RI ARA March 24, 2019 E-Newsletter by RI ARA

Publication 20119 Issue 13 Published in house by the RI ARA

March 24, 2019 E-Newsletter

Health Plans For State Employees Use Medicare’s Hammer On Hospital Bills .States. They’re just as perplexed as the rest of us over the ever-rising cost of health care premiums. Now some states are moving to control costs of state employee health plans. And it’s triggering alarm from the hospital industry. The strategy: Use Medicare reimbursement rates to recalibrate how they pay hospitals. If the gamble pays off, more private-sector employers could start doing the same thing. “Government workers will get it first, then everyone else will see the savings and demand it,” said Glenn Melnick, a hospital finance expert and

professor at the University of Southern California. “This is the camel’s nose. It will just grow and grow.” In North Carolina, for instance, state Treasurer Dale Folwell next year plans to start paying hospitals Medicare rates plus 82 percent, a figure he said would provide for a modest profit margin while saving the state more than $258 million annually. “State workers can’t afford the family premium [and other costs]. That’s what I’m trying to fix,” he said. The estimated $60 million in savings to health plan members, he said, would mainly

come from savings in out-of-pocket costs. That approach differs from the traditional method of behind-thescenes negotiating, in which employers or insurers ask for discounts off hospital-set charges that rise every year and generally are many times the actual cost of a service. Privateinsurer payments, even with those discounts, can be double or triple what Medicare would pay. This state-level activity could be a game changer, fueling a broad movement toward lower hospital payments. Montana’s state employee program made

the adjustment two years ago; Oregon will start this fall. Delaware’s state employee program is also considering such “Medicare-based contracting” as one of several options to lower spending. The bold move comes as other factors — notably marketplace competition among hospitals and high-deductible insurance plans aimed at getting consumers to “shop” for lower prices — have largely failed to slow rising health care premiums. For hospitals, though, it can be viewed as “an existential threat,” said USC’s Melnick...Read More

Many Older Adults with Medicare Not Getting the Long-Term Help They Need A new study by the Commonwealth Fund examines the use of longterm services and supports (LTSS) among Medicare beneficiaries age 65 and older, and finds that the Medicare program is falling behind in offering the supports many older adults need. Currently, Medicare does not broadly

cover most types of LTSS that could help older adults and people with disabilities remain in their homes and communities as they age. While Medicare Advantage does cover some limited LTSS, this coverage is

spotty, and does not apply to the

environmental modifications, or caregivers to accomplish what are known as activities of daily living, or ADLs. ADLs are everyday self-care tasks like approximately two-thirds of walking, feeding yourself, Medicare beneficiaries who rely dressing and grooming, on Original Medicare. toileting, bathing, or transferring As average life expectancy from one body position to has lengthened, more people are another. ...Read More relying on assistive devices,

Connecticut Alliance President Bette Marafino Testifies about Social Security Expansion on Capitol Hill The House Ways and Means Social Security Subcommittee held the second hearing in its series on “Protecting and Improving Social Security” on Wednesday. Bette Marafino, President of the Connecticut Alliance for Retired Americans, testified and shared several retirees’ stories that vividly

demonstrated the challenges facing older Americans. Rep. John Larson of Connecticut is the subcommittee chair.

"To ensure all Americans have the dignified retirement they have earned after a lifetime of work, the Alliance for Retired Americans urges

Congress to expand Social Security and increase earned benefits for current and future beneficiaries," said President Marafino. Watch an interview Ms. Marafino gave prior to her testimony here.

Rhode Island Alliance for Retired Americans, Inc. • 94 Cleveland Street • North Providence, RI • 02904-3525 • 401-480-8381 riarajap@hotmail.com • http://www.facebook.com/groups/354516807278/

