The Centers for Medicare & Medicaid Services (CMS) has awarded the American Academy of Hospice and Palliative Medicine (AAHPM), in partnership with the National Coalition for Hospice and Palliative Care and the RAND Corporation, a three-year grant of $5.5 million to develop quality measures for community-based palliative care, reports Home Health Care News . "Only a few of the quality measures currently available for reporting under the Merit-Based Incentive Payment System are meaningful for palliative care clinicians who treat a broad population of seriously ill people, particularly in outpatient settings," says AAHPM's Joe Rotella. "The new measures under development will matter for palliative care recipients and the clinicians who are accountable for the quality of their care." The measures could entail major changes for how Medicare covers palliative care for beneficiaries under home healthcare. Medicare presently covers home visits for certain medical clinicians, but key members of the palliative care team, such as social workers and chaplains, are not covered. "Earlier this year, AAHPM and the Coalition to Transform Advanced Care presented proposals to the Physician-Focused Payment Model Technical Advisory Committee (PTAC) for alternate payment models for providing palliative care in people's homes," Rotella notes. "Both models were recommended for demonstration, and AAHPM and C-TAC have provided additional recommendations to the Center for Medicare and Medicaid Innovation. Any alternative payment model for serious illness tested by CMS would include accountability for quality. We expect that the quality measures to be developed here for MIPS would also be applicable to relevant alternative payment models."

A study published in JAMA Network Open found Medicare penalties for above-average readmission rates among persons admitted with acute myocardial infarction (MI), heart failure, and pneumonia do not seem to have impacted mortality rates either in-hospital or following discharge, reports MedPage Today . In-hospital mortality rates fell among Medicare beneficiaries hospitalized for acute MI, heart failure, and pneumonia in the 2006-2014 period spanning the U.S. Hospital Readmissions Reduction Program's (HRRP) rollout in 2010-2012. Although rates of 30-day post-discharge also declined for acute MI but rose for heart failure and pneumonia, readmission penalties were not a factor. "While post-discharge mortality for heart failure and pneumonia rose over the study period, these increases began in 2007 and 2006, respectively, over three years before the announcement of the HRRP and three years before the implementation of its associated financial penalties," the team noted. "Moreover, neither the announcement of the HRRP nor its implementation was associated with an increase in the changes in post-discharge mortality rates," whereas there was a significant decrease in readmissions across the board. These findings correlate with a study presented at the American Heart Association meeting last fall, which found boosts in 30-day and 12-month mortality that offset the lowered readmissions from the HRRP.

The Centers of Medicare and Medicaid Services (CMS) has announced a 6 percent decrease in Medicare Advantage (MA) premiums in 2019 due to MA enrollment, health plan options, and benefits hikes, reports HealthPayerIntelligence . CMS said the average 2019 MA premium will fall from $29.81 to $28 and improve health plan affordability for most beneficiaries. Eighty-three percent of enrollees are expected to have either the same or a lower premium next year, while CMS estimated that 46 percent of MA beneficiaries in their current plan will have a $0 premium. MA also is offering 600 more health plan options and boosting the average number of MA choices for consumers. An estimated 3,700 MA health plans will be available in the market in 2019, with 91 percent of beneficiaries able to choose from 10 or more options. CMS expects MA enrollment to increase from 20.2 million to 22.6 million enrollees next year. "Medicare Part D and Medicare Advantage demonstrate the successes possible when we harness consumer choice and private-sector innovation to improve care and lower cost," said Department of Health and Human Services Secretary Alex Azar. "Meanwhile, the significant steps taken to maximize competition among Medicare Advantage plans and support and empower Medicare beneficiaries are a crucial piece of allowing enrollees to define and drive value."

A study published in The Lancet Public Health suggests older adults with larger social networks of family members and close friends may be better at adhering to recommended preventive health screenings and checkups than others, reports Reuters . Investigators polled 5,362 adults born in 1946 in England, Scotland, and Wales about their social relationships 24 times over several decades, until they were 68 to 69 years old. They also reported how often they engaged in recommended preventive health activities, and by the time they were 68 to 69, 2,132 people were still alive and participating, and 44 percent were up to date on all recommended preventive health services and screenings. People who were unmarried or not living with a romantic partner were 33 percent more likely to be lagging on some preventive services and screenings than those who were married or cohabiting. Those with few close friends were 51 percent more likely than those with larger social networks to be behind on preventive health services and screenings. Persons who experienced better quality in their social connectedness from ages 53 to 69 were 7 percent less likely to lag on preventive services and screenings than those who had consistently limited social networks. "It suggests that if we can intervene to get people more socially connected, then there may be benefits for their preventive healthcare use," says University College London's Mai Stafford.

A study published in Scientific Reports found adults with a regular bedtime are more likely to weigh less and to have lower blood sugar, risk of heart disease, and diabetes than those who do not, reports Reuters . Analysis of the sleep cycles of nearly 2,000 adults, average age 69 years, employed a new metric called the Sleep Regularity Index. The index examines sleep variation across a 24-hour day and compares one day to the next to measure regular sleep and wake times in addition to midday naps. The investigators found people with high sleep irregularity tended to go to bed later, sleep more during the day, and less at night than regular sleepers. They also have less light exposure and higher daytime sleepiness. More sleep irregularity also correlated with a higher 10-year risk of heart disease and greater obesity, hypertension, fasting glucose, and diabetes. The study also linked sleep irregularity to higher levels of stress and depression. African Americans were most likely to have the greatest sleep irregularity. Duke University Medical Center's Jessica Lunsford-Avery recommends that future studies consider mechanisms that connect sleep irregularity and disease risks, along with cause-and-effect relationships.

