by Peter Murray July 22nd, 2011
After decades of sluggish progress the battle against Alzheimer’s disease is moving fast. Just last year scientists showed that spinal fluid can diagnose Alzheimer’s disease with a 100 percent accuracy. And a pair of studies published earlier this month showed brain scans to be reliable enough for commercial use. Now a group of researchers has shown that blood can be used to diagnose the disease. Routine blood tests could lead to earlier diagnoses and prove invaluable in efforts to treat the disease early and eventually find a cure.
The findings of Samantha Burnham and her colleagues from the Australian national research organization CSIRO caused quite a buzz at the latest Alzheimer’s Association International Conference. Of the 273 study participants, the blood screen correctly diagnosed Alzheimer’s in 83 percent of people previously diagnosed with cognitive tests or brain scans. It also correctly excluded 85 percent of people without the disease. For further confirmation they applied their model to two studies conducted by other groups. After plugging in the data, the model was very good at diagnosing the disease as well as predicting the amount of plaques–the tangles of protein thought to muck up neuron function in Alzheimer’s.
The screen measures the blood levels of nine different proteins or hormones. Included among these is beta-amyloid protein, the tangled protein in plaques and the long-standing poster boy for Alzheimer’s markers. Five of the other markers had already been implicated in Alzheimer’s but three had not. The group is concealing the identity of these latter three, waiting to verify the individual predictive power of the new markers before they go public with them. If they’re confirmed, the field will have three new markers with which to diagnose and possibly three new targets for treatment.
A blood screen for Alzheimer’s disease represents a major advance from current diagnostic methods. Although both positron emission tomography (PET) brain scans and spinal taps are accurate, they’re far from convenient. Alzheimer’s disease is typically diagnosed when someone begins showing symptoms such as dementia. But it is believed that the disease actually begins about ten years before those symptoms begin to show. However diagnosing Alzheimer’s before symptom onset would require people to undergo routine PET scans and/or spinal taps, which most people, understandably, aren’t willing to do. Simple blood screens make early detection of Alzheimer’s a realistic goal. Not only will it benefit patients who could start treatment earlier, but it would enable scientists to track the disease’s progress early in its development. Not much is known about the physiological changes that take place during the early stages. Learning about them could lead to new insights into underlying causes – something scientists at the moment seriously lack.
Which brings up an important point. Right now there is no cure for Alzheimer’s disease. Currently our small handful of drugs only treat symptoms. They can improve cognitive function or help with behavioral symptoms such as anxiety or sleeplessness. But even so the effectiveness of the drugs is limited. As the drugs are only expected to improve symptoms for a few months or a few years, being diagnosed with Alzheimer’s is about the worst kind of news a person can get from the doctor’s office. The only thing American’s fear more than hearing they have Alzheimer’s is hearing they have cancer.
So, if it’s a lost cause, why tell the patient in the first place? The question is one that is currently being debated. And for a great number of people it’s a pertinent one. Right now 5.4 million people in the US are suffering from Alzheimer’s disease. It’s the sixth leading cause of death, with just under 75,000 deaths in 2009.
Brian Carpenter, associate professor of psychology at Washington University in St. Louis, has taken a scientific approach to answering the question of whether or not to tell someone they have Alzheimer’s disease. He cites clinicians who don’t tell their patients they have dementia because “they think patients won’t understand or remember what they are told, that their is little to be done for patients anyway, and that telling them could spark depression or suicide.” But Carpenter – who does think patients ought to be told – rebuts this reasoning by observing that “these concerns are not an issue for most patients.” In a 2008 study his lab followed 90 patients and their families during the course of their diagnosis. They didn’t see much depression or anxiety. The typical reaction, in fact, was relief to have their sudden and frustrating symptoms explained. In practice though most doctors do tell their patients when they’ve developed dementia. But with the new blood screen doctors may very soon be deciding whether or not to tell otherwise perfectly healthy people that they will most probably develop Alzheimer’s.
Blood screens such as Burnham’s are poised to fundamentally change clinical diagnosis. We’ve covered screens that detect Down syndrome and schizophrenia. There’s still some ground to cover before the current test can be used in clinics, however. The announcement by Burnham and her colleagues is based on a single study. But I’m sure the group is wasting no time to confirm their initial findings. We can only hope that the axiom knowing more is better than knowing less will have real world consequences for Alzheimer’s patients, their families, and the scientists searching for a cure.
By JANE E. BRODY
Published: June 28, 2011
An 80-year-old friend was lifting a corner of the mattress while making her bed when, as she put it, “I broke my back.”
In fact, she suffered a vertebral fracture – a compression, or crushing, of the front of a vertebra, one of the 33 bones that form the spinal column. This injury is very common, affecting a quarter of postmenopausal women and accounting for half of the 1.5 million fractures due to bone loss that occur each year in the United States.
By age 80, two in every five women have had one or more vertebral compression fractures. They often result in chronic back pain and impair the ability to function and enjoy life. They are one reason so many people shrink in height as they age.
Multiple vertebral fractures, found in 20 percent to 30 percent of cases, often result in a hunched posture, a condition called kyphosis that impairs breathing and compresses the abdomen, leading to a protruding stomach with limited capacity.