Costly Confusion: Medicare’s Wellness Visit Isn’t The Same As An Annual Physical .When Beverly Dunn called her new primary care doctor’s office last November to schedule an annual checkup, she assumed her Medicare coverage would pick up most of the tab. The appointment seemed like a routine physical, and she was pleased that the doctor spent a lot of time with her. Until she got the bill: $400. Dunn, 69, called the doctor’s office assuming there was a billing error. But it was no mistake, she was told. Medicare does not cover an annual physical exam. Dunn, of Austin, Texas, was tripped up by Medicare’s confusing coverage rules. Federal law prohibits the health care program from paying for annual physicals, and patients who get them may be on the hook for the entire amount. But beneficiaries pay nothing for an “annual wellness visit,” which the program covers in full as a preventive service. “It’s very important that someone, when they call to make an appointment, uses those magic words, ‘annual wellness visit,’” said Leslie Fried, senior director of the Center for Benefits Access at the National Council on Aging. Otherwise, “people think they are making an appointment for an annual wellness visit and it ends up they are having a complete physical.” An annual physical typically involves an exam by a doctor along with bloodwork or other tests. The annual wellness visit generally doesn’t include a physical exam, except to check routine measurements such as height, weight and blood pressure. The focus of the Medicare wellness visit is on preventing disease and disability by coming up with a “personalized prevention plan” for future medical issues based on the beneficiary’s health and risk factors.

At their first wellness visit, patients will often fill out a riskassessment questionnaire and review their family and personal medical history with their doctor, a nurse practitioner or physician assistant. The clinician will typically create a schedule for the next decade of mammograms, colonoscopies and other screenings and evaluate people for cognitive problems and depression as well as their risk of falls and other safety issues. They may also talk about advance care planning with beneficiaries to make decisions about what type of medical treatment they want in the future if they can’t make decisions for themselves. At subsequent annual wellness visits, the doctor and patient will review these issues and check basic measurements. Beneficiaries can also receive other covered preventive services such as flu shots at those visits without charge. When the Medicare program was established more than 50 years ago, its purpose was to cover the diagnosis and treatment of illness and injury in older people. Preventive services were generally not covered, and routine physical checkups were explicitly excluded, along with routine foot and dental care, eyeglasses and hearing aids. Over the years, preventive services have gradually been added to the program, and the Affordable Care Act established coverage of the annual wellness visit. Medicare beneficiaries pay nothing as long as their doctor accepts Medicare. However, if a wellness visit veers beyond the bounds of the specific covered preventive services into diagnosis or treatment — whether at the

urging of the doctor or the patient — Medicare beneficiaries will typically owe a copay or other charges. (This can be an issue when people in private plans get preventive care, too. And it can affect patients of all ages. The ACA requires insurers to provide coverage, without a copay, for a range of preventive services, including immunizations. But if a visit goes beyond prevention, the patient may encounter charges.) And to add more confusion, Medicare beneficiaries can opt for a “Welcome to Medicare” preventive visit within the first year of joining Medicare Part B, which covers physician services. Meanwhile, some Medicare Advantage plans cover annual physicals for their members free of charge. Many patients want their doctor to evaluate or treat chronic conditions like diabetes or arthritis at the wellness visit, said Dr. Michael Munger, who chairs the board of the American Academy of Family Physicians. But Medicare generally won’t cover lab work, such as cholesterol screening, unless it’s tied to a specific medical condition. At Munger’s practice in Overland Park, Kan., staffers routinely ask patients who come in for a wellness visit to sign an “advance beneficiary notice of noncoverage” acknowledging that they understand Medicare may not pay for some of the services they receive. As long as beneficiaries understand the coverage rules, it’s not generally a problem, Munger said. “They don’t want to come back for a separate visit, so they just understand that there may be extra charges,” he said. Beneficiaries may not be the only ones who are unclear about what an annual wellness visit involves, said Munger.

Providers may be put off if they think that it’s just another task that adds to their paperwork. A recent study published in the journal Health Affairs found that in 2015 just over half of practices with eligible Medicare patients didn’t offer the annual wellness visit. That year, 18.8 percent of eligible beneficiaries received an annual wellness visit, the analysis found. Primary care physicians generally want to see their patients at least once a year, Munger said, but it needn’t be for a complete physical exam. A wellness visit or even a visit for a sprained ankle could give doctors an opportunity to check in with patients and make sure they’re on track with preventive and other care, Munger said. When Dunn called the doctor’s office about the $400 bill, she said, the staff told her she had signed papers agreeing to pay whatever Medicare didn’t cover. Dunn doesn’t dispute that. “There were lots of papers that I signed,” she said. “But nobody told me I would get a bill for $400. I would remember that.” In the end, the clinic waived all but $100 of the charge, but warned her that next year she’ll have to pay $300 if she wants an annual physical with that doctor. If she comes in just for an annual wellness visit, she’ll be seen by a physician assistant. Dunn is considering her options. She would like to stay with her new doctor, who came highly recommended, and she’s worried she might have trouble finding another one just as good who accepts Medicare. But $300 seems steep to her for a checkup. “This whole thing was so stressful for me,” she said. “I lost sleep for nights. It’s not that I couldn’t afford it, but it didn’t seem right.”

