A new bill would establish a loan repayment program for mental health care providers that commit to working in designated high-needs communities. Representatives John Katko (R-NY) and Grace Napolitano (D-CA) introduced the bipartisan legislation, called the Mental Health Professionals Workforce Shortage Loan Repayment Act of 2018 (H.R.6597), to address a critical shortage in the number of mental health care providers across the country.
Under the proposed program, the Health Resources and Services Administration would be responsible for repaying up to $250,000 of an individual’s student loans if they are not already receiving similar benefits from other federal programs. Eligible providers include any person working full-time in a direct treatment or recovery support capacity for patients recovering from a mental illness, broadly speaking.
Currently, over 100 million Americans live in areas where there is a defined shortage of mental health professionals, a disparity that leaves many individuals living with mental illness without access to needed care. “This bipartisan legislation will incentivize students and professionals pursuing careers in mental health care to work in areas of our country desperately in need of more options for care,” said Rep. Katko. “It will go a long way towards addressing the current critical shortage in the workforce and ensure more people nationwide struggling with mental illness have access to the care they need.”
The National Council applauds Reps. Katko and Napolitano for their leadership on this issue and looks forward to supporting the bill through to passage.
Bob became ill with a chest infection and was treated as an outpatient. After treatment, he was admitted to the hospital in a confused state.
“I see spiders,” he said to Glyn as he picked at the air from his hospital bed.
Glyn told Bob’s doctors he had been a perfectly coherent, a spry 88-year-old before his hospital admission. The doctors seemed indifferent.
As often happens with old people, after his acute hospitalization, Bob was transferred to a nursing home. When he arrived, the staff immediately returned him to the hospital, saying he was too sick to be in a nursing home and suggested further evaluation and treatment.
I flew from Denver to California to be with Bob and his family and see what I could do to sort out Bob’s medical care. He died before I got to his bedside.
On the surface, this might seem to be just another death of an elderly man. Often when elderly spouses are separated, one will die. As I sat with the family the day after Bob died, with his granddaughter Ann, in her final year of medical school, she and I reconstructed the details of Bob’s final days.
Bob’s physicians had started him on antibiotics a few weeks before his death. As we listened to the course of his illness and the timing of events, Ann and I began asking questions.
“Tell me again how he was acting,” I asked.
“Bob was seeing people who weren’t there and talking nonsense,” Glyn said.
I recalled the spiders. These hallucinations sounded like liver failure, usually caused by chronic alcohol use, but also caused by certain medications with a similar effect on the liver, especially in the elderly. Bob wasn’t a drinker.
“Was he yellow?,” I asked.
“Yes, at the end.”
Another sign of liver failure.
“Do you remember what antibiotics he was taking?,” I asked.
“No.”
“Was he getting regular blood tests while on the antibiotics?”
“I don’t know. He had blood drawn when he was in the hospital.”
Too few facts, but Ann and I looked at each other. I mentioned medication-induced liver failure.
Ann nodded her head and said, “That’s what I’ve been thinking.”
As near as we could tell from the limited facts, it appeared the antibiotics had damaged Bob’s liver, leading to his confusion, jaundice, and death. In general, medications are processed by the liver or the kidneys before being excreted. Some medications have well-known side effects on the organs. Specific antibiotics are notorious for this, especially in the elderly. The standard of care is to check the liver enzymes in the blood. If the levels are up, it means the liver cells are being damaged. It was not clear to me Bob’s liver enzymes had been regularly checked.
It appeared to me his physicians paid no attention to Glyn and considered Bob to be a confused old man who was grieving over separation from his wife, perhaps even thinking him an old geezer not worth saving.
A couple of days before Bob died, his physicians recognized he was jaundiced — yellow because of liver failure. Bob was confused because of the build-up of ammonia from his liver’s inability to process it. Bob probably died of the side effects of medications toxic to his liver.
Had Bob been cared for by clinicians who remembered to check his liver enzymes, he might have lived through his illness.
This should cut the number of medical services provided and kill off expensive PWD....
The Trump administration’s fiscal year 2019 budget request signals that the Centers for Medicaid and Medicare Services (CMS) intends to use regulatory authority to allow states to drop the Medicaid non-emergency medical transportation (NEMT) benefit. This benefit has been part of Medicaid since the program’s inception in 1966. Changing that would be a stunning precedent, reversing more than 50 years of Medicaid policy.
Many low-income individuals do not have access to affordable transportation to get to and from medical appointments. For them, transportation issues can be a major barrier to needed health care. The requirement for states to provide NEMT benefits in Medicaid was established based on the premise that the Medicaid entitlement is meaningless if patients are unable to get to and from their necessary health care appointments. That premise has not changed.
In 2013, a systematic literature search of peer-reviewed studies on transportation barriers to health care access concluded that transportation barriers to access are common and greater for low-income and chronically ill patients. Two peer-reviewed studies reported that 25 percent of patients missed an appointment due to transportation problems, and 25 separate studies found that 10–51 percent of patients reported transportation was a barrier to health care access.
Information from the largest manager of Medicaid NEMT services indicates that the most frequently cited reasons for using NEMT are accessing behavioral health services (including mental health and substance abuse treatment), dialysis, preventive services (including doctor visits), specialist visits, physical therapy/rehabilitation, and adult day health care services (see Exhibit 1).
