The U.S. Centers for Medicare and Medicaid Services (CMS) has launched a five-year project to retool how Medicare pays for emergency treatment following a 911 call, reports Politico Pro . The ET3 voluntary payment experiment will offer a new approach for healthcare providers to conduct emergency triage, treatment, and transportation. CMS will pay participating ambulance teams to transport beneficiaries to hospital emergency departments, as well as to places such as a primary care physician's office, or to deliver on-the-spot care under the supervision of a qualified practitioner or via telehealth. Medicare currently pays only for emergency ambulance trips to hospitals, skilled nursing communities, or dialysis centers. That means most beneficiaries are likely to be brought to a hospital following a 911 call. Department of Health and Human Services Secretary Alex Azar said the ET3 model is designed to help beneficiaries "get convenient, appropriate treatment in whatever setting makes sense for them." The project is one of the first payment models to be issued by the CMS Innovation Center under the leadership of director Adam Boehler.

A Harvard University study published in Health Affairs determined the per-beneficiary growth rate of Medicare spending decelerated from 1992 to 2012, reports Forbes . Program spending per enrollee rose by 3.8 percent annually until 2004, then grew only 1.1 percent between 2005 and 2012. Medicare spending grew much faster overall, mainly because many more people turned 65 and enrolled in the program. However, spending for each beneficiary grew less rapidly than forecast, with actual spending about $3,000 less than predicted by 2012. Analysis found 50 percent of the lower-than-expected spending was linked to fewer acute cardiovascular-related medical events, with half of that savings credited to more use of medications that prevent or control conditions like high blood pressure, high cholesterol, or diabetes. There were few new drug treatments developed for these conditions, but consumers used existing drugs more regularly, partly thanks to lower prices and the development of the Medicare Part D drug benefit. Hospitalizations for heart disease and strokes have fallen by 56 percent and 41 percent since 1999, respectively. However, the study offers evidence that growing human longevity will require the United States to shift resources from medical care to long-term care.

U.S. Sen. Debbie Stabenow (D-Mich.) and Rep. Brian Higgins (D-N.Y.) have revived legislation permitting Americans to buy into the Medicare program at age 50, as opposed to universal access, reports NewsChannel5 . Under the buy-in proposals, Americans 50 to 64 could purchase Medicare plans via Affordable Care Act (ACA) exchanges. Federal funding would be unnecessary because enrollees would pay the premiums, but lower- and moderate-income participants could qualify for ACA subsidies to help defray their costs. Sponsors say this approach's benefits include fast enactment, whereas the Medicare for all approach would require a complete revamp of the national healthcare system. "It could happen now if it passed, using the current system — a trusted system — with those individuals who are most struggling right now in terms of health care costs," Stabenow notes. The buy-in legislation also would preserve the private insurance system.

Two prominent technology executives have agreed to join President Trump's advisory board to direct the future of workforce policy, CNBC News states. Apple CEO Tim Cook and IBM Chief Executive Ginni Rometty are just two of the 25 members appointed to the American Workforce Policy Advisory Board. Its stated goal is to develop and implement a strategy to revamp America's labor force "to better meet the challenges of the 21st century." The board will be co-chaired by U.S. Commerce Secretary Wilbur Ross and Ivanka Trump, the president's daughter. It's part of a federal government initiative to help bridge the skills gap that is widening in the modern economy partly because of the rise of automation. Members will work on a national campaign to promote education and training, as well as recommend ways to provide more relevant labor market data.

A University of Otago study published in Environment and Behavior found interaction with nature improves older adults' physical, mental, and spiritual well-being, reports Medical Xpress . "As most people living into advanced old age often experience significant physical disability, the restorative benefits derived from the natural environment are not as readily accessible," acknowledged Otago Professor Yolanda van Heezik. "Nearby green spaces such as home gardens become increasingly important as sites where people can see and interact with nature." According to the study, older people spent less time in natural sites as they aged, and garden variability meant the quality of nature experience was likely lessened for those in downsized and rest communities. "Although a strong personal connection to nature reduced the decline in time older adults spent in natural landscapes, a significant proportion of those reporting negative impacts with regard to nature encounters and engagement, expressed feelings of sadness, frustration, and anger," van Heezik said. Otago Professor Claire Freeman stressed the importance of policymakers and planners incorporating accessible green spaces when designing environments. "We know that even where there is good greenspace provision it may not be accessible for older adults as they can't walk or drive to it, so they need green immediately around their home," she noted. "Gardens that attract birds are also highly valued by urban residents and were specifically mentioned by a number of people in the study."

