Insurance For Over 65

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Greg Nicholaides

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How to Prepare to Leave a Legacy: Study

The latest Merrill Lynch/Age Wave study finds that most adults 55 and over haven’t taken care of the essentials.

By Bernice Napach| ThinkAdvisor | Feb. 07, 2019  

Death is not taboo, but failing to prepare for it financially is looked down upon. Those are just two of the many findings of a new report from Merrill Lynch in partnership with Age Wave that may interest advisors, especially those with clients who are middle-aged and older.

The study of 3,000 adults, with a focus on those 55 and older, found that nine out of 10 are open to discussing end-of-life preferences with friends and family, and dementia and pain are their biggest fears around dying.

Getting their affairs in order beforehand is key, but only 55% of Americans have wills and only 18% have the three recommended essentials — a will, health care directive and durable power of attorney, according to the study.

Respondents with $1 million or more in investable assets were the most prepared — 41% of them had taken care of the three essentials compared with 27% for those with $250,000 to just under $1 million in assets, but that’s still less than half.

This unpreparedness is a “call to action,” Surya Kolluri, a managing director of Bank of America Merrill Lynch who leads the thought leadership for its retirement group, tells ThinkAdvisor. “If you want to pass along life values and lessons, you need to have your financial affairs in order.”

Passing on values and lessons was considered the most important part of one’s legacy in the study, cited by 59% of respondents.

Asked to identify what they want to be remembered for, respondents overwhelmingly said it was the memories they shared with loved ones (70%) rather than the wealth they had accumulated (5%).

There were several surprises in the study, according to Kolluri, including the finding that two-thirds of respondents prefer to distribute on average 30% of their estate while they’re alive and an equal percentage believing in leaving a larger inheritance to the child who provides them care than the child who does not.

Another unexpected finding, according to Kolluri: 43% of respondents were concerned about not having an advocate to look after their best interests as they age.

Retirees and their families need to talk about these issues, said Kolluri, and 87% of respondents said it’s the responsibility of a parent to initiate these conversations.

“It’s critical that people take early and comprehensive steps to prepare essential documents,  communicate their preferences and shape the legacies they wish to leave behind,” said Lorna Sabbia, head of retirement and personal wealth solutions at Bank of America Merrill Lynch, in a statement.

Financial advisors can play a key role in helping clients have the necessarily conversations with family members and collect and store in a safe place the information and documents they will need.

“A well-prepared legacy could be one of the greatest final gifts for those you love,” Kolluri said.

This Merrill Lynch/Age Wave study is the fourth in a multi-year research series that examines five distinct life stages: early adulthood, parenting, caregiving, widowhood and end of life/legacy. In the latest study, 41% of respondents had less than $50,000 in investable assets; 10%, $50,000 to under $100,000; 22%, $100,000 to under $1 million; and 7%, $1 million or more. ‘Greg Says‘ believes all seniors should have a Will and an Advanced Directives document.  

See the following for more information: https://www.nia.nih.gov/health/advance-care-planning-healthcare-directivesand www.theconversationproject.org

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U.S. Leads Health Care Spending Among Richer Nations, But Gets Less

U.S. Leads Health Care Spending Among Richer Nations, But Gets Less

Jan. 7, 2019 Health Day News

by Robert Preidt

Higher costs, not better patient care, explains why the United States spends much more on health care than other developed countries, a new study indicates.

U.S. health care spending was $9,892 per person in 2016. That was about 25 percent more than second-place Switzerland’s $7,919 and more than twice as high as Canada’s $4,753, researchers found.

It was also twice what Americans spent in 2000, and 145 percent higher than the Organization for Economic Cooperation and Development (OECD) median of $4,033. The OECD includes 34 countries.

“In spite of all the efforts in the U.S. to control health spending over the past 25 years, the story remains the same — the U.S. remains the most expensive because of the prices the U.S. pays for health services,” said study author Gerard Anderson. He’s a professor at Johns Hopkins Bloomberg School of Public Health in Baltimore.

“It’s not that we’re getting more; it’s that we’re paying much more,” Anderson said in a school news release.

Evaluating the drivers behind soaring U.S. spending, his team cited higher drug prices, higher salaries for doctors and nurses, higher hospital administration costs and higher prices for many medical services.

Despite those higher costs, Americans have less access to many health care services than residents of other OECD countries, according to the study.