But while vertebral fractures are a telltale sign of bone loss among women over age 50 and men over age 60, most who suffer them are unaware of the problem and receive no treatment to prevent future fractures in vertebrae, hips or wrists, the bones most likely to break under minor stress when weakened.
Yet, if a vertebral fracture is diagnosed and properly treated, the risk of future fractures, including hip fractures, is reduced by half or more, studies have shown.
“Most vertebral fractures do not come to medical attention at the time of their occurrence,” Dr. Kristine E. Ensrud and Dr. John T. Schousboe wrote recently in The New England Journal of Medicine. One reason is that the pain may be minimal at first or, if more severe, attributed to a strain that subsides over a few weeks.
Indeed, patients or their physicians are made aware of these fractures in just one-fourth to one-third of the instances in which they are discovered on X-rays, according to the doctors.
“The patient may have had a chest or back X-ray for some other reason, perhaps to rule out pneumonia, but the focus is on why the test was ordered, and an incidental finding of a vertebral fracture is ignored,” Dr. Ensrud said in an interview. “Doctors need to be more aware of this problem, and maybe patients should ask to see the report.”
Dr. Ensrud, an internist and epidemiologist who researches osteoporosis at the University of Minnesota and the Veterans Affairs Medical Center in Minneapolis, noted that in a person with severe osteoporosis, a vertebral fracture can be caused by something as mundane as coughing, sneezing, turning over in bed or stepping out of a bathtub.
In patients whose bone loss is less advanced, a fracture may occur when lifting something heavy, tripping or falling out of a chair.
“A lot of the time, people don’t recall the incident,” Dr. Ensrud said. “They just report that their back has been bothering them.” Patients also may mistakenly assume that their chronic discomfort is a result of arthritis or a normal consequence of age, and never mention it to their doctors.
About one-third of the postmenopausal women found to have vertebral fractures do not have osteoporosis as defined by bone mineral density testing, according to Dr. Ensrud and Dr. Schousboe. Rather, test scores indicate that these women are suffering from a lesser form of bone loss called osteopenia.
Yet the occurrence of vertebral fractures means that the situation is worse than bone density testing would suggest. “The identification of a vertebral fracture indicates a diagnosis of osteoporosis,” Dr. Ensrud and Dr. Schousboe concluded in their article.
Asked if such women should receive bone-preserving medication, Dr. Ensrud said emphatically, “Yes!” One major study found that a vertebral fracture raises the risk of further vertebral fractures by five times in just one year.
A vertebral fracture can be seen on an ordinary X-ray of the spine. But there is a more practical approach involving much less radiation: a scan of the spine called a lateral DEXA, an acronym for dual energy X-ray absorptiometry, as part of a routine bone density exam.
The scan requires special computer software. Patients must ask whether a particular clinic or hospital is able to perform a lateral DEXA.
If a postmenopausal woman whose bone density measures in the osteopenic range (suggesting bone loss, but not yet full-blown osteoporosis) is found to have a vertebral fracture, her doctor may decide to prescribe medication that increases bone strength. Often the drug will be a bisphosphonate like alendronate (brand name Fosamax), which is now available in an inexpensive generic form.
Future fractures can often be prevented if a bisphosphonate is taken by someone found to have one or more vertebral fractures, even if these fractures cause no discomfort. There are many other bone-building options, too, including a once-a-year injection.
In addition, patients should consume adequate amounts of calcium and vitamin D, the critical nutrients for strong bones: a total of 1,200 milligrams of calcium daily from food and supplements, and 1,000 international units daily of vitamin D.
Initially, a painful vertebral fracture may be treated with a short period of bed rest and pain medication like a nonsteroidal anti-inflammatory drug, narcotic, pain patch or an injection or nasal spray of calcitonin. But if too much time is spent in bed, the resulting weakness can increase the risk of further fractures.
Whatever is done, or not done, to treat the injury, the pain of a vertebral fracture usually subsides over the course of several weeks.
Dr. Ensrud and Dr. Schousboe cautioned in their article against rushing into two invasive procedures that have become increasingly common in this country: vertebroplasty and kyphoplasty. During these procedures, a kind of cement is injected into the compressed vertebra to stabilize it.
The operations are performed by interventional radiologists who, naturally, endorse them enthusiastically. However, two scientifically conducted studies of vertebroplasty using sham procedures as a control found no benefit with respect to pain, disability or quality of life.
Nor are these procedures completely free of risk. Although rarely, they can sometimes injure nerves or cause pulmonary embolisms. They also may result in fractures of adjacent vertebrae by increasing the mechanical stress on them.
Exercises to improve posture, strengthen back muscles and enhance mobility are less costly and likely to be more effective in the long run, the doctors wrote.
Leisure time. Doesn’t it sound great? When you’re building your career, your business, raising your family and climbing the corporate ladder, there isn’t enough of it. When you retire, there can be too much of it. Here’s some news about what we do in our leisure time that is actually dangerous.
A study of adults in our country published by the National Institutes of Health <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796695/?tool=pubmed> suggests that far too many of us are spending more than two hours of our free time a day watching TV or sitting in front of a computer screen. According to the researchers, about 55% of waking hours is spent in sedentary behaviors such as these among both adults and children in the U.S.