Whew! Any possibility of rationality in regards to this issue?....
President Donald Trump late Monday officially signed off on H.R. 6042, a widely supported bill to delay the nationwide deadline for electronic visit verification (EVV) in Medicaid-reimbursed personal care services.
The 21st Century Cures Act, signed into law in 2016 under the Obama Administration, originally required home care providers and state agencies to begin adopting EVV systems by Jan. 1, 2019. H.R. 6042, sponsored by Rep. Brett Guthrie (R-Kentucky), pushes that deadline back to Jan. 1, 2020.
The bill passed through both the U.S. House of Representatives and Senate without opposition.
Monday’s news of H.R. 6042 becoming law comes with little surprise, as most industry stakeholders anticipated President Trump signing the bill.
In addition to delaying the previously set deadline, H.R. 6042 delays potential penalties providers may have otherwise incurred for failure to fully adopt or at least make progress toward the implementation of EVV in their operations.
The two-page bipartisan bill was presented to the president on July 19. It was co-sponsored by Rep. Diana DeGette (D-Colorado), Rep. James Langevin (D-Rhode Island) and Rep. Greg Walden (R-Oregon).
As enrolled, H.R. 6042 also encourages the Centers for Medicare & Medicaid Services to convene at least one public meeting in 2018 to give Medicaid stakeholders the opportunity to provide any necessary feedback related to the implementation process.
Supporters of the bill say it will give officials and providers more time to prepare for a significant change in how care is authenticated. Even so, not all state Medicaid offices plan on taking advantage of the extra leeway.
The Ohio Department of Medicaid, for example, plans to stick to the original timeline, according to The Columbus Dispatch. The decision to move forward as planned was made despite a “firestorm” of complaints lodged when EVV initially started to roll out in the state.
“I never imagined that this could happen.”
In just a few months, I have heard more than a few of my patients say this to me after undergoing an operation.
In these moments, I cannot help but ask myself, what did we fail to communicate to these patients during informed consent such that they are blindsided by an outcome? I wonder, what could we have done differently such that patients can better understand the choices they face?
In our current model, the physician and the patient meet in an office or inpatient setting to discuss consent for an upcoming procedure or clinical trial. Often filled with medical jargon, the conversation rarely assesses the patients’ baseline level of knowledge or their degree of comprehension afterward.
For instance, given the advances in computer software and even social media, we no longer need to be limited to a single place or time.
Using a virtual platform, the patient can find all essential information related to the intervention in one location prior to the hospital admission or office visit. Its content, organized by the provider, will walk the patient through the traditional components of informed consent. While the basic components stay the same, the fundamental difference here is that social media has the potential to render it more dynamic, interpersonal, and equitable.
To optimize patient learning, medical jargon can be linked to background articles or easy-to-understand media. Occasional quiz questions can pop-up to ensure the patient comprehends the crucial details. Because interactions are not restricted by office space and one-on-one time, patients can spend as much time as needed to review the content and even pose questions to the provider-team directly, to be answered during the upcoming appointment.
One of the fundamental limitations of informed consent is that no matter how much we optimize the process, the patient cannot fully understand the implications of an intervention until he or she experiences them firsthand. For instance, no words from a physician could ever hope to illustrate the feelings of post-operative pain, or the day-to-day limitations of living with stroke deficits. Physicians may know the science, but we have not experienced the day-to-day realities of patients. It is oftentimes our failure to convey these types of information that patients often find themselves blindsided by the aftermath.
However, they may be able to get some of these perspectives from other patients who have gone through them. If mutually desired, the platform can help connect patients to share their experiences or organize meetings, so they may be able to better understand the realities of potential benefits and complications. In these instances, we need to believe that patients, not just physicians, may also know best, and enable them to empower each other.
Insurers will be relieved, and markets will avoid a big hit.
The Trump administration says it is restarting a key Affordable Care Act program, a little more than two weeks after announcing its suspension.
At the time, the administration said it was stopping the program, known as “risk adjustment,” in order to comply with a federal court ruling. Critics questioned that explanation, noting that the administration had options that would allow the program to keep operating, and suspected yet another effort by President Donald Trump and his allies to sabotage Obamacare.
Now the administration has gone ahead and used one of the available options. And that’s a big deal, because of the critical role risk adjustment plays in keeping insurance markets stable.
Risk adjustment is basically a set or payments that flow back and forth among insurers ― in this case, among the carriers that sell coverage to small businesses and directly to individuals. Insurers that end up with lots of relatively healthy customers put money into the program, while insurers with relatively sick customers get money out of it.
The idea is to make sure carriers aren’t making extra profits simply by finding ways to attract the healthiest beneficiaries ― say, by constructing doctor networks or pharmacy formularies that patients with cancer, HIV or other serious diseases would try to avoid. The federal government calculates the amounts, collects the contributions and makes the payouts.
Each year, billions of dollars go through the Affordable Care Act’s version of the scheme, with some insurers paying large sums and others receiving them. But some insurers have sued the federal government, arguing that the existing system doesn’t treat them fairly. In one of those cases, a lower level federal judge in New Mexico sided with the plaintiffs and declared the formula invalid, at least until the federal government could explain its rationale. The Trump administration subsequently asked the judge to reconsider his ruling.
