RI ARA March 17, 2019 E-Newsletter by RI ARA

Publication 20119 Issue 12 Published in house by the RI ARA

March 17, 2019 E-Newsletter

Three months of HELL, My Story, by John A. Pernorio, Pres. RI ARA So after three months of hospital, nursing home, hospital, acute rehab, nursing home, hospital and acute rehab again, this week was a challenge doing things. It will take time to get to some kind of normal. I have so much catching up to do on everything that it's like the Smoky and the Bandit song, " I have a long way to go, and a short time to get there." So much mail to open and so much junk mail to get rid of, I need a secretary. Here is one example of my

nursling home experience: At 2:30 one morning my body started sliding off the bed. I pushed the call button for help. After about 10 minutes, with my body half off the bed, I started calling "HELP!” Finally at 3:15 someone came in to see what I needed. While I was waiting, I was holding on to the bed railing with my left arm, I pushed the bed down button to get closer to the floor in case I couldn't hold on any longer to the bed rails. My feet were literally on the floor. Do not, I repeat, do not send your loved ones to Elmhurst Rehabilitation Center

in Providence, RI if you value their lives. If it wasn't for the fact that my surgery was scheduled for Friday, February 22nd,, I would have been GONE! Nursing homes do not have two way communications between the patients room and nursing station like hospitals. Patients have no voice and or are afraid of retaliation. If you, your family and friends need rehab after a surgery, please request a ACUTE Rehab facility such as the Southern New England at Fatima Hospital, North Providence, RI,

Rehabilitation Hospital of Rhode Island in North Smithfield, RI or Kent Hospital, Warwick, RI.. Places like these are Acute Rehab hospitals, not nursing homes, that give you three hours of one on one therapy a day. 1 1/2 hours of PT and 1 /12 hours of OT. Also, these Acute Rehab stays are considered Hospital stays and are covered under Medicare Part A, Hospitalization, not Skilled Nursing Facilities therefore do not count toward your 100 day SNF Medicare coverage.

Why Do People Leave Medicare Advantage for Original Medicare? This week, researchers released an analysis of patterns in Medicare showing that people with high needs—like significant chronic illness—and people with both Medicare and Medicaid coverage choose to leave their Medicare Advantage (MA) plans more often than people without similar health issues or Medicaid coverage. The researchers sought to discover why these patterns exist and what the implications might be for MA going forward. While most people with Medicare get their coverage from Original Medicare, some choose Medicare Advantage plans instead. MA plans are private health plans that are paid a fixed amount per person to provide all of the same benefits as Original Medicare. They can also offer some additional benefits, like limited dental and vision coverage, and

have an out-of-pocket cap on beneficiary expenses. However, MA plans also have different coverage rules, like requiring enrollees to remain innetwork for services. People with Original Medicare can choose any doctor that accepts Medicare. People with MA must choose from the list of doctors that contract with the MA plan. Similarly, though MA plans must cover the same health services as Original Medicare, people with MA may have to pay more for certain services or take additional steps to obtain needed care. For example, an MA plan may require a referrals to see a specialist or require providers to request prior authorization before some services are covered. In studying the patterns around MA enrollment and disenrollment, researchers found

that people with Medicare who have complex medical needs or Medicaid coverage are far more likely to leave MA for Original Medicare than beneficiaries who are not covered by Medicaid or who are in better health. Importantly, though high-quality MA plans saw fewer people dropping out in favor of Original Medicare in general, disenrollment rates remained high among both people with complex needs and those with Medicaid eligibility. According to the researchers, this suggests that some aspect of MA plans, especially lower quality plans, may be unattractive to sicker enrollees, and to people with fewer financial resources. The researchers suggest that these unattractive qualities might be the limited networks MA plans offer, driving sicker

beneficiaries into Original Medicare where they have a wider choice of doctors. They also suggest that more should be done to ensure that people with complex conditions or Medicaid eligibility get the coverage and care they need within MA. Choosing between MA and Original Medicare can be a complicated decision, and if mismanaged, beneficiaries may end up in coverage that is not the best fit for their unique circumstances. We urge the Administration and Congress to do more to empower people with Medicare to make informed, timely, optimal coverage choices, and to ensure they get the care they need regardless of the coverage pathway they select.