I guess it’s no wonder that our country has this problem with so many people being overweight. But, did you know that there is also a direct link between too much TV or computer time and something called “metabolic syndrome”?
What’s that? It’s a combination of several heart disease and diabetes risk factors including obesity, high triglycerides, low HDL cholesterol, high blood pressure and high blood sugar.. Metabolic syndrome affects about 36% of our U.S. population. Who knew so many things could go wrong from just sitting around watching TV or surfing the net too long?
What they found in the study is that in men, four or more hours of leisure time sedentary behavior, such as computer and television viewing time may put you at higher risk of metabolic syndrome, even if you exercise! I’m an exerciser, and I was shocked by this. Not that I have time to sit around and watch four hours a day of TV. It was surprising that four hours of leisure time computer viewing and TV watching seemed to increase the risk of heart disease in men.
Fortunately, in the women they studied, getting the recommended amount of exercise (150 minutes a week) seemed to mitigate the risk for metabolic syndrome. So if you take a walk for 30 minutes five days a week, it sounds as if it’s not as bad a risk for us females, even with a few hours of screen watching.
Here’s what I got from this, ladies: we can’t let our men become couch potato retirees.
There have been plenty of studies of how retired people spend their time. You guessed it, many of them spend hours and hours watching TV. The number of hours spent in front of a TV appears to increase with age.
If we want to live long and well, we surely need to pry ourselves off the couch and out of the chair. As tempting as it may be to get engrossed in computer games, the net or broadcast TV, we need to keep longevity in mind if we want to avoid metabolic syndrome in retirement.
Successful retirement is more than avoiding being a couch potato or dodging metabolic syndrome. It’s a positive state of well being, with a sense of meaning in your life. You get there by maintaining structure in your days, connecting to your community, and finding your purpose after you give up the big career.
From what this study teaches us, being engaged in your retirement life with other people, as opposed to screen watching time, will also have a positive effect on our health. Mental wellness <http://agingparents.com/index.php?option=com_content&view=article&id=145:staymmentallyhealthy&catid=76:elder-psychology&Itemid=142> is just as important as physical wellness. So plan well, put your efforts toward retiring with lots of good, trouble free years ahead, and get off the couch.
Published: June 20, 2011
As some surgeons crowded into an operating room at New York Eye and Ear Infirmary and others watched a live video broadcast, Dr. Corinne Becker, the French doctor who pioneered the procedure, harvested lymph nodes from a patient’s groin to transplant to her underarm, where nodes had been removed earlier during cancer treatment.
“Voila!” she exclaimed, motioning to her colleagues as she rubbed a small piece of tissue between thumb and fingertips to check for the presence of the small, pearl-shaped lymph nodes. “Look what is here — a wonderful node.”
She warned that extracting too much tissue could injure the patient, even causing lymphedema in another limb. Using the French word for ‘greedy,’ she said, “It’s better not to be ‘gourmand’ — aggressive.”
This innovative procedure, called an autologous vascularized lymph node transfer, is used to treat lymphedema, a common side effect of breast cancer treatment. Removal of the lymph nodes under the arm closest to the affected breast is believed to stem the spread of cancer, although new research suggests it can be avoided in many cases. But the loss of lymph nodes often leads to chronic swelling and soreness in the arm.
In the new experimental surgery, the missing lymph nodes are replaced with a handful of healthy nodes transplanted from elsewhere in the patient. If all goes according to plan, the lymph nodes make themselves at home in their new location and connect with lymph vessels and start doing their job, filtering waste and draining fluid that has accumulated in the arm.
But the operation is controversial and not without risk, and though it is reported to have cured some patients and improved the condition in many others, it is seldom performed in the United States. Even proponents say it should be reserved for patients who don’t respond to conventional treatment.
The first randomized clinical trial of its effectiveness is just getting underway, led by Dr. Constance Chen, a New York City plastic surgeon who specializes in muscle-sparing reconstructive breast surgery that uses the patient’s own tissue.
Even in the absence of good data, however, demand for the procedure is bound to grow. More than 2 million women in the United States have been treated for breast cancer, and some studies suggest lymphedema develops within five years in up to 40 percent of women who have undergone breast cancer surgery. While the condition can be managed with constant care and physical therapy, it often severely restricts activity and is generally considered incurable.
In the absence of better data about the benefits of lymph node transfer, however, insurers may balk at covering the procedure, which involves expensive, complex microvascular surgery to connect tiny blood vessels.
“From just a plumbing standpoint, it makes sense — someone took out the lymph nodes, you put them back in,” said Dr. Babak Mehrara, a reconstructive plastic surgeon at Memorial Sloan-Kettering Hospital in Manhattan. “The problem is that some of the science doesn’t support it. It probably works for some people and doesn’t for others.”
Prior to transferring nodes to their new location, Dr. Becker aggressively clears away dense scar tissue under the arm that may be “clogging up” the lymphatic channels and preventing fluid circulation. That is one of the riskiest aspects of the surgery, because nerves and blood vessels leading to the arm could be affected.
“We worry that if a person already has a compromised lymphatic surgery, you can go in there and do further damage. We always say the less surgery the better,” said Saskia Thiadens, executive director of the National Lymphedema Network.