Not too many observers paid attention to the court decision until early July, when the Center for Medicare and Medicaid Services (CMS), which administers the risk adjustment program, announced it was halting payments until the courts cleared up the legal ambiguity.
Emergency Preparedness and Response: Model Policies and Procedures for State Long-Term Ombudsman Programs
Preparing for and responding to emergencies that affect individuals living in long-term care facilities requires coordinating the work of many. While Long-Term Care Ombudsman programs are not first responders, they can play an important role in emergency planning and response. Ombudsman programs can resolve complaints, protect rights, and promote access to services for residents before, during, and after emergencies and disasters. This document was procuded by the Administration for Community Living to assist in developing polices and procedures for State Long-Term Care Ombudsman programs regarding Emergency Preparedness.
Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers
The rule was published on September 16, 2016 and is effective as of November 15, 2016. The regulations must be implemented by affected entities by November 15, 2017. The regulations require nursing facilities to be in compliance with all federal, state and local emergency preparedness requirements.
CMS Emergency Preparedness Final Rule Crosswalk
These tables represent a visualization of the association between the CMS Emergency Preparedness Final Rule Conditions of Participation and existing regulatory and accreditation standards. This crosswalk is intended to serve as a “Quick Reference Guide” and not as interpretive guidance or instructions on how to achieve compliance. Specific questions on individual facility compliance must still be directed to AOs, surveyors, and Centers for Medicare and Medicaid Services (CMS). This crosswalk is a product of Yale New Haven Health System Center for Emergency Preparedness and Disaster Response’s (YNHHS‐CEPDR) and has not been reviewed or approved by the CMS or by any AO.
CMS Emergency Preparedness Rule: Resources at Your Fingertips
This document provides links to numerous related resources applicable to a variety of providers and suppliers related to the Emergency Preparedness Rule.
Ethics of consent-less study of prehospital agitation treatment questioned.
Following revelations last month about two controlled trials of ketamine for treating severe agitation -- with drugs injected by first responders without the patients' individual consent -- the consumer group Public Citizen and dozens of independent physicians are calling for a federal investigation.
The Minneapolis Star Tribune newspaper published a series of stories in June detailing the trials, which were the first quasi-randomized studies comparing ketamine with traditional medications (i.e., haloperidol and midazolam) used to sedate agitated patients in emergency settings. The trials had been approved under a "waiver of consent" process, under which the investigators said risks were minimal; they also consulted beforehand with community groups, including patients in a homeless shelter under treatment for substance abuse.
Public Citizen is now hoping to make a federal case out of it. Their letter, dispatched just after midnight Wednesday, called on the FDA and the Department of Health and Human Services' Office for Human Research Protections to "immediately launch formal compliance oversight investigations."
The letter cited the adverse-event rates from the initial trial as indicating that the risks associated with ketamine were far from minimal, and questioned the method used to determine whether patients were severely agitated (scores of 2 or 3 on the Altered Mental Status Scale). It also said the institutional review board (IRB) that approved the trials, as well as the sponsors and investigators, should be scrutinized.
For Thomas P. Yacoe, the word is “terrifying.”
Leah Hemberry describes it as “constant fear.”
For Michael Tausig Jr., the terror is “beyond description.”
All three are patients struggling with chronic pain, but what they are describing is not physical agony but a war inside the medical community that is threatening their access to painkillers — and, by extension, their work, their relationships, and their sanity.
Two years after the United States saw a record 27,000 deaths involving prescription opioid medications and heroin, doctors and regulators are sharply restricting access to drugs like Oxycontin and Vicodin. But as the pendulum swings in the other direction, many patients who genuinely need drugs to manage their pain say they are being left behind.
Doctors can’t agree on how to help them.
“There’s a civil war in the pain community,” said Dr. Daniel B. Carr, president of the American Academy of Pain Medicine. “One group believes the primary goal of pain treatment is curtailing opioid prescribing. The other group looks at the disability, the human suffering, the expense of chronic pain.”
Pain specialists say there is little civil about this war.
“There’s almost a McCarthyism on this, that’s silencing so many people who are simply scared,” said Dr. Sean Mackey, who oversees Stanford University’s pain management program.
“The thing is, we all want black and white. We don’t do well with nuance. And this is an incredibly nuanced issue.”
Nuance does not matter to people like Tausig, 43, who has been unable to work or socialize since 2008, when the last of his five spinal reconstruction surgeries left him in constant pain.
He last got a taste of life without opioids a few years ago, when his pharmacy’s corporate parent imposed opioid-distribution limits, forcing him to find a new one.
“Those three days were among the worst of my life,” he said. “I wandered the house at night, legs shaking like a whirling mass of putty, sleepless and without respite from the pain.”
Now, with regulators and health industry leaders continuing to bear down on opioids, and the arrival of a new president whose statements indicate that he might further restrict opioid distribution, Tausig’s worries have deepened.
“It’s put the fear of God in me.”
When a professional home health agency isn’t an option, family and other unpaid caregivers are often asked to pick up the slack.
It’s estimated that more than 34 million people in the United States provide unpaid care to individuals 50 and older. The economic impact of those services is far from trivial. Indeed, unpaid caregivers—largely adult children, siblings, spouses or other family members—provide an estimated $500 billion worth of care service annually, according to estimates.
