Final Fee Schedule Includes Payment for Advance Care Planning
Officials at the Centers for Medicare & Medicaid Services have issued the final 2016 fee schedule for physicians, making modifications to the Physician Quality Reporting System (PQRS) and loosening requirements for its controversial two-midnight rule. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Authors: Alicia Gallegos Source Type: news

Helping Your Facility Adjust to a Rainbow World
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Authors: Jeffrey Nichols Source Type: news

Congress Curbs Medicare Premium Increase
Lawmakers acted to limit an increase in Medicare Part B premiums as part of the budget deal negotiated between outgoing House Speaker John Boehner (R-Ohio) and the White House, and approved by the House on Oct. 28. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Authors: Gregory Twachtman Source Type: news

Statins May Inhibit Flu Vaccine Response in Elders
According to a pair of studies published online in the Journal of Infectious Diseases, statins — a class of drugs widely utilized by older adults to reduce cholesterol — may have the unintended consequence of reducing immunotherapeutic response to and effectiveness of influenza vaccination. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Authors: Matt Mahady Source Type: news

Physicians Sought for Trial to Prove Utility of Amyloid Imaging
A major study aimed at proving the clinical utility of amyloid imaging in diagnosing dementia is now recruiting participating physicians. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Authors: Michele G. Sullivan Source Type: news

FRONTIER Screen Distinguishes Frontotemporal Dementia From Alzheimer's
Researchers who administered the FRONTIER Executive Screen (FES) — a brief bedside questionnaire designed to assess verbal fluency, inhibitory control, and working memory — were able to distinguish patients with behavioral-variant frontotemporal dementia (bvFTD) from patients with Alzheimer's disease, according to a study published in the Journal of Neurology, Neurosurgery & Psychiatry. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Authors: Mike Bock Source Type: news

So You Give Great Care; Do You Have Data To Back That Up?
Every medical professional will experience a 6% reduction in Medicare payments if they fail to submit the required amount of quality data to the Centers for Medicare & Medicaid Services in 2016. In 2015, only physicians working in groups with 10 or more medical professionals face that 6% penalty. That penalty is imposed as part of the Value Based Purchasing (VBP) Program. Hospitals, nursing facilities, and other providers receiving Medicare Part A or Part B payments are subject to similar payment reductions. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Authors: Rod Baird Source Type: news

Frail Elders at High Mortality Risk in the Year Following Surgery
SAN DIEGO — Frail elderly patients face a significantly increased risk of mortality in the year after undergoing major elective noncardiac surgery, a large study from Canada showed. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Authors: Doug Brunk Source Type: news

ADHD in the Elderly: An Unexpected Diagnosis
A 70-year-old patient with no psychiatric history presents to your office complaining of memory problems. The patient frequently misplaces items, forgets appointments, and has difficulty completing tasks. You observe that the patient interrupts you frequently and misinterprets your instructions during cognitive screening. The patient is concerned about having dementia. That's on your differential, but could it be attention-deficit/hyperactivity disorder? Even in an older patient, it's worth considering. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Authors: Kalya Vardi Source Type: news

Mild Cognitive Impairment in Parkinson's Warrants Caution
Dementia is very common in patients with advanced Parkinson's disease, but when the condition is subtle, clinicians should take a cautious approach, according to Israeli expert Amos D. Korczyn, MD. Careful evaluation and follow up are in order, rather than a formal diagnosis. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Authors: Judith M. Orvos Source Type: news

Readmissions for Infections High Among Elderly
LAS VEGAS — More than one in 10 patients with Clostridium difficile infection at the time of hospital discharge are readmitted for C. difficile infection within 90 days, according to findings from a review of Medicare data from 2009 to 2011. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Authors: Sharon Worcester Source Type: news

Revived Alzheimer's Symptomatic Drug Set to Test as Donepezil Combo
BARCELONA — RVT-101, a novel small molecule that increases acetylcholine release, is poised for what its developers say could be its pivotal trial for U.S. approval. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Authors: Michele G. Sullivan Source Type: news

INTERACT Order Sets Target Avoidable Hospitalizations
This column strives to highlight innovations in care transitions. This month, we discuss an order set product that will enhance the INTERACT quality improvement program. Caring for the Ages does not endorse any specific product or products. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Authors: David Robertson and Joseph G. Ouslander Source Type: news