In 2015, for example, there were 7.9 practicing nurses and 2.6 practicing physicians for every 1,000 Americans, compared to the OECD medians of 9.9 nurses and 3.2 physicians.

That year, the United States had only 7.5 new medical school graduates per 100,000 people compared to the OECD median of 12.1. And the nation had just 2.5 acute care hospital beds per 1,000 people compared to the OECD median of 3.4.

Yet the United States ranked second in the number of MRI machines per person and third in the number of CT scanners per person, suggesting relatively high use of these expensive resources. (Japan ranked first in both categories, but was one of the lowest overall health care spenders in the OECD in 2016).

Among the other findings:

  • U.S. health spending outpaced that of the other OECD countries between 2000 and 2016 — growing an average of 2.8 percent a year compared with the OECD median annual increase of 2.6 percent.
  • Inflation-adjusted spending on pharmaceuticals rose 3.8 percent annually in the United States versus an OECD median of 1.1 percent.
  • In 2016, U.S. health care spending accounted for more than 17 percent of gross domestic product, compared with an OECD median of less than 9 percent.

The findings appear in the January issue of the journal Health Affairs.

At ‘Greg Says’ we believe that much more focus needs to be placed on the ever-increasing costs for basic healthcare services in the U.S. Comparing data from several other OECD countries with that of the U.S. indicates that more needs to be done regarding public policy to stem the growth of pricing for healthcare services in the U.S.

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Medicare Ambulance Rides May No Longer End Up at ER

By Ricardo Alonzo-Zaldivar – The Associaed Press

WASHINGTON (AP) — Medicare wants to change how it pays for emergency ambulance services to give seniors more options besides going to a hospital emergency department, officials said recently.

Other options could include going to an urgent care center, a doctor’s office, or even treatment at home under supervision of a doctor via telehealth links.

It’s just a pilot project for now, but if adopted nationwide the idea could save Medicare more than $500 million a year and allow local fire departments and ambulance services to focus the time and energy of first responders on the most serious emergencies.

Some advocates for patients welcomed the plan, but said it needs careful review and supervision.

“We definitely think this is intriguing and exciting, but it really does need to be monitored very closely,” said Julie Carter, a federal policy expert with the Medicare Rights Center, which advocates on behalf of beneficiaries. “We see this as a potential opportunity to keep people out of the ER when they don’t need to be there.”

Medicare officials said nothing’s going to change overnight, and they pledged the pilot program would be closely evaluated. Patients will retain the option of going to a hospital emergency room if that’s their wish.

Later this year, Medicare will announce up to 40 grants available to local governments or agencies that operate 911 dispatch centers. The pilot program would start early next year and run for two years. If successful, it could be adopted nationwide. Medicare says it also wants to get state Medicaid programs and private insurance companies interested in the approach.

The idea came out of the Center for Medicare and Medicaid Innovation, created under the Obama health care law to improve quality and reduce wasteful spending in the two giant health care programs. Although President Donald Trump tried to repeal the Affordable Care Act, his administration has now tapped the center in its own efforts to cut costs and help patients become more knowledgeable consumers of services.

Unveiling the ambulance proposal at a Washington, D.C., fire station, Adam Boehler, the innovation center director, said he was astounded to learn that under current rules Medicare will only pay for emergency ambulance services if the patient is going to a hospital, in most cases. Transportation to rehab centers or nursing homes, as well as dialysis facilities, is also allowed.

“I thought that was a joke,” said Boehler, a former health care entrepreneur who ran a company providing in-home medical care to seriously ill patients. He called Medicare’s current policy a “ridiculous incentive” to funnel patients to the most high-cost setting. Most private insurance plans discourage emergency room use by imposing higher copays, and some state Medicaid plans are trying similar tactics.

Appearing at the same event, the chief medical officer for the New York City fire department endorsed Medicare’s experiment. Dr. David Prezant said his agency is overwhelmed with non-emergency calls and transporting patients to a hospital is a time-consuming process that keeps ambulance crews needlessly tied up.

“If only 20 percent of our calls no longer required transport to an ED (emergency department), we would save lives in cases when every second counts,” Prezant said.

‘Greg Says‘ thinks this proposal is worth evaluating as a way to lower the overall cost of emergency services for Medicare, the emergency service providers, and the patient.