Rhode Island Alliance for Retired Americans, Inc. • 94 Cleveland Street • North Providence, RI • 02904-3525 • 401-480-8381 riarajap@hotmail.com • http://www.facebook.com/groups/354516807278/

Trump outlines a significant Social Security cut in his 2020 budget This past Monday, March 11, President Trump unveiled his fiscal 2020 budget proposal for the federal government. As a reminder, fiscal years for the federal government end on Sept. 30 and begin on Oct. 1. Unveiling a budget months in advance of the actual implementation is supposed to allow Congress to make tweaks, as needed, to get a yearlong budget passed. Trump's 2020 budget featured a lot of talking points (as presidential budgets often do), a number of which came under harsh criticism by members of the Democratic Party. In particular, political opponents of the president focused on a handful of proposed cuts to social programs, which go against Trump's campaign promises in 2016 not to touch so-called entitlement programs like Medicare and Social Security. Contained within the president's budget were calls for about $1.5 trillion in cuts to Medicaid over the next 10 years, which would be achieved by moving payouts to block grants; an $845 billion reduction to Medicare spending over the next decade that targets a decrease in wasteful spending via lower prescription drug costs; and -- surprise -- a roughly $26 billion decrease in Social Security spending over the next 10 years.

Big change to Social Security's disability program While Trump's budget proposal aims to curtail a number of perceived inefficiencies with the Social Security program, the bulk of the savings ($10 billion total between 2020 and 2029) are expected to be realized from a single change to the Social Security Disability Insurance program. As of January 2019, according to the Social Security Administration (SSA), 10.15 million people were receiving a Disability Insurance benefit payment each month, 8.52 million of whom were long-term disabled workers. Of course, proving a long-term disability to the SSA, assuming you have the required lifetime work credits to receive a disability benefit, isn't a flip-of-the-switch process. Rather, the average time from application to approval can take around five months. However, not all disability recipients file their claims with the SSA right away. Should you choose to apply for Social Security Disability Insurance long after you've actually become disabled, you may be able to receive retroactive benefits. These retroactive disability benefits would cover the time period from when you actually became disabled through when you applied for Social Security Disability benefits, with a maximum collectible period of 12 months. It should be noted that the SSA will subtract the five-month waiting period from your filing, meaning you must apply for benefits 17 months or longer after the onset of your disability if you're to receive the full 12 months of retroactive disability pay. Trump's budget proposal for fiscal 2020 aims to halve the amount of retroactive pay disabled persons can recover to six months from 12 months. Doing so would reduce program outlays by $3.61 billion between 2020 and 2024, and almost $10 billion on the dot, in aggregate, over the next decade.

Virtually no chance of being implemented With Trump proposing $26 billion in cuts to Social Security between 2020 and 2029, you might be growing a bit concerned that bigger expenditure cuts might follow. But this is the point where I tell you that everything's going to be OK. In fact, the chance of this particular proposal being implemented is very slim, in my opinion. To begin with, presidential budgets are often a rough draft from which Congress begins pushing and pulling to fit certain fiscal and political agendas. Or, in plain English, it's a starting point from which discussion begins, not a final draft. By the time a federal spending bill has been signed into law, it often looks nothing like the annual budget or 10-year projections presented months earlier by the president. Secondly, a divided Congress practically ensures that next to nothing is going to get donewhen it comes to major social programs like Medicare, Medicaid, and Social Security. Democrats in the House are certain to oppose any reduction to Social Security benefits, including halving the period whereby retroactive disability benefits can be collected. Without support from the Democratic majority in the House, I don't see how this provision has any chance of being included in a final spending bill for fiscal 2020. Third and finally, Trump is unlikely to take a hard-line stance on keeping this provision in his budget, especially with his own election now less than 20 months away. Back in 2013, while speaking at the Conservative Political Action Conference, Trump had this to say: A " s Republicans, if you think you are going to change very substantially for the worse Medicare, Medicaid, and Social Security in any substantial way, and at the same time you think you are going to win elections, it just really is not going to happen... What we have to do and the way to solve our problems is to build a great economy." In other words, Trump understands that direct changes to Social Security means some group is going to lose out and be worse off than they were before. Therefore, making any direct changes to Social Security prior to an election is akin to political suicide. Long story short, President Trump's budget is bound to hit on a number of talking points, but it's unlikely to incite any change to the existing structure of the Social Security program.