Many Benefits to Managing My Own Care
I manage my own health care, because despite good staff in my facility, given the number of residents and different shifts, there were gaps in keeping my care organized. I select all my providers, make medical, dental, lab, surgical, and transportation appointments, as well as do pharmacy follow-ups. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Authors: Penelope Ann Shaw Source Type: news

Evidence-Based Medicine: the Future of Health Care
WASHINGTON — The widespread use of evidence-based pathways will be a good thing for health care, according to Ascension Health senior vice president Michael Schatzlein, MD. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Authors: Gregory Twachtman Source Type: news

Low Levels of Vitamin D May Hasten Cognitive Decline
Cognitive function may decline faster in older adults with low levels of vitamin D, according to a study published online in JAMA Neurology. In particular, older black and Hispanic adults may be more at risk than whites for cognitive decline associated with low vitamin D levels. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Authors: Carey Cowles Source Type: news

Documenting Preferences About Health Care
Caring for the Ages Editor in Chief Karl Steinberg, MD, CMD, spells out the alphabet soup of advance care planning. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Tags: Caring Source Type: news

Nonpharmacologic Options Come First for Cancer Palliation
Management of symptoms is key for preserving quality of life in elderly patients with cancer, but medication should not be the first choice, according to researchers from Memorial Sloan-Kettering Cancer Center (MSKCC) in New York. Given the potential for comorbidities in this population, they recommend a comprehensive evaluation, starting with a physical examination and focusing on maximizing function while minimizing drug-drug interactions. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Authors: Judith M. Orvos Source Type: news

From the December Issue of JAMDA
A simple screening tool that relies on data routinely collected in nursing homes can help identify frail and prefrail residents who are at risk for incident falls, hospitalizations, disability, and death, according to results from a 9-year longitudinal follow-up study in Hong Kong. (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Source Type: news

News From the ASSOCIATION
The greatest challenge in palliative medicine is that the system isn't currently set up to deal with patients dying from chronic illnesses, according to KellyAnn Light-McGroary, MD, clinical assistant professor of internal medicine at the University of Iowa Carver College of Medicine. She will be addressing this and other issues at the Meet the Expert Breakfast Session during AMDA's annual conference in Orlando, FL, next March. Set for Saturday, March 19, Dr. Light-McGroary's presentation is entitled “Heart Failure Throughout the Continuum of Care: Where Does Palliative Care Fit In?” (Source: Caring for the Ages)
Source: Caring for the Ages - November 25, 2015 Category: Health Management Source Type: news

Practitioners Turn Advocacy Into Action
AMDA President Naushira Pandya, MD, CMD, wasn't sure what to expect when she participated in AMDA's Hill Day on Sept. 17, where Society members, leaders, and staff visited with policy makers and their teams on Capitol Hill. However, she learned that one voice added to the chorus can be heard and can help make a difference. (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Authors: Joanne Kaldy Source Type: news

Don't Worry, Be Happy: Positivity a Core Trait of Successful Aging
SAN DIEGO — According to Dilip V. Jeste, MD, aging presents mankind with a paradox: Physical health may decline, but psychosocial functioning often improves with age, even in people with serious illnesses. (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Authors: Doug Brunk Source Type: news

Documentation Defines Clinical Conditions for Pressure Ulcers
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

Dextromethorphan Plus Quinidine Helps Quell Agitation
A phase II randomized trial shows that dextromethorphan in combination with quinidine may have potential for treatment of agitation in patients with Alzheimer's disease. The results are particularly notable, say the authors, because this is the first trial in dementia to employ a sequential parallel comparison design to help offset the “placebo effect.” (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Authors: Judith M. Orvos Source Type: news

Diabetic Foot Ulcer: Close Wound Early
SAN DIEGO — Early wound closure prior to hospital discharge after surgical debridement of infected diabetic foot ulcers yields higher ulcer healing rates and a shorter time to healing, compared with various nonclosure wound management methods, according to a propensity-matched study reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy. (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Authors: Bruce Jancin Source Type: news

ICU Improves Survival From Pneumonia Without Raising Costs
Compared with care on a general hospital ward, care provided in the intensive care unit improved survival without raising costs significantly in a study of more than 1 million Medicare patients hospitalized with pneumonia. (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Authors: Mary Ann Moon Source Type: news

