Health and Disability

The President’s FY2016 budget proposal would reduce net Medicare spending by $423 billion between 2016 and 2025, and is estimated to extend the solvency of the Medicare Hospital Insurance Trust Fund by approximately five years. This brief summarizes the Medicare provisions included in the President’s FY2016 Budget, with highlights noted below:

• More than one-third (34%) of the proposed Medicare savings are due to reductions in Medicare payments to providers, most of which affect providers of post-acute care (Figure 1).
• Nearly one-third (30%) of the proposed savings are related to Medicare prescription drug spending. The largest single-source of Medicare savings (23% of Medicare savings) is a provision that would require drug manufacturers to provide Medicaid rebates on prescriptions for Part D Low Income Subsidy enrollees, a proposal which was also included in the President’s FY2014 and FY2015 proposed budgets.
• About one-sixth (17%) of the proposed Medicare savings is due to increases in income-related premiums, increases in prescription drug copayments for low-income enrollees to encourage the use of generic drugs, an increase in the Part B deductible for new enrollees, and a new home health copayment for new enrollees.
• The President’s FY2016 budget would also repeal the Sustainable Growth Rate (SGR) formula and proposes about $54 billion in new Medicare spending, including, for example, provisions to reform physician payments and eliminate the 190-day lifetime limit on inpatient psychiatric care.

Results of a study were published last week looking at the cumulative use of strong anticholinergics on the development of dementia in the elderly (those aged 65 years). ¹ The results revealed that long term use of one or several drugs with anticholinergic effects could be associated with an increased risk of dementia, includingAlzheimer's disease.¹ Anticholinergics are used to treat the symptoms of overactive bladder (OAB), as well asdepression and allergy related conditions such as hay fever.

Many patients with OAB will continue to be treated successfully with anticholinergic drugs, but if there are concerns regarding high anticholinergic burden (e.g. in elderly patients on multiple treatments), alternative treatments for OAB are available, and should be considered, and NICE guidelines should be referred to. ⁹

Betmiga (mirabegron) is a selective β3-adrenoreceptor agonist that has been accepted for use by the SMC¹⁰ and is recommended by NICE¹¹ as an option for treating patients with symptoms of OAB in whom antimuscarinic drugs are contraindicated, clinically ineffective, or have unacceptable side effects. This means that Betmiga belongs to a different class of OAB therapeutics which does not contribute to anticholinergic burden. The decision regarding prescribing the most beneficial treatment for patients suffering OAB symptoms shall be based on judgement of health care practitioners.

The President's Fiscal Year 2016 Budget was released today. The plan reverses sequestration cuts and focuses on the needs of the middle class. Increases were proposed for the Lifespan Respite Care Program, the National Family Caregiver Support Program, and Aging and Disability Resource Centers. The National Respite Coalition will join forces with national, state and local partners to work toward achieving these increases for the next fiscal year.

In January 2010, the Congressional Budget Office projected that the federal health spending would total a bit more than $11 trillion between 2011 and 2020.

Today, the Congressional Budget Office thinks it made a mistake. Costs are coming in lower-than-expected, and the CBO's newest projections suggest the federal government will spend $600 billion less on health care than they predicted back in 2010.

So far, so good: projections are always wrong by at least a bit, and it's nice to have the extra $600 billion in America's pocket.

But here's the incredible thing: as Paul Van de Water, a health care expert at the Center on Budget and Policy Priorities, points out, the January 2010 projection didn't include any of the spending associated with Obamacare. The latest projections include all of the spending associated with Obamacare.

The meta-analysis showed that even a hint that performance was being pre-judged because of age criteria was enough to affect older people's performance.

Ruth Lamont said that the study evidence highlighted that even 'subtle differences' in the way people behave toward older people - such as being patronising or speaking slowly - could be enough to make them underperform when others are testing their abilities, either formally or informally.

Researchers have previously concluded that stereotype threat affects the major social categories of gender and ethnicity, but this new meta-analysis, which looked at evidence from over a decade of research, highlights the need to be just as concerned about age stereotypes, Ruth Lamont suggested.

The research team further conclude that the vulnerability of some older adults to ABST when they perform memory, cognitive or physical tasks has important social, economic and clinical implications which will become more relevant given an increasingly aging population and workforce.

The practice is called medical “spend-down” and it affects people with disabilities and the elderly. Organizations such as the Arc of Midland are concerned that some of the people they serve will barely eke out a life for themselves because the spend-down takes away so much of their money. The Lansing-based Michigan Disability Rights Coalition is gathering like-minded groups in hopes of finding a legislative way out of the spend-down.

The spend-down affects people with medical costs that overwhelm their incomes but whose incomes exceed predetermined thresholds. As a result, they are not eligible for Medicaid. They might receive Medicare, which provides primary insurance. But it doesn’t pay for expensive services they might need, such as in-home health care or support services. They might receive disability assistance or have part-time jobs.

To spend down to Medicaid eligibility, the person subtracts health care expenses from his/her income. The spend down is monthly. So if a person has an $800 spend-down he/she will have to pay $800 out of pocket each month before Medicaid kicks in, explained Jan Lampman, executive director of the Arc of Midland.

Yesterday, 200 patients, advocates, scientists, doctors and researchers gathered at the White House to hear President Obama’s launch of the Precision Medicine Initiative. According to the President, precision medicine aims to tailor treatments to each individual. President Obama likened precision medicine to how we match blood transfusions to blood type – only now we should aim to match a wide range of treatments to a wide range of varying genetic and biounique markers.

The initiative begins with a budget request for $215 Million in new funds. The funds will be used, mainly at the NIH, to:

• Develop a national cohort of a million volunteers who will donate their health-related data for open research.
• Provide increased funding for research to identify genetic drivers of cancer.
• Help the FDA speed up the regulatory process
• Fund the development of data interoperability standards

But, was remarkable about the day —in addition to the announcement which means a great deal to a great many —was the composition of the room and the event.

After most of the invited guests were seated (and selfies of the presidential podium were taken), approximately 20 more VIPs were escorted in to the front rows of the East Room.

They were patients, or families of patients.

The President was introduced by Elana Simon, a 19 year old student who’s high school science fair project focused on a genetically identified treatment for her own liver cancer. In other words, the President of the United States was introduced by an ePatient.

lanna Shaikh makes it her business to tackle the world’s most pressing health issues — from HIV/AIDS to the diminishing effectiveness of antibiotics. But when her father developed Alzheimer’s disease, she found herself face to face with an illness she had never deeply considered. Watching him struggle — and understanding that the genetic odds mean that she, too, could develop the disease — Shaikh resolved to prepare for it in concrete ways: by improving her physical condition, cultivating Alzheimer’s friendly hobbies, and becoming a better person.

Shaikh spoke about her experiences at the TED conference, and to her surprise, the talk (watch: “How I’m preparing to get Alzheimer’s,” above) hit a nerve and became among TED’s most popular. In this Q&A, Shaikh talks about the relationship between kindness and healing, how she now views dementia through the lens of public health, and how to live an enjoyable life in the present while planning for the future.

What succeeded, weirdly enough, is I honestly think I am a better person. By deliberately choosing to be kind over and over again, it seems to now come naturally to me.

What were you like before?

Very judgmental and critical. I was committed to being a good person, but I wasn’t particularly worried about being a nice person. One of my friends in college told me that his favorite thing about me was I always had something bitchy to say about someone. This is someone who loves me — he meant it as a positive. I don’t think anybody who’s known me in the last couple of years would say that now. Dealing with my dad made me realize how much nice actually matters. And kindness. I had never really thought about what kindness and niceness have to do with each other.