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CPAP withdrawal: It may foster diabetes, heart disease, study says

HME News - Fri, 06/16/2017 - 09:12
06/16/2017HME News Staff

YARMOUTH, Maine – Not using CPAP therapy could have grave repercussions for patients with sleep apnea, according to a study published this month in the Journal of Clinical Endocrinology & Metabolism.

“OSA recurrence during CPAP withdrawal increases plasma free fatty acids (FFA) and glucose during sleep, associated with sympathetic and adrenocortical activation,” researchers concluded. “Recurring exposure to these metabolic changes may foster diabetes and cardiovascular disease.”

Researchers based their findings on a randomized crossover trail of CPAP vs. CPAP withdrawal. They used 31 patients with moderate to severe OSA acclimated to CPAP.

To conduct the study, patients underwent polysomnography while sleeping with CPAP or after CPAP withdrawal, in random order. Venous blood was sampled at about 20 minute intervals on both nights. In 11 patients, researchers assessed glucose kinetics with an infusion of 6,6-[2H2]glucose.

Researchers found CPAP withdrawal caused recurrence of OSA associated with hypoxemia, sleep disruption, and heart rate elevation. CPAP withdrawal dynamically increased nocturnal FFA (p = 0.007), glucose (p = 0.028), and cortisol (p = 0.037), in proportion to respiratory event frequency, heart rate elevation, or sleep fragmentation.

CPAP withdrawal also increased systolic blood pressure (p = 0.017) and augmentation index (p = 0.008), but did not affect insulin, triglycerides, glucose production, oral glucose tolerance, cholesterol, or hsCRP.

CMS details healthcare spending by state

HME News - Thu, 06/15/2017 - 10:00
06/15/2017HME News Staff

WASHINGTON – While most states experienced faster growth in healthcare spending in 2014 due to Medicaid expansion and Health Insurance Exchange enrollment, per capita spending in Medicaid expansion and non-expansion states grew at similar rates, according to a CMS analysis of data from 1991-2014.

The data also shows that the most recent economic recession, which ended in 2009, and the modest recovery since then has had a sustained impact on healthcare spending and health insurance coverage. Every state experienced slower growth in per capita personal healthcare spending from 2010-13 vs. 2004-09, CMS says.

“Recent economic and health sector factors have had clear impacts by state, both by payer and in the rates of overall per capita personal healthcare expenditure growth; however, during the 2009-14 period, the variation in spending between the lowest and highest states was virtually unchanged,” said David Lassman, the lead author of a report on the data, published in Health Affairs.

Topline findings from the report include:

Considerable regional variation on personal health care spending

·      In 2014, the New England and Mideast regions had the highest levels of total per capita personal health care spending ($10,119 and $9,370, respectively), or 26% and 16% higher than the national average ($8,045).

·      In contrast, the Rocky Mountain and Southwest regions had the lowest levels of total personal health care spending per capita in 2014 ($6,814 and $6,978, respectively) with average spending roughly 15% lower than the national average. 

Similar growth in Medicaid expansion and non-expansion states

·      While most states experienced faster growth in 2014 compared to 2013 due to Medicaid expansion and enrollment in Health Insurance Exchange plans, per capita health spending in Medicaid expansion and non-expansion states grew at similar rates, 4.4% and 4.5% respectively. The similar growth in per capita spending for expansion and non-expansion states was due largely to two effects: Faster growth in the use of healthcare goods and services in expansion states relative to non-expansion states due to a larger increase in the percent of people insured in those states; and faster growth in spending per insured person in non-expansion states relative to expansion states.

Impact of recent economic recession and recovery

·      The most recent economic recession, which ended in 2009, and modest recovery since then, had a sustained impact on health spending and health insurance coverage.

·      For 2010-13, per capita personal health spending grew at a rate of 2.8 % per year on average, substantially slower than during 2004-09, when spending averaged 5.2% growth per year.

·      During 2010-13, every state experienced slower growth in per capita personal health care spending with an average deceleration of just over two percentage points compared to the 2004-09 period. 