Pruritus in the Elderly Linked to Atopic-Like Dermatosis
PARK CITY, UT — When an otherwise healthy 75-year-old patient presents with persistent pruritus as the chief complaint, the first thing to do is rule out specific dermatologic disorders, according to Kevin C. Wang, MD. (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Authors: Doug Brunk Source Type: news

CLL Therapy: Focus on Comorbidities, Not Age
CHICAGO — The majority of patients with chronic lymphocytic leukemia are elderly patients older than 65, which underscores the need for a careful assessment of fitness for therapy — not necessarily because of age, but because of comorbidity burden, according to John G. Gribben, MD. (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Authors: Sharon Worcester Source Type: news

No ADT for Men With Prostate Cancer, Comorbidities
Forgoing androgen deprivation therapy cuts rather than raises overall and cardiac mortality in certain patients with prostate cancer, depending on their comorbidities, according to a “Research Letter to the Editor” published in the Journal of the American Medical Association. (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Authors: Mary Ann Moon Source Type: news

Radiation Plus Lumpectomy May Increase Survival in Triple-Negative Breast Cancer
Older women with triple-negative breast cancer appear to get an overall survival and disease-specific survival benefit with the addition of radiation to breast-conserving surgery, authors of a retrospective study said. (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Authors: Neil Osterweil Source Type: news

Psychotropic Medications May Increase Risk of Death
Risk of death is increased in patients taking benzodiazepines, antidepressants, and antipsychotics regardless of whether or not they have dementia, according to a report by Danish researchers published in European Neuropsychopharmacology. The findings — from one of the largest ever studies of use of the drugs in individuals with dementia and matched controls — suggest a need for caution when prescribing these types of medication to the elderly. (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Authors: Judith M. Orvos Source Type: news

The Role of the ‧SNFologist' in Today's Transitional Care
The long-term care model has morphed over the years in an effort to provide efficient, high-quality medical care to increasingly higher acuity skilled nursing facility residents, while minimizing gaps in post-acute care and readmissions to acute facilities. A new primary care specialty, the nursing home specialist, sometimes referred to as an “SNFologist” or “SNFist,” transitionalist, or post-acute care specialist, has emerged to address these concerns. The SNFologist provides continuity of care after a hospital admission by seeing residents of SNFs at least weekly, if not several times a week. (Sou...
Source: Caring for the Ages - October 30, 2015 Category: Health Management Authors: William C. Wilson Tags: Legal Issues Source Type: news

From New Jersey to Maine: The Focus Is on ‧Super-Utilizers'
Much has been written about ways to lower health care costs by focusing on the most expensive patients, and by integrating community-based care and facility-based services, usually emphasizing the former to mitigate the higher costs of the latter. (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Authors: Bill Kubat Tags: Community LTC Source Type: news

Where's the ‧Assisted' in Assisted Living?
When my mother-in-law, Eloise, finally agreed with her sons it was time to move into an assisted living facility (ALF) in New York City to be nearer to us, I felt a combination of excitement, anxiety, and something resembling having my chest colonized by hummingbirds. A sense of dread, perhaps, or maybe a visceral anticipation of what was to come. (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Authors: Ann D. Gross Tags: A Daughter-in-Law's Journal Source Type: news

2016 Medicare Fee Schedule: What You Should Know
The comments are in and shaping of the final Medicare Physician Fee Schedule for 2016 rests now in the hands of officials at the Centers for Medicare & Medicaid Services. What are key provisions doctors need to know about to practice successfully in 2016? Experts gave their opinions in a webinar sponsored by the American Health Lawyers Association (AHLA). (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Authors: Alicia Gallegos Source Type: news

NIH: Lives Saved With Lower Systolic Blood Pressure
Deaths were reduced by nearly one-quarter when systolic blood pressure was treated to a target of 120 rather than 140 mm Hg, according to a large National Institutes of Health–sponsored study comparing standard blood pressure treatment with more-intensive lowering of systolic blood pressure. The lower blood pressure group also saw a 30% reduction in the primary composite endpoint of cardiovascular events, stroke, and cardiovascular death. (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Authors: Kari Oakes Source Type: news

Hospital Trip May Not Mean Road to Recovery
Karl Steinberg, MD, CMD, talks about the risks and benefits of hospital stays for frail elders. (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Tags: Caring Source Type: news

From the November Issue of JAMDA
Individuals with early cognitive impairment who are more educated and have higher executive function are often more willing to engage in advance care planning, according to results from a study in Singapore. (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Tags: Journal Highlights Source Type: news

