Category Archives: Health care

U.S. can’t afford not to invest in Alzheimer’s research

Advocates for the Alzheimer’s Association made a push in Congress this week for more funding for research. They based their argument on the costs of Alzheimer’s. This disease, which causes so much pain for patients and their families, also threatens the nation’s financial health.

According to the association, the total health care cost of caring for individuals with Alzheimer’s will be $214 billion this year, with Medicare and Medicaid paying $150 billion of that. Almost 20 percent of everything the federal government spends on Medicare is spent caring for patients with Alzheimer’s and other forms of dementia.

As the baby boomers age and as costs of care increase, the numbers become truly scary. By the middle of this century, overall annual medical costs for Alzheimer’s and other dementias are projected to rise to $1.2 trillion.

More than five million Americans now have Alzheimer’s – 200,000 of them under the age of 65. It is the country’s sixth leading cause of death. About 52,000 Arkansans have it – 8,000 of them between the ages of 65-74, according to the Alzheimer’s Association.

Progress has been made in recent years with other diseases – most notably AIDS, which was a certain death sentence a couple of decades ago until it became a national priority. Between 2000 and 2010, deaths attributed to HIV fell 42 percent. They also fell for stroke, heart disease, prostate cancer and breast cancer.

But deaths attributed to Alzheimer’s increased 68 percent over that same time period. While five approved drugs will treat the symptoms for 6-12 months in half the patients, there’s no cure, no long-term effective treatment, and no means of prevention.

Congress did increase funding for research by $100 million this year, which was a good start. However, for every $1 that the National Institutes of Health now spends on Alzheimer’s research, Medicare and Medicaid spend $265 on patient care, and it’s often not the kind of care that prolongs productivity or enhances quality of life. We’re warehousing a lot of people.

The Alzheimer’s Association says that, if the onset of Alzheimer’s could be delayed five years, the national costs of care would be cut by half. It’s asking for another $200 million for research, which is a significant increase in this kind of budgetary environment. On the other hand, it’s less than the cost of two of the Pentagon’s proposed 2,400 new F-35 Joint Strike Fighter planes – a weapons system that, as “60 Minutes” recently reported, is $163 billion over budget and seven years behind schedule.

Alzheimer’s is a clear and present danger. If we’re truly worried about America’s future, couldn’t we get by on 2,398 planes and use the savings from the other two to fund Alzheimer’s research? If not, I’m betting we can find $200 million somewhere in the federal budget.

None of this, of course, is taking into account the human toll Alzheimer’s takes on individuals and their families. Alzheimer’s is a particularly villainous disease. It robs individuals of their golden years, when they still have work to do and wisdom to offer. The mental decline can be rapid, but the physical death can stretch into decades. For loved ones, the long goodbye can be an almost unbearable mix of exhaustion, distraction, grief and guilt.

When Japan bombed Pearl Harbor, Americans mobilized for action. The same occurred when the Russians beat us into space.

Alzheimer’s is that kind of threat. Discovering a cure would be a gift to the world. Find the $200 million.

Health care finally goes digital

Arkansas’ health care system, and the rest of the country’s, is finally adopting the same communications technology that the rest of the economy adopted two decades ago.

Eventually, that will mean no more handwritten prescriptions or paper files. The same information that your doctor has about you will be available to your cardiologist.

The transition has not been easy. The transition will disrupt practices that are already busy serving patients. Some older doctors do not want to change. Parts of Arkansas are still on dialup. Plus, there are privacy concerns.

Across America, physicians are eligible for up to $64,000 in federal funds to ease the transition, while hospitals can get up to $2 million. It’s a fraction of the cost, but that’s still taxpayer money going to doctors to do something the rest of us did on our own.

There’s more at my column this week for the Arkansas News Bureau.

Kids and the Web: Is balance best?

How do you feel when you spend too much time on the internet?

Dr. Erick Messias, a psychiatrist and epidemiologist, and his fellow UAMS professor, Dr. Juan Carlos, have found a correlation between heavy internet/gaming and depression among young people.

They looked at the results of the past two Youth Risk Behavior Surveys, a biannual report by the Centers of Disease Control in which thousands of young people are asked about their health habits. Kids who said they spent five or more hours surfing and playing were more likely to have had two-week periods of sadness in the past year. They also were more likely to have contemplated, planned or attempted suicide.

Which came first: the screen time or the sadness? They freely admit they don’t know.