Social Security Expansion Bills Numerous bills to expand Social Security have been filed during this Congress. These bills will strengthen Social Security while improving the economic and retirement security of millions of Americans. For decades, Social Security has delivered its guaranteed benefits on time and without interruption to millions of Americans. Although Social Security’s hard-earned benefits are modest – they are vitally important to all who rely on them, including seniors, people with disabilities and families of deceased workers. Today nearly 63 million Americans – 1 out of every 5 households – rely on Social Security’s lifetime, guaranteed benefits. Here is a summary of some of the expansion bills: Social Security Expansion Act The Social Security Expansion Act, S. 478 and H.R. 1170, introduced by Senator Bernie Sanders (DVT) and Representative Peter

DeFazio (D-OR), increases Social Security benefits on average by $65 a month or $800 a year, adopts the CPI-E to calculate a more accurate cost-of-living adjustment (COLA) and strengthens the Social Security Trust Fund. The bill also reinstitutes benefits, until age 22 for children enrolled in college, to children whose parent has died or children of a disabled adult, and combines the Old Age and Survivors and Disability Trust Funds to ensure solvency of both programs. To pay for it and extend the trust fund through 2071, the bill raises the cap on earnings subject to Social Security contributions (currently capped at $132,900) for incomes above $250,000 and imposes a 6.2% Social Security tax on investment income for incomes above $200,000. Protecting Our Widows and Widowers in Retirement Act The Protecting Our Widows and Widowers in Retirement (POWR) Act, H.R. 1540, introduced by Representative

Linda Sanchez, D-CA, ensures a widow or widower will continue to receive up to 75% of the combined household benefits after the loss of a spouse. This is particularly important to women who generally suffer greater financially after the loss of a loved one. Women have lower earnings during their lifetime and live longer. According to the National Academy of Social Insurance, the average widow loses 33% to 5o% of their Social Security benefits after the loss of their spouse. Social Security Fairness Act The Social Security Fairness Act, S. 521 and H.R. 141, introduced by Sherrod Brown (D-OH) and Representative Rodney Davis, repeals the government pension offset (GPO) and the windfall elimination provision (WEP), which claws back workers’ and their spouses’ Social Security benefits, if they worked for a period of time in jobs not covered by Social Security. Twenty-five percent of public employees

nationwide, including millions of retired federal, state and local government employees who worked as teachers, police, firefighters and general employees and their survivors, are affected by these provisions. The GPO has a particularly harsh affect on moderate-and low-income pensioners, with women affected disproportionately and more likely to end life in poverty. The Social Security 2100 Act The Social Security 2100 Act, S. 269 and H.R. 860, introduced by Senator Blumenthal (D-CT) and Congressman John Larson (DCT), provides a 2% benefit increase to all current and future beneficiaries, and institutes the CPI-E. It protects the lowest income beneficiaries by ensuring they receive at least 125% of the federal poverty level in retirement. The bill gradually increases the payroll tax for workers by 1.2% and lifts the cap on payroll taxes for those earning above $400,000.

Social Security expansion bill poised to gain traction in Congress As Social Security's funding problems loom ever closer on the horizon, the program has emerged as a pet project on many lawmakers' fix-it list. Now in control of the House, Democrats have thrown their weight behind a measure that would extend and expand the program — largely by asking high earners to pony up, along with a gradual increase in the Social Security tax rate that applies to workers' income. "Democrats have agreed that we should expand, not cut, Social Security and have the wealthy pay their share," said Nancy Altman, president of advocacy group Social Security Works. Due to a variety of factors —

including an aging demographic, longer life spans, lower birth rates and the widening income gap — the Social Security Trustees 2018 report projects that beneficiaries will see a 21 percent cut in benefits by 2034 unless Congress takes action to prevent the funding shortfall. The Congressional Budget Office's estimate is more dire, pegging the year at 2031. More than 200 lawmakers, all Democrats, have signed onto the Social Security 2100 Act in the House. Introduced by Rep. John Larson, D-Connecticut, the bill would require that earnings above $400,000 be subject to the payroll tax that funds the

program. Currently, earnings above a certain level — $132,900 for 2019 — are not subject to Social Security taxation. This means someone who makes $132,900 pays the same amount into the program as someone earning, say, $1 million. A CBO report released in December shows that because earnings for the highest-paid workers have grown faster than the average wage, about 83 percent of earnings fell below the Social Security's taxable wage cap in 2016, down from 90 percent in 1983. "When Congress enacted Social Security changes in 1983,

no one anticipated the income stagnation," Altman said. The bill also would gradually increase the payroll contribution by workers and employers to 7.4 percent each by 2043 from 6.2 percent (to 14.8 percent altogether from the current 12.4 percent). Social Security recipients also would benefit, getting an increase of about 2 percent of average benefits. And, the yearly cost-of-living adjustment — called COLA — would use a different formula to determine annual bumps intended to more accurately reflects rising costs for older Americans. . ….Read More