But America’s network of these volunteer, unsalaried caregivers is shrinking—and at the most inopportune time.
Each day, roughly 10,000 baby boomers turn 65, past studies by the Pew Research Center have found. The ratio of caregivers to care recipients, meanwhile, peaked in 2010 and has been falling ever since.
The Wall Street Journal highlighted the looming care deficit in a new report published Friday.
“Families have fewer children, older adults are more likely to have never married or to be divorced and adult children often live far from their parents or may be caring for more than one adult or their own children,” stated a 2016 study by the National Academy of Sciences.
In effort to keep up the pace of care, families have even resorted to piecing together support networks made up of childhood friends and ex-spouses, The Wall Street Journal reported. It’s unclear how sustainable that strategy is, however.
Additionally, many of those caregivers have been forced to coordinate care from hundreds or even thousands of miles away as jobs have become more mobile and spread out geographically.
There are scores of personal and work-related challenges in taking on the role of an unpaid caregiver, The Wall Street Journal highlighted in its report.
About 68% of caregivers cited the mental and physical time and effort required of the role as a top challenge, while 45% identified the ability to navigate the U.S. health care system as a major obstacle. Another 45% of caregivers identified the changing relationship dynamics as a prominent challenge as well.
Statistics come from a study conducted by Merrill Lynch and Age Wave.
When brought into the care plan, home health agencies often strive to help family members mitigate many of those points. Findings suggest the role of a home health provider may become even more prevalent moving forward.
Besides psychological and social factors, there’s a very real financial toll tied to caring for an aging loved one.
Family caregivers, on average, spend about $7,000 per year on out-of-pocket costs related to caregivers, a 2016 report by AARP determined.
Our criminal justice system has long struggled to accommodate persons with disabilities. So when a state prison reforms how it treats incarcerated people with disabilities, those reforms can have an immediate and vital effect. As a result of a groundbreaking settlement approved yesterday by Judge Jeremiah Lynch in our case, Langford v. Bullock, just such a set of reforms is now underway at the Montana State Prison.
While life at Montana State Prison is certainly difficult for all prisoners, it is especially hard on those who are disabled. Deaf prisoners have been punished for failing to respond to orders to stand for count issued through an intercom they could not hear. Men with mobility impairments, many of whom are elderly due to the long sentences handed down in the state, were denied access to vocational and educational programs the prison offered on the second floor of one of its buildings and in areas that were otherwise inaccessible.
Prisoners with mental disabilities have been punished for behavior that is the product of their disability, including instances where they have cut or otherwise harmed themselves. Too often prisoners with mental disabilities are placed in solitary confinement cells after sham disciplinary hearings that they were unable to understand or participate in due to their illnesses.
This is discrimination, pure and simple. It is also illegal under the Americans with Disabilities Act, a federal statute that bars disability-based discrimination and punishment and prohibits prisons and jails from denying disabled prisoners access to programs, services, and activities available to other prisoners.
The sweeping settlement agreement, when fully implemented, will turn the promise of the Americans with Disabilities Act into reality at Montana State Prison. The settlement requires prison officials to institute a reliable system to track prisoners with disabilities and accommodate them so they have equal access to all programs and services offered at the prison. It requires the creation of a viable grievance process for disability-related complaints, which will be handled by a full-time ADA coordinator responsible for overseeing an ADA compliance program.
The disciplinary process will be overhauled to bar punishment of prisoners for behavior that is the result of their disability. Hearings, classes, and other programs will be modified so those with cognitive disabilities will be able to meaningfully participate, which increases their chances for early release and parole. The building where classes are held on the second floor is now equipped with an elevator. Ramps and walkways have been built and repaired, and will be maintained, so that the entire facility is accessible to those with mobility impairments.
When The Washington Post published a piece detailing how a Starbucks employee mocked a customer for stuttering while ordering a drink at Starbucks, I wasn’t surprised. In fact, as a person who also stutters, I was resigned.
I can’t even count the number of times an interaction with a stranger has left me feeling disrespected and defeated — the banker, the customer, the men I’ve dated, just to name a few.
But the incident at Starbucks did surprise me in one way: After the barista openly mocked the customer, Sam, for his stutter — first in conversation and again by printing his drink label in a pejorative fashion (“SSSam”) — people took action.
Largely thanks to a social media post, news of Sam’s encounter gained national attention. In the end, Starbucks let the barista go, and the corporation ― already knee-deep in necessary anti-bias and sensitivity training — has confirmed there will be more training on ”additional topics in the months to follow.”
This may not seem like much to celebrate, but for those of us committed to raising awareness for the disabled population, it feels worth commemorating. Nearly 1 in 5 people in the U.S. have a disability, and yet, the activism for our movement has been an uphill battle. Recently, however, there has been more acknowledgment of the different kinds of prejudice disabled people experience and more visibility for differently abled bodies. Embracing this discussion has been a crucial development for disability advocacy.
Despite setbacks, we can now objectively say that disability awareness is growing.
In fact, from the outside, it would seem as though the disability movement might finally be receiving the attention it deserves. Perhaps prompted by the gross disrespect and erasure by our nation’s new political leadership, it seems we are currently in “a new wave of activism by disabled Americans who want to change the way disability is viewed in the U.S.,” according to Time.