Nursing Home Fines Drop As Trump Administration Heeds Industry Complaints The Trump administration’s decision to alter the way it punishes nursing homes has resulted in lower fines against many facilities found to have endangered or injured residents. The average fine dropped to $28,405 under the current administration, down from $41,260 in 2016, President Barack Obama’s final year in office, federal records show. The decrease in fines is one of the starkest examples of how the Trump administration is rolling back Obama’s aggressive regulation of health care services in response to industry prodding. Encouraged by the nursing home industry, the Trump administration switchedfrom fining nursing homes for each day they were out of compliance — as the Obama administration typically did — to issuing a single fine for two-thirds of infractions, the records show.

That reduces the penalties, giving nursing homes less incentive to fix faulty and dangerous practices before someone gets hurt. “It’s not changing behavior [at nursing homes] in the way that we want,” said Dr. Ashish Jha, a professor at the Harvard T.H. Chan School of Public Health. “For a small nursing home it could be real money, but for bigger ones it’s more likely a rounding error.” Since Trump took office, the administration has heeded multiple nursing home complaints about zealous oversight. It granted facilities an 18-month moratorium from being penalized for violating

eight new health and safety rules. It also revoked an Obama-era rule barring homes from preemptively requiring residents to submit to arbitration to settle disputes rather than go to court. The slide in fines occurred even as the Centers for Medicare & Medicaid Services issued financial penalties 28 percent more frequently than it did under Obama. That’s due to a policy begun near the end of Obama’s term that required regulators to punish a facility every time a resident was harmed, instead of leaving it to their discretion. While that policy increased

the number of smaller fines, larger fines became less common. The total amount collected under Trump fell by 10 percent compared with the total in Obama’s final year, from $127 million under Obama to $114 million under Trump. (KHN compared penalties during 2016, Obama’s last year in office, with penalties under Trump from April 2017 through March 2018, the most recent month for which federal officials say data is reliably complete.) CMS said it has revised multiple rules governing fines under both administrations to make its punishments fairer, more consistent and better tailored to prod homes to improve care. “We are continuing to analyze the impact of these combined events to determine if other actions are necessary,” CMS said in a statement. ….Read More

President’s Budget Targets Key Health Care Programs The President’s annual budget request is a statement of values. It is incredibly troubling then, that President Trump’s budget blueprint for FY 2020, submitted this week, again prioritizes deep cuts to programs on which older adults and people with disabilities rely, including Medicare, Medicaid, and the Affordable Care Act. The President’s FY 2020 budget includes harmful policy and payment changes that would impose barriers to care for people with Medicare. Among other things, the administration’s proposal would curtail Medicare beneficiaries’ appeal rights and increase the amount many would pay for needed prescriptions. It would also jeopardize beneficiary access

to critical services by significantly cutting provider payments and greatly expanding prior authorization in traditional Medicare in a manner that could incentivize health care providers to stint on care for those with ongoing, chronic conditions. The budget would be particularly devastating for people with Medicare who also rely on Medicaid, as it would cut the program by over $1.4 trillion in the next decade, transform it into a block grant or per-capita cap system, and end Medicaid expansion. Gutting Medicaid would lead to the rationing of care and could force many low-income seniors and people with disabilities out of

their homes and into more costly institutional settings. In addition, the proposed policies would endanger Medicaid coverage for struggling families by imposing punitive coverage restrictions and administrative barriers such as work requirements and asset tests. Further, the budget renews the administration’s efforts to repeal the Affordable Care Act and replace it with something similar to the failed 2017 Graham-Cassidy plan. That approach was widely reviled by the American people, in large part because it would have ended health coverage for millions and restricted access for millions more. Whether in the President’s

budget or a stand-alone bill, any plan that would reduce coverage, weaken protections for people with pre-existing conditions, or make devastating cuts to Medicare, Medicaid, or the Affordable Care Act was, and always will be, unacceptable. Similar to last year’s request, the President’s FY 2020 budget is full of damaging policies that would make it harder for older adults, people with disabilities, and working families to meet their basic needs. We urge Congress and the administration to reject this flawed budget, and to instead pursue bipartisan solutions that prioritize the health and well-being of all Americans….Read More