Medicare Rights Comments on 2020 Draft Rate Notice and Call Letter Each year, the Centers for Medicare & Medicaid Services (CMS) releases a draft rate notice and call letter, which outlines rules and payment policies that will apply to Medicare Advantage plans in the upcoming plan year. Interested parties—including plans, beneficiaries, and advocates—can submit comments in response, which CMS takes into consideration when finalizing its proposal. The agency then releases a final rate notice and call letter in the spring, which contains information that plans use to submit their bids to offer Medicare Advantage and Part D

plans. This year, part of the draft call letter implements the Bipartisan Budget Act of 2018, which allows plans to offer nonprimarily health related supplemental benefits to people with chronic illnesses. In recent CMS guidancesur rounding this flexibility, the agency has allowed plans to broadly define “chronic illness” and to significantly expand the types of supplemental benefits a plan may offer. Medicare Rights’ comments focused, in part, on how beneficiaries will learn about these benefits and

their right to access them. We were encouraged to see that CMS will require plans to use the standard appeals process for disputes related to coverage of supplemental benefits, but we urged CMS to also require plans to make the standards for coverage publicly available and easily understandable. CMS also proposed to make more changes to the tiering structures allowed in Part D, by eliminating any tiers that combine brand name and generic drugs. CMS argues that such a change will lead to increased adoption of generic

and lower-cost medications and will aid beneficiaries in plan selection. We support this proposal, which would create simplified tiering structures that encourage generic and biosimilar utilization—resulting in cost savings for people with Medicare and the program itself. We encourage CMS to explore other opportunities to reduce the complexity of formularies and tiers, and to adopt policies that simplify shopping for and comparing plans. Read our comments here. Read the draft rate notice and 2020 call letter here.

Stop & Shop Workers Authorize Strike. Let’s Show Our SUPPORT!!!! UFCW Local 328 members employed at Stop & Shop unanimously voted to authorize a strike today! We would like to thank our membership for their amazing turnout despite the bad weather. We stand strong and united for a deal that respects our hardworking members, their families, and the communities they serve.

Military Doctors In Crosshairs Of A Budget Battle The U.S. military is devising major reductions in its medical corps, unnerving the system’s advocates who fear the cuts will hobble the armed forces’ ability to adequately care for health problems of military personnel at home and abroad. The move inside the military coincides with efforts by the Trump administration to privatize care for veterans. The Department of Veterans Affairs last month proposed rules that would allow veterans to use private hospitals and clinics if government primary care facilities are not nearby or if they have to wait too long for

an appointment. Shrinking the medical corps within the armed forces is proving more contentious and complex. In 2017, a Republican-controlled Congress mandated changes in what a Senate Armed Services Committee reportdescr ibed as “an under-performing, disjointed health system” with “bloated medical headquarters staffs” and “inevitable turf wars.” The directive sought a greater emphasis for military doctors on combat-related needs while transferring other care to civilian providers. Details of reductions have

yet to be finalized, a military spokeswoman said. But within the system and among alumni, trepidation has increased since Military.com, an online military and veterans organization, reported in January that the Department of Defense had drafted proposals to convert more than 17,000 medical positions into fighting and support positions — a 13 percent reduction in medical personnel. “That would be a drastic first cut,” said Dr. David Lane, a retired rear admiral and former director of the Walter Reed

National Military Medical Center in Bethesda, Md. At most risk in the current planning are positions that aren’t considered essential to troops overseas, such as training spots for new doctors and jobs that can be outsourced to private physicians and hospitals — obstetricians and primary care doctors, for example. The reductions may also limit the military’s medical humanitarian assistance and relief for foreign natural disasters and disease outbreaks…..Read More

Take Action to Support Expiring Medicaid Protections In January, Congress temporarily extended two important Medicaid provisions that help older adults and people with disabilities live at home and participate in the community—the home and community-based (HCBS) spousal impoverishment protection and the Money Follows the Person (MFP) program. Unless Congress acts soon, these programs will expire on March 31. Take action to help protect Medicaid HCBS.  1. Call the U.S. Capitol Switchboard at (202) 2243121 and ask for the office of your Senator/ Representative. Once connected, explain that you are a constituent who is calling to ask the Senator/ Representative to support two important Medicaid HCBS bills.  2. H.R. 1343, which would make the Medicaid HCBS ‘

spousal impoverishment protection permanent; and  The EMPOWER Care Act (H.R. 1342, S. 548) which would reauthorize and fund the Medicaid MFP program for five years.  · Amplify your voice!  · Forward this alert to your networks; and  · Spread the word on social media using #HCBS, #Medicaid, and #FundMFP. Learn more about these provisions and their impact on older adults and people with disabilities.  · Read Medicare Rights’ fact sheets on Medicaidand Medicaid and Medicare;  Justice in Aging’s spousal impoverishment protection fact sheet; and  A one-pager on The EMPOWER Care Act.

