle, or pharmaceutical interventions/modifications, an Agency for Healthcare Research and Quality evidence report has concluded.
A total of 25 systematic reviews and 250 primary research studies were included. Only a few factors showed a consistent association with AD or cognitive decline across multiple studies, including both observational studies and randomized controlled trials (when available). Such factors associated with increased risk of AD and cognitive decline were: diabetes, epsilon 4 allele of the apolipoprotein E gene (APOE e4), smoking, and depression. Factors showing a fairly consistent association with decreased risk of AD and cognitive decline were: cognitive engagement and physical activities.
A consistent association does not imply that findings were robust, as the data were often limited, and the quality of evidence was typically low. In addition, the risk modification effect of reported associations was typically small to moderate for AD, and small for cognitive decline. Some of the factors that did not show an association with AD or cognitive decline in this review may still play an influential role in late-life cognition, but there was not sufficient evidence to draw this conclusion. Many of the factors evaluated are not amenable to randomization, so rigorous observational studies are required to assess their effect on AD and cognitive decline.
Further research that addresses the limitations of existing studies is needed prior to be able to make recommendations on interventions, the report concluded.
To view Alzheimer's Disease and Cognitive Decline, Structured Abstract, April 2010, go to: www.ahrq.gov/downloads/pub/evidence/pdf/alzheimers/alzcog.pdf.
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Older People in Assisted-Living Facilities Sleep Poorly, Study Reports
May 7, 2010
Sixty-five percent of Assisted Living Facility residents in Los Angeles had clinically significant sleeping problems, new research by the University of California, et al. shows. Poor sleep was associated with declining quality of life and increased depression over a six month follow-up period.
Evidence suggests that ALF residents are at a very vulnerable period in their lives, with a high risk for further functional decline and subsequent nursing home placement.
The study looked at the sleep habits of 121 older people living in ALFs in the Los Angeles area and found that on average they slept about six hours per night and for about one and a half hours during the day. 74% had resided in an ALF for two years or less. 65% of participants were suffering significant sleep disturbance as measured on the Pittsburgh Sleep Quality Index. The most commonly reported factors contributing to "trouble sleeping" included waking up in the middle of the night or early morning (60.3%) and the inability to fall asleep within 30 minutes (59.5%).
At the initial study visit, sleeping poorly was associated with lower health-related quality of life, needing more help with activities of daily living (e.g., bathing, dressing, grooming), and more symptoms of depression. Participants were visited again three and six months later, and the researchers discovered that sleeping poorly at the initial visit predicted a worsening of quality of life, needing even more help with activities of daily living and even worse symptoms of depression.
"We cannot conclude that poor sleep truly causes these negative changes; however, future studies should evaluate ways to improve sleep in ALFs to see if sleeping better might improve quality of life, delay functional decline and reduce risk of depression," said lead author Jennifer Martin, PhD, of the University of California, Los Angeles and VA Greater Los Angeles Healthcare System.
The study is published in the May issue of the Journal of the American Geriatrics Society.
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Thomson Reuters Releases Analysis of 2010 Health Care Act
May 5, 2010
The Tax & Accounting business of Thomson Reuters recently published The Complete Analysis of the Tax and Benefits Provisions of the 2010 Health Care Act. Topics include:
"RIA's Complete Analysis of the Tax and Benefits Provisions of the 2010 Health Care Act explains in detail the many complex tax and employee benefits, mandates, restrictions, reporting requirements, penalties, and opportunities for tax assistance that this new law introduces both for businesses and individuals," said James A. Seidel, director of federal tax information at Thomson Reuters.
Analysts explain the steps professionals should take as the provisions go into effect over the next four years. The analysis is available in print, or on the Checkpoint platform, which allows users to link to certain sections or the text of the law itself. It can be obtained by calling 800-950-1216 or visiting http://ria.thomsonreuters.com/estore/detail.aspx?ID=CA102P.