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How a Mediterranean Diet Could Lower Your Risk of Heart Disease

It is a well-known fact that your diet affects your heart health. Doctors often warn their patients to avoid certain foods in order to keep their cholesterol and blood pressure at healthy levels. Typically, diets must be adjusted, and whole food groups have to be cut out to maintain a healthy heart. However, one region’s everyday diet is now proving to be a heart-healthy choice across the board. The Mediterranean diet, which features vegetable and olive-oil-rich dishes, is now being recognized as a great option to lower your risk of cardiovascular disease.

Study Linking Mediterranean Diet and Heart Disease

A new study by researchers at Brigham and Women’s Hospital, Harvard Medical School, and the Harvard T.H. Chan School of Public Health focuses on the link between women’s heart health and a Mediterranean diet. Their research, which drew data from over 25,000 women, revealed that the women who primarily ate a Mediterranean-type diet had a 25 percent less chance of developing cardiovascular disease.

The team noted that this type of diet worked to lower the chances of heart disease by minimizing primary risk factors, including glucose metabolism, insulin resistance and inflammation. And while this study was performed on women, there is no reason to believe the results would not be similar in men.

“Our study has a strong public health message that modest changes in known cardiovascular disease risk factors contribute to the long-term benefit of a Mediterranean diet on cardiovascular disease risk,” says lead author Shafqat Ahmad, Ph.D.

What’s in a Mediterranean Diet?

For those looking to incorporate more Mediterranean foods into their diet, understanding the components can help making the switch a bit easier. The Mediterranean diet primarily consists of the following unprocessed foods:

Vegetables and Legumes

Veggies are a large part of the Mediterranean diet. Popular vegetables in this region include tomatoes, onions, cauliflower, broccoli, and cucumbers. Leafy greens like kale and spinach are packed with fiber and nutrients. Potatoes, sweet potatoes, and yams also appear often in Mediterranean dishes as a healthy, filling starches. Legumes, such as chickpeas, are often turned into hummus and served as a delicious dip. Beans, peas and lentils are other legumes often served with vegetables to add healthy fats and proteins in many Mediterranean dishes.

Fruits

Apples, oranges, figs, pears, grapes, and dates are often seen in Mediterranean dishes, and they make great snacks throughout the day. Additionally, apples have been known to exponentially decrease one’s chance of heart disease all on their own.

Whole Grains

Studies have shown that whole grain intake is consistently associated with improved cardiovascular disease outcomes, which makes them a perfect addition to this diet. Brown rice, rye, whole oats, buckwheat, whole-grain bread, and barley add healthy carbohydrates and fiber to many dishes in this genre.

Seafood and Poultry  

It can be difficult to imagine a Mediterranean meal without seafood. Salmon, sardines, trout, clams, and shrimp are bountiful in the Mediterranean Sea and are full of heart-healthy proteins.

If you need something heartier hardier, chicken, turkey and duck are also commonly seen in Mediterranean meals, usually cooked in healthy fats like olive oilor avocado. Popular seasonings for these meats if you want to add a dash of flavor include rosemary, basil, mint, and garlic. These lean protein options are a great choice for anyone hoping to reduce their risk of heart disease and lose a little weight in the process.  

Dairy  

Dairy is a large part of any Mediterranean diet due to the abundance of delicious cheeses, such as Feta, Parmigiano (Parmesan) and Manchego. Goat cheese and creamy Greek yogurt are also nutritious, yummy options. Sprinkle a touch of Feta on top of a Mediterranean-style salad or slice up some Mozzarella with tomatoes for the perfect finishing touch. If finding heart-healthy recipes seems difficult or intimidating, perhaps the best place to look is in a Mediterranean cookbook or online. Of course, eating a healthy diet does not completely minimize your risk of heart disease. Exercise and regular visits with your cardiologist are also vital for your heart’s long-term health.

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Telemedicine and Medicare

Forthcoming policies from CMS will open up the home as a covered site of care in which hospitals can earn payment. 

Dec. 14, 2018 – By Susan Morse,Senior Editor, Healthcare Finance

This past October, the Centers for Medicare and Medicaid Services came out with an eagerly-anticipated new rule expanding the ways providers can use telehealth and get paid by Medicare Advantage plans. 

The biggest way the rule changes the status quo, once it goes into effect in 2020, is that providers will be able to keep track of a patient’s health through remote monitoring and consumers will be able to connect to their physicians through telehealth from their homes.

IMPROVING CARE FOR CHRONIC CONDITIONS

Remote monitoring is especially important in controlling chronic conditions, diseases which affect seniors in particular.  Previously, consumers had to be in a provider’s office or another designated place, or live in a rural area, to use telehealth, at least from the standpoint of reimbursement.