The spousal impoverishment protection makes it possible for a married couple to meet basic needs without jeopardizing their eligibility for Medicaid home and communitybased services (HCBS). These financial protections have long been available for married couples receiving Medicaid long-term services and supports (LTSS) in an institution and should equally apply to LTSS received at home. Congress must pass HR 1343 to make the HCBS spousal impoverishment protection permanent. The Money Follows the Person (MFP) program has helped over 88,000 older adults and people with disabilities move out of institutions and into the community. It is a commonsense way to fund Medicaid HCBS that not only improve health outcomes

and quality of life, but also save federal and taxpayer dollars. Congress must pass The EMPOWER Care Act to reauthorize the MFP program. Allowing these programs to expire would effectively separate people from their homes, communities, families, and friends against their will. Without these supports, some older adults and people with disabilities would be forced out of their homes and into more costly institutional care, while others who are currently in institutions would be prevented from returning home. People and families across the country would suffer, and the progress states have made in helping older adults and disabilities live and age with dignity, independence, and choice would erode.

Medieval’ Diseases Flare As Unsanitary Living Conditions Proliferate

Jennifer Millar keeps trash bags and hand sanitizer near her tent, and she regularly pours water mixed with hydrogen peroxide on the sidewalk nearby. Keeping herself and the patch of concrete she calls home clean is a top priority. But this homeless encampment off a Hollywood freeway ramp is often littered with needles and trash, and soaked in urine. Rats occasionally scamper through, and Millar fears the consequences. “I worry about all those diseases,” said Millar, 43, who said she has been homeless most of her life. Infectious diseases — some that ravaged populations in the Middle Ages — are resurging in California and around the country, and are hitting homeless populations especially

hard. Los Angeles recently experienced an outbreak of typhus — a disease spread by infected fleas on rats and other animals — in downtown streets. Officials briefly closed part of City Hall after reporting that rodents had invaded the building. People in Washington state have been infected with Shigella bacteria, which is spread through feces and causes the diarrheal disease shigellosis, as well as Bartonella quintana, which spreads through body lice and causes trench fever. Hepatitis A, also spread primarily through feces, infected more than 1,000 people in Southern California in the past two years. The disease also has erupted in New Mexico, Ohio

and Kentucky, primarily among people who are homeless or use drugs. Public health officials and politicians are using terms like “disaster” and “public health crisis” to describe the outbreaks, and they warn that these diseases can easily jump beyond the homeless population. “Our homeless crisis is increasingly becoming a public health crisis,” California Gov. Gavin Newsom said in his State of the State speech in February, citing outbreaks of hepatitis A in San Diego County, syphilis in Sonoma County and typhus in Los Angeles County. “Typhus,” he said. “A medieval disease. In California. In 2019.” The diseases have flared as the nation’s homeless

population has grown in the past two years: About 553,000 people were homeless at the end of 2018, and nearly one-quarter of homeless people live in California. The diseases spread quickly and widely among people living outside or in shelters, fueled by sidewalks contaminated with human feces, crowded living conditions, weakened immune systems and limited access to health care. “The hygiene situation is just horrendous” for people living on the streets, said Dr. Glenn Lopez, a physician with St. John’s Well Child & Family Center, who treats homeless patients in Los Angeles County. “It becomes just like a Third World environment where their human feces contaminate the areas where they are eating and sleeping.”...Read More

Older Adults Lose Billions of Dollars Each Year to Financial Abuse A new report from the Consumer Financial Protection Bureau (CFPB)— the government agency charged with enforcing federal consumer financial laws—sheds light on the widespread problem of elder financial abuse. Studies show that financial exploitation is the most common form of elder abuse. Perpetrators can include a wide variety of people ranging from close family members to offshore scammers, and estimates of annual losses to older adults have ranged from $2.9 billion to $36.5 billion. Financial institutions are uniquely positioned to prevent and respond to elder financial exploitation. They often come in contact with victims and perpetrators, know their customers personally, and have the opportunity to observe how funds move from the older person to the perpetrator. In 2013, the federal government began requiring banks, credit unions, and other financial services providers to

report suspicious activities targeting older adults. Since then, over 180,000 events totaling more than $6 billion have been reported. The CFPB’s report— the first-ever public analysis of these Suspicious Activity Reports (SARs)—identifies key trends and patterns, offering a chance to better understand elder fraud and to find ways to improve prevention and response. Among the Key Findings: Elder Financial Exploitation Is Widespread, yet Underreported. While SAR filings on elder financial exploitation quadrupled from 2013 to 2017, these reports do not capture the full scope of the problem. Based on recent prevalence studies, these reports likely represent a tiny fraction of actual incidents of elder financial exploitation. The Financial Consequences for Older Adults are Significant. The aver age amount an older adult lost was

