Hearing Aids–seeking affordable solutions

People who use hearing aids frequently complain about their high prices. Often their families complain too, since the unaffordability of a solution means continual frustrations for both speaker and listener, and a deepening sense of isolation for all. Organizations from the National Association for the Deaf to The Better Hearing Institute (BHI) have been campaigning for years for a  tax credit of up to $500 to cover costs for the purchase of a hearing aid that is not covered by insurance. The credit would only be available to parents of children with hearing losses, or adults over 55. If you fall into either of those categories, your income must not exceed $200,000.

At least it was probably cheap.

At least it was probably cheap.

Reasonable as that all may seem, the bill is alas, stuck in committee, with a predicted 0% chance of getting passed. Still, we like to tilt at windmills, so we suggest you look at BHI’s site dedicated to the bill.

Outside of Washington, there’s a wonderful effort to get hearing aids to more people.  The Kentucky Assistive Technology Network (KATS) is running a drive to collect old hearing aids, which they will clean (obviously) and refurbish, and then distribute to those who can’t afford the several thousand dollar cost of new aids.

If you wish to donate, you can contact KATS at 800.327.5287 for a self-addressed, stamped envelope. Or you might consider starting such a program for your own local community. If you know of any similar, existing programs, please let us know and we’ll get the word out.

 

Medicare tries to make its stars shine brighter

Screen Shot 2014-10-07 at 7.14.15 PMIn an earlier post, we had mentioned that the New York Times exposed that many nursing homes have figured out how to game Medicare’s Five Star Quality Ratings System. CMS (the Centers for Medicare and Medicaid Services) has just announced improvements to the ratings system, which will be implemented next year. They attempt to address many of the issues highlighted in the Times’s piece, including manipulation of staffing schedules so that homes appear to have better patient-to-staff ratios.

Here are the highlights of CMS’s goals:

  • Nationwide Focused Survey Inspections: Effective January 2015, CMS and states will implement focused survey inspections nationwide for a sample of nursing homes to enable better verification of both the staffing and quality measure information that is part of the Five-Star Quality Rating System.
  • Payroll-Based Staffing Reporting: CMS will implement a quarterly electronic reporting system that is auditable back to payrolls to verify staffing information. This new system will increase accuracy and timeliness of data, and allow for the calculation of quality measures for staff turnover, retention, types of staffing, and levels of different types of staffing.
  • Additional Quality Measures: CMS will increase both the number and type of quality measures used in the Five-Star Quality Rating System. The first additional measure, starting January 2015, will be the extent to which antipsychotic medications are in use. Future additional measures will include claims-based data on re-hospitalization and community discharge rates.
  • Timely and Complete Inspection Data: CMS will also strengthen requirements to ensure that States maintain a user-friendly website and complete inspections of nursing homes in a timely and accurate manner for inclusion in the rating system.
  • Improved Scoring Methodology: In 2015, CMS will revise the scoring methodology by which we calculate each facility’s quality measure rating, which is used to calculate the overall Five Star rating.  We also note that sources independent of self-reporting by nursing homes already are weighted higher than self-reported components in the scoring methodology.

You can find the full release on CMS’s website. While you’re there, you may want to check out their list of acronyms, always useful when dealing with the government!

FDA approves new treatment for diabetes-related vision loss

According to the American Diabetes Association, “Approximately 25% of Americans over the age of 60 years have diabetes, and aging of the U.S. population is widely acknowledged as one of the drivers of the diabetes epidemic.”

One of the more frightening consequences of diabetes is diabetic macular edema (DME), which can lead to acute vision loss. After three tries, the FDA has approved Iluvien, an implant that releases a low-dose corticosteroid over a three-year period to relieve pressure on the eye, and if all goes well, improve vision.

Alimera expects to begin selling Iluvien in the U.S. during the first quarter of 2015.

Obviously, if you’re considering having something injected into your eye, you want to have a thorough discussion with your doctor about side-effects. In the meantime, watching this demonstration video about Iluvien injection should get anyone who’s been warned about developing Type 2 diabetes to do whatever it takes to avoid the disease.

[youtube http://www.youtube.com/watch?v=u2lcTLDgacs#t=11]

New website addresses medical conflict-of-interest

As many seniors often grumble, they see their doctors more than they see their children. If your doctor receives a payment from a drug or device company, whether lunch or full-funding of a research program, can she or he stay objective about that company’s offerings? The answer may ultimately lie with the ethics of the individual doctor,* but now at least you have some resources to understand what’s going on behind the scenes.