Updated Federal Poverty Guidelines Announced Each year, the Department of Health and Human Services (HHS) updates the federal poverty guidelines, which ar e then used to determine eligibility for programs including Medicaid, the Low Income Subsidy for Part D (LIS), and Medicare Savings Programs. The 2019 guidelines for the 48 contiguous states and DC* are:  $12,490 for a household of 1  $16,910 for a household of 2  $25,750 for a household of 4 These amounts are established by federal law, which requires the Secretary of HHS to update them based on the Consumer

Price Index for All Urban Consumers (CPI-U). The CPIU is a measure of inflation, or the amount that the cost of certain goods and services has increased over time. The previous poverty guideline amounts are multiplied by the CPI-U number, then rounded and adjusted for family size. Some government programs that rely on the guidelines to determine eligibility use the numbers directly, while other programs use a percentage multiplier. For example, the income limit for LIS, which is

also called Extra Help, is 138% of the federal poverty guideline. Various programs also have specific rules about how income is counted. For example, for Medicare Savings Program applications, earned income is calculated at about 50%, so if a person’s income is largely from wages, they might seem to be over the income limit for a program but actually qualify. If you or a friend or family member believe that you might be eligible for a federal program or assistance, or your income is close to the limits for those

programs, Medicare Rights encourages you to learn more and apply. *The guidelines for Alaska and Hawaii are different, and published in a separate chart. In Puerto Rico and other outlying jurisdictions, Federal programs may use the contiguous states and DC guidelines or the office that administers the program can use a different procedure. Learn more about the Medicare Savings Programs. Learn more about the Extra Help/LIS Program.

Death By A Thousand Clicks The U.S. government claimed that turning American medical charts into electronic records would make health care better, safer, and cheaper. Ten years and $36 billion later, the system is an unholy mess. Inside a digital revolution gone wrong. The pain radiated from the top of Annette Monachelli’s head, and it got worse when she changed positions. It didn’t feel like her usual migraine. The 47year-old Vermont attorney turned innkeeper visited her local doctor at the Stowe Family Practice twice about the problem in late November 2012, but got little relief. Two months later, Monachelli was dead of a brain aneurysm, a condition that, despite the symptoms and the appointments, had never been tested for or diagnosed until she turned up in the emergency room days before her death. Monachelli’s husband sued Stowe, the federally qualified health center the physician worked for. Owen Foster, a newly hired assistant U.S. attorney with the District of Vermont, was assigned to defend the government. Though

it looked to be a standard medical malpractice case, Foster was on the cusp of discovering something much bigger — what his boss, U.S. Attorney Christina Nolan, calls the “frontier of health care fraud” — and prosecuting a first-of-itskind case that landed the largestever financial recovery in Vermont’s history Foster began with Monachelli’s medical records, which offered a puzzle. Her doctor had considered the possibility of an aneurysm and, to rule it out, had ordered a head scan through the clinic’s software system, the government alleged in court filings. The test, in theory, would have caught the bleeding in Monachelli’s brain. But the order never made it to the lab; it had never been transmitted. The software in question was an electronic health records system, or EHR, made by eClinicalWorks (eCW), one of the leading sellers of recordkeeping software for physicians in America, currently used by 850,000 health professionals in the U.S. It didn’t take long for Foster to assemble a dossier of

troubling reports — Better Business Bureau complaints, issues flagged on an eCW user board, and legal cases filed around the country — suggesting the company’s technology didn’t work quite the way it said it did. Until this point, Foster, like most Americans, knew next to nothing about electronic medical records, but he was quickly amassing clues that eCW’s software had major problems — some of which put patients, like Annette Monachelli, at risk. Damning evidence came from a whistleblower claim filed in 2011 against the company. Brendan Delaney, a British cop turned EHR expert, was hired in 2010 by New York City to work on the eCW implementation at Rikers Island, a jail complex that then had more than 100,000 inmates. But soon after he was hired, Delaney noticed scores of troubling problems with the system, which became the basis for his lawsuit. The patient medication lists weren’t reliable; prescribed drugs would not show up, while discontinued drugs would appear as current, according to the complaint. The

EHR would sometimes display one patient’s medication profile accompanied by the physician’s note for a different patient, making it easy to misdiagnose or prescribe a drug to the wrong individual. Prescriptions, some 30,000 of them in 2010, lacked proper start and stop dates, introducing the opportunity for under- or overmedication. The eCW system did not reliably track lab results, concluded Delaney, who tallied 1,884 tests for which they had never gotten outcomes…..Read More