$34,200. It was even higher when the older adult knew the suspect ($50,000). One third of the individuals who lost money were aged 80 or older, and adults ages 70 to 79 had the highest average monetary loss ($45,300). Money Transfers and Bank Accounts are Common Targets. Mor e than half of the reported events involved a money transfer and an average loss of $32,800. 44% of scams involved a checking or savings account, and these events had the highest average monetary losses ($48,300). The suspicious activity reported took place, on average, over a four-month period. Financial Institutions are Not Reporting Elder Financial Exploitation to Law Enforcement or Adult Protective Services. Fewer than one third of reports indicated that the financial institution reported the suspicious activity to a local,

state, or federal authority. This study provides new insights into the dimensions and nature of financial exploitation of older adults and the responses of financial institutions when they see it. Financial institutions, law enforcement, social service agencies, and policymakers at the local, state, and federal level can use these detailed findings to strengthen efforts to prevent, detect, and respond to this major threat to the financial security of older adults. If you believe that you or someone you know is a victim of financial exploitation, contact your local adult protective services (APS) agency. You can find out how to reach your APS office from the Eldercare Locator at eldercare.acl.gov or by calling 1-800-677-1116. You can also report scams or fraud to the Federal Trade Commission at ftc.gov/complaint. Read the CFPB’s report.

As Hospitals Post Price Lists, Consumers Are Asked To Check Up On Them With much fanfare, federal officials required hospitals nationwide this year to post their “list” prices online. But it’s not yet clear how many are doing it, even as the government has taken the rare step of asking consumers to monitor hospital compliance. Most hospitals appear to be complying with the rule, according to hospital officials and a small sampling of websites. However, the feds acknowledge they are not yet enforcing the rule, industry groups are not monitoring compliance, many hospitals are burying the information on their websites, and debate continues about whether the price lists are creating more confusion than clarity among consumers.

The rule took effect Jan. 1, after a year-long controversy about its necessity and usefulness. It requires every hospital in the country — about 6,000 — to post its full price list online. The lists, known in the industry as “chargemasters,” present prices for the thousands of individual services and products for which a hospital may bill — everything from the price for a bed per day, blood tests and surgical operating room time (billed in 15-minute intervals) to the cost of a single Tylenol tablet. The problem: Services and products are identified in obscure abbreviations, billing codes and medical terminology

that even doctors or nurses often don’t understand. Additionally, the chargemaster lists only rarely reflect final billed charges because insurers and the government generally negotiate significantly lower prices. In most cases, these posted rates are the highest a hospital would ever charge per service. Even so, officials at the Centers for Medicare & Medicaid Services (CMS) said full public disclosure was a logical first step in a transparency initiative aimed at eventually encompassing physician and prescription drug prices. CMS contends the listings will help patients compare

facilities, spur competition among hospitals to lower prices and prompt software developers to build tools that consumers can use to comparison shop. “We think this information will empower patients,” said Seema Verma, the CMS administrator. “And we look forward to seeing consumers continue to drive the demand for hospitals to provide greater price transparency.” Verma has enlisted the public in an unusual effort to monitor whether hospitals are complying. In appearances, opinion pieces and through social media, she has urged consumers to check their local hospitals’ websites to see if chargemaster lists are posted and let the agency know if they are not….Read More

RI ARA HealthLink Wellness News

How Much Difference Will Eli Lilly’s Half-Price Insulin Make? When Erin Gilmer filled her insulin prescription at a Denverarea Walgreens in January, she paid $8.50. U.S. taxpayers paid another $280.51. “It eats at me to know that taxpayer money is being wasted,” said Gilmer, who has Medicare and was diagnosed with Type 1 diabetes while a sophomore at the University of Colorado in 2002. The diagnosis meant that for the rest of her life she’d require daily insulin shots to stay alive. But the price of that insulin is skyrocketing. Between 2009 and 2017 the wholesale price of a single vial of Humalog, the Eli Lilly and Co.-manufactured insulin Gilmer uses, nearly tripled — rising from $92.70 to $274.70, according to data from IBM Watson Health. Six years ago, Gilmer qualified for Social Security Disability Insurance — and thus,

