Fungus in humans identified for first time as key factor in Crohn's disease

Fungi are hard to get rid of because they share many genes with us. Anything that would kill them outright is likely to do us real damages as well. Got to be more subtle......
https://goo.gl/z45NGH

A Case Western Reserve University School of Medicine-led team of international researchers has for the first time identified a fungus as a key factor in the development of Crohn's disease. The researchers also linked a new bacterium to the previous bacteria associated with Crohn's. The groundbreaking findings, published on September 20th in mBio, could lead to potential new treatments and ultimately, cures for the debilitating inflammatory bowel disease, which causes severe abdominal pain, diarrhea, weight loss, and fatigue.

"We already know that bacteria, in addition to genetic and dietary factors, play a major role in causing Crohn's disease," said the study's senior and corresponding author, Mahmoud A Ghannoum, PhD, professor and director of the Center for Medical Mycology at Case Western Reserve and University Hospitals Cleveland Medical Center "Essentially, patients with Crohn's have abnormal immune responses to these bacteria, which inhabit the intestines of all people. While most researchers focus their investigations on these bacteria, few have examined the role of fungi, which are also present in everyone's intestines. Our study adds significant new information to understanding why some people develop Crohn's disease. Equally important, it can result in a new generation of treatments, including medications and probiotics, which hold the potential for making qualitative and quantitative differences in the lives of people suffering from Crohn's."


Commitment to Person-Centered Care for Long-Term Care Facility Residents

https://goo.gl/kS7OeD

We are committed to doing everything we can to increase the knowledge and power that can help families undergo these transitions, particularly with regard to the rights of residents to high quality safety and care. Last year, CMS began offering consumers and families the ability to easily compare facilities based on successful discharges, unplanned emergency visits, and re-hospitalizations through a five-star website. However, the rules of the road for long-term care facilities haven’t had a comprehensive update since 1991. Today, we are pleased to announce that we have finalized new rules to protect and empower residents of long-term care facilities.

The rule makes important changes to strengthen the rights of residents and families in the event that a dispute arises with a facility. Historically, many facilities require residents to agree to binding arbitration clauses when they are admitted to these facilities. These clauses require the resident to settle any dispute that may arise using arbitration rather than the court system. Effective November 28, 2016, our final rule will prohibit the use of pre-dispute binding arbitration agreements. This means that facilities may not require residents to sign pre-dispute arbitration agreements as a condition of admission to that long-term care facility.

Facilities and residents will still be able to use arbitration on a voluntary basis at the time a dispute arises. Even then, these agreements will need to be clearly explained to residents, including the understanding that these arbitration agreements are voluntary, and that these agreements should not prevent or discourage residents and families from talking to authorities about quality of care concerns.


The Gap in Medigap

https://goo.gl/ZuOZQ1

Medicare provides coverage for a wide array of medical and drug benefits, but, with its deductibles, cost-sharing requirements, and lack of an annual out-of-pocket spending limit, many people on Medicare purchase Medigap supplemental insurance to help cover their out-of-pocket costs. Roughly 11 million of the 57 million people on Medicare—around 20 percent of all beneficiaries—have a Medigap policy, which helps protect against catastrophic expenses, spreads costs over the course of the year, and simplifies medical bills and paperwork. Thanks to a 1990 federal law, people age 65 and older are able to buy a Medigap policy when they sign up for Medicare, but younger Medicare beneficiaries with disabilities are not granted the same right unless they live in a state that requires it.

Today, Medicare covers 9 million people under 65 with disabilities. Most people under 65 who qualify for Medicare must first become eligible to receive disability insurance benefits (SSDI) and then wait 24 months for Medicare coverage to begin. Given this pathway to Medicare, it may not be a surprise that younger beneficiaries with disabilities have poorer self-reported health status than seniors on Medicare, along with higher rates of cognitive impairments and functional limitations, and lower incomes, with half having income of $17,000 or less. And even with Medicare, beneficiaries under 65 with disabilities report greater difficulty accessing the care they need, sometimes because they cannot afford the cost. For some, this may be related to not having supplemental coverage, such as Medigap, to help with their out-of-pocket costs. In fact, a much smaller share of beneficiaries under 65 with disabilities than seniors have a Medigap policy (2% versus 17%, respectively), and a much higher share have no supplemental coverage whatsoever (21% versus 12%).