But, she added, “Obviously we’re eager to see what the outcomes are.”
Dr. Chen, who co-organized the symposium hosting Dr. Becker with Dr. Joshua L. Levine, director of breast reconstructive services at New York Eye and Ear Infirmary, agrees that more scientific evidence is needed. But she is optimistic the surgery will benefit patients and says the toll lymphedema takes has not been fully appreciated by the medical community.
“Treatment for lymphedema generally doesn’t end,” Dr. Chen said. “Women will say managing their lymphedema is worse than coping with breast cancer — now they have to deal with an every day affliction that affects their day to day lives.”
She is launching the first double-blinded randomized clinical trial of lymph node transfer, a multicenter study that will enroll 88 patients with lymphedema in one arm. Half will be randomly assigned to lymph node transfer, while the others will undergo a dummy surgical procedure. The patients will be followed for two years after the operation to see if their quality of life improves.
“There are naysayers with every single surgical innovation that comes along,” Dr. Chen said.
Dr. Becker claims to have had enormous success, but while she has operated prolifically in Europe and other parts of the world on patients with cancer as well as those with congenital lymphedema, she has published only sporadically.
In a 2006 paper in Annals of Surgery, she reported that 90 percent of patients improved after surgery and almost half were cured, but the sample included only 24 women and there was no control group.
One of the patients operated on by Dr. Becker and Dr. Chen during the daylong symposium, Jennifer Miller, 40, a portfolio manager at an investment firm in Manhattan, said she has already felt a dramatic improvement.
“I used to have this pain that was like my whole arm had a headache, and that’s gone,” Ms. Miller said.
Ten days after surgery the swelling in her right arm was reduced by half, compared with measurements taken 10 days prior to the operation, and she has been able to bare her arm, which she used to keep covered in a compression treatment sleeve most of the day.
Though her right arm is still swollen and larger than her left, she said, “It already feels more manageable, and I’m still recovering from surgery. Even if this is all the improvement I get, I’m happy.”
But whether the change is a true effect of the transfer or a placebo effect of undergoing treatment is not known. Doctors say it is unlikely the transplanted nodes are already functioning, and it’s possible some other aspect of the surgery is having a beneficial effect, Dr. Chen suggested.
Get a move on
Exercise is safe—and highly recommended—for most people with type 2 diabetes, including those with complications. Along with diet and medication, exercise will help you lower blood sugar and lose weight.
However, the prospect of diving into a workout routine may be intimidating. If you’re like many newly diagnosed type 2 diabetics, you may not have exercised in years.
If that’s the case, don’t worry: It’s fine to start slow and work up. These tips will help you ease back into exercise and find a workout plan that works for you.
Try quick workouts
As long as you’re totaling 30 minutes of exercise each day, several brief workouts are fine, says George Griffing, MD, professor of endocrinology at the Saint Louis University School of Medicine in St. Louis.
“We need people with diabetes up and moving,” Dr. Griffing says. “If you can do your exercise in one 30 minute stretch, fine. But if not, break it up into increments you can manage that add up to at least 30 minutes each day.”
Focus on overall activity
Increase activity in general—such as walking or climbing stairs—rather than a particular type of exercise.
However, don’t rely on housework or other daily activity as your sole exercise. Too often, people overestimate the amount of exercise they get and underestimate the amount of calories they consume. (A step-counting pedometer can help.)
Get a pedometer
Stanford University researchers conducted a review of 26 studies looking at the use of pedometers as motivation for physical activity. Published in 2007, the review found that people who used a pedometer increased their activity by 27%.
Having a goal of 10,000 steps a day (about five miles) was important, even if the goal wasn’t reached. Pedometer users lost more weight, had a greater drop in blood pressure, and walked about 2,500 steps more per day than those who didn’t use a pedometer.
Work out with a friend
Working out with friends can be an important motivator, particularly for people over 60, according to Vicki Conn, PhD, the associate dean for research at the University of Missouri in Columbia, Mo., who has studied diabetes and exercise.
Having a friend call or setting up an exercise “contract” with a buddy may help. “One of the things we found with our meta-analysis is that behavioral strategies work better; that means setting up some sort of stimulus in the environment where you exercise,” says Conn.
Set specific, attainable goals
For example, you might set a goal of walking 10 minutes every Monday, Wednesday, and Saturday.
“That doesn’t sound like a lot, but…setting up very specific goals like that helps people a lot more than telling people, ‘Gee, you’ve got to exercise more,’ ” says Conn.
Rather than focusing on the bad things that could happen if you don’t exercise, reward yourself for reaching your goals. You might say “OK, if I exercise 10 minutes, three times a week for the next three weeks, I’ll call my sister-in-law who lives in Australia,” says Conn.
Don’t hold out for weight loss as an emotional “reward.” Focus on other benefits, such as having more energy or enjoying the outdoors when you walk.
Use visual cues
Put a note on the refrigerator or keep your walking shoes next to the back door as a reminder to go for a walk and it’ll be more likely to happen.
Write it all down
Write down your goals, be specific, and keep a record every time you do exercise, says Conn.
