Kaiser Health News had an article on the failure of doctors to provide recommended interventions for chronic health issues. "Large numbers of seniors aren’t receiving recommended interventions that could help forestall medical problems and improve their health, according to a new survey from the John A. Hartford Foundation." Medicare pays doctors about three times their ordinary office visit rate for asking about older adults’ ability to function, evaluating their mood, recommending preventive services, and connecting them with community resources during wellness visits.
Notably, one-third of older adults said doctors didn’t review all their medications, even though problems with prescription and over-the-counter drugs are common among the elderly, leading to over 177,000 emergency room visits every year. More than two-thirds of the time doctors and nurses didn’t ask older patients whether they’d taken a tumble or provide advice about how to avoid tripping on carpets or slipping on the stairs. 62 percent of seniors said doctors and nurses hadn’t inquired about whether they were sad, depressed or anxious.
The results, which cover a period of 12 months, speak to doctors’ and nurses’ lack of training in geriatric medicine. Providers need to recognize that “care of an 80 year old differs from that of a 50 year old,” said Dr. Rosanne Leipzig, professor of geriatrics at the Mount Sinai School of Medicine in New York.
USA Today reported on one of the biggest successes of the Affordable Care Act–more than 2.65 million Medicare recipients have saved more than $1.5 billion on their prescriptions this year, a $569-per-person average, while premiums have remained stable. The Department of Health and Human Services announced in August that 2012 Medicare prescription drug plan premiums would average about $30 a month, compared to $30.76 in 2011.
A provision in the health care law put a 50% discount on prescription drugs in the "doughnut hole," the gap between traditional and catastrophic coverage in the drug benefit, also known as Part D. Seniors who reach the doughnut hole in prescription benefits receive a 50% discount on name brand prescription drugs. Drug companies must provide the discount to participate in the prescription plan. Before the health care law took effect, Medicare patients had to pay full price for their prescriptions once they reached the gap in coverage.
Also, more than 24 million people, or about half of those with traditional Medicare, have gone in for a free annual physical or other screening exam since the rules changed this year because of the health care law. Preventive care should lower the cost of future care.
MedPage had two interesting and related articles on End of Life Counseling and Advance Directives among among long-term care residents. A CDC report found there was an advance directive on record for 28% of home healthcare patients, 65% of those at nursing homes, and 88% of hospice patients, according to an analysis of data from the 2004 National Nursing Home Survey and the 2007 National Home and Hospice Care Survey. The differences were more pronounced among home healthcare and nursing home populations. At nursing homes, 77% of those 85 and older had an advance directive on file compared with 36% under age 65. The rates were 41% versus 17% in home healthcare. In hospice, where the likelihood of having an advance directive was higher overall, the rates were less affected by age (93% of those 85 and over had one versus 81% of those under 65).
The most common forms of advance directives noted in the surveys were living wills and do-not-resuscitate orders. It’s been 20 years since Congress passed the Patient Self-Determination Act requiring most healthcare facilities to inform adult patients of their right to execute an advance directive.
Unfortunately, after Republican lies about "death panels" and other nonsense, the Obama administration is dropping a new regulation specifying that Medicare will pay for end-of-life counseling. The rule required that as part of an annual wellness visit, Medicare will pay for elective discussions about end-of-life plans, which can, in turn, be used to prepare an advance directive stating what treatments a patient would want and treatments they would not want.