A study published in the Journal of Alzheimer's Disease of 101,150 persons followed in general and neuropsychiatrist practices in Germany did not uncover a link between antiepileptic drug (AED) use and dementia risk, reports News-Medical . The researchers analyzed data from the Disease Analyzer database, including information on seniors whose first dementia diagnosis was documented between January 2013 and December 2017. Dementia-free controls were matched to those with dementia by age, gender, physician, diagnosis of mild cognitive impairment, and observation time prior to the index date. Generally, no significant association between AED use and dementia risk was observed, nor was the duration of AED treatment associated with a risk of dementia. The only drug family associated with higher dementia risk were generic levetiracetam brands, but no association was seen with the original levetiracetam brand. "The major message of this study is an all-clear for people with epilepsy, who should not fear that their AED use will result in a higher risk of dementia," concluded Louis Jacob at the University of Versailles Saint-Quentin-en-Yvelines.

A study published in the Journal of Applied Physiology found older men who exercised improved their brains' executive function more than women, reports United Press International . Participants were 67 and older, and they disclosed their age height, sex, weight, and resting heart rate, which was used to calculate cardiorespiratory fitness. The female participants exhibited higher local network efficiency and lower global network efficiency, while their male counterparts experienced more improvement in both categories. "Our findings that cardiorespiratory fitness is associated with brain function in a sex-dependent manner underscore the importance of considering sex as a factor when studying associations between exercise and brain health in older adulthood," the researchers concluded.

Nurses in Texas are lobbying to broaden their authority to practice without physician oversight, reports Politico Pro . Nearly half of the 50 states and the Veterans Administration allow nurses with advanced degrees to practice without a contract with a physician to review their cases, while in December the U.S. Department of Health and Human Services recommended expanding the ability of non-physician providers to treat beneficiaries. Advocates in Texas see improved odds of such bills passing, amid growing doctor shortages and healthcare budget austerity. Rep. Stephanie Klick (R-Texas) says she intends to file a bill allowing nurse practitioners, nurse midwifes, and clinical nurse specialists to practice independently after an interval of physician oversight, and another permitting beneficiaries to see a physical therapist without a physician referral. An earlier stipulation that nurses must have an agreement with a physician in order to diagnose conditions and prescribe medication has met resistance from nurses, who say these pacts are expensive and onerous. Nearly 20 percent of nurses pay an often-high fee to doctors for the agreements. They also refute claims from physicians that with the growth of online nursing degree programs, many nurses are unqualified to practice independently.

A study published in the Journal of Bone and Mineral Research found hip fractures among older adults are associated with an adverse long-term effect on health-related quality of life over a decade, reports Healio . In addition, hip, spine, and rib fractures have lasting negative effects on self-care, mobility, and ambulation in older men and women. Women who had a hip fracture were unlikely to recover to prefracture-level scores, according to the Health Utility Index. The researchers analyzed data from 7,753 adults at least 50 years old. Incident hip fractures among females were linked to significant deficits, and the magnitude of these deficits was similar for spine and rib fractures, apart from ambulation. Incident hip or spine fractures among men were associated with deficits in mobility and ambulation. "These findings support the evidence that individuals with these types of fragility fractures do not regain their functional ability," the researchers concluded.

A recently released study from Stannah Stairlifts USA that surveyed more than 2,000 senior citizens found Alabama to be the most budget-friendly U.S. state for older Americans, reports Fox Business . Alabama's low property taxes, exemptions on Social Security, and affordable assisted living care were three of the key drivers of this friendliness. Other top states for senior friendliness were Florida, New York, and Alabama. Meanwhile, Alaska was ranked at the bottom of the list mainly due to some of the highest taxes in the country and its frequently inclement weather. The survey measured factors that included health and safety, finance, environment, social life, and accessibility.