A study published in the Journal of the American Geriatrics Society suggests hospitalization, critical illness, and major infection can trigger brain structure changes and accelerate cognitive decline, reports Johns Hopkins Magazine . "We believe our study is one of the first to look specifically at how both critical illness and infection might promote brain changes that set the stage for late-life cognitive decline, and serve as independent risk factors for dementia," says Johns Hopkins University's Keenan Walker. The investigators used data from the Atherosclerosis Risk in Communities Study, including magnetic resonance imaging scans showing brain structure, in addition to social, demographic, and hospital information for a large group of participants followed over 24 years. Of the 1,689 participants analyzed, 72 percent were hospitalized, 4 percent had a critical illness, and 14 percent had a major infection. Hospitalization during the follow-up period, regardless of the reason, was tied to 9 percent greater white matter hyperintensity volume and significantly lower integrity of white matter microstructure. Hospitalized participants who had one or more critical illnesses had a 3 percent smaller brain volume in brain regions such as the hippocampus that are implicated in Alzheimer's. Major infection was linked with both smaller brain volume in regions vulnerable to Alzheimer's and 10 percent larger brain ventricle volume.

A newly launched website is designed to trigger memories in people with dementia by helping them "reconnect with the music they have loved," according to The Australian . BBC Music Memories features snippets of around 1,800 musical tracks, including the biggest songs from the last century, TV and radio theme tunes, and the most popular pieces from 20 classical composers. By browsing for tracks based on decade and genre, BBC Music Memories can help users find their most powerful musical memories and create and share their own personalized playlist. The site is supported by leading dementia organizations and is located at musicmemories.bbcrewind.co.uk . "My dad has dementia and anything that throws a light on the disease and helps in any way to reconnect people with their lost memories is something I want to be involved in," says Snow Patrol singer Gary Lightbody. He also says music "is the most powerful international language. It can break you and mend you sometimes in the span of a single song."

Alaska Gov. Bill Walker signed a law on Thursday establishing another option for a person to be helped by others besides traditional guardianship, reports KTUU . The statute, sponsored by Rep. Charisse Millett (R), permits "Supported Decision-Making Agreements." Under the new law, a person with a disability or a senior can choose a "supporter" or team of supporters — perhaps children, parents, or friends — who would sign an agreement with the individual naming the help that was needed. "It could be part of anyone's natural support network," notes Anne Applegate, an attorney on the staff of the Governor's Council on Disabilities & Special Education. She says a team could agree to do something such as help a senior with computers, Wi-Fi, or a smartphone, or an agreement could concentrate on healthcare or legal advice. "It's innovative legislation that will end up saving the state money and will allow the freedom that seniors — and folks with intellectual and development disabilities — to gauge how much support they need," Millett says.

A brief from the Center for Retirement Research (CRR) at Boston College estimates that the U.S. fertility rate has fallen despite the economic rebound, reports ThinkAdvisor . The researchers note that although fertility "typically rises in expansions," this time it has declined "more than it did during the recession." The potential permanency of this trend is suggested by factors that include a falling birth rate among Hispanics, a growing percentage of women with college degrees, a declining birth rate among non-religion-affiliated people, and a rise in the female-to-male wage ratio. "The future of the fertility rate is important in that it determines the age structure of the population, the ratio of workers to retirees and, hence, the finances of the Social Security system (which operates largely on a pay-as-you-go basis)," the report notes. "According to the 2018 Social Security Trustees Report, a total fertility rate of 1.8 children per woman instead of 2.0 would increase the program's 75-year deficit by 0.41 percent of taxable payrolls or a present value of almost $2 trillion." A CRR blog also stresses that, lacking a surge in immigration, there will be no workers coming in from outside the United States to counter lower Social Security contributions with their own. The blog also cites an AARP Public Policy Institute forecast of a "decline in the number of family members and friends available in the future to care for seniors."

Data from Aetna Behavioral Health found corporate spending on employee mental health programs has been rising rapidly, with annual costs climbing twice as fast as all other medical expenses in recent years, reports CNBC . Meanwhile, a Willis Towers Watson poll noted workers with depression, bipolar disorder, or substance abuse cost employers more money, and make six times as many emergency room visits as the overall population. They also submit two to four times as many medical claims, with depressives submitting an average of $14,967 annually, versus $5,929 annually for the total population. Some companies are prioritizing improving the costs and treatment of mental illness, with 57 percent of surveyed employers saying they plan to focus on mental and behavioral health to a great or "very great extent" over the next three years. "We all have a point at which stress can creep into negatively impacting our overall health and wellness," says Darcy Gruttadaro with the American Psychiatric Association Foundation. "Employers are increasingly recognizing ... the importance of taking care of health, well-being, and mental health, and also the role stress, isolation, loneliness, and some of these other factors can play in overall mental health and well-being." Aetna Behavioral Health's Mark Friedlander notes employers' behavioral health costs have increased more than 10 percent annually over the last five years, compared with an annual rise of 5 percent for other medical costs. He suggests this trend may be positive, because "as things expand on the behavioral health side, there may overall be benefits on the medical cost side."