Competitive Bidding Program Temporarily Lapses—Expected to Begin Again in 2021 On January 1, 2019, the durable medical equipment (DME) competitive bidding program temporarily ended. The competitive bidding program was originally designed to reduce out-of-pocket expenses and help ensure that people with Medicare had access to quality DME, supplies, and services from suppliers they could trust. The program benefited people who had Original Medicare, lived in a competitive bidding area, and needed DME that fell under the competitive bidding program. Under this program, suppliers submitted bids to Medicare to say how much they would charge for DME, and then Medicare used these bids to set DME prices. Suppliers who agreed to provide DME at the rate that Medicare set were called contract suppliers. If an Original Medicare beneficiary lived in a competitive bidding area and was prescribed DME affected by the program, they had to use a contract supplier— one who would supply the product for the price Medicare had determined through the

bidding process and meet other Medicare requirements. The latest supplier contracts ended on December 31, 2018, and Medicare did not move forward with the process needed to continue the program. This temporary end to the competitive bidding program is expected to last two years, until December 31, 2020. New proposals for the details of the next bidding process are underway. The revised program, with different bidding rules, should begin in 2021. Bids would be taken in 2020, and new contract suppliers would be named in 2021. During the lapse in the competitive bidding program, there will be no contract suppliers. This means that a beneficiary can get DME from any supplier who is enrolled in Medicare. Most beneficiaries will not need to switch suppliers and can continue to use the same supplier they used in 2018. Instances when a beneficiary

may need to switch suppliers include if they permanently move outside of their supplier’s normal service area, or if their current supplier is unwilling to continue providing DME on or after January 1, 2019. Advice from Medicare Rights If you have Original Medicare and need new DME, you can use the online Medicare Supplier Directory or call 1-800MEDICARE to locate a supplier. It is important that you choose a supplier who is enrolled in Medicare and takes assignment. If the supplier does not take assignment, you could be responsible for paying a higher out-of-pocket cost. Capped rental items and oxygen equipment If you have a capped rental item (meaning an item that Medicare covers for rental first, rather than purchase, because of its high cost), your provider must continue to provide your item through the rest of your 13month rental period. After 13 months, you will own the

equipment. Examples of capped rental items include wheelchairs and hospital beds. If you have oxygen equipment, your supplier must continue to provide oxygen and equipment through the rest of your 36-month rental period. After the 36th month in a row, the supplier must continue to provide oxygen and oxygen equipment for the rest of the equipment’s lifetime as long as you still have the medical need. The exception is if you travel or permanently move outside of your supplier’s service area. In that case, the supplier must connect you with a new supplier in your area once the 36-month rental period is over. Throughout the temporary gap period, you should be aware of aggressive marketing by suppliers. You should be cautious about anyone trying to persuade you to switch suppliers, and should first speak with your current supplier to determine if you need to make a change. For more information about durable medical equipment, visit Medicare Interactive.

Social Security Fairness: Repeal the GPO/W EP Our Goal is to Repeal the GPO and WEP:  Educate: Inform the public about the injustice of the GPO and WEP, two Social Security provisions which penalize 1/3 of all educators and 1/5 of all public employees.  Motivate: Energize all affected, both active and retired, to speak up for justice.  Activate: Coordinate with all professional organizations affected in efforts to repeal the GPO/WEP. he Government Pension Offset (GPO) and the Windfall Elimination Provision (WEP) deny retirement benefits earned by public workers in America. If you earn even part of a

Social Security Fairness Repeal the Government Pension Offset and the Windfall Elimination Provision

public pension from a government job that doesn't pay into Social Security (FICA), you can lose all or part of your earned Social Security retirement benefits. Rodney Davis introduces House bill to Repeal the GPO & WEP! See where your representative stands on Bill H.R. 141 Sen. Sherrod Brown introduces Senate bill to amend title II of the Social Security Act to Repeal the GPO & WEP: S.521 Windfall Elimination Provision (WEP)

An amount up to half the value of your pension can be cut from the Social Security you have earned in other work in which you paid the required FICA taxes. Government Pension Offset (GPO) If you are married to someone who is earning Social Security, you will probably lose all Social Security spousal or survivor retirement benefits due to you from taxes paid by your spouse during the marriage. What YOU can do now: Sign up for our Action