Record on your calendar every day whether you exercised for 10 or 15 minutes or more.
Join a class
A class is good because there is an exercise leader and someone to call for emergency help, if necessary, says Conn.
“There is a structured experience exercising and they will learn how their body will react and then they will grow more confident to go out and exercise on their own,” she says.
Don’t set goals too high
“It’s much better to set a lower goal and be successful at it,” says Conn. “That increases one’s sense of confidence. Then you can set a slightly higher goal the next time. You are much more likely to be successful if you start with small, easily attainable goals and gradually increase them.”
Look at the big picture
Working up to a moderate amount of exercise quickly isn’t that important in terms of your health.
“What really matters is next year, you are doing it all the time,” says Conn. “Getting there eventually in a way that you are able to stay with it is what is important because it is long-term behavior change that has health consequences.”
Change one behavior at a time
“What we found—and this is across many studies with thousands of people—if the study focuses only on changing one behavior, namely exercise, they get twice as much of an improvement in their hemoglobin A1C,” says Conn.
Get an exercise “prescription”
In this case, a fitness or exercise physiologist can measure how physically fit you are and prescribe a specific intensity of exercise and how to progress to the next level.
“It’s based on that individual’s fitness stake,” says Conn. “For a person that is very unfit, and has not been exercising, the exercise prescription will be at a low moderate intensity and then move to a slightly higher intensity and longer duration.”
Connect with a “mentor” or become one
Test yourself regularly
Severe weather can strike in any state, at any time. According to the National Weather Service, there are an average of 10,000 thunderstorms, 5,000 floods, 1,000 tornadoes and two hurricanes that make landfall each year.
No matter where you live, you need to be prepared to deal with severe weather. If you have children, get them involved in planning and preparing — it will help them learn what to do to stay safe. They can help pack emergency kits and make lists of other items such as books and games to keep them occupied, blankets and pillows, and pet care items.
These tips and checklists from Energizer will help you get ready before severe weather strikes.
Severe weather storm-ready checklist
- Know your community’s warning systems for severe weather.
- Talk to someone at your local emergency management office to find out the types of severe weather or natural disasters most likely to happen in your area. Ask about animal care after a disaster as well.
- Pick a safe place in your home for family members to gather. For tornadoes, it should be a basement, storm cellar, or an interior room with no windows on the lowest floor. For severe thunderstorms, it should be away from windows and doors that could be broken by strong winds or hail.
- Have a hurricane evacuation plan in place which includes designated places to meet. When an evacuation is called, leave immediately.
- Practice severe weather drills so everyone knows where to go and what to do.
- If someone in your home is dependent on electricity powered medical equipment, make sure you have backup power available.
- Move or secure lawn furniture, trash cans or anything else that can be picked up by high winds.
- Make sure you know what plans your workplace and your child’s school or day care center have for severe weather occurrences.
Emergency preparedness kit
The American Red Cross recommends that you have an easily accessible Emergency Kit ready for severe weather outbreaks and power outages. It should have supplies for at least three days.
- Water — One gallon per person, per day, for drinking and for hygiene
- Food — Nonperishable foods
- Flashlights or other battery-powered lighting devices
- Battery powered weather radio
- Extra batteries
- Cell phones and chargers
- First aid kit
- Sanitation and personal hygiene items
- Copies of personal documents — medical information, birth certificates, deed/lease to home, insurance policies, credit cards, etc. Keep them in a waterproof bag.
- Family and emergency contact information
- Extra cash
- Food, water and medication for pets
- Pack the items in easy-to-carry containers, such as duffle bags, backpacks or covered trash receptacles. Make sure the containers are clearly labeled.
What to do during a power outage
Power outages can range from a minor nuisance of an hour or two, to a prolonged outage of several days. Either way, keep these safety tips in mind:
- Turn off and unplug all unnecessary electronic equipment — when the power comes back on, a power surge could damage it.
- Leave one light switched on so when the power does come on, you’ll know right away.
- Do not use candles during a power outage — the potential risk for fire is too great. Instead, use flashlights or lanterns, and make sure they are easily accessible to all family members. The line of Energizer Weather Ready lights feature long-lasting LED technology to provide extended run times.
- Keep refrigerator and freezer doors closed. An unopened refrigerator will keep foods safely cold for about 4 hours; a full, unopened freezer will keep its temperature for about 48 hours.
- If the power will be out for more than a day, use a cooler with ice for cold items.
Let them know you’re safe If your community experiences a weather-related disaster, the American Red Cross can help you let friends and family know you are safe. Register on the Safe and Well website.
Know the difference between watch and warning
Severe Thunderstorm Watch: Severe thunderstorms are possible in and near the watch area.
Severe Thunderstorm Warning: Severe weather has been reported or indicated by radar. Warnings indicate impending danger to life and property.
Tornado Watch: Tornadoes are possible in and near the watch area.
Tornado Warning: A tornado has been sighted or is indicated by weather radar. Find shelter immediately.
Hurricane Watch: Hurricane conditions (sustained winds of 74 mph or higher) are possible within a specific coastal area. Generally issued 48 hours in advance of the anticipated onset of tropical storm force winds.