Thanks to the efforts of activists, there is now more representation of disabled characters in television and film. More disabled perspectives and opinions are being shared on the prospective ban on plastic straws ― but only because the needs of the disabled population (who often use straws out of necessity) were not taken into account. There have also been some genuine triumphs for the disability community, of course, such as the clothing brand Aerie and its recently released and incredibly inclusive ad campaign. Despite setbacks, we can now objectively say that disability awareness is growing.
Lone Frank has written The Pleasure Shock: The Rise of Deep Brain Stimulation and its Forgotten Inventor about the early brain stimulation work of psychiatrist Robert G. Heath in the 1950s and 1960s. Frank draws well on her background as a neurobiologist to create a portrait of Heath as both a misunderstood pioneer and an overambitious opportunist that is compelling for both the layperson and the specialist. She provides an engaging first-person account of her investigation into Heath's career, and contrasts this with developments in the use of modern DBS for mental illness, punctuated with cameos by several of the current thought leaders in the field to provide scientific context for this cutting-edge field.
At Tulane University (New Orleans, LA, USA), Heath established the Department of Psychiatry and Neurology, and chaired it from 1949 to 1980. During his tenure, brain electrodes were implanted into more than 50 patients to investigate the physical manifestation of human emotion—particularly pleasure and reward—and its role in psychiatric conditions. This work preceded the discovery of antipsychotic medications, and came at a time when mental illness represented a major social burden: asylums were full and available treatments—including lobotomy, electroshock therapy, and insulin-induced hypoglycemic coma—were ineffective and troubling.
Heath focused on electrically stimulating the septum, the subcortical reward centre containing the nucleus accumbens that is widely connected to several structures that were resected during topectomy procedures. He made several interesting observations, including the careful documentation of stimulation-induced euphoria that he used to reach withdrawn patients with schizophrenia. Heath eagerly presented mixed preliminary results suggesting improvement in a subset of patients, which were met with initial interest but also harsh criticism that his methods were uncontrolled and fraught with bias. This became the prevailing critique of Heath's work: he was quick to present sensational findings without using established scientific methods to verify his conclusions.
Heath's work also raised ethical concerns. It is unclear whether legitimate informed consent for invasive brain stimulation procedures was obtained. In many cases, additional electrodes were placed throughout the brain to measure responses to septal stimulation, without therapeutic benefit to the patient. Some experiments had questionable scientific merit—most infamously, Heath attempted homosexual conversion of a gay man by stimulating the septum while the patient engaged in sexual acts with a female prostitute. In another questionable experiment, his group isolated a protein he called taraxein from people with schizophrenia that purportedly induced the disorder in prisoners; this finding was dismissed when results were not reproducible outside Heath's laboratory.
The push to move consumers needing long-term services and supports (LTSS) out of residential placements and into community settings continues. Part of the push is that there are currently 59 lawsuits related to Olmstead open across the country, which require states to find ways to support care individuals in the community (see Olmstead Litigation in the 12 U.S. Circuit Courts of Appeals). And there are the cost issues. The majority of the services—both institutional and community-based—required to support these consumers are covered by Medicaid. Generally, the community-based options are less expensive than residential care options (see For I/DD, The Question Isn’t Managed Care Or Not-It’s Residential Care Or Not). But while there are an estimated 6.2 million people with I/DD who are on the Medicaid roles, only 689,144 (11.2%) are receiving HCBS services. An estimated 200,000 are on state HCBS waiver waiting list for those services (see How Many Consumers With I/DD Are Served By Medicaid HCBS Waivers & How Many Consumers Are On A Wait List?: An OPEN MINDS Market Intelligence Report).
The raises the question, what’s the hold up? A recent congressional briefing identified four major challenges to HCBS availability for consumers with I/DD (see Congressional Briefing Identifies Waiting Lists, Workforce, Caregivers & Housing As Key Challenges To Medicaid HCBS For I/DD). These challenges include lack of state funding causing waiting lists, high staff turnover rates and overall lack of adequate numbers of direct support professionals, state reliance on unevenly skilled family caregivers, and limited housing opportunities. Without addressing these issues, the numbers of consumer with I/DD with the option of living in the community will continue to lag.
This is what happens when you choose short term savings over long term costs...
The death rate from liver cancer in the U.S. skyrocketed for American adults between 2000 and 2016, according to a new report, because more people are developing the deadly disease than at any time on record. The figures, which come from a report released Tuesday by the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics, are at odds with a decrease in mortality for all cancers combined. Liver-cancer death rates increased for both men and women 25 and older, as well as white, black, and Hispanic people—only Asians and Pacific Islanders saw a decrease in mortality from the disease. “I think the main reason for the increase in liver cancer incidence and death rate in the U.S. is the increase in the prevalence of excess body weight and hepatitis C virus infection in baby boomers,” said Farhad Islami, scientific director of cancer-surveillance research at the American Cancer Society. Throughout the 16 years analyzed, the death rate of liver among men was two to 2.5 times higher than it was for women, according to the report.
"I think the main reason for the increase in liver cancer incidence and death rate in the US is the increase in the prevalence of excess body weight and hepatitis C virus infection in baby boomers," said Islami, who authored a study on liver cancer occurrence between 1990 and 2014.
