The Trump administration this week is expected to announce a federal reorganization plan that will include a consolidation of safety-net programs under a rebranded U.S. Department of Health and Human Services (HHS), reports Politico Pro . The plan calls for renaming HHS the Department of Health and Public Welfare and shifting the $70 billion food stamp program out of the U.S. Department of Agriculture (USDA) to the new agency. These changes are part of a sweeping government restructuring envisioned by Office of Management and Budget Director Mick Mulvaney. HHS currently oversees Temporary Assistance for Needy Families, which provides cash aid to low-income households, and Medicaid, which offers health coverage for more than 70 million Americans. The Heritage Foundation think tank in 2017 recommended that USDA nutrition programs, including food stamps, nutrition education, and school meal programs, be transferred over to HHS.

A demonstration of a new model of graduate nurse education (GNE) authorized by the Affordable Care Act published in the New England Journal of Medicine supports a modernized, cost-effective version of Medicare's coverage of training in the provision of community-based primary care, reports ScienceDaily . In three projects, each GNE site, managed by one teaching hospital hub, blended the training capacity of entire communities across health systems, hospitals, private medical practices, clinics, long-term care, and universities. By offering payment to Medicare providers, communities were able to scale up high-quality training for advanced practice nurses in environments where they are most needed when they graduate. The largest demonstration site included nine universities, multiple health systems, and more than 600 community healthcare providers in the greater Philadelphia region. The researchers are urging a change in Medicare funding from diploma nursing programs that produce entry-level registered nurses to permanent, national funding of training for advance practice RNs. Analysis determined Medicare funds for nurse training have fallen 30 percent from 1991 to 2015, and that most funding still goes to hospital-operated diploma programs that currently train less than 5 percent of RNs. They also found hospitals in six states were allocated 53 percent of Medicare nurse-training funds in 2015, mainly because they have historically been home to a disproportionate number of diploma nursing schools.

A study published in Scientific Reports details a new home-based method for screening for age-related cognitive decline through a test that asks people to detect sounds and flashes on their laptop or phone, reports ScienceDaily . The researchers found the test could help improve early diagnosis of Mild Cognitive Impairment (MCI) and provide interventions as early as possible. A total of 123 participants were asked to press a button whenever they saw a flash of light or heard a sound. At times, the flashes or sounds were presented alone, while at other times the two appeared simultaneously. Included were 51 healthy young adults, 49 healthy older adults, and 23 older MCI adults. The team measured whether participants were faster at detecting flashes or sound, and the degree to which they benefited from detecting an auditory-visual event compared to either flashes or sounds. These measures enabled the researchers to accurately ascertain a person was diagnosed with MCI using standard clinical tests. "Our findings open the exciting possibility that a simple perceptual task could be a valuable complementary screening and assessment tool for MCI," notes City University of London's Trudi Edginton. "However, the test we introduced should not yet be considered as a substitute or replacement for tests currently used in clinical practice."

Medicare officials are soliciting feedback on how to revise physician self-referral rules to help reduce healthcare costs, reports Politico Pro . The 1989 Stark Law largely prohibits doctors from referring clients to care settings where they could see some financial gain. The law and subsequent regulations were put in place to prevent unnecessary care, but conservative lawmakers claim they could be impeding better care coordination and controlled spending. For example, if a physician-led accountable care organization wants to treat someone in a lower-cost surgery center instead of a hospital, the current rules may bar such a referral. The Department of Health and Human Services (HHS) is requesting information on how Stark regulations hinder care coordination and how to surmount those obstacles while ensuring that self-referrals would be transparent and not unnecessarily raise costs. Centers for Medicare and Medicaid Services Administrator Seema Verma notes she is seeking out "bold ideas," while HHS Deputy Secretary Eric Hargan is spearheading this effort. Comments are due on Aug. 24.

The retiring baby boomer generation is putting the squeeze on U.S. senior welfare programs, with trustees for Social Security noting the program is dipping into its trust fund for the first time since 1982 to cover benefits, reports the Wall Street Journal . In addition, growing employee pension costs have forced states to reduce spending on programs like education and healthcare. The Pew Charitable Trusts estimates that state pension funds had $2.6 trillion in assets to pay for liabilities of $4 trillion in FY 2016. The gap between assets and liabilities has risen $295 billion year over year partly because of investments falling short of states' expectations. Furthermore, new census numbers show concentrations of rapidly graying counties in the Northeast, Upper Midwest, and across southern and western coastal areas that attract retirees. Florida is the state with highest age-dependency ratio, with 34 retiree-aged people for every 100 of working age. Washington, D.C., has the lowest ratio at 17, followed by Alaska, Utah, and Texas at 17, 18, and 20, respectively. A flattening in the U.S. birth rate since the 2007-2009 recession is increasing the country's reliance on immigrants to slow its aging. But the concurrent immigration crackdown could undermine that dynamic in the future.

The House on Wednesday passed H.R. 5773, a bill requesting technological changes that may lead to an overhaul for the Medicare drug plan prescription preauthorization process, reports ThinkAdvisor . One section of the Preventing Addiction for Susceptible Seniors Act of 2018 urges the secretary of the U.S. Department of Health and Human Services (HHS) to have electronic preauthorization system for Medicare Advantage plans and Medicare Part D prescription drug plans implemented by Jan. 1, 2021. Another section would call for encouraging Medicare Advantage plans and Medicare Part D drug plans should to expand use of electronic preauthorization systems. The bill says expanding usage of the systems should "reduce access delays, by resolving coverage issues before prescriptions for such drugs are transmitted." The legislation also would require Medicare plans to make high-risk enrollees eligible for medication therapy management program benefits by Jan. 1, 2021, and mandate the HHS secretary develop a program to warn Medicare Part D prescribers if the providers were prescribing more opioids than comparable providers. In addition, the HHS secretary would be required to establish a website that Medicare drug plans could use to share information about possible fraud, waste, and abuse with the department and each other. Mark Farrah Associates estimates that about 43.5 million Americans have drug benefits from a Medicare Advantage plan or a Medicare Part D drug plan.