Three major payers

·      Medicare: States with above average per enrollee Medicare spending were generally located in the eastern United States while states with the lowest spending were generally in the western United States. The state with the highest per enrollee Medicare spending in 2014 was New Jersey ($12,614) with spending levels roughly 15% above the national average ($10,986). In 2014, Montana was the state with the lowest per enrollee Medicare spending, at $8,238 per enrollee (25% below the national average per enrollee).

·      Medicaid: The recent trends in per enrollee spending were driven by the Medicaid coverage expansion, which increased the share of relatively less expensive enrollees relative to the previous Medicaid beneficiary population mix in expansion states. Total Medicaid spending increased 12.3% from 2013 to 2014 for states that expanded Medicaid, compared with 6.2% for states that did not expand Medicaid. However, on a per enrollee basis Medicaid spending declined considerably for the expansion states (-5.1%) in 2014, because of the enrollment of relatively less expensive enrollees, whereas per enrollee Medicaid spending in the non-expansion states increased 5.1%. 

·      Private Health Insurance: Per enrollee private health insurance spending was $4,551 in 2014, an average annual increase of 3.3% since 2009 ($3,872). Total private health insurance spending grew more rapidly in states that did not expand Medicaid eligibility by 2014 than in states that did expand eligibility, at rates of 6.8% and 4.6%, respectively.

OIG finds savings increase from Senior Medicare Patrols

HME News - Wed, 06/14/2017 - 09:18
06/14/2017HME News Staff

WASHINGTON – Senior Medicare Patrol projects achieved $163,904 in cost avoidance on behalf of Medicare and Medicaid in 2016, up from $21,533 in 2015, according to a study from the Office of Inspector General.

Savings to beneficiaries and others totaled $53,559, up from $35,059, the OIG says.

In 2016, 53 projects had a total of 6,126 active team members who conducted a total of 26,220 group outreach and education events, reaching an estimated 1.5 million people. The projects also had 195,386 individual interactions with, or on behalf of, a beneficiary, according to the OIG.

“We note that the projects may not be receiving full credit for recoveries, savings, and cost avoidance attributable to their work,” the report states. “It is not always possible to track referrals to Medicare contractors or law enforcement from beneficiaries who have learned to detect fraud, waste, and abuse from the projects. In addition, the projects are unable to track the potentially substantial savings derived from a sentinel effect, whereby Medicare beneficiaries' scrutiny of their bills reduces fraud and errors.”

Senior Medicare Patrol projects receive grants from the Administration for Community Living to recruit and train retired professionals and other senior citizens to recognize and report instances or patterns of healthcare fraud. The OIG has collected performance data on the projects since 1997.

Stakeholders rack up ‘impressive’ list of co-signers for bid relief letter

HME News - Tue, 06/13/2017 - 08:31
06/13/2017HME News Staff

WASHINGTON – The HME industry has met its goal of at least 150 co-signers for a letter calling on Health and Human Services Secretary Tom Price to provide relief from Medicare’s competitive bidding program.

Thanks to a few late additions, stakeholders were able to secure 154 co-signers for the letter, spearheaded by Reps. Cathy McMorris Rodgers, R-Wash., Dave Loebsack, D-Iowa, Lee Zeldin, R-N.Y., and Diana DeGette, D-Colo.

“This is an impressive number considering only two weeks were given to gain supporters and much of that time was when Congress was out of session,” VGM stated in a bulletin to members.

AAHomecare President and CEO Tom Ryan had called on stakeholders to secure at least 150 co-signers for the letter at the Washington Legislative Conference on May 24-25. The letter remained open through June 9.

The letter asks Price, along with CMS Administrator Seema Verma, to consider more long-term fixes to the competitive bidding program; to permanently protect accessories for complex wheelchairs from bid-related reimbursement cuts; and to reverse a recent “double dip” cut to oxygen concentrators.

A similar letter spearheaded by the House Small Business Committee and Rep Blaine Luetkemeyer, R-Miss., a committee member, has received support from four other members. That letter will remain open until this Friday, June 16.

Both letters will be sent to Price and Verma, sending a clear message that they need to make DME policy reform a priority, stakeholders say.

