Greg Nicholaides

Nov. 2, 2021

By Amy Norton HealthDay Reporter

Nearly one-third of older U.S. adults visit at least five different doctors each year — reflecting the growing role of specialists in Americans’ health care, a new study finds.

Over the past 20 years, Americans on Medicare have been increasingly seeing specialists, researchers found, with almost no change in visits with their primary care doctor.

On average, beneficiaries saw a 34% increase in the number of specialists they visited each year. And the proportion of patients seeing five or more doctors rose from about 18% in 2000, to 30% in 2019.

Is the trend good or bad? “It’s probably both,” said Dr. Michael Barnett, the lead researcher.

On one hand, he noted, medicine has grown by leaps and bounds in recent decades — yielding a deeper knowledge of various health conditions and more options for diagnosing and treating them. “There are a lot more things that a specialist can do now, and that’s good,” said Barnett, a primary care doctor and an assistant professor at the Harvard T.H. Chan School of Public Health in Boston.

However, managing all of those medical appointments, various prescriptions and information from different providers can be “maddening,” Barnett pointed out. “If nothing else,” he said, “transportation to those appointments is a big issue for older adults.”

So the broader question of how all this specialist care is affecting older Americans’ quality of life is a complicated one, according to Barnett. What is clear, he said, is that the American health care system is “very specialist-oriented.”

Back in 1980, Americans aged 65 and older mostly saw primary care providers. About 62% of their medical appointments were with a primary care doctor, while 38% were with specialists, according to Barnett’s team. But by 2013, those figures had flipped.

That makes the United States different from many other developed health systems in the world, which put more emphasis on primary care. And, the Harvard researchers said, studies suggest those systems provide better care at lower costs.

The new findings — published Nov. 1 in the Annals of Internal Medicine — are based on claims data from Americans on Medicare between 2000 and 2019. Over time, the average beneficiary saw more specialists and had more visits to specialists, the investigators found. But there was no real change in their number of annual visits to primary care providers. By 2019, Medicare recipients saw two specialists, on average. But many saw more: That included the 30% of beneficiaries who saw five or more doctors.

Alice Bonner is a geriatric nurse practitioner and senior advisor to the nonprofit Institute for Healthcare Improvement. She agreed that the trend toward more — and pricier — specialist care is neither good nor bad, but more complex than that. “It could be that it’s helping people, or it could be that it’s wasteful,” Bonner said. “It’s so dependent on the individual situation.”

One question, she noted, is whether older adults are becoming “more assertive” in asking to see specialists. Visits to a busy primary care provider can be brief, Bonner pointed out. “If people are not having their concerns addressed,” she said, “they may seek care elsewhere.”

Like Barnett, she said that seeing multiple doctors can add a layer of complexity that burdens older adults — from transportation to managing medications. “It’s not uncommon for patients to be on nine or more medications,” Bonner noted.

Ideally, health care should be helping older adults live not only longer but better, and understanding “what matters” to any one patient is key, according to Bonner. “Most older people tell us they don’t want their lives overmedicalized,” she said. “If they’re busy traveling from doctor to doctor, they may have less time for doing what matters to them.”

Barnett made a similar point, saying primary care doctors should “help patients do what matters most to them.” In some cases, Barnett said, that might mean “pulling back” on some specialist care — though, he noted, the general culture of the health care system is to add care rather than take away. So patients may need to ask. “It’s always reasonable for patients to ask their primary care doctor whether any care they’re receiving is still necessary and needs to continue,” Barnett said.

Specialist care also adds complexity to the job of primary care providers, who are supposed to be coordinating it all, Barnett pointed out. In the current system, that may or may not be happening smoothly. Since doctors are mainly paid per service they provide during an office visit, any time spent coordinating patients’ care is uncompensated. That system, the researchers said, is a “disincentive.”

A high-carb diet, and the attendant high blood sugar, are associated with cognitive decline.

By Olga Khazan – The Atlantic

In recent years, Alzheimer’s disease has occasionally been referred to as “type 3” diabetes, though that moniker doesn’t make much sense. After all, though they share a problem with insulin, type 1 diabetes is an autoimmune disease, and type 2 diabetes is a chronic disease caused by diet. Instead of another type of diabetes, it’s increasingly looking like Alzheimer’s is another potential side effect of a sugary, Western-style diet.

In some cases, the path from sugar to Alzheimer’s leads through type 2 diabetes, but as a new study and others show, that’s not always the case.

A longitudinal study, published in the journal Diabetologia, followed 5,189 people over 10 years and found that people with high blood sugar had a faster rate of cognitive decline than those with normal blood sugar – whether or not their blood-sugar level technically made them diabetic. In other words, the higher the blood sugar, the faster the cognitive decline.

