“As the interne…

“As the internet plays an increasingly central role in connecting Americans of all ages to news and information, government services, health resources, and opportunities for social support, these divisions are noteworthy—particularly for the many organizations and individual caregivers who serve the older adult population.”

–PewResearch Internet Project, Older Adults and Technology Use, April 2014

Read my blog post on Older Adults and the Digital Divide at the Center for Health, Media & Policy.

It’s Heart Health Month

I’m not a big fan of designating specific months to promote awareness of specific diseases — after all, disease management and prevention is important year ’round — but it does serve the purpose of making some noise about key  health issues.

rotator_4February is Heart Month; the American Heart Association, CDC, and other groups have ramped up the volume on heart health, disease awareness, and warning signs — an especially important message for women.

Many women in the U.S. still don’t realize that heart disease is their number one killer. Although heart disease is sometimes thought of as a “man’s disease,” around the same number of women and men die each year of heart disease in the United States.

Women are more likely to die following a heart attack than men are. Women are also more likely to experience delays in emergency care and to have treatment to control their cholesterol levels, according to the CDC.

Often, women have no outward signs of heart disease. Almost two-thirds (64%) of women who die suddenly of coronary heart disease have no previous symptoms. Others may describe chest pain that is sharp and burning and more often have pain in the neck, jaw, throat, abdomen, or back. Sometimes heart disease may be silent and not diagnosed until a woman has signs or symptoms of a heart attack, heart failure, an arrhythmia (abnormal heart rhythm), or stroke.

Black women are at highest risk of dying early from heart disease and stroke (78 preventable deaths per 100,000 people), followed by American Indian/Alaska Native (46 preventable deaths per 100,000 people), White (36 preventable deaths per 100,000 people), Hispanic (30 preventable deaths per 100,000 people), and Asian/Pacific Islander women (22 preventable deaths per 100,000 people).

Key risk factors for heart disease include high blood pressure, high LDL cholesterol, and smoking. About half of Americans (49%) have at least one of these three risk factors.

Several other medical conditions and lifestyle choices can also put people at a higher risk for heart disease, including:

  • Diabetes
  • Overweight and obesity
  • Poor diet
  • Physical inactivity
  • Excessive alcohol use

Also realize that you’re never “too young” for heart attack or stroke. Do you know the warning signs and symptoms?

A woman suffers a heart attack about every 90 seconds in the United States. If you think you or someone you know is having a heart attack, call 9-1-1 immediately. If you seek help quickly, treatment can save your life and prevent permanent damage to your heart muscle. Treatment works best if given within 1 hour of when symptoms begin.

Remember that the Affordable Care Act requires coverage of preventive care including blood pressure and cholesterol screening, obesity counseling, tobacco cessation counseling and diabetes screening for adults with high blood pressure — without a deductible or copay. Take advantage of annual well visits, get checked, exercise, and enjoy a balanced diet.

Your heart will thank you.

For more information, visit Go Red for Women or the CDC’s Million Hearts Campaign. And, check out this primer about heart disease on HealthyWomen.org

Sedentary Older Women Face Greater Risk of Premature Death

exerciseWe all know that exercise is crucial to better health. For older women however, that can often be challenging, particularly during the winter. But getting up and moving around for even 10 minutes at a time, several times a day, has a positive effect on all-cause mortality, according to a new study in the American Journal of Preventive Medicine.

Researchers from Cornell University looked at physical activity of nearly 93,000 postmenopausal American women found those with the highest amounts of sedentary time – defined as sitting and resting, excluding sleeping – died earlier than their most active peers. The association remained even when controlling for physical mobility and function, chronic disease status, demographic factors and overall fitness – meaning that even habitual exercisers are at risk if they have high amounts of idle time.