News From the Association
Three nationally known experts have been named to speak at AMDA's 2016 Annual Conference general sessions. The program is scheduled for March 17–20 in Orlando. (Source: Caring for the Ages)
Source: Caring for the Ages - October 30, 2015 Category: Health Management Source Type: news

Societies Help Guide LGBT Care Conversation
With same-sex marriage now the law of the land, many PA/LTC facilities are seeking to implement policies and other initiatives to ensure and promote a safe, welcoming environment for lesbian, gay, bisexual, and transgender elders. Those who question the need or value of these policies may want to talk to Vassar Byrd, CEO of Rose Villa Senior Living in Portland, OR. After a radio spot aired about the community as a welcoming place for LGBT seniors, a delivery person came to Ms. Byrd in tears. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2015 Category: Health Management Authors: Joanne Kaldy Source Type: news

Overpayment Ruling Could Lead to Liability Lawsuits
In a novel decision, the U.S. District Court for the Southern District of New York has ruled that the 60-day clock to return overpayments to the government begins ticking when a health care provider receives notice that a potential overpayment exists, not when an overpayment is conclusively ascertained. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2015 Category: Health Management Authors: Alicia Gallegos Source Type: news

She's Not the Same Mother I Loved
Dear Dr. Jeff: (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2015 Category: Health Management Authors: Jeffrey Nichols Tags: Dear Dr. Jeff Source Type: news

Physical Activity, Omega-3 Supplements No Cognitive Panacea
Neither a physical activity program nor omega-3 long-chain polyunsaturated fatty acid supplements improved cognitive function in two separate studies of high-risk elderly patients reported online in the Journal of the American Medical Association. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2015 Category: Health Management Authors: Mary Ann Moon Source Type: news

Joint Commission Announces New Falls Prevention Tool
The Joint Commission recently announced a new online tool to address fall prevention in adult hospital patients. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2015 Category: Health Management Authors: Joanne Kaldy Source Type: news

Contemplating the Transitions of a ‧Poor Yorick'
If Prince Hamlet were present to contemplate contemporary issues — for example, scenes riddled with frail elders living in skilled nursing facilities — he might not simply ponder the merits of his own death, but rather how complex patients, within the health care continuum, could experience comprehensive, compassionate, and meaningful patient-centered care. He might ask what the medical system could do to educate, monitor, and manage his own relatives in an acceptable and satisfying way. He would be more occupied, considering how an act would play if his own “Yoricks” were to become ill, maybe ill e...
Source: Caring for the Ages - September 29, 2015 Category: Health Management Authors: Wayne S. Saltsman Tags: Caring Transitions Source Type: news

More Elders, Super Elders Undergoing Emergent Surgeries
CHICAGO — An increasing number of octogenarians are undergoing emergent abdominal surgeries, but the mortality associated with these procedures has not changed significantly, a national American College of Surgeons/National Surgical Quality Improvement Program analysis found. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2015 Category: Health Management Authors: Patricia Wendling Source Type: news

AAIC: Exercise Program Improved Mild Cognitive Impairment
WASHINGTON — A 3-month program of supervised aerobic exercise and strength training led to modest but statistically significant improvement in cognition in a pilot, single-center study that enrolled 15 patients with mild cognitive impairment. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2015 Category: Health Management Authors: Mitchel L. Zoler Source Type: news

Primary Care Screening Doubles Dementia Diagnosis Rate
WASHINGTON — A 7-minute screening tool nearly doubled the rate at which primary care physicians could identify elderly patients in their practices with dementia in a German study involving more than 6,800 community-dwelling people. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2015 Category: Health Management Source Type: news

EEG + Software Detects Early Conversion to Alzheimer's Disease
WASHINGTON — Electroencephalography combined with proprietary software can distinguish mild cognitive impairment from prodromal Alzheimer's disease years before clinical symptoms become evident, according to a longitudinal assessment of patient data from a memory clinic in Iceland. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2015 Category: Health Management Authors: Brian Hoyle Source Type: news

New Treatment Target for Hypothyroid in Elderly Patients
ESTES PARK, CO — The latest major guidelines on management of hypothyroidism create a new, looser treatment target for older patients. (Source: Caring for the Ages)
Source: Caring for the Ages - September 29, 2015 Category: Health Management Authors: Bruce Jancin Source Type: news