Many people who had Marketplace coverage and then qualified for Medicare made a costly mistake. They kept their Marketplace coverage and did not enroll in Medicare because they mistakenly believed that their Marketplace subsidies would continue.
As a result they now face Medicare Part B late enrollment penalties and, for many, gaps in coverage.
CMS has launched an initiative to provide these individuals with equitable relief including a Special Enrollment Period to sign up for Part B and, importantly, relief from Part B late enrollment penalties. Last year CMS extended its original deadline for equitable relief to September 30, 2018.
That September
deadline is fast approaching and, because the best way to apply is through an in-person visit to a Social
Security office, your clients should not wait until the last minute.
The deadline for applications is September 30, 2018
Please share this opportunity broadly!
2nd edition of a great book....
In this new edition of his classic book, Peter Block offers an alternative to the increasing economic, relational, and ideological divides in our culture. To achieve a deeper sense of connection and belonging, we need to change the narrative from one of deficiencies and entitlement to one of possibility and generosity.
This is how community is created, and Block shows how it's done with examples from neighborhoods, towns, and cities around the United States. To bring transformation into everyday life, Community outlines six conversations that create shared accountability and shows how to design systems that foster this sense of belonging.
The basic standard is that the disability has to prevent all competitive employment in the US no matter what it is. The mushier the disability, the harder it is to actually succeed in meeting this standard even if you do meet it...
The SSA recognized the potentially unfair obstacles for people with fibromyalgia and issued new guidelines for fibromyalgia disability claims in 2012.
Getting access to Medicare benefits due to disability for fibromyalgia isn’t easy, but it can be done. Here’s what you should know so you have the best chance of getting approved.
The first hurdle in getting a disability claim approved is proving a “medically determinable impairment,” or MDI, with Social Security. The SSA defines an MDI like this: “an impairment that results from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques.”
In plain language, it means that your impairment, or disability, must be backed up with objective medical tests and evidence. It’s not enough to just have subjective statements that you have a disease or condition—the SSA needs proof.
That’s where things get difficult for people with fibromyalgia. Unlike other conditions such as rheumatoid arthritis or disc disease which can be seen on x-rays and other imaging studies or lab work, there’s no definitive test that proves fibromyalgia. Diagnosis usually depends on self-reported symptoms of pain, dizziness, “fibro fog,” and other classic signs of fibromyalgia.
Reevaluate This!
Disabled folks dread that perpetually recurring time of the year. It’s when those of us who avail ourselves of certain public support programs have to be reevaluated to make sure we are still eligible. In other words, we must prove we are still crippled.
In my case, reevaluation day takes the form of an annual (more or less) home visit from a social worker from the Illinois Department of Human Services. DHS pays the wages of the members of my pit crew, which is what I call the people I hire to come to my home every day and help me put on my pants, take a shower, et cetera.
During these visits, the DHS social worker asks me if I still have the same disability I had the last time I was reevaluated. I say yes. She asks me if I still need help putting on my pants, taking a shower, et cetera. I say yes again. She asks me to spell the word “world” backward. I say d-l-r-o-w. I’m suspicious of that question. I guess it’s some kind of cognitive test. But how much weight does it carry? What if I choked under pressure and spelled it wrong? Would that make me too incompetent to qualify? Or does spelling it right make me too competent to qualify? I don’t know.
Hey, I know some sort of reevaluation process is necessary. Sometimes, people are temporarily crippled and may no longer qualify. I just think people like me, who are always going to be at least as crippled as we are now, ought to be grandfathered in somehow. It’s like making an older person prove every year that they’re still over sixty-five.
In a frenzied bid for higher profits in the decade following the 2008 financial crisis, Wall Street pension fund managers have siphoned as much as $624 billion from Americans’ retirement savings — and, as a direct result, taxpayer coffers — through a vicious combination of high fees and foolish investment strategies, according to an analysispublished Thursday by Yahoo Finance.
The steepest costs to taxpayers have stemmed from Wall Street pension managers’ commitment to so-called alternative funds, which invest in private equity and hedge funds rather than traditional stocks and bonds.
“The total amount pension funds could have saved by simply investing in index funds could be more than $1 trillion,” notes Yahoo Finance reporter Dion Rabouin. “Because pensions are guaranteed, the underperformance has hit taxpayers in the form of budget cuts for schools, hospitals, and libraries and decreased spending on infrastructure, healthcare, and other public projects.”
Responding to Yahoo’s analysis in a series of tweets on Thursday, Capital & Main journalist David Sirota observed that in five years of reporting on Wall Street’s investment tactics, he has found that “most people (including policymakers) still have no idea that skimming fees off public employees’ retirement savings has become one of the largest sources of profits for Wall Street moguls.
Just how difficult is it to check pay records to see if they match staffing records? It's easy, and the failure to do so is evidence of supporting corrupt practice....
Most nursing homes had fewer nurses and caretaking staff than they had reported to the government, according to new federal data, bolstering the long-held suspicions of many families that staffing levels were often inadequate.
The records for the first time reveal frequent and significant fluctuations in day-to-day staffing, with particularly large shortfalls on weekends. On the worst-staffed days at an average facility, the new data show, on-duty personnel cared for nearly twice as many residents as they did when the staffing roster was fullest.