“Dementia is one of the most prevalent psychiatric conditions strongly associated with poor quality of later life,” said the lead author, Wuxiang Xie at Imperial College London, via email. “Currently, dementia is not curable, which makes it very important to study risk factors.”

Melissa Schilling, a professor at New York University, performed her own review of studies connecting diabetes to Alzheimer’s in 2016. She sought to reconcile two confusing trends. People who have type 2 diabetes are about twice as likely to get Alzheimer’s, and people who have diabetes and are treated with insulin are also more likely to get Alzheimer’s, suggesting elevated insulin plays a role in Alzheimer’s. In fact, many studies have found that elevated insulin, or “hyperinsulinemia,” significantly increases your risk of Alzheimer’s. On the other hand, people with type 1 diabetes, who don’t make insulin at all, are also thought to have a higher risk of Alzheimer’s. How could these both be true?

Schilling posits this happens because of the insulin-degrading enzyme, a product of insulin that breaks down both insulin and amyloid proteins in the brain – the same proteins that clump up and lead to Alzheimer’s disease. People who don’t have enough insulin, like those whose bodies’ ability to produce insulin has been tapped out by diabetes, aren’t going to make enough of this enzyme to break up those brain clumps. Meanwhile, in people who use insulin to treat their diabetes and end up with a surplus of insulin, most of this enzyme gets used up breaking that insulin down, leaving not enough enzyme to address those amyloid brain clumps.

According to Schilling, this can happen even in people who don’t have diabetes yet – who are in a state known as “prediabetes.” It simply means your blood sugar is higher than normal, and it’s something that affects roughly 86 million Americans. Schilling is not primarily a medical researcher; she’s just interested in the topic. But Rosebud Roberts, a professor of epidemiology and neurology at the Mayo Clinic, agreed with her interpretation.

In a 2012 study, Roberts broke nearly 1,000 people down into four groups based on how much of their diet came from carbohydrates. The group that ate the most carbs had an 80 percent higher chance of developing mild cognitive impairment – a pit stop on the way to dementia – than those who ate the smallest amount of carbs. People with mild cognitive impairment, or MCI, can dress and feed themselves, but they have trouble with more complex tasks. Intervening in MCI can help prevent dementia.

Rebecca Gottesman, a professor of neurology at Johns Hopkins, cautions that the findings on carbs aren’t as well-established as those on diabetes. “It’s hard to be sure at this stage, what an ‘ideal’ diet would look like,” she said. “There’s a suggestion that a Mediterranean diet, for example, may be good for brain health.”

But she says there are several theories out there to explain the connection between high blood sugar and dementia. Diabetes can also weaken the blood vessels, which increases the likelihood that you’ll have ministrokes in the brain, causing various forms of dementia. A high intake of simple sugars can make cells, including those in the brain, insulin resistant, which could cause the brain cells to die. Meanwhile, eating too much in general can cause obesity. The extra fat in obese people releases cytokines, or inflammatory proteins that can also contribute to cognitive deterioration, Roberts said. In one study by Gottesman, obesity doubled a person’s risk of having elevated amyloid proteins in their brains later in life.

Roberts said that people with type 1 diabetes are mainly only at risk if their insulin is so poorly controlled that they have hypoglycemic episodes. But even people who don’t have any kind of diabetes should watch their sugar intake, she said.

“Just because you don’t have type 2 diabetes doesn’t mean you can eat whatever carbs you want,” she said. “Especially if you’re not active.” What we eat, she added, is “a big factor in maintaining control of our destiny.” Roberts said this new study by Xie is interesting because it also shows an association between prediabetes and cognitive decline.

That’s an important point that often gets forgotten in discussions of Alzheimer’s. It’s such a horrible disease that it can be tempting to dismiss it as inevitable. And, of course, there are genetic and other, non-nutritional factors that contribute to its progression. But, as these and other researchers point out, decisions we make about food are one risk factor we can control. And it’s starting to look like decisions we make while we’re still relatively young can affect our future cognitive health. “Alzheimer’s is like a slow-burning fire that you don’t see when it starts,” Schilling said. It takes time for clumps to form and for cognition to begin to deteriorate. “By the time you see the signs, it’s way too late to put out the fire.”

They sound similar, but each serves different populations—though there can be some overlap.

Oct. 12, 2021 – By David Levine

Although they were born on the same day, Medicare and Medicaid are not identical twins. And even though they have been around for 55 years, many people still confuse these two government-backed health care programs.

On July 30, 1965, President Lyndon Johnson signed the laws that created Medicare and Medicaid as part of his Great Society programs to address poverty, inequality, hunger and education issues. Both Medicare and Medicaid offer health care support, but they do so in very different ways and mostly for different constituencies.

According to the Medicare Rights Center:

• Medicare is a federal program that provides health coverage to those age 65 and older, or to those under 65 who have a disability, with no regard to personal income.
• Medicaid is a combined state and federal program that provides health coverage to those who have a very low income, regardless of age.