The study analyzed a multiethnic group of 92,234 post-menopausal women aged 50–79 years at baseline (1993–1998) who participated in the Women’s Health Initiative Observational Study through September 2010. They looked at the relationship between sedentary time and total cardiovascular disease (CVD); coronary heart disease (CHD); and cancer mortality among women who reported the greatest and least amount of sedentary time over this period. Independent of other health factors, those with 11 or more hours of self-reported inactivity were 12 percent more likely to die prematurely compared with women who reported four or fewer hours of sedentary time.

Sitting still for long periods negatively impacts health at every age, from “brain fog” to muscle deterioration. Prior studies estimated that life expectancy in the U.S. would increase by two years if people reduced sitting time to fewer than 3 hours per day. Among older adults, physical inactivity has been linked to depression, decreased muscle mass, poorer lung capacity, and higher blood pressure.

While some physical changes are attributed to normal aging processes, older adults who can maintain regular physical activity –– cardiovascular, strength, endurance, and flexibility – are less likely to need long term care, according to exercise science professor Len Kravitz, Ph.D. of the University of New Mexico. Additionally, strength and flexibility exercises may prevent falls and injuries by improving balance and mobility, manage stress, alleviate sleep problems, reduce cognitive decline, lower cost of care and improve overall mental outlook.

CDC surveillance data show that about 23.1 percent of adults aged 65-74 and 35.9 percent of adults aged 75 or older are inactive — engaging in no leisure time, household or physical activity.

Proper clinical evaluation and referral to physical therapy are important to assess physical function and develop an appropriate exercise “prescription” that older adults can safely fulfill. A recent clinical review in JAMA concluded that even frail elderly and those with mobility limitations can and should participate in appropriate physical activity “Addressing functional deficits and environmental barriers with exercise and mobility devices can lead to improved function, safety, and quality of life for patients with mobility limitations.”

Finding safe and affordable venues for seniors to exercise can be challenging — particularly in cities that are not considered “walkable.” Policy stakeholders and others who promote “aging in place” should factor in the need for physical activity as they develop long-range plans for more livable “age-friendly” communities.

Mark your calendar – 2014 ACA dates to know

Whether you signed up for a new insurance plan through one of the state exchanges, endured the glitches on the federal web site, or simply plan to keep the health insurance you already have, everyone will be affected by at least some Affordable Care Act provisions. Here are some key issues to be aware of this year:

Jan 1
Although this date has already come & gone, most of the remaining provisions of the Affordable Care Act went live at the start of the year for those who signed up by December 24. Millions of people who were previously unable to obtain affordable health insurance now have at least minimum benefits through health exchanges (assuming premiums are paid on time) or through Medicaid. Check the status of your state’s action on Medicaid expansion here.

Among the key provisions now in effect:

  • a “10 essential benefits” coverage requirement under all new plans
  • Insurance companies can’t turn people with pre-existing conditions away or drop people once they get sick
  • premiums for everyone – regardless of gender or health status, are the same as those for healthy men in new plans
  • caps on higher rates for older people
  • no more annual limit on care, and a maximum limit of $6,350 for individuals for out of pocket costs per year

The individual mandate is now in effect. Most Americans must have some type of insurance or pay a penalty on their 2014 income taxes.

Remember, premium subsidies are available to families with incomes between 133-400% of the federal poverty level to purchase insurance through the Exchanges, while cost sharing subsidies are available to those with incomes up to 250% of the poverty level.

Businesses with 50 or more full-time employees must offer insurance benefits to their employees, but they will not be subject to penalty until 2015.

Businesses with fewer than 25 employees may be eligible for a tax credit equal to 50 percent of the amount they contribute to the insurance premiums of their employees.

January 10
This is the cutoff for premium payments for those who enrolled in individual plans. Most insurers allowed a grace period for the first premium payment and will make coverage retroactive to January 1. However carriers have different rules – so check with your provider about when your payment is due, and how to pay if you haven’t received your first bill.

March 31
2014 open enrollment ends unless there is a qualifying life event like job loss, marriage, or birth of a child. This is the deadline for most people to get coverage to avoid a fine.