The data, analyzed by Kaiser Health News, come from daily payroll records Medicare only recently began gathering and publishing from more than 14,000 nursing homes, as required by the Affordable Care Act of 2010. Medicare previously had been rating each facility’s staffing levels based on the homes’ own unverified reports, making it possible to game the system.
The payroll records provide the strongest evidence that, over the past decade, the government’s five-star rating system for nursing homes often exaggerated staffing levels and rarely identified the periods of thin staffing that were common. Medicare is now relying on the new data to evaluate staffing, but the revamped star ratings still mask the erratic levels of people working from day to day.
ALJ's have been under pressure to rule against clearly eligible persons in SSI and SSDI application since the early 80's. Now, there will be no need for pressure since securing the job will be contingent on agreeing to corrupt practice....
Previously, appointments to the position of ALJ have been made through competitive examination and competitive service selection procedures. The role of ALJs, however, has increased over time and ALJ decisions have, with increasing frequency, become the final word of the agencies they serve. Given this expanding responsibility for important agency adjudications, and as recognized by the Supreme Court in Lucia, at least some ‑‑ and perhaps all ‑‑ ALJs are “Officers of the United States” and thus subject to the Constitution’s Appointments Clause, which governs who may appoint such officials.
Pursuant to my authority under section 3302(1) of title 5, United States Code, I find that conditions of good administration make necessary an exception to the competitive hiring rules and examinations for the position of ALJ. These conditions include the need to provide agency heads with additional flexibility to assess prospective appointees without the limitations imposed by competitive examination and competitive service selection procedures. Placing the position of ALJ in the excepted service will mitigate concerns about undue limitations on the selection of ALJs, reduce the likelihood of successful Appointments Clause challenges, and forestall litigation in which such concerns have been or might be raised. This action will also give agencies greater ability and discretion to assess critical qualities in ALJ candidates, such as work ethic, judgment (code word for political beliefs), and ability to meet the particular needs of the agency (including the prosecution of a specific political ideology).
The less information people have, the sooner they die......
On July 10, 2018, the Centers for Medicare and Medicaid Services (CMS) released a new funding opportunity announcement for the navigator program for 2019, as well as a series of frequently asked questions and an overview of the application process. This funding is for navigators in the 34 states with a federally facilitated marketplace; states with their own marketplaces or partnership marketplaces can invest additional resources in navigator and other outreach and education programs.
Consistent with press reports, CMS will cut navigator funding to only $10 million for 2019. This is down from $36.8 million for the 2018 plan year (which was, itself, cut from about $63 million for the 2017 plan year). Since the Trump administration took office in January 2017, the navigator program has been cut by about 84 percent. CMS is scaling back the navigator program due to what it believes is heightened public awareness of the marketplace and new coverage options.
Navigators will be required to prioritize assistance to uninsured individuals who are unaware of their coverage options through the marketplace, or through association health plans or short-term plans. CMS repeatedly emphasizes the need for navigators to reach this community, which it refers to as the “left behind” population.
Applications are due quickly, on August 9th. CMS expects to award 25 to 50 grants that will range from $100,000 to up to $1.25 million per state. Grant awards will be announced on September 12th.
Medicare is currently exploring two alternative payment models for Hospital at Home services, which may allow more healthcare organizations to provide these options.
A recent report outlines five strategies for enhancing the way healthcare providers collect data on patient experience.
Although integrating artificial intelligence into healthcare has great potential, experts also need to understand the limitations of the technology.
What will drive positive changes in healthcare? A recent survey revealed six topics that experts believe will improve care.
Acute care visits rose five-fold in time after coverage gap.
The longitudinal study including over 168,000 adults with type 1 diabetes found roughly a quarter experienced an interruption in their private insurance coverage between 2001-2015, reported Mary Rogers, PhD, MS, of the University of Michigan in Ann Arbor, and colleagues.
Following these insurance interruptions, patients experienced a five-fold increase in the use of acute care services compared to before their interruption in health coverage, the group wrote in Health Affairs. This increase in acute care visits from the 30 days prior to the interruption versus 30 days after the interruption also varied according to the gap length (P<0.001 for all):
This increase in acute care visits was elevated after the interruption for both men and women, although was slightly higher among women.
"These acute care services are costly, and largely preventable with regular self-care guided by a primary care physician or an endocrinologist," Rogers noted in a statement.
More specifically, each individual interruption in insurance coverage was associated with a 3.6% (95% CI 1.2 to 5.9, P=0.003) relative increase in HbA1c level for these patients, increasing in a dose-response manner. Also associated with coverage interruptions were lower perceived health status by patients and a lower satisfaction with life.
"Type 1 diabetes requires intensive daily management, in order to simply remain alive, so interruptions to care and coverage of insulin and supplies can pose a major risk," explained Rogers, adding that "while we expected gaps in coverage to affect health in some way, the size of the effect and the frequency of gaps were striking."
“I don’t see any reason why we waste resources on severely retarded people,” someone asked in the popular r/changemyview subreddit in 2014. “Why would we ever spend our resources on something like this rather then [sic] people that will benefit far more from them?” The harsh question netted over 300 replies with many people debating whether euthanasia is a “merciful” solution for people who are “not really human beings.” A few commenters said that the entire conversation dehumanized disabled people. Ultimately, the original poster concluded: “Even though my view on the burden on society remain unchanged, you’re right that there’s probably no real way to implement [a way to make value judgements on who should be allowed to live and die].”