Hurricane Warning: Hurricane conditions (sustained winds of 74 mph or higher) are expected within a specific coastal area. Generally issued 36 hours in advance of the anticipated onset of tropical storm force winds.
Article Written By: Wendy D’Uva Options Home Health
- More than 1/3 of patients are on 3 or more drugs
- More than 1/2 of the patients see more than 1 physician regularly
- After a patient comes home from an acute care center, they are placed on generic medications and continue taking them in addition to the medication that they were taking at home
- Insurance companies change patients medications due to coverage
- Due to lack of communication and understanding, patients are placed on similar medications by different doctors
- Due to lack of knowledge, patients discontinue medications because of side effects and lack of understanding the therapeutic effects
- Pt’s do not get regular blood levels when on certain medications that require it because of lack of knowledge Medicare luckily acknowledges this issue and will cover in home medication teaching.
This is one of the most important roles a home care nurse can have in the home.
- Understanding why a drug is taken
- When it should be taken
- Communicating medication regimens to all physicians seen by patient
This is just one of the services that Options Home Health can provide, that will also have the most profound effect.
Educating our patients to their medication regimen and disease processes will increase medication compliance and therefore ultimately decreasing hospitalizations, drug interactions and medication errors.
The government is looking for a way to track and report denial rates to consumers as part of health insurance exchanges.
By Emily Berry, amednews staff. Posted April 11, 2011.
A government review of the rates at which insurers decline to write policies and reject claims for payment found that when physicians and patients appealed denied claims, those appeals were “frequently” successful, with 39% to 59% resulting in a reversal.
The Government Accountability Office report, released March 16, also found that many health insurance claims denials stem from miscodings, incomplete information or other paperwork errors, pointing to the need for further automation of claims processing.
The report examined what the GAO called “application denials” — declining to write a policy for someone — as well as “coverage denials” — deciding not to pay a claim. The Patient Protection and Affordable Care Act called on the GAO to examine both. The Dept. of Health and Human Services, which has started tracking application denials, plans to track and publish rates of coverage denials as part of the health insurance exchanges that will be part of the health reform law, according to the report.
Until HHS tracks application and coverage denials in a comprehensive way, there is limited information available about both. The GAO noted that the American Medical Association helped the authors interpret and understand the limitations of denial data available.
Rejected applications, denied claims
The GAO examined application denial data in the individual insurance market, collected by the HHS during the first quarter of 2010 and from six states that already track denials.
Researchers found that the rate at which insurers declined to offer an applicant coverage averaged 19%, but rates varied widely. The report’s authors noted that there was a long list of reasons for that variability, and no one appears to be tracking the reasons cited for application denials.
It was difficult to gauge how rejected applications end up faring: Nobody seems to track whether rejected applicants ultimately find coverage through another company or whether an applicant is offered coverage at an affordable rate.
An average of 19% of health insurance applicants were denied coverage in the first quarter of 2010.
The rate at which insurers denied claims for payment also varied.
In California, for example, insurers rejected about 24% of claims in 2009, while Ohio reported an 11% denial rate the same year. The varying rates are in part due to how states define “denial.” The GAO report noted that while one state would count an instance where a claim was found to be a patient’s responsibility because a deductible had not been met as a denial, another state would not.
The AMA, which began releasing an annual report card on insurers’ claims handling in 2008, found an average denial rate of 4% in claims data for major insurers from two months in 2010, according to the GAO report. The low rate may have been due to the source and timing of the AMA’s sample — the Association looked at only electronic claims, which would have a lower denial rate than paper claims. In addition, the data came from February and March, after most enrollees typically exhaust their deductibles and claims denials tend to drop.
Waiting for more reliable data
If the federal government can find a way to uniformly report denial rates, the information would be useful to patients who want to avoid out-of-pocket costs and doctors negotiating a health plan contract, said Susanne Madden, CEO of Nyack, N.Y.-based Verden Group. The company tracks insurance companies’ policy changes, preauthorization requirements and other “hassle factors” for physicians.
“I think what physicians are beginning to wake up to now is considering what rates payers pay, but also what’s the cost of doing business?” Madden said. “If [a company] pays good rates but has a 40% denial rate, the business proposition is eroded quickly.”
Health insurance claims filed electronically have a lower denial rate than paper claims.
She said some of the GAO’s findings suggesting that physician offices’ paperwork errors were to blame for many denied claims raise questions about insurers, too.
Despite the high reported success rate in appealing claims denials, Madden said, physicians should file appeals judiciously. It’s not smart, she said, to spend $800 worth of physician and staff time on getting a $200 claim paid.
Appealing a single claim can cost more time and energy than it’s worth. But she advised physicians and staff to look for patterns of denials and consider challenging denied claims in “batches” when denials appear to be related.
And, she said, physicians should consider getting the patient involved in appeals. “Insurance companies will often listen to customers more than vendors.”
If denial data are made public, they should be reported uniformly and carefully so customers understand the limitations of the figures, said Robert Zirkelbach, spokesman for trade group America’s Health Insurance Plans. He said his group will help HHS make that happen.
“I know that we’ve provided a lot of information commenting on these and shared a lot of information to make the process work better,” he said.