House Republicans have introduced a 2019 budget whose goals include eviscerating Social Security and Medicare and repealing the Affordable Care Act, reports ThinkAdvisor . The budget aims to save $5.4 trillion on mandatory programs that include Social Security, Medicare, and Medicaid and impose reconciliation instructions on 11 House authorizing committees to secure at least $302 billion in deficit reduction over the next 10 years. Republicans claim mandatory spending "consumes approximately 70 percent of all federal spending. Without action, the Congressional Budget Office projects that mandatory spending will increase from $2.8 trillion in FY 2018 to $4.9 trillion in FY 2028." Social Security's costs are forecast to climb from $984 billion in FY 2018 to $1.8 trillion in FY 2028, while Medicare spending is expected to rise from $707 billion to $1.5 trillion in that same timeline. "This level of growth is not only unsustainable but threatens each program's solvency," the GOP states. "In fact, CBO projects Social Security and Medicare will be insolvent by 2030 and 2026 respectively." Committee for a Responsible Federal Budget President Maya MacGuineas notes the committee is "glad that the proposed budget sets a fiscal goal that would put the debt on a downward path relative to the economy and includes reconciliation instructions to reduce projected deficits ... over the next decade." However, Rep. John Yarmouth (D-Ky.) has blasted the plan, warning, "its repeal of the Affordable Care Act and extreme cuts to healthcare, retirement security, anti-poverty programs, education, infrastructure, and other critical investments are real and will inflict serious harm on American families."

A study from Hearts & Wallets expects more people to stay employed into their retirement years, reports Financial Advisor . Income from employment accounts for 8 percent of all retirement income, and Hearts & Wallets predicts within several years 10 percent of all retirement income will be generated from working retirees. Retirees with pensions are the least likely to continue working, and 50 percent of those with pensions say they will stop working at a certain age, while 32 percent of those without pensions agree. Also anticipated is growing reliance on investment assets. Nationally, dividends from stocks and mutual funds account for 4 percent of retirement income for all current retirees and taxable brokerage accounts represent 2 percent of income; those figures are expected to double for future retirees. Presently, 4 percent of all retirement income comes from withdrawals from accounts such as IRAs, 401(k)s, 403(b), and 457. Those not yet retired expect 16 percent of their income to come from their retirement accounts. Just 1 percent of current retirement income is derived from real estate and future retirees predict it will increase to 3 percent. However, for those few retirees with real estate investments, 22 percent of their individual income comes from those assets. Social Security comprises about 50 percent of retirement income, and Hearts & Wallets says having a diversified income is optimal for retirement.

A study published in the Journal of Bone and Mineral Research showed that older adults with long-term or recent weight loss of at least 5 percent had deterioration in both cortical and trabecular bone density and microarchitecture, especially at the weight-bearing skeleton, reports Healio . The researchers analyzed data from 1,361 older adults, including the adult children and spouses of the original participants of an earlier study. All participants underwent high-resolution peripheral quantitative computed tomography scans at the tibia and radius between 2012 and 2016. The average relative long-term weight change was 9 percent, and average relative recent weight change was -1 percent. Within the cohort, 12 percent exhibited long-term weight loss of at least 5 percent, and 22 percent had recent weight loss of at least 5 percent. Both long-term and recent weight loss correlated with lower cortical density and thickness, higher cortical porosity, and lower trabecular density and number. Results continued after adjustment for age, sex, height, current smoking status, and diabetes status, but stronger linkage was seen at the tibia compared to the radius after adjustment. Moreover, trabecular volumetric bone mineral density and failure load were reduced in people with long-term weight loss, although this was not noticed in adults with short-term weight loss. "The lower values for many of the microarchitecture measures that were observed in the weight-loss group were accompanied by an increase in the total area of the bone," the researchers say. "This suggests the possibility that as loading of the skeleton is reduced with weight loss, the reduction in bone density and cortical thickness may lead to a compensatory expansion of the periosteal surface to maintain bone strength."

The California Department of Corrections and Rehabilitation estimates that about 18,400 people older than 55 currently reside in state prisons, and California's main prison medical facility is taking initial steps to establish a dementia unit there, reports Reuters . "We have identified a specific need for a specialized unit for our dementia population and are in the very early phases of concept development," notes California Correctional Health Care Services' Elizabeth Gransee. The dementia unit would rely on inmate volunteers and a modest staff to assist, rather than a more costly medical wing. Seven percent of California's 130,000 prisoners were older than 60 in 2016, versus 1 percent 20 years earlier. At the Stockton facility, physicians and nurses are trained to work with an increasing number of inmates with cognitive decline, says Chief Medical Officer Dr. Anise Adams. The setup of a dementia unit in California would follow a similar move by New York, which opened one for its prison populace in 2006. California officials say it is too early to know how much the wing will cost, but it should be relatively simple to renovate an existing ward for use by people with dementia. About 500 prisoners are being treated for dementia or Parkinson's Disease in California penitentiaries, including 200 at Stockton.