Days after the new MA rule was announced, traditional Medicare also got a boost to allow for more codes for telehealth in the home, for a broader range of conditions.  Remote patient monitoring is expected to be the biggest use.

This will cut down on the amount of visits by high users of the ER and improve the management of patients’ conditions, said Dr. David McSwain, CMIO at Medical Univ. of SC.

“There’s a huge amount of investment from insurance companies,” said McSwain, who chairs the American Telemedicine Association Pediatric Telemedicine Guidelines Committee. 

The rule makes it more likely that MA plans will offer the benefits and that more enrollees will be able to use the benefits, CMS said.  What’s more, private commercial insurers and state Medicaid agencies tend to follow Medicare’s lead, McSwain said. 

CMS promoted Medicare Advantage plans ahead of open enrollment this year, and adding flexibility to telehealth only added to their attraction for insurers and consumers.  Insurers, as shown most recently by their third quarter earnings, are doing well with Medicare Advantage plans. Next year, enrollment in Medicare Advantage is projected to increase by 11.5 percent, and the number of plans to increase by 600. About a third of all Medicare beneficiaries are in a Medicare Advantage plan as compared to fee-for-serviceMedicare, and that number is projected to grow.

Adding telehealth to MA benefits increases plans’ ability to take cost out of the healthcare system.  If telehealth can do so without sacrificing quality, that’s the basis of value-based care. 

HOW PROVIDERS ARE ALREADY USING TELEHEALTH

Because of the convenience there is the potential for over-utilization, and there’s the risk of fragmented care according to McSwain.  But telehealth can have dramatic impacts on healthcare outcomes and healthcare costs, he said. 

Telehealth is driving value, CMS Administrator Seema Verma said on November 15, addressing the Alliance for Connected Care. 

Telehealth includes remote monitoring, such as for glucose and vital signs, tracking weight and blood pressure.  It spans a wide array of communication, from video visits to text messaging and phone calls. 

Medicare-age patients often have numerous doctors’ appointments. Consumers welcome the ability to connect from their homes rather than travelling to the office.  Patients with restricted mobility will often miss appointments. 

The Cleveland Clinicuses remote patient monitoring that sends live-time data back to clinicians, Verma said during the Alliance for Connected Care conference.  A mission control center at the hospital assimilates the data and if needed, triggers an intervention. 

About five years ago, Dallas Children’s Health wanted to look at telemedicine as a strategy for population health, said Julie Hall-Barrow, former vice president of Virtual Health and now the senior vice president of Network Development and Innovation. 

Telehealth is being used in the children’s hospital for remote patient monitoring programs, such as digital sensors that measure medication compliance.  “We set the stage knowing it’s covered,” Hall-Barrow said of reimbursement. “I think anytime we reduce barriers for how to deliver care, it’s a win for everybody,” she said. It offers, “the ability for us to provide high quality care at any delivery point.” 

The big picture for telehealth is how to design programs in a way that lead to improved outcomes that have the biggest impact on cost of care access and quality, McSwain said. 

The Medical University of South Carolina is one of only two national Telehealth Centers of Excellence in the United States. The system is currently awaiting word on a National Institutes of Healthgrant that would allow it to leverage a network of healthcare institutions across the country to facilitate the design and completion of telehealth studies, such as what is being taught at MUSC. 

Bryan Adams, chief commercial officer at digital health company GreatCall, said of telehealth, “Everyone is interested. Everyone is trying to find out the right entry point.”  GreatCall provides cell phones, medical alert devices and sensors for independent living at home. Sensors can monitor for risk, such as for falls from a bed or chair, or even be put in the tank of a toilet to detect toilet flushes.  The use of the sensor has resulted in the reduction in the use of long-term care and acute hospitalization, Adams said. 

“This is truly a whole new world of healthcare innovation,” Verma said of telehealth. 

McSwain added that CMS’s new flexibilities “sent a serious wave of excitement around the country.  We’ve been fighting the battle for telehealth in the home, it’s been such a barrier. Those restrictions coming down is like the fall of the Berlin Wall.

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‘Greg Says’believes that telehealth and telemedicine have a big role to play in reducing the overall cost of healthcare in the USA.  Now that there are additional financial incentives for healthcare providers to adopt these tools to remotely serve patients, the door is opening to increased use.