By ROBERT PEAR
Published: April 12, 2011
WASHINGTON — President Obama has deep disagreements with House Republicans about how to address Medicare’s long-term problems. But in deciding to wade into the fight over entitlements, which he may address in a speech Wednesday afternoon, the president is signaling that he too believes Medicare must change to avert a potentially crippling fiscal crunch.
So the real issue now is not so much whether to re-engineer Medicare to deal with an aging population and rising medical costs, but how.
Even before they debate specific proposals, lawmakers across the ideological spectrum face several fundamental questions:
Will the federal government retain its dominant role in prescribing benefits and other details of the program, like how much doctors and hospitals are paid and which new treatments are covered? Will beneficiaries still have legally enforceable rights to all those services?
Will Medicare spending still increase automatically with health costs, the number of beneficiaries and the amount of care they receive? Or will the government try to limit the costs to taxpayers by paying a fixed amount each year to private health plans to subsidize coverage for older Americans and those who are disabled?
Public concern about the federal deficit and debt has revived interest in proposals to slow the growth of Medicare, including ideas from Mr. Obama’s deficit reduction commission. Here are some leading proposals:
- Increase the age of eligibility for Medicare to 67, from 65.
- Charge co-payments for home health care services and laboratory tests.
- Require beneficiaries to pay higher premiums.
- Pay a lump sum to doctors and hospitals for all services in a course of treatment or an episode of care. The new health care law establishes a pilot program to test such “bundled payments,” starting in 2013.
- Reduce Medicare payments to health care providers in parts of the country where spending per beneficiary is much higher than the national average. (Payments could be adjusted to reflect local prices and the “health status” of beneficiaries.)
- Require drug companies to provide additional discounts, or rebates, to Medicare for brand-name drugs bought by low-income beneficiaries.
- Reduce Medicare payments to teaching hospitals for the cost of training doctors.
In debate last year over Mr. Obama’s health plan, Republicans said repeatedly that he was “raiding Medicare” to pay for a new entitlement providing insurance for people under 65. The Senate Republican leader, Mitch McConnell of Kentucky, said the Democrats were using Medicare as a piggy bank. Senator Jim Risch of Idaho said, “We are talking about a half-trillion dollars that is being stolen from Medicare.” Senator Charles E. Grassley of Iowa said the cuts “threaten seniors’ access to care.”
Now it is Republicans, especially House Republicans, proposing to cut the growth of Medicare, with a difference.
“Any potential savings would be used to shore up Medicare, not to pay for new entitlements,” said Representative Paul D. Ryan, Republican of Wisconsin and chairman of the House Budget Committee.
The House is expected to vote this week on his budget blueprint for the next 10 years.
Mr. Ryan points to Medicare’s prescription drug coverage as a model. That benefit, added to Medicare under a 2003 law, is delivered entirely by private insurers competing for business, and competition has been intense. Premiums for beneficiaries and costs to the government have been much lower than projected.
Republicans rarely mention one secret to the success of Medicare’s drug program. Under presidents of both parties, Medicare officials have regulated the prescription drug plans to protect consumers and to make sure the sickest patients have access to the drugs they need.
Many Democrats like Medicare as it is: an entitlement program in which three-fourths of the 47 million beneficiaries choose their doctors and other health care providers, and one-fourth have elected to enroll in managed-care plans. These Democrats acknowledge that care could be better coordinated, but say that could be done in the traditional fee-for-service Medicare program, without forcing beneficiaries into private health plans offered by insurance companies.
Marilyn Moon, a health economist and former Democratic trustee of the Medicare trust fund, said serious discussion of changes in Medicare was warranted, and she noted that the government spent more than a half-trillion dollars a year on the program. Still, Ms. Moon said, it would be preferable to shore up Medicare without “the philosophical sea change” sought by Republicans, who would give private insurers more latitude to decide what benefits are available and what services are covered.
Obama administration officials said Tuesday that Medicare could save $50 billion over 10 years by reducing medical errors, injuries, infections and complications that prolong hospital stays or require readmission of patients.
In any program as big as Medicare, which accounts for one-fifth of all health spending, even decisions about small, seemingly technical questions can have vast consequences for beneficiaries, the health care industry and the economy as a whole.
Gradually raising the eligibility age, for example, would save $125 billion over 10 years, the Congressional Budget Office says.
But it would increase costs for people who would otherwise have Medicare. Some of those 65- and 66-year-olds would obtain insurance from Medicaid or from employers, as active workers or retirees, thus increasing costs for Medicaid and for employer-sponsored health plans.
If Congress decided to make a fixed contribution to a private health plan on behalf of each Medicare beneficiary, lawmakers and lobbyists could spend years debating how to set payment rates and how to adjust them, based on increases in consumer prices or medical costs or the growth of the economy.
Those decisions would directly affect beneficiaries. Under the House Republican proposal, the Congressional Budget Office said, beneficiaries “would bear a much larger share of their health care costs,” requiring them to “reduce their use of health care services, spend less on other goods and services, or save more in advance of retirement.”
The history of Medicare is filled with unsuccessful efforts to rein in costs. Private health plans entered Medicare with a promise to shave 5 percent off costs, but ended up costing more than the traditional Medicare program. For two decades, Congress has tried to limit Medicare spending on doctors’ services, but the limits have proved so unrealistic that Congress has repeatedly intervened to increase them.