The substantially lower rate of Medigap coverage among under age 65 adults with disabilities may be due in large part to the provision in the federal law mentioned above that gives Medicare beneficiaries age 65 and older the right to purchase a Medigap policy during the first six months after they enroll in Medicare Part B and under other limited circumstances, but does not provide the same guarantee to younger people who are entitled to Medicare due to having a disability. According to the Centers for Medicare & Medicaid Services, 31 states have gone beyond the federal minimum standard to require insurers in their states to provide at least one kind of Medigap policy to beneficiaries younger than age 65, but the other 19 states and DC have not (Figure 1).


A New Kind of Paramedic for Less Urgent 911 Calls

https://goo.gl/3kwMCC

Now a new approach is showing promise in reducing visits to the ER by what the Centers for Medicare and Medicaid Services calls “super-utilizers,” typically defined as those who use emergency services four or more times a year. The National Conference of State Legislatures estimates that up to 27 percent of all visits to ERs are for nonemergencies. But so-called community paramedic programs are finding new ways to manage these frequent flyers.

Minnesota has been a pioneer in community paramedicine. Under its program, a hospital will typically identify four or five super-utilizers who need a managed care approach. Then community paramedics will go into those people’s homes to look not only at their overall health issues but also at factors like safety precautions and nutrition. Through the program, Minnesota has seen ER use by super-utilizers decrease by 60 to 70 percent.


Is It Dementia? Or is it Lyme Disease?

https://goo.gl/Z2nvh7

For years, songwriter and actor Kris Kristofferson was told he was suffering from Alzheimer’s disease or some other type of dementia. His memory was getting progressively worse.

But Kristofferson, 79, has revealed that he was misdiagnosed — he actually has Lyme disease, according to a June 6 story in Rolling Stone. A positive test result confirmed the hunch earlier this year, the magazine said.

“He was taking all these medications for things he doesn’t have, and they all have side effects,” his wife, Lisa, told Rolling Stone. After three weeks of Lyme treatment, there are still some down days, but on other days he seems normal, she said. “All of a sudden he was back.”

Lyme disease is caused by an infected blacklegged tick, also known as a deer tick. If left untreated, it can eventually cause a host of debilitating symptoms, including severe headaches, one or more rashes, stiff neck, severe joint pain and swelling, heart palpitations, facial paralysis, dizziness, nerve pain and memory loss, according to the Centers for Disease Control and Prevention (CDC).

Other cognitive problems that can occur after months or even years include, according to the Lyme and Tick-Borne Diseases Research Center of Columbia University Medical Center:

  • problems remembering names or words
  • slowed thinking
  • “brain fog”
  • difficulty following conversations.

“My brain is so destroyed. To me it’s amazing I can still get up and go to the show,” Kristofferson told the Las Vegas Review-Journal last fall. “But I can remember all the songs.”

- See more at: http://vaelderlaw.com/lawyer/2016/06/24/Aging-in-Place/Is-It-Dementia-Or-is-it-Lyme-Disease_bl25454.htm#sthash.PY7hCGU8.dpuf


Federal judge grants preliminary injunction in Medicaid lawsuit

This is important in Michigan as well, since systems are always trying to use algorithms to force specific service levels without the bother of a person centered plan.....

https://goo.gl/1Y7v7m

The court found that the plaintiffs have demonstrated that they are likely to succeed on the merits of their procedural due process claim relating to the APS algorithm, that they are likely to suffer irreparable harm, the balance of hardships tips in their favor and a preliminary injunction is in the public interest, according to the opinion.

“The court therefore finds that plaintiffs have satisfied each of the requirements for a preliminary injunction…and this extraordinary equitable relief is warranted in this case,” the opinion states.