Medicare — because of a range of health issues. At the time, the insulin she needed cost $167.70 per vial, according to IBM Watson Health. “When it’s taxpayer money paying for medication for someone like me, it makes it a national issue, not just a diabetic issue,” Gilmer said. Stories about people with Type 1 diabetes dying when they couldn’t afford insulin have made headlines. Patient activists like Gilmer have protested high prices outside Lilly’s headquarters in Indianapolis. Last October in Minnesota, state Attorney General Lori Swanson sued insulin manufacturers, alleging pr ice gouging. Pharmaceutical executives were grilled about high drug prices by the Senate Finance Committee on Feb. 26. This is the backdrop for

Lilly’s announcement last week that it is rolling out a halfpriced, generic version of Humalog called “insulin lispro.” The list price: $137.35 per vial. “Patients, doctors and policymakers are demanding lower list prices for medicines and lower patient costs at the pharmacy counter,” Eli Lilly CEO David Ricks wrote in a blog post about the move. “You might be surprised to hear that we agree – it’s time for change in our system and for consumer prices to come down.” No Panacea When Lilly’s Humalog, the first short-acting insulin, came to market in 1996, the list price was about $21 per vial. The price didn’t reach $275 overnight, but yearly price increases added up. In February 2009, for example, the wholesale price

was $92.70, according to IBM Watson Health. It rose to $99.65 in December 2009, then to $107.60 in September 2010, $115.70 in May 2011, and so on. “There’s no justification for why prices should keep increasing at an average rate of 10 percent every year,” said Inmaculada Hernandez of the University of Pittsburgh School of Pharmacy, who was lead author of a January report in Health Affairs attributing the skyrocketing cost of prescription drugs to accumulated yearly price hikes. “The public perception that we have in general is that drugs are so expensive because we need to pay for research and development, and that’s true,” Hernandez said. “However, usually research and development is paid for in the first years of life of a drug.” …..Read More

Heart Attacks Striking More Young Adults Although Americans are suffering fewer heart attacks, the rate is dramatically increasing among those under 40. In fact, 20 percent of people who have a heart attack are 40 or younger, a rate that has risen 2 percent a year for 10 years, new research reports. Some of these people are now in their 20s and early 30s, said senior study author Dr. Ron Blankstein, a cardiologist at Brigham and Women's Hospital in Boston. He said it used to be "incredibly rare" to see anyone under age 40 with a heart attack. "Based on what we are seeing, it seems that we are moving in the wrong direction," he said. These young heart attack victims also have the same risks of dying from another heart

attack or stroke as older patients. "Even if you're in your 20s or 30s, once you've had a heart attack, you're at risk for more cardiovascular events and you have just as much risk as someone who may be older than you," Blankstein said. Risk factors such as diabetes, high blood pressure, smoking, family history of premature heart attack and high cholesterol were the same among older and young people who suffered a heart attack, researchers found. Younger patients drank less alcohol but were more likely to be substance abusers -- 18 percent used marijuana and 9 percent used cocaine. For the study, Blankstein and

colleagues collected data on close to 2,100 patients under age 50 admitted to two hospitals for heart attacks. "Many people think that a heart attack is destined to happen, but the vast majority could be prevented with earlier detection of the disease and aggressive lifestyle changes and management of other risk factors," Blankstein said To protect yourself, he recommends avoiding tobacco, getting regular exercise, eating a heart-healthy diet, losing weight if you need to, managing your blood pressure and cholesterol, avoiding diabetes, and staying away from cocaine and marijuana. In a related study, Blankstein's

team found that 1 in 5 patients who suffer a heart attack before age 50 also have diabetes. Diabetics are more likely to have repeated heart attacks and die from a heart attack than other people. These patients need aggressive treatment, Blankstein said. Some diabetes medications can reduce heart attack risk, he added. The findings are to be presented March 17 at the American College of Cardiology's annual meeting in New Orleans. Research presented at meetings is considered preliminary until published in a peer-reviewed journal. More information For more about heart attacks, visit the American Heart Association