Some people may be eligible for both Medicare and Medicaid, known as dually eligible, and can qualify for both programs. The two programs work together to provide health coverage and lower costs. And although Medicare and Medicaid are both health insurance programs administered by the government, there are differences in the services they cover and in the ways costs are shared.

Medicare Defined

Medicare is a federal health insurance program. According to the Department of Health and Human Services, the program pays medical bills from trust funds that working people have paid into during their employment. It offers essentially the same coverage and costs everywhere in the United States and is overseen by the Centers for Medicare & Medicaid Services, an agency of the federal government.

Medicare is designed primarily to serve people over 65, whatever their income, and younger disabled people and dialysis patients who are diagnosed with end-stage renal disease (permanent kidney failure requiring dialysis or transplant). Patients pay a portion of their medical costs through deductibles for hospital and other services. They also pay small monthly premiums for non-hospital coverage.

Medicare has two parts. Part A covers hospital care, and Part B covers other services like doctor’s appointments, outpatient treatment and other medical expenses. HHS says you are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:

• You receive retirement benefits or are eligible to receive benefits from Social Security or the Railroad Retirement Board.
• You or your spouse had Medicare-covered government employment.

If you are under age 65, you can get Part A without having to pay premiums if:

• You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months.
• You are a kidney dialysis or kidney transplant patient.

HHS says that most people do not have to pay a premium for Part A, but everyone must pay a premium for Part B. This is deducted monthly from your Social Security, railroad retirement or Civil Service retirement check; those who do not get any of these payments are billed for their Part B premium every three months.

Prescription drugs are covered under Medicare Part D. Everyone with Medicare, regardless of income, health status or prescription drug usage, can obtain prescription drug coverage for a monthly premium.

While the federal government administers what’s known as Original Medicare, it is also possible to purchase Medicare plans from some private insurance companies. These plans are known as Medicare Advantage. These include Part A and Part B coverage, but may or may not include prescription drug coverage.

Medicaid Defined

Medicaid is a government assistance program administered by both the federal government and state governments. As such, its rules of coverage and cost vary from one state to another.

It serves low-income people, families and children, pregnant women, the elderly and people with disabilities of every age. Income levels are generally based on the federal poverty level, but each state can determine who qualifies and who doesn’t.

According to HHS, patients usually pay none of the costs for covered medical expenses or a small co-payment. Some states cover all low-income adults below a certain income level. Since the enactment of the Affordable Care Act, states have been allowed to expand their Medicaid programs to cover all people with household incomes below a certain level. Some states have done so, while others have not.

Whether you qualify for Medicaid coverage depends partly on whether your state has expanded its program. HHS says that, in states that have expanded Medicaid coverage, you can qualify for Medicaid if your household income is below 133% of the federal poverty level. Some states use a different income limit, however.

The Fine Print

Being government programs, both Medicare and Medicaid can be complicated, confusing and challenging to navigate for some people.

Once you turn 65 years old, Medicare automatically becomes your primary insurance payer, says Diane Omdahl, president and founder of 65Incorporated, a Medicare consulting firm. If you also qualify for Medicaid, that becomes your secondary payer. “It works like a supplement plan, picking up the costs that Medicare Part A and B don’t cover,” she says. However, she recommends talking to a consultant or a representative of your state health insurance assistance program, known as SHIP, for guidance. “Talk to someone about what needs to be done, because you can’t rest assured that it will be done automatically,” she says.

When picking a Medicare or Medicare Advantage plan, the choices can be overwhelming. How flexible is the coverage offered? Are your doctors included in the plan? Does it cover your needs for, say eye care or mental health care?

Heart Conditions – CardioVascular Group – Sept.4, 2021

High blood pressure is a serious condition which can lead to heart disease and a stroke. Did you know there are several ways to improve your blood pressure without medication? We consider medication a last resort. 

The first option? Rethink your lifestyle. We don’t recommend you attempt to make these changes overnight; that’s not fair to you. Instead, try one at a time. Then add another. And another. That’s the smart path to lowering your blood pressure without medication.

Living a healthy lifestyle is crucial to improving blood pressure. CardioVascular Group cares about your health and suggests these lifestyle tips to lower your blood pressure without medication.

Exercise

Any form of aerobic exercise or moderate-intensity activity is proven to reduce blood pressure. As you start to exercise regularly, the pressure in your arteries decreases and your heart doesn’t have to work as hard. According to Dr. Randall Zusman, a cardiologist at Harvard Health, you should get 150-minutes of exercise per week. That means walking 30 minutes a day, five days a week, can reduce your blood pressure. So take the stairs at work. And park in the back of the parking lot. 