The Open Payments website, mandated as part of the “Physician Payments Sunshine Act,” has just been launched by the the Centers for Medicare and Medicaid Services. According to Modern Healthcare, it’s supposed to: “to increase transparency of payments for research, consulting and promotional work and other transfers of value of $10 or more, such as gifts, travel, and meals, made by manufacturers and group purchasing organizations to physicians and teaching hospitals. There also will be information about physicians’ ownership and investment in manufacturers or group purchasing organizations.”

You should be able to use Open Payments to check on your own doctor or hospital. Unfortunately, the website is overly detailed, and frankly, confusing. ProPublica does a good job of breaking down what’s on it, and more importantly, what’s still missing. Much information is redacted, although the government promises more complete updates.

ProPublica's Dollars for Docs.

ProPublica’s Dollars for Docs.

If you’ve got a legal or medical research background, you may be able to get something out of the current version of Open Payments, but at the moment, don’t expect something as simple as typing in your doctor’s name and getting an answer. For that, we suggest ProPublica’s website Dollars for Docs which is just what you’d like, although the answers you discover may not be.

*UPDATE: The Pew Charitable Trust has just produced an infographic about drug company influence that suggests we were being overly idealistic:

Screen Shot 2014-10-01 at 4.54.59 PM

Click on image to enlarge.

For the full graphic with more dismaying statistics, click here.

AMA on EMRs

In 2009, the American Recovery and Reinvestment Act required that by this year, seventy percent of primary care providers should be using Electronic Medical Records (EMRs). Perhaps unsurprisingly then, the AMA has just issued a press release complaining about them.

ama-logoWhile it may be reassuring to discover that your doctor finds forms just as confusing as you do, the problems with EMRs or EHRs (for “health” records) can affect the care you receive.

Ideally, an EMR (sometimes known as an EHR, for “health” records) should be a complete computer file of all your doctor visits, conditions, complaints, and prescriptions. Everything you tell your primary care doctor should be easily readable by the specialist(s) she sends you to see, avoiding time-wasting repetition and the risk of contra-indicated medications.

The reality is that, alas, EMRs are currently provided by many competing vendors, leaving doctors with many different products to learn that don’t inter-operate as promised. When medical providers should be listening to you, they may instead be distracted by trying to figure out what field to fill in on the electronic form. Worse, many of the promises of mobile health—that you should be able to check your own records on your smart phone, for example—are also on hold while the technology evolves.

The AMA lists the following priorities for fixing the problem:

  • Enhance Physicians’ Ability to Provide High-Quality Patient Care
  • Support Team-Based Care
  • Promote Care Coordination
  • Offer Product Modularity and Configurability (make it customizable for particular specialties and institutions)
  • Reduce Cognitive Workload (in other words, make it less confusing!)
  • Promote Data Liquidity (make it easier for information to “flow” back and forth among providers by using common terms and other standards)
  • Facilitate Digital and Mobile Patient Engagement
  • Expedite User Input into Product Design and Post-Implementation Feedback

The importance of finding the right fix is explained by Steven Steinhubl of the AMA Advisory Committee on EHR Physician Usability: “Given the rapid growth of digital technology in health care, whether for health and wellness, or the management of chronic illness, a comprehensive health information technology strategy must include interoperability between a patient’s mobile technology, telehealth technology, and the electronic health record.”

SDCs–Self-Driving Cars

The most exciting development everyone in this room is going to live to see is driverless cars.

USC Professor Jeffrey Cole to AARP Ideas@50+ audience.

One of the biggest fears of getting older is losing the ability to drive. For those with enough money, that problem is getting closer to being solved. Mercedes Benz already offers enhanced “Intelligent Drive,” and GM has just announced that starting in the 2017 model year, Cadillacs will come equipped with an auto-pilot mode, which they will eventually offer on all their brands.

Many other manufacturers, including Nissan and Acura, have self-driving cars in the works, although the first generation offerings might better be described as “assisted driving,” since the driver in still in control of when to use the technology. For example, the Cadillac, as described in the Los Angeles Times, relies on the driver to determine when assistance is needed: “The system will allow drivers to switch the vehicle into a semi-automated mode in which it will automatically keep the car in its lane, making necessary steering adjustments, and autonomously trigger braking and speed control to maintain a safe distance from other vehicles.”