Doctor privacy advocates defend a 30-year ban on releasing data from challenges on Capitol Hill and in the courts.
By Charles Fiegl, amednews staff. Posted April 4, 2011.
Washington — A Senate bill aimed at curtailing Medicare fraud would publish physician billing data online, letting viewers determine how much individual doctors earn annually from the program.
The release of the data has been prohibited by a court ruling for more than 30 years. But some lawmakers recently stepped up their efforts to lift the ban and bring Medicare billing data to light to prevent fraud.
Sen. Charles Grassley (R, Iowa) introduced a program integrity measure before a Senate Finance Committee hearing on Medicare and Medicaid fraud on March 2. The bill in part would require the Dept. of Health and Human Services by the end of 2012 to start publishing Medicare claims and payment data on the website USAspending.gov.
In making the information public, the government could help prevent billions of dollars each year from going to those defrauding the program, Grassley said. Sen. Ron Wyden (D, Ore.) said he was drafting his own legislation that would make Medicare claims data publicly available.
“More transparency about billing and payments increases public understanding of where tax dollars go,” Grassley said. “The bad actors might be dissuaded if they knew their actions were subject to the light of day.”
But the American Medical Association, along with HHS, has opposed challenges to the decades-old ban on publicizing the information. Physician organizations have said allowing public access effectively could permit anyone to determine how much an individual doctor makes in a year, especially if that doctor has a patient population that is mostly Medicare. Publicizing raw claims data without any necessary context would be of dubious anti-fraud value, they said.
“Releasing Medicare claims data to the public does not further the goal of combating fraud, as those tasked with this responsibility already have access to the data,” said Ardis Dee Hoven, MD, chair of the AMA Board of Trustees.
However, Grassley said the government is not the only entity trying to smoke out Medicare fraud. During the Finance hearing, he cited a recent series of Wall Street Journal articles that examined Medicare claims from 1999, 2001 and 2003-08. Under a special arrangement, the journal, working with the Center for Public Integrity in Washington, D.C., paid the Centers for Medicare & Medicaid Services $12,000 for a 5% sample of the Medicare carrier payment file for those years. The newspaper reported that it was able to identify tens of thousands of physicians and other health professionals who could be considered outliers based on the relatively large amounts they billed Medicare in those years.
However, the journal could not name the physicians based on its data usage agreement with CMS. That policy stems from the federal court decision that protects the privacy of the physician data.
“I think it’s time to revisit this decision and make some transparency of payment physicians receive from Medicare,” said Grassley, a long-time farmer. “Pretty much like you will see Chuck Grassley’s name in the newspaper sometimes that I’ve gotten a farm subsidy through the U.S. Dept. of Agriculture.”
Reviving an old court fight
In 1978, the Florida Medical Assn. and six physicians filed a class-action lawsuit to prevent the predecessor department to HHS from disclosing a list of all medical professionals who received Medicare payments the previous year. The AMA joined the lawsuit as a plaintiff in June 1978.
In October 1979, the judge in the case ruled that individual billing data were exempt from public disclosure laws and barred the department “from disclosing any list of annual Medicare reimbursement amounts, for any years, which would personally and individually identify those providers of services under the Medicare program.” The ruling protects AMA members and doctors in Florida, but HHS has applied the prohibition to all physician billing data.
Several recent challenges to the 1979 ruling have failed. In 2009, an appeals court decided that the government was not required to release claims information to the marketing firm Real Time Medical Data based in Birmingham, Ala. The same year, another appeals court denied a similar request from Consumers’ Checkbook/Center for the Study of Services, a nonprofit consumer organization based in Washington, D.C. In that case, the court said release of the data was an “unwarranted invasion of personal privacy.”
In the latest legal challenge, The Wall Street Journal‘s parent company, Dow Jones & Co., filed motions on Jan. 25 to reopen the 1979 case and intervene as a defendant. A federal judge is scheduled to hear arguments on these motions on April 14.
The paper said the original decision prevented reporters from naming physicians they believed were defrauding the Medicare program.
In a series of articles, titled “Secrets of the System,” the newspaper cited doctors with questionable billing records. For instance, one New York family physician took in more than $2 million in 2008 from Medicare, the journal reported.
The AMA, meanwhile, “intends to vigorously defend the current injunction, which protects the privacy of physician data while allowing it to be seen by the agencies working to identify fraud,” Dr. Hoven said.
“Medicare fraud threatens our entire health care system, and the AMA supports targeted efforts by the Dept. of Justice, [HHS] Office of Inspector General and others to identify perpetrators of fraud — the vast majority of whom are not physicians,” she said.
There’s little doubt that the vast majority of physicians are billing the Medicare program appropriately, said Jason Conti, an attorney for Dow Jones in New York. However, restrictions on access to the claims data prevent further investigation of true outliers in the program.
“If the data is released, more fraud will be exposed,” he said.
As it has since 1979, HHS is opposing reopening the case. The restrictions placed on the newspaper in the data usage agreement are based on a statutory exception to the Privacy Act of 1974 and not the 1979 court decision, HHS said in court papers.