VGM gave a shout-out to stakeholders in Alabama, Iowa, North Dakota, South Dakota, Maine, Vermont, Wyoming and Rhode Island, who were able to get all of their representatives to sign on to the Rodgers letter. Stakeholders in Missouri, Kentucky, Tennessee, Utah, Idaho, Minnesota, Mississippi, New Hampshire, Wisconsin, West Virginia, Colorado, Connecticut and Massachusetts were able to secure all but one or two of their representatives.

How the Funeral Rule Helps Consumers

Long Term Care Link - Sun, 06/11/2017 - 19:00
In 1984 the Federal Trade Commission established the Funeral Rule to give consumers of funeral services certain protections.

Caring for a Loved One at Home Can Be Challenging

Long Term Care Link - Sun, 06/11/2017 - 19:00
Informal caregivers are family, friends and volunteers who provide care and support for an aging loved one. These selfless individuals are rarely paid for their services and often endure a significant amount of stress while providing care.

Estate Planning As Part of Your Long Term Care Plan

Long Term Care Link - Sun, 06/11/2017 - 19:00
A key deficiency in the process of planning for long term care occurs when seniors fail to provide for the orderly distribution of assets after death or fail to let their family know what to do when the senior can no longer handle his or her own affairs.

Perpetrators of Elder Abuse Are Usually Family Members

Long Term Care Link - Sun, 06/11/2017 - 19:00
Many elderly rely entirely on family or other trusted individuals to help them. Whether it is physiological or psychological, as people grow older they tend to need guidance and support. Unfortunately, the dependence upon caregivers or family members makes an older person more vulnerable to abuse.

Osteoporosis - What You Need To Know

Long Term Care Link - Sun, 06/11/2017 - 19:00
Your body is constantly replacing bone, the older you are, the slower the bone is replaced. Osteoporosis is a bone disease that happens when the body loses too much bone or makes too little bone.

Include End-Of-Life Planning When Anticipating Long Term Care

Long Term Care Link - Sun, 06/11/2017 - 19:00
A key deficiency in the process of planning for long term care occurs when seniors fail to provide for orderly distribution of assets at death and fail to let their family know what to do when the senior can no longer handle his or her own affairs.

Gut Health and Antibiotics

Long Term Care Link - Sun, 06/11/2017 - 19:00
Most people do not think about gut health. In fact, the majority of people don't know what gut health is.

What Should I Expect to Pay for Funeral and Burial Expenses

Long Term Care Link - Sun, 06/11/2017 - 19:00
A common goal among many aging seniors and their families is to put money aside for funeral and burial expenses.

Arthritis Among Seniors

Long Term Care Link - Sun, 06/11/2017 - 19:00
Arthritis affects millions of people of all ages, including children (1 in every 250 children in the United States each year).

Parkinsons Disease

Long Term Care Link - Sun, 06/11/2017 - 19:00
In the U.S., over one million Americans suffer from Parkinsons disease (approximately 10 million worldwide).

What to Do When an Aging Loved One Dies

Long Term Care Link - Sun, 06/11/2017 - 19:00
If and when my parent passes away,which will likely take place in my own home, I wouldnt know what to do.

How Elder Law Can Help You

Long Term Care Link - Sun, 06/11/2017 - 19:00
The specialty of Elder Law is becoming more important as our population ages. People are living longer, but in many cases, are not living better.

Home the Desired Setting for Elder Care

Long Term Care Link - Sun, 06/11/2017 - 19:00
Most of those receiving long-term care and most caregivers prefer a home environment.

Is Medicaid Planning Ethical?

Long Term Care Link - Sun, 06/11/2017 - 19:00
As in any area of consumer spending, knowing what to look for and what strategies to use in arranging for paid care services can often result in saving money.

Fall Prevention and Coping after a Fall

Long Term Care Link - Sun, 06/11/2017 - 19:00
Age related physical changes, mental conditions, health conditions, and even medications increase the risk of injury. Falling is the leading cause of injury among seniors ages 65 and older.

Vietnam and PTSD - 40 Years Later

Long Term Care Link - Sun, 06/11/2017 - 19:00
40 years ago - May 7th - marked the end of the Vietnam War. Many of those alive 40 years ago can still easily recall where they were on the 7th of May and what they were doing on that memorable day.
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