Category: Seniors

Rationing Senior Care: It’s Already Started

Want an appointment with kidney specialist Adam Weinstein of Easton, Md.? If you’re a senior covered by Medicare, the wait is eight weeks.

How about a checkup from geriatric specialist Michael Trahos? Expect to see him every six months: The Alexandria-based doctor has been limiting most of his Medicare patients to twice yearly rather than the quarterly checkups he considers ideal for the elderly. Still, at least he’ll see you.

Top-ranked primary care doctor Linda Yau is one of three physicians with the [Washington, DC] District’s Foxhall Internists group who recently announced they will no longer be accepting Medicare patients.

Full article on Medicare cuts for seniors.

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Nov 29, 2010 | 7 comments | by

Markets in Everything: Home Health Care Managers

After a hospitalization, you will need help doing things that you’re unable to do for yourself — even with performing basic tasks like cleaning and dressing. You may need a nurse to change the bandage on a wound or to administer intravenous drugs. You may need equipment, too: a walker, a bath seat or a commode to ensure you don’t injure yourself during recovery…

If you don’t have the time or stamina to figure out an ideal home health care plan for yourself or a loved one, turn to a health care advocate or, in the case of elderly patients, a geriatric care manager…… These consultants charge an hourly fee of $90 to $160, which is not reimbursed by insurers. But a one-hour consultation could potentially save you hours of precious time.

A nurse advocate or geriatric care manager can explain how insurance and Medicare work and the services you may be entitled to, and they can speak to doctors on your behalf.

Full article on temporary at-home health care.

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Nov 29, 2010 | 4 comments | by

What’s Wrong in the Long-Term Care Market?

MetLife announced last Thursday that it wanted to get as far away from the business as possible. It is not alone:

In the last decade, 11 companies that were once in the top 10 in market share in this area have bailed out, according to Limra, an industry research group…

Genworth Financial is seeking an 18 percent [premium] increase on older policies held by about 25 percent of its customers. And John Hancock has filed for permission to raise premiums for about 80 percent of its customers by an average of 40 percent. It has also temporarily stopped offering new long-term care insurance plans through employers while it tries to figure out what to charge.

The problems: low interest rates, the decisions to cover assisted living, policyholder persistence (fewer drop outs) and increased life expectancy.

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Nov 18, 2010 | 10 comments | by

One-Third of Seniors Over-Medicated

The Affordable Care Act eliminated the donut hole in Medicare Part D drug plans by 2019 – making it easier for seniors to afford needed medications. However, recent research suggests that  seniors take too many drugs; not too few:

  • Up to one-third of seniors may be over-medicated.
  • One-in-five of seniors’ hospital admissions are due to adverse drug reactions.
  • The cost of over-medicated seniors surpasses $80 billion annually. 
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Nov 12, 2010 | 6 comments | by

AARP: Wrong About Drug Prices

AARP, the huge organization of seniors and not-so-seniors (age fifty and up), has been publishing quarterly reports on the prices of branded drugs since 2005. The reports focus on the drugs most used by the elderly, and they invariably conclude that prices have been increasing much faster than inflation. The latest report, released on August 25, 2010, looked at the prices of 217 branded drugs. It found that, on average, prices increased by 8.3 percent in 2009 while the overall consumer price index declined by 0.3 percent. Remarkably, all but six of the 217 drugs registered increases. But this conclusion is misleading: after factoring in generic-drug prices — which AARP ignores — drug costs for the elderly are actually decreasing.

Full report from American Enterprise Institute here.

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Nov 02, 2010 | 4 comments | by

Seniors to Pay More Out-of-Pocket for Health Care

A new letter by Medicare Chief Actuary, Richard Foster, to Senate Republicans quantifies the expected losses for seniors. Those enrolled in Medicare Advantage plans will see their out-of-pocket costs rise by $346 per year in 2011, peaking at $923 in 2017.

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Oct 28, 2010 | 8 comments | by

An Unintended Consequence of the War on Drugs

Some nursing home patients go days without relief:

Dr. Jonathan Musher, a geriatrician and past president of the American Medical Directors Association, a trade group of long-term-care doctors and administrators…recently had a patient move to a nursing home after a hip fracture. At the time, she was not on narcotic pain medication. That night the nurse called Dr. Musher to say that the woman was in pain. “I was told I had to call the pharmacist,” he said. “O.K., what’s the pharmacist’s number? The nurse has to call me back, she wasn’t sure. I get a call back with the number. I call the 800 number and leave a message. I get a call back a half hour later.

“So now there’s been a 45-minute delay. Now he tells me I have to fax in a prescription. I’m not home, so I say I will do it in 15 minutes. After I fax it, I call the nursing home, and they haven’t heard anything from the pharmacist. Finally I told them to send the patient to the hospital.”

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Oct 15, 2010 | 6 comments | by

The Rest of the Story on Medical Homes

Medical homes are the new fad. For glowing reports on how well they worked for Group Health’s 8,000 Washington patients, see articles in Health Affairs, JAMA [gated, but with abstract], NEJM, the American Journal of Managed Care, by the Commonwealth Fund, and in The Lancet. Group Health claims the distribution of illness was the same as it was in a control group and medical homes lowered costs by 2%. Here’s the rest of the story, courtesy of Buz Cooper:

medical-home-table

Clearly, the socioeconomic characteristics of the two groups are not the same.

Read More » »

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Jun 17, 2010 | 4 comments | by

Medical Homes Study Flawed

One idea being pushed by “reformers” is the notion of a “medical home.” But like a lot of swell ideas, the advocates tend to cherry pick the information that supports the idea and ignore anything that counters it. Buz Cooper, MD, of the University of Pennsylvania, reviewed articles recently published in Health Affairs and JAMA about Group Health’s version of a medical home. He says, “The big news is that costs for patients in their Medical Home were a full 2% lower than in conventional practices, hardly a great success — it wasn’t even statistically significant.  But was even this small difference due to the Medical Home, or was it because Medical Home patients were less likely to consume care?”

The articles he references said that the study group and the control group were similar in age, sex and diagnosis, but they plumb forgot to compare the groups for health status, education, or income — which are the most important factors in determining outcomes. He also notes that patients dropped out of the pilot program at alarming rates. It started 2006 with 9,200 patients enrolled but ended 2009 with only 7,018.

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May 25, 2010 | 4 comments | by

How the Market for Long-Term Care Could Be Destroyed

The long-term care insurance ownership rate among those at genetic risk for developing Huntington Disease (HD) (50 percent) is five times the rate of ownership in the general population (10 percent). Furthermore, among individuals whose genetic testing shows that they are 100 percent at risk to develop HD, 50 to 75 percent own insurance… In addition to HD, three other diseases with long disability periods and similar long-term care needs — Parkinson’s, Alzheimer’s, and Lou Gehrig’s or ALS — have some genetic basis.

Full article on long-term care insurance in NBER Digest.

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Mar 18, 2010 | 4 comments | by
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