October 1
When some insurers began dropping beneficiaries from existing plans in late 2013 because plans were not ACA-compliant, intense pressure led to an administrative change which allowed companies to extend existing plans for another year. Experts predict complaints to skyrocket again, when insurers must certify that all policies meet ACA requirements.

November 4
Mid-term elections could be a strong indication of how well people like the Affordable Care Act. Obama will still have two more years left in his term to counter any additional Republican proposals to repeal all or part of the law.

November 15
2015 open enrollment begins for plans that take effect at the start of 2015. You can switch coverage from your 2014 plan if you want to during this time – through January 15, 2015.

In addition to all that’s happening with the ACA in 2014 — MedPage Today’s David Pittman highlights some important deadlines for CMS, provider, pharma and health IT companies.

Looks like anything but a dull year for health care.

Will Virtual Consults Solve the Provider Shortage?

I’ve attended several health conferences over the past couple of months and whether the conversations are about the Affordable Care Act allowing more people to get preventive care, using more home care instead of institutional care, or caring for our aging population, one topic that consistently comes up is the projected shortage of primary health care providers.

There are numerous ideas on the table to address this: expand scope of practice for nurse practitioners and physician assistants, provide incentives or loan forgiveness for med students willing to go into primary care, or use telemedicine to improve efficiency. All reasonable ideas… but I wonder about the latest telemedicine venture from a company called Doctor on Demand..

laptop and stethoscopeThis virtual venture allows anyone to have a face-to-face consult with a physician for $40 per visit — about the same as many insurance co-pays. Users can access a licensed US provider 24/7 from any computer, tablet or smartphone. They can discuss symptoms, ask questions, get answers to non-emergency medical questions, specialist referrals, and even obtain short-term prescriptions or refills.

“We created Doctor On Demand to help modernize and transform the health care system,” Adam Jackson, co-founder and CEO, Doctor On Demand said in a press release. “Our main goal is to ease the stress patients encounter while navigating the U.S. health care system and bring the focus back to quality and convenience for both patients and doctors. We’re helping patients receive high-quality medical care without having to leave their homes or offices, therefore cutting down time, cost and worry.”said in a press release,

Some of the common health issues the company says it can address include colds, rashes, coughs, sinus infections, muscle and sports injuries, pediatric care including fever and vomiting, eye problems, and urinary tract infections. All this without a provider ever laying hands on a patient. Instead, patients can upload high-resolution photos to help with diagnosis.

I’m a strong proponent of telemedicine — under the right circumstances. Maybe I’m just skeptical by nature, but I question this approach.

Telemedicine works well when there is an existing relationship between a patient and a provider who knows and understands that patient’s quirks, pre-existing conditions, compliance issues, outliers or other important factors affecting a his or her well-being.

Telemedicine works when there’s clinical documentation that supports referral to a specialist who may be 100 miles away from a rural clinic, or when a home health care nurse has an opportunity to check up on that patient in his or her home and make a comprehensive visual assessment. The VA, among others, has been using telemedicine successfully for many years – as an adjunct, not a total replacement.

When a clinician knows and understands a patient’s dynamics, routine observations and video chats absolutely can save time and costs. There are currently several bills in Congress that support expansion of virtual visits. But I don’t know if this is what they had in mind.

Can telemedicine work like it’s supposed to when a clinician has no knowledge of the patient aside from what’s presented via Web cam in a 10 minute chat?

There are still many unanswered questions.

How does a professional diagnose an unfamiliar patient without actually doing some of the physical assessments — checking for swollen lymph nodes, for example, or peering down a patient’s sore throat or into the sinuses? How many prescriptions will be handed out unnecessarily? What if that “minor” issue is really more serious than the patient lets on?

Many people will see this type of “virtual” care as a plus — no travel or waiting times, instant gratification. Fast has its place. What about thorough?

I’ll be following the concept of virtual practices with curiosity. Perhaps they will prove to be just the panacea the health care world needs. Perhaps not. Stay tuned.

Photo credit: jfcherry / Foter.com / CC BY-SA