Johnston wrote that the plaintiffs had to meet the four criteria to merit a preliminary injunction to have their 2014 benefits restored.....

The plaintiffs claim in contrast, each year APS generates the benefit amounts arbitrarily through a secret and proprietary computer algorithm that does not give appropriate weight to recipient need and the amount of waiver benefits actually authorized in prior years.

The plaintiffs are seeking restoration of the lost benefits for themselves and class members. They’re being represented by Gary M. Smith, Lydia C. Milnes and Bren J. Pomponio of Mountain State Justice.

Health Library Publications: The Center for Health Law and Policy Innovation of Harvard Law School (CHLPI)

https://goo.gl/wjjlba

The Health Law & Policy Clinic of the Center for Health Law and Policy Innovation publishes reports, issue briefs, toolkits, and fact sheets on our broad range of national and state law and policy initiatives aimed at achieving more equitable and just health and public health care systems. The health library provides access to all of CHLPI’s published research along with recordings of webinars, presentations, articles from academic journals, and legal documents like amici briefs and administrative complaints.

Publications within the health library can be found by selecting any combination of the search categories in the sidebar or directly inputting search terms in the Keyword Search at the bottom of the sidebar. All of CHLPI’s publications can also be accessed using the interactive map directly below – clicking on a specific state will bring up all of the publications relevant to that state.


Dental Therapy Is a Solution to the Oral Health Crisis Everyone Can Agree On

https://goo.gl/HLCZwV

Chances are you know someone who has struggled to access dental care. It is a nationwide crisis that, according to the American Dental Association, is only projected to worsen. The need for accessible dental care is most urgent in rural areas and for vulnerable populations. This problem was recently covered in a National Public Radio story that cited “a quarter of Americans went without dental care they needed in 2014 because they couldn't afford it.” Wouldn’t it be nice if there was a solution that would increase access to care that a wide range of stakeholders could agree upon? Well there is – expanding the number of dental therapists providing care.

Dental therapists are early intervention and prevention dental professionals who are specially trained to provide a limited scope of services under the supervision of a dentist. In leading edge states, it has been demonstrated that licensure of dental therapists can garner bipartisan support from both lawmakers and the public.


Seniors / Aging Falls are leading cause of injury and death in older Americans

https://goo.gl/v9itgC

Older adults also can take simple steps to prevent a fall:
  • Talk to your healthcare provider about falls and fall prevention. Tell your provider if you've had a recent fall.
  • Although one out of four older Americans falls each year, less than half tell their doctor.
  • Talk to your provider or pharmacist about medications that may make you more likely to fall.
  • Have your eyes checked by an eye doctor once a year. Update eyeglasses as needed.
  • Participate in evidence-based programs (like Tai Chi) that can improve your balance and strengthen your legs.
  • Contact your local Council on Aging for information about what is available in your community.
  • Make your home safer by getting rid of fall hazards.

For more information on the NCOA, see https://www.ncoa.org/.


Failure to Improve Is Still Being Used, Wrongly, to Deny Medicare Coverage

https://goo.gl/Vsy5eP

Translation: Mrs. Kirby wouldn’t receive Medicare coverage for furtherphysical therapy or for the nursing home. If she wanted to stay and continue therapy, she’d have to pay the tab herself.

Medicare beneficiaries often hear such rationales for denying coverage of skilled nursing, home health care or outpatient therapy: They’re not improving. They’ve “reached a plateau.” They’re “stable and chronic,” or have achieved “maximum functional capacity.”

Deanna Kirby wasn’t buying it. “I knew they couldn’t refuse you, even if you’re not improving,” she said.

She’s right. A federal judge last month ordered the federal Centers for Medicare and Medicaid Services to do a better job of informing health care providers and Medicare adjudicators that the so-called improvement standard was no longer in effect.

What matters, as the 2013 settlement of a class-action lawsuit specified, is maintenance. Medicare must cover skilled care and therapy when they are “necessary to maintain the patient’s current condition or prevent or slow further deterioration.”