Health Care Measures Everything, Except What Really Matters To Seniors

As board chair of a community hospital, I am often confronted with the dozens of quality and safety measures that state and federal regulators use to score and pay us, and private organizations use to rate us. And as someone who works to improve the quality of care for older adults, I am struck by how much all these measures miss when it comes to what really matters for seniors.

Here’s an example: Imagine an 85-year-old widow with mild dementia who lives alone at home. She comes to the emergency department of her local hospital with severe hip pain. She is treated quickly and efficiently in the ED. The orthopedic surgeon finds that she has severe arthritis and determines the best treatment is hip replacement surgery.

The Risks Of Social Isolation For Older Adults

Socially-isolated older adults are likely to be sicker and die sooner, and have higher health care expenses, than seniors who retain their social connections. A new study by researchers from the AARP Public Policy Institute, Stanford University, and Harvard finds that Medicare spends an estimated $6.7 billion more each year on seniors who have little social contact with others.

An Easy Way To Reduce Health Costs…And Patient Stress

Health experts often focus on the needs of a relatively small number of people who are the heaviest users of medical treatment. You know: that five percent of Medicare beneficiaries who account for half the program’s costs.

But a new study published in the October volume of the journal Health Affairs (paywall) looks at another cost-driver in our health care system. This one will be familiar to many seniors and their adult children: Needless high-volume but relatively inexpensive tests and procedures such as cardiac screenings for low-risk patients, PSA prostate cancer tests for men aged 75 and older, and imaging for common low-back pain.

Two Proposed Tax Changes That Will Hurt Frail Older Adults

Two of the many major changes House Republicans would make to the federal tax code could make it harder for fail older adults, younger people with disabilities, and their families to receive badly-needed services.

Repeal of the medical expense deduction would severely hurt those who face major uninsured expenses for medical treatment or long-term supports and services, including care at home or in facilities. At the same time, other proposals that would cut the tax benefits for charitable giving would hurt community-based non-profits that often provide direct services to seniors and younger people with disabilities.

Medical expense deduction

Medicare Spends Far More On Older Adults Who Need Personal Assistance

Want to know if an older adult is likely to use lots of medical care? Just ask if she needs help with living activities such as bathing, dressing, or getting out of bed.

In a new study with important implications for both caregivers and policymakers, researchers at the Long-Term Quality Alliance (LTQA) found that Medicare spends an average of three times as much on an older adult who has these functional limitations than on a senior who does not. Even after adjusting for age, the number of chronic conditions, or Medicaid eligibility, the pattern is the same: If you have severe functional limitations or cognitive impairments such as dementia, Medicare will spend far more on your medical care than if you do not. Earlier studies, including one in 2011 by Judy Feder and Harriet Komisar reached similar conclusions.

A Simple Solution To Medicare’s Enrollment Mess

Enrolling in Medicare Part B should be simple. But for years the government has been making enrollment nearly impossible for millions of seniors, especially those who are still working or who have delayed taking their Social Security benefits. They are never told that are eligible for Medicare, they don’t know that they face still penalties if they don’t enroll by a deadline, and they can’t figure out how Medicare fits with other health insurance they may have.

Middle Income 50-Somethings Will Be Big Losers From Trumpcare

President Trump’s multi-pronged administrative attack on the Affordable Care Act would sharply increase premiums for middle-aged people who purchase insurance in the individual market, likely driving many to drop coverage.

Most would not feel the effects until 2019, though some will face sharply higher premiums in 2018—rate hikes they’ll see when the open enrollment season begins next month.

The President announced several changes to the ACA this week. They are complicated and address different parts of the 2010 law. But the overall effect will be that millions of older, sicker Americans will be priced out of comprehensive coverage while many younger, healthier people may get access to new low-cost, low-benefit policies. Those who are aged 50-64, just before they are eligible for Medicare, could be among the biggest losers.

What Are Adult Day Centers—Besides The Basis For Political Insults?

Adult day centers seem to have made it into the political debate in Washington, though not in a good way. In his nasty weekend  back-and-forth with President Trump, Senator Bob Corker (R-TN) suggested the White House has become an “adult care center” and wondered if the staff had “missed a shift” when Trump launched his Sunday Twitter storm. Yesterday, Rep Diane Black (R-TN)—who wants to run for governor—replied that the Senate “is an adult day care center” that can’t get anything done.

Leaving aside this mature level of political discourse, the name-calling does raise an important question: What are adult day centers and how do they work?

A Step Down The Road To Better Medicare For Those With Chronic Disease

Last week, the Senate quietly and unanimously passed a bill that would improve some Medicare benefits for people with chronic disease. The measure would do many good things but the most important is this: It would take important steps toward breaking down the wall between medical treatment and non-medical supports and services in Medicare, beginning a process that would make it much easier for frail seniors to receive the right care when they need it.

Graham-Cassidy’s Pre-Existing Conditions Rule Is A Very Big Deal

The still-evolving Senate Republican replacement for the Affordable Care Act could make health insurance unaffordable for more than 50 million middle-aged Americans by allowing insurers to raise premiums for those with pre-existing conditions. Other provisions would allow carriers to boost insurance costs for even health people aged 50-64.

The bill would give states federal dollars to help subsidize those rate increases, though  it would also slash the federal contribution to Medicaid in most states. Overall the combined federal share of Medicaid and insurance subsidies would be $160 billion lower over the next 10 years than under the ACA, according to the Kaiser Family Foundation.