Study Urges Seniors to Get Moving to Live Longer Can you tell how long you'll live? For seniors, how fit you are may offer a clearer forecast of life span than traditional markers such as high blood pressure, high cholesterol, diabetes and smoking, a new study suggests. It included more than 6,500 people, age 70 and older, who had an exercise stress test between 1991 and 2009. The test measured their fitness by having them exercise on the treadmill as hard as they could. After the test, participants were tracked for an average of just under 10 years. During the follow-up, 39 percent died. Researchers found that the people who were most fit were

more than twice as likely to be alive a decade later than the least fit. Surprisingly, the number of heart disease risk factors was not associated with odds of death. Participants with no risk factors had about the same chance of dying as those with three or more risk factors, according to the study, though researchers only found an association between fitness and life span. "We found fitness is an extremely strong risk predictor of survival in the older age group -- that is, regardless of whether you are otherwise

healthy or have cardiovascular risk factors, being more fit means you're more likely to live longer than someone who is less fit," said lead author Dr. Seamus Whelton. He's an assistant professor of medicine at Johns Hopkins School of Medicine in Baltimore. "This finding emphasizes the importance of being fit, even when you're older," Whelton said in an American College of Cardiology (ACC) news release. While Whelton said a stress test using a treadmill or stationary bicycle is the best way to assess fitness, doctors can get general idea of a

patient's fitness by asking about their physical activity habits. "People who aren't exercising or are sedentary would likely benefit from starting a routine of low- to moderate-intensity exercise, though they should talk with their physician first," he suggested. The study is scheduled to be presented March 16 at the ACC's annual meeting, in New Orleans. Research presented at meetings is considered preliminary until published in a peer-reviewed journal. More information The U.S. National Institute on Aging has more about exercise and physical activity.

Too Few Seniors Are Getting Their Memory Tested Most seniors expect their doctor to recommend testing of thinking and memory when it's needed. But a new survey discovered that is rarely the case: Only one in seven seniors received a regular assessment for memory and thinking (or "cognitive") troubles. That finding is in sharp contrast to those who receive assessments for other common health issues. Ninety-one percent of seniors said they were regularly checked for blood pressure, and 83 percent said their cholesterol levels were routinely tested. "Both doctors and patients have a strong belief that cognitive assessment is important, but there's a disconnect about who should bring it up," explained Joanne Pike, chief program officer at the Alzheimer's Association, which conducted the survey. The survey found that most seniors thought that the doctor would recommend such screening when it was necessary. Meanwhile, doctors were waiting for patients or family members to report that

someone might be having memory issues. Pike said that while seniors reported believing that early detection of memory and thinking issues would be beneficial, many didn't tell their doctors about their own memory concerns. "Half of all seniors were aware of some change in memory, but less than half reported that change to their doctor," Pike said. The survey found that only 15 percent of seniors said they brought up memory or thinking issues on their own. Why are so few reporting their concerns? Dr. Zaldy Tan, medical director of the UCLA Alzheimer's and Dementia Care Program, said that "patients usually aren't the best person to know they've forgotten. Usually a concerned family member or friend brings it up." Tan explained that "patients do want to know, but they're also afraid to find out. They don't want their current status threatened. Children may think you can't live alone or drive. If

one person in a couple has memory impairment, spouses tend to cover the problem. No one wants a threat to their current way of living." In fact, Keith Fargo, director of scientific programs and outreach at the Alzheimer's Association, noted that the survey found that almost onethird of seniors said they were afraid to know the answer if they had a cognitive assessment. "There's a sense of futility. Some said there's no treatment," he explained. But there are good reasons to bring up memory and thinking concerns with your doctor, both Pike and Fargo noted. First, some forms of memory loss are reversible. Sleep apnea, depression, thyroid problems and vitamin deficiencies can all cause problems with thinking and memory. "Even if your doctor diagnoses Alzheimer's disease, there's hope in clinical trials. There are some potential disease-modifying drugs in clinical trials today," Fargo said. Dr. Gayatri Devi, a

neurologist at Lenox Hill Hospital in New York City, agreed that it's important to get a diagnosis so that you can take steps to slow the disease. Changes in lifestyle, such as blood pressure and cholesterol management, increased exercise and more socialization can help delay or prevent Alzheimer's disease, Devi said. "This is all the more reason why it's important for primary care practitioners to be vigilant and proactive about inquiring into cognitive problems in their patients," Devi said. Pike pointed out that a brief cognitive assessment is a required component of the annual Medicare wellness visit for seniors. Only one-third of seniors reported knowing that fact. Nine out of 10 of the doctors surveyed said they'd like more guidance and tools for screening for memory and thinking troubles. To that end, Fargo said that the Alzheimer's Association is developing guidelines for primary care physicians that he hopes will be available in the next few months….Read More