Alert and participate in our coordinated monthly protest. If you miss an Alert, check the website. ALL THE ALERTS STILL POSTED ON THIS WEBSITE ARE RELEVANT. YOU CAN STILL DO THEM! Use D.C. Action to get your message to Washington. Local Action has ideas and tools to help you spread the word and get support from your family, friends and colleagues. GPO/WEP Explained will give you more detailed information about the offsets. Also, Calculate Your Offset. Allies — has other organizations that have links to this site and and to many groups working for repeal….Read More

2019 SENIOR SURVEY Tell Us What You Think! Your responses to this survey will help inform the public and members of Congress on issues affecting older Americans. You will also help us bring you better services to meet your needs and priorities. The results will help craft The Senior Citizens League’s legislative agenda and represent your interests on Capitol Hill. Your answers are vitally important and will be kept anonymous. Thank you! ….Click Here To Take Survey

Discussing Financial and Life Changes with Your Doctor It helps the doctor—and you—if he or she knows about the non-medical parts of your life. Where you live, how you get around, and what activitiesare important to you—these are all things that can make a difference in decisions about your health care. The following are some examples of practical matters you might want to discuss with your doctor. For additional information and resources on these topics, see the resources at the end of this article. Planning for Care in the Event of a Serious Illness You may have some concerns or wishes about your care if you become seriously ill. If you have questions about what choices you have, ask your doctor. You can specify your desires through documents called advance

directives, such as a living will or healthcare proxy. One way to bring up the subject is to say: “I’m worried about what would happen in the hospital if I were very sick and not likely to get better. Can you tell me what generally happens in that case?” In general, the best time to talk with your doctor about these issues is while you are still relatively healthy. Medicare and private health insurance may cover these discussions with your doctor. If you are admitted to the hospital or a nursing home, a nurse or other staff member may ask if you have any advance directives. Learn more about advance care planning. Driving

Driving is an important part of everyday life for many people, and making the decision to stop driving can be very difficult. Tell your doctor if you or people close to you are concerned about your driving and why. He or she can go over your medical conditions and medications to see if there are treatable problems that may be contributing to driving difficulties. Find out more about older drivers. Moving to Assisted Living Another hard decision that many older people face is whether or not to move to a place where they can have more help—often an assisted living facility. If you are considering such a move, your doctor can

help you weigh the pros and cons based on your health and other circumstances. He or she may be able to refer you to a social worker or a local agency that can help in finding an assisted living facility. Read more information about long-term care. Paying for Medications Don’t hesitate to ask the doctor about the cost of your medications. If they are too expensive for you, the doctor may be able to suggest less expensive alternatives. You can ask if there is a generic or other less expensive choice. You could say, for instance: “It turns out that this medicine is too expensive for me. Is there another one or a generic drug that would cost less?”...Read More

Trump Proposes Cutting Postal Employees’ Pay, Benefits in $100B Savings Package President Trump’s postal reform task force recommended on Tuesday that the U.S. Postal Service eliminate the ability of employees to negotiate over compensation and develop a dual-tiered pricing model—one for essential services and another for deliveries deemed to have a profit motive. Led by the Treasury Department, the task force completed its reportand delivered recommendations to the White House in August. But the administration decided to keep the report’s findings secret until after last month’s midterm elections, and to delay implementation until a new Congress is installed in January. Trump launched the task

force, made up of officials at Treasury, the Office of Management and Budget and the Office of Personnel Management, through an executive order in April in an effort to tackle the Postal Service’s perennial financial problems. The task force concluded that the Postal Service's troubles stem from providing delivery for commercial entities at below-market rates, combined with lagging volumes of mail delivery and onerous labor costs, both in compensation and retiree health benefits. “The shift toward digital correspondence and the corresponding decline in USPS

mail volume have been compounded by caps on mail pricing, leading to mail revenue declines of around 4 percent per year,” a senior administration official told reporters Tuesday. “Additionally, the USPS has not been able to sufficiently reduce costs to offset declines in revenue, resulting in net losses totaling $69 billion since fiscal 2007.” Officials said that the task force stopped short of calling for the privatization of the Postal Service because of its “financial state,” but suggested several ways to reduce the labor costs associated with nationwide mail delivery, chief among them

ending the ability for postal workers to negotiate over pay. “USPS’ dual-labor model— combining private sector collective bargaining law with government employee compensation law—creates unsustainable labor costs,” the report stated. “USPS employee rights should be more closely aligned with other federal employee rights by eliminating collective bargaining over compensation.” “USPS employees should not be afforded protections and rights not enjoyed by other federal employees,” the group wrote….Read More SIGN UP FOR OUR POSTAL NEWS BLAST!