Most famously, Google has been piloting self-driving cars for several years, leading both the California legislature and insurance agencies to start thinking about questions of liability in accidents.Continue Reading

Clinical Trials and Medical Devices

Feedback from readers has made us realize that many people think clinical trials are only for the desperate: Either those who are looking for a cure of last resort or those who need money so badly they’re willing to be human guinea pigs. While it is true that many participate in clinical trials for those reasons, the real purpose of clinical trials is to gather medical knowledge, which often leads to new treatments; for that reason, clinical trials are of wide-spread value. Of especial interest to seniors, trials are held for devices, as well as medications.

If you participate in a clinical trial, nothing like this will happen. Image courtesy: CuddlyCavies

If you participate in a clinical trial, nothing like this will happen. Image courtesy: CuddlyCavies

The FDA’s “basic” definition of a medical device is nearly 130 words long, so it’s easier to go with what they say it isn’t:  “If the primary intended use of the product is achieved through chemical action or by being metabolized by the body, the product is usually a drug.”

In other words, many devices can be non-invasive. They can be new types of monitors and sensors, some of which may be implanted under the skin, but many of which may simply be worn over clothing. They can also be assistive technologies that range from elaborate exoskeltons and other robotics to training systems for fall prevention.

Participating in a clinical trial, like donating blood or bone marrow, can be a selfless gift to people you’ll never meet, or a way to potentially help yourself or family members who suffer from particular conditions. If you are interested in discovering the wide-range of clinical trials, please check clinicaltrials.gov, which will let you search for trials by various terms, including topic and location.

A brief chat with Congressman Scott Peters (D-CA)

If you’re mad at somebody, don’t yell at the TV–call me.*

 

Scott Peters

*(that would be whoever your representative is.)

We promise we’ll avoid politics, except when it’s of note for seniors. Last night, at a local senior center, the 52nd District’s Congressman, Democrat Scott Peters, reminded the audience that for all of Congress’s notorious dysfunction, there’s one way it does work. It may not go forward on the big issue you care about, but if there’s a personal issue, say a problem with Medicare, you should call your representative and ask for Constituent Services. You may not always get satisfaction, but at least they will try to help you cut through the red-tape.

At least the traffic's moving.

At least the traffic’s moving.

As for the Medicare and technology issues of interest to seniors, Peters says that Congress is attempting to change Medicare reimbursements so that doctors will be compensated for consultations, not just procedures, which would give a boost to telemedicine.

In addition, they’re still working on trying to get compensation for in-home care, so that people aren’t forced into nursing homes. (Regarding nursing homes, the New York Times has an important article about how homes are gaming the Medicare rating system. Unfortunately, “five star” may not be as reassuring as it appears. We highly recommend you read the comments as well; they offer some good, albeit heartbreaking, advice.)

Whether you’re voting for Congress or trying to advocate for a favorite cause, you may want to check out OpenSecrets.org, a non-partisan website that tracks who’s getting money from whom in Washington.

Another Day, Another Acronym

The FCC has published new rules for MBANs or “Medical Body Area Networks.” However you feel about government regulations, you have to be reassured that the FCC is making sure that the  frequency your doctor may one day use to check a diagnostic sensor on your body will be different from the one Amazon is using to fly a delivery drone over your house.

The FCC is quite optimistic about the future potential of MBANs. From their report:

MBAN devices promise to enhance patient safety, care and comfort by reducing the need to physically connect sensors to essential monitoring equipment by cables and wires.  Because they will provide a cost-effective way to monitor patients in health care institutions, MBAN systems can provide clinicians with more extensive real-time data that will permit faster patient intervention.  The resulting benefits – including reductions in emergency transfers and less exposure to hospital-acquired infections – could save countless lives and reduce nationwide health care expenses by billions of dollars.

If you wish to chew on the entire 35 pages, you can find them here. If you’d like a summary, please check our sister site, Health Tech Insider.

And if you need a quick reference for what all the acronyms you encounter in so many fields refer to, our favorite cheat sheet is Acronym Finder.

 

Happy National Senior Citizens Day! (Did you know it existed?)

Today, August 21st, is National Senior Citizens Day, a holiday that was proclaimed by President Reagan in 1988, but hasn’t seemed to catch on outside of nursing homes. Remarkably, even the greeting card industry hasn’t taken to it.

Instead of waiting around to be vaguely “honored” simply for being old, we propose that those 50 and older make this a day of activism. The most obvious place to start would be the re-authorization of the Older Americans Act, but whatever your cause, here are online resources for getting in touch with government officials and agencies:

Okay, so maybe there's a good reason it didn't catch on...

Okay, so maybe there’s a good reason it didn’t catch on…

Of course, if you’d rather just relax and celebrate, Seniordiscounts.com has discounts organized by both type and place. Enjoy!