Change Your Diet

We all know adding fruits and vegetables to our diet is the healthy thing to do…but why? It reduces inflammation in the cardiovascular system, making blood flow more efficient. Eating processed and refined foods (i.e. junk food) damages the blood vessel walls, leading to high blood pressure and other severe conditions. Here are some tips that are essential in blood pressure health:

1. Increase potassium in diet – Potassium regulates blood pressure in the body. Foods high in potassium include:

Avocado
Banana
Nuts
Spinach

2. Decrease sodium (salt) intake – Where salt goes, water always follows. When you consume too much salt, your body retains water that could cause serious cardiovascular issues. A weakened heart causes fluid retention. To avoid this vicious cycle, reduce the amount of salt you consume by choosing low-sodium alternatives and avoiding processed foods.

3. Avoid sugar – Sugary foods cause weight gain, forcing your heart to work harder. Over time, this leads to high blood pressure. Ready to do something about it? Start incorporating whole foods in your diet. Also, avoid sodas. Both are great ways to start reducing sugar consumption.

4. Eat less dairy – According to Mark Hyman, MD, dairy contains unhealthy saturated fats and may be linked to heart disease – More: Dairy: 6 Reasons You Should Avoid It At All Costs…
Many healthcare professionals believe dairy products can be harmful to your health and suggest substituting almond or soy milk.

5. Relieve Stress – Although the effects of chronic stress on blood pressure are still unknown, studies show that reducing stress levels, paired with adequate exercise, can lower blood pressure. When you are stressed, the endocrine system produces an excess amount of hormones that trigger a fight-or-flight mode. The blood vessels constrict and force the heart to work overtime. Here are a few coping mechanisms you can try to reduce your stress levels:

6. Rest and relaxation – Take time each day to relax. The intention here is to get out of your head and into the now.

7. Meditation – Evidence shows that meditation may activate the parasympathetic nervous system, also known as the “Rest and Digest” system. Meditation relaxes the body by slowing the heart rate and lowering blood pressure.

8. Analyze your schedule – Avoid overworking and engaging in activities that cause stress—practice boundaries and learn how to say “No!”

9. Get plenty of sleep – Not getting enough sleep can throw your hormones off-balance and cause you to go into a frenzy quicker than usual. Make sure to get at least seven hours of sleep every night.

Stop Smoking

Smoking hardens the inner lining of the blood vessels and makes it harder for them to relax. In turn, the workload on the heart becomes more demanding, and blood pressure increases. Smoking is bad for your health in general and should be avoided at all costs.

by Robert King | FIERCE Healthcare

Oct 7, 2021

New data show that beneficiaries on Medicare Advantage (MA) have a 19% lower rate of hospitalizations for COVID-19 during the first nine months of the pandemic compared to traditional Medicare participants.

The data – released Oct. 7 by MA advocacy group Better Medicare Alliance – also show that fewer MA beneficiaries died of COVID-19 compared with those on traditional Medicare.

“COVID-19 illuminated opportunities for policymakers to lean in, learn and improve our healthcare system,” said Allison Rizer, principal and lead research of ATI Advisory, the consulting firm that conducted the study. “This analysis adds to that dialogue by showing that some of the most vulnerable individuals during the pandemic may have fared better in Medicare Advantage than those in Medicare [fee-for-service].”

Researchers looked at data from the fall 2020 Medicare Current Beneficiary Survey. The study discovered that there were 664 COVID-19 hospitalizations per 100,000 MA beneficiaries compared to 788 hospitalizations for those in traditional Medicare.

Fee-for-service Medicare also saw a 22% mortality rate of beneficiaries who were hospitalized with the virus, compared with 15% for those in MA. 

“Medicare Advantage beneficiaries comprised 40% of the Medicare population during the studied time frame and 36% of all Medicare beneficiaries hospitalized with COVID-19,” according to a release on the study. “By comparison, [fee-for-service] Medicare beneficiaries were 60% of the Medicare population and 64% of hospitalizations.”

The study also showed that access to care during the pandemic among dual-eligible beneficiaries was greater among those on MA than those on traditional Medicare.

For example, 78% of dual-eligible beneficiaries on Medicare and Medicaid in MA had access to diagnostics compared to 66% for traditional Medicare. Another 58% of duals were able to get a regular checkup compared with 43% in traditional Medicare.

MA dual-eligible beneficiaries also had a slight advantage (68%) for getting treatment for an ongoing condition compared to traditional Medicare (63%).

MA and traditional Medicare beneficiaries both had roughly the same access to telehealth services, with MA beneficiaries slightly above at 50% and traditional Medicare at 48%. Telehealth use burgeoned during the pandemic after the federal government loosened restrictions on reimbursement for providers.

MA has exploded in popularity among insurers as more payers are participating ahead of open enrollment that starts Oct.15.