RI ARA HealthLink Wellness News

Oral Health Care Remains an Important Missing Piece of Medicare Oral health is an integral part of overall health. Medicare does not cover routine dental care, and the majority of people on Medicare have no dental coverage at all. According to a new Kaiser Family Foundation report, nearly 37 million Medicare beneficiaries lack dental insurance coverage and must pay out of pocket for dental care. The amount spent is significant; in 2016 19% of Medicare beneficiaries who used

dental services spent more than $1,000 outof-pocket on dental care. “Dental coverage should be included under Medicare. The Alliance is engaged with our allies on Capitol Hill to make that happen,” said Robert Roach, Jr., President of the Alliance. "When you combine having no dental benefits and paying too much for their prescription drugs, many

seniors end up having to choose between food and medicine." Untreated cavities and gum disease can exacerbate certain diseases, such as diabetes and cardiovascular disease, and lead to chronic pain, infections, and loss of teeth. Lack of routine dental care can also delay diagnosis of conditions, which can lead to potentially preventable complications, high-cost

emergency room visits, and adverse outcomes. Limited or no dental insurance coverage can result in relatively high out-of-pocket costs for some and foregone oral health care for others. Almost half of all Medicare beneficiaries did not have a dental visit within the past year (49%), with higher rates among those who are black (71%) or Hispanic (65%) and have low incomes (70%), as of 2016.

Heart Attacks Fall By One-Third Among Older Americans A groundbreaking new study holds heartening news for older Americans. Since the mid-1990s, the number of seniors who suffered a heart attack or died from one dropped dramatically -evidence that campaigns to prevent heart attacks and improve patient care are paying off, Yale University researchers said. The study of more than 4 million Medicare patients found that hospitalizations for heart attacks dropped 38 percent between 1995 and 2014. At the same time, deaths within 30 days of a heart attack reached an all-time low of 12 percent, down more than one-third since 1995. "This is really amazing progress," said lead researcher Dr. Harlan Krumholz, a professor of cardiology. The study looked at Medicare patients because people 65 and older have the highest risk for heart attack, and account for as many as two-thirds of them, he said. The turnaround stems from major efforts to change people's lifestyles to reduce heart attacks, and also to improve care so more patients survive

one, Krumholz said. Since the 1990s, the U.S. Centers for Medicare and Medicaid, the American Heart Association (AHA), the American College of Cardiology and other organizations have emphasized prevention. The efforts have focused on lifestyle changes, including adoption of healthy eating habits and getting more exercise. They have also helped patients reduce their blood pressure and cholesterol, two key contributors to heart attack. In-hospital care is also better now than it was in the 1990s, Krumholz said. Patients who arrive at the hospital with a heart attack are now treated within minutes, using procedures to open blocked arteries, rather than the hours it used to take, he noted. And more patients are leaving the hospital with prescriptions for blood pressure drugs, aspirin and statins, which help prevent a repeat heart attack. Though costs associated with heart attacks have increased,

preventing them and improving survival ends up saving money on other health care costs, Krumholz added. But the picture isn't entirely rosy. Some places have seen little or no change in heart attacks since the 1990s. These areas need special attention to improve care, Krumholz said. In addition, the obesity epidemic, along with its associated increase in type 2 diabetes, threatens to undermine the reported gains, he added. That's because obesity and diabetes are prime risk factors for heart attacks, raising blood pressure and damaging blood vessels. "It's not a time to rest on our laurels or become complacent," Krumholz said. "We believe there are still improvements possible. We'd like to see heart attacks relegated to the history of medicine." Dr. John Osborne, a volunteer expert with the American Heart Association, agreed. "It is wonderful to celebrate these advances, but still one person in the U.S. dies of

cardiovascular disease every 38 seconds, and it continues to be the greatest killer of Americans," he said. "[These are] wonderful advances in the war against heart disease, but our war is still not finished." AHA spokesman Dr. Gregg Fonarow said much more remains to be done. "The majority of the myocardial infarctions [heart attacks] still occurring could be prevented with better implementation of evidencebased primary and secondary prevention strategies," Fonarow said. The report was published online March 15 in JAMA Network Open. More information To learn more about heart attack, visit the American Heart Association.