Also interesting, kids who never played/surfed were more likely to have been sad than those who played or surfed an hour or less a day. The non-users were more likely to have thought about or planned suicide than some of the other groups and were the second likeliest to have attempted suicide.

Again, the authors don’t know why this is so, but a good bet is that a large percentage of the non-users are living in poverty, which is a risk factor for depression and suicide.

Still, maybe balance is best. Messias lets his own son play/surf one hour a day and two on the weekends.

More here in my column this week for the Arkansas News Bureau.

Good news: Medical malpractice insurance rates going down

Looking for good news in a bad economy? Medical malpractice rates have not only stabilized but are decreasing.

According to the latest available information, rates in Arkansas are down 1.3 percent since 2006 as a result of malpractice insurance companies paying out less in claims, and they appear likely to remain at low rates.

According to Lars Powell, Ph.D., Whitbeck-Beyer chair of insurance and financial services at the University of Arkansas at Little Rock College of Business, “Every new piece of information we get about claims and loss experience has been less than what we’ve seen before. So it’s possible the rates could go back up. But you would expect to see that precipitated by large losses or an increased frequency of claims, and to my knowledge, we haven’t see either one in Arkansas yet.”

The decrease follows a big run-up in rates during the first part of the 2000s, when the state Insurance Department allowed companies to have double-digit increases several straight years and turned down increase requests of as much as 100 percent.

So why are the rates going down? Primarily it’s the economy. Nationally, the Physician Insurers Association of America says claims frequency is down 25-30 percent from four or five years ago. That’s because plaintiffs’ attorneys don’t want to pay the high costs of filing suit unless they have a very good case. According to the PIAA, only 30 percent of all claims filed against doctors end up in a payment to the plaintiffs.

There are also more competitors in the marketplace. In 2004, when the dominant St. Paul Fire and Marine Insurance Company abruptly left the market, no one was offering coverage. Now there are a couple of dozen companies either renewing business or seeking new policyholders.

Other reasons: Arkansas has not had any huge verdicts in several years. Also, physicians appear to be doing a better job of applying risk management practices that reduce the potential of a lawsuit.

One factor not really affecting the rates: tort reform. Arkansas’ 2003 law has been eviscerated by the courts. Health care reform also should have little effect, good or bad, on rates.

We’re due for a comprehensive Insurance Department report that will shed more light on the subject. I will keep you posted.

Medicaid overhaul to move slower, be more targeted

The overhaul of the state’s Medicaid system will move a little more slowly than earlier anticipated, but it’s still moving.

That was one of the takeaways from a question and answer session in Little Rock attended by hundreds of medical providers and led by State DHS Director John Selig, Medicaid Director Dr. Joe Thompson, Medicaid Medical Director Dr. Bill Golden, and Steve Spaulding, vice president of enterprise networks for Blue Cross.

DHS and the Beebe administration have proposed replacing the state’s fee for service system, in which Medicaid keeps paying as long as doctors keep treating, with concepts such as “bundled payments” for “episodic care.” The state has gotten a waiver from the federal Department of Health and Human Services to try to implement the idea as a pilot project.

In other words, the state would pay a certain amount to all the providers (bundled payments) for an episode, such as an appendectomy, and no more. The idea is to give medical providers a financial incentive to provide only necessary care.

How that system will work is a topic of big concern and debate in the medical community. As originally planned, providers would decide how to divide the money for each patient. That’s still being talked about, though Selig did indicate to one questioner that Medicaid could be the decision maker. Still, it could be a mess. As David Wroten, director of the Arkansas Medical Society told me, a state is a pretty big pilot project.

The plan was to start going into effect in July 2012, and that’s still the timeline, but the presenters said the state may begin by trying to pick low-hanging fruit and roll out the changes over time. For example, an early focus area could be early delivery of babies, which data show is being done too often for convenience instead of medical necessity.

The idea is being considered because the state faces a $200 million shortfall in Medicaid in 2013, with future deficits looking even scarier. Thompson pointed out that a 5 percent savings in Medicaid’s $4 billion budget would equal $200 million.

Medicaid is the program that pays for care for the poor, the disabled, many nursing home residents and others, and you can’t reform health care without it. In Arkansas, 750,000 people are on it, and it pays for 60 percent of all childbirths.

Spaudling said Blue Cross wants to participate so it won’t be at cross purposes with the state. “The whole idea is to share information and find ways that we can both push on the same side of the rock,” he said.

I talked with Selig (above) after the meeting to get his thoughts. I have no idea why his head is so flat in the video. I promise he does not look like that in real life.