While the original question is reprehensible, the conversation echoes a largely held opinion in the environmental movement about who “deserves” resources. The assumption that disabled lives are worth less is at the core of these conversations, and a failure to reckon with that warped premise alienates the disability community. Implying that nondisabled people need and deserve more resources than disabled people also distracts from finding real solutions to issues such as climate change, resource scarcity, and pollution.
Nowhere is this more evident than in the current fight over plastic straws, a cause célèbre of the environmental movement. “Stop sucking,” a cheeky environmental campaign exhorts, noting that millions of straws end up in the trash, and often the ocean, every year. A heartrending video of a sea turtle with a plastic straw sticking out of its nose has become emblematic for the war on straws, just as chilling images of birds ensnared in six-pack ringspushed consumers to demand changes to beer and soda packaging in the 1990s.
Straws represent independence for some disabled people who can’t drink on their own without one and would otherwise need the help of a caregiver to drink. Others need a straw even when drinking with assistance because of hand tremors, limited muscle control, or other issues. Telling disabled people they should rely on support or slop fluids all over themselves is infantilizing, but also dangerous: An aide isn’t always available to help someone take a sip and dehydration can be fatal.
While alternatives to plastic—such as glass, metal, silicone, and paper—exist, some express concerns about their practicality and usability; metal may cut a person’s mouth, for example, while paper isn’t sturdy enough for someone with limited muscle control. Mentioning the effect that banning straws might have on disabled people has become a dangerous proposition. On social media, the anti-straw brigade lectures about alternatives disabled people are already aware of or shames disabled people for needing to drink. “Quit harming the environment because you can’t take care of your own needs,” said one helpful commenter. “Sorry, the trouble cleaning and inconvenience still doesn’t trump the damage caused by plastics,” said another.
Picking a fight over straws may seem nonsensical, but the larger low-waste and zero-waste movements, which tend to be overwhelmingly white and nondisabled, frequently single out products that benefit the disability community, like straws or pre-cut fruits and veggies, as a wasteful use of natural resources. It’s a two-part logic: One, the planet’s resources are limited and growing scarcer, and two, the way to control that is by cutting back on the use of nonrenewables. This does little to explore which humans are using the majority of resources on Earth and where the real choke points of waste lie. And it feeds insidious attitudes about who should be “allowed” to use the resources that are available.
The Prisoner’s Dilemma has some important implications for the world of business and economics. But today, as the fundamental structure of our world and industries are altered by exponential technologies, these implications ought to be questioned. In many ways, the Prisoner’s Dilemma oversimplified human nature and makes some erroneous assumptions about it. It was theorized at a time where basic economic models and theories determined how players in various markets behave. Today, these models are losing credence.
Even based on social realities, it’s often tempting to take a cynical view of human nature. Given the various unpleasant interactions that we tend to have with people — from a friend taking advantage of us to a business deal ripe with corruption — it’s natural that we jump to this view.
The selfish parts of our nature undoubtedly exist. But so do the good ones, and these parts warrant as much attention as the bad parts. According to neuroscientists, altruism — the practice of concern for the welfare of others — may be more hardwired in our brains than previously thought.
Neuroscience has demonstrated that giving is a powerful pathway for creating more personal joy. Helping others triggers impacts to our brain in many positive ways. When we help others, our brains release oxytocin, serotonin and dopamine. These hormones have the effect of boosting our mood and counteract the effect of cortisol (the stress hormone).
This might urge some people to ask: is giving itself inherently selfish then? Perhaps, but that’s not a bad thing. On a neurobiological level, studies suggest that giving social support to others may benefit the giver more than the receiver. In one study, that compared giving versus receiving, participants were asked about various scenarios in which they either gave or received support. In a series of fMRI neuroimaging tests, the study found that giving ultimately had greater benefits than receiving. In other words, from an evolutionary perspective, our brains are hardwired to feel rewarded more for magnanimity and selflessness than for meanness and selfishness.
The brain images showed than when a participant was giving support, certain brain areas showed more activation: 1) reduced stress-related activity in the dorsal anterior cingulate cortex, and right amygdala, 2) greater reward-related activity in the left and right ventral striatum and 3) greater caregiving-related activity.
Tecovirimat is a drug on its way to FDA approval, but as F. Perry Wilson, MD, describes in this 150-Second Analysis, if anyone ever has to prescribe this drug we are in deep, deep trouble.
When I pitched reviewing this study to my producer, he said, "You want to talk about a drug no one is ever going to use?" Yes. Yes I do.
The drug is tecovirimat and the disease it treats is smallpox.
Smallpox, through the power of vaccination, was eradicated in 1980. This is Rahima Banu. She was one of the last recorded cases. She survived, by the way.
But how do you test a drug for a disease that no longer exists?
Well, smallpox may not exist. But monkeypox and rabbitpox exist and have been validated as animal models for human smallpox.
Would tecovirimat save animals infected with these viruses? The results were fairly compelling. The mortality rate for monkeys infected with monkeypox was 95% in the absence of the drug. With treatment (initiated at 4 days after the monkeys developed skin lesions), the mortality rate dropped to zero. Similar numbers were seen in the rabbitpox model.