10 minutes of leisurely activity per week may lower death risk New research suggests that adults over the age of 40 who engage in leisurely physical activity — such as dancing, gardening, or going for a walk — for even a short amount of time each week may have a lower risk of death from multiple causes. Previous research has shown that engaging even in low-level physical activity — including leisurely tasks, such as gardening — may help protect brain health and cardiovascular health, among other benefits. Now, a recent observational study, working with tens of thousands of people aged 40 and over has found a link between a

lower risk of death from different causes and low levels of physical activity. This was a collaborative study by researchers from the Shandong University in Jinan, China, the University of Texas Medical Branch in Galveston, and the University of Minnesota in Minneapolis, as well as from other research institutions. The research — whose results appeared yesterday in the British Journal of Sports Medicine — indicate that people who spend even a short time each week being physically active have a lower risk of death linked to cardiovascular, cancer, and all-

cause mortality. At the same time, the study authors note that participating in more intense types of exercise, including running and cycling, do have the potential to bring more significant health benefits. Even low-level activity cuts death risk The researchers analyzed data collected through the National Health Interview Surveys — a series of yearly surveys that ask people from the United States to offer information about their health and lifestyle habits. First author Min Zhao and colleagues looked at information gathered in 1997–2008 from 88,140 adults in the U.S., with

ages ranging from 40 to 85. They also collated that data, which referred to health and physical activity practices, with information from national death registers, available up to the end of 2011. For reference, the team estimated that 1 minute of vigorous exercise would equate to 2 minutes of moderate-intensity activity, such as gardening, dancing, or going for a brisk walk. In their analysis, the researchers only included physical activities that lasted for 10 or more minutes at one time….Read More

Is high blood pressure always bad? Hypertension, or high blood pressure, is a risk factor for several health conditions, including cardiovascular problems, diabetes, and other metabolic issues. However, is high blood pressure always a cause for concern? New findings question that assumption. Up to 75 million adults in the United States have high blood pressure, according to the Centers for Disease Control and Prevention (CDC). What is high blood pressure?

Well, it is hard to accurately answer that question, as specialists are still debating what counts as normal blood pressure. Different organizations currently offer different guidelines on high blood pressure. For instance, the National Heart, Lung, and Blood Institute explain that, among adults, hypertension is a "consistent systolic reading of 140 mm Hg [millimiters of mercury] or higher."

However, the American Heart Association (AHA) suggest that hypertension occurs when a person has a systolic blood pressure of 130 mm Hg or above. Meanwhile, the CDC consider people with systolic blood pressure of 120– 139 mm Hg as being only "at risk" of hypertension. Generally speaking, doctors advise their patients — especially older adults — to keep monitoring their own blood pressure and keep it in

check. This is to make sure that it does not reach the threshold for hypertension, which many healthcare professionals consider to be a risk factor for heart disease and stroke, among other things. Now, however, a study that researchers at Charité Universitätsmedizin Berlin in Germany carried out suggests that some older people may not face other health problems if they have high blood pressure….Read More

Napping may be as good as drugs for lowering blood pressure A midday nap may be just what you need, not just to boost your energy levels but also to lower high blood pressure. This, at least, is what new research from Greece suggests. When the afternoon slump hits in the middle of a busy workday, many of us may feel tempted to catch some shut-eye in a quiet corner. Daytime napping can definitely help boost our energy levels and productivity for the rest of the workday, but does it bring any other health benefits?

A new study that investigators from the Asklepieion General Hospital in Voula, Greece conducted now suggests that taking a nap at midday can effectively help people lower their blood pressure levels. One of the study researchers, Dr. Manolis Kallistratos, is due to present the findings at the American College of Cardiology's 68th Annual Scientific Session in New Orleans, LA next Monday.

"Midday sleep appears to lower blood pressure levels at the same magnitude as other lifestyle changes. For example, salt and alcohol reduction can bring blood pressure levels down by 3 to 5 [millimeters of mercury (mmHg)]," reports Dr. Kallistratos. In this study, the investigators worked with 212 participants who had a mean blood pressure of 129.9 mm Hg. According to guidelines from the National

Heart, Lung, and Blood Institute, a person has high blood pressure if their readings of systolic blood pressure (pressure during a heartbeat) are 140 mm Hg or higher, and their readings of diastolic blood pressure (pressure between heartbeats) are 90 mm Hg or higher. The participants were, on average, 62 years old, and close to one in four of them smoked, had a diagnosis of type 2 diabetes, or both...Read More