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Consumer Reports Health: How To Navigate The Newly Reformed Health Care System
May 4, 2010
Consumer Reports Health has a report on the next steps for consumers in a variety of situations under the new health reform law—those who are currently insured; Medicare and Medicaid recipients; people with pre-existing conditions; parents of children with pre-existing conditions; parents of uninsured young adults; and people who develop serious illnesses.
The report appears in the June issue of Consumer Reports and online at www.ConsumerReportsHealth.org.
Here are the highlights from the Medicare section:
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Mood and Anxiety Disorders Affect Many Older Adults
May 3, 2010
Rates of mood and anxiety disorders appear to decline with age but the conditions remain common in older adults, especially women. “Given the rapid aging of the U.S. population, the potential public health burden of late-life mental health disorders will likely grow as well, suggesting the importance of continued epidemiologic monitoring of the mental health status of the young-old, mid-old, old-old and oldest-old cohorts,” researchers from the University of California conclude.
Amy L. Byers, Ph.D., M.P.H., of the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, and colleagues determined nationally representative estimates of mood, anxiety and combined mood and anxiety disorders using a sample of 2,575 survey participants age 55 and older. Of these, 43 percent were ages 55 to 64; 32 percent, 65 to 74 years; 20 percent, 75 to 84 years; and 5 percent, 85 years or older.
A total of 5 percent of participants had a mood disorder, including major depressive disorder or bipolar disorder, within the previous year. Rates of anxiety disorders—such as panic disorder, agoraphobia, other phobias, generalized anxiety disorder and posttraumatic stress disorder—were 12 percent overall. About 3 percent had co-occurring mood and anxiety disorders.
Prevalence of all the conditions declined with age. When comparing persons age 55 to 64 with those age 85 and older, 7.6 percent vs. 2.4 percent had mood disorders, 16.6 percent vs. 8.1 percent had anxiety disorders, and 4.8 percent vs. 0 percent had both conditions.
Women were more likely to have any of the disorders than men; 6.4 percent of women and 3 percent of men had mood disorders, 14.7 percent of women and 7.6 percent of men had anxiety disorders, and 3.7 of women and 1.6 percent of men had both.
“Knowledge of the prevalence of mood and anxiety disorders and co-existing mood-anxiety disorder in older community-dwelling adults is important; these are hidden and undertreated but treatable disorders associated with poor health outcomes,” the authors write as background information in the article.
The article appears in the May issue of Archives of General Psychiatry, 2010;67[5]:489-496.
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Door-to-Door Visits Begin for 2010 Census
May 3, 2010
About 635,000 Census takers across the nation begin going door to door tomorrow to follow up with households that either didn’t mail back their 2010 Census form or didn’t receive one. An estimated 48 million addresses will be visited through July 10.
If a 2010 Census worker knocks on your door, here are some ways to verify that person is a legitimate census taker:
View release
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Outstanding Older Volunteers To Be Honored In Washington, DC
May 3, 2010
MetLife Foundation and National Association of Area Agencies on Aging will honor 26 individuals over age 50 who are doing exemplary community volunteer work. The ceremony will be held May 7 in Washington, D.C.
The 2010 MetLife Foundation Older Volunteers Enrich America Awards, now in its eighth year, honors older volunteers making exemplary contributions to their communities and promotes volunteering among older adults nationwide.
This year’s winners, who range in age from 59 to 95 years, come from Alabama, Arizona, California, Colorado, Florida, Maryland, Massachusetts, Minnesota, Missouri, Nebraska, New Jersey, Pennsylvania, Tennessee and Virginia.
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USPSTF Seeks Input on Glaucoma Treatment
May 1, 2010
The U.S. Preventive Services Task Force is seeking public comment on the key questions of the evidence on Screening and Treatment of Glaucoma.
To comment, go to http://www.ahrq.gov/clinic/tfcomment.htm and select "Comparative Effectiveness of Screening for Glaucoma" or "Comparative Effectiveness of Treatment for Glaucoma."
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