Senior Living Financial Assistance: Insurance and Medicare

   If you are satisfied with the clinicians at your primary care office, cherish those relationships.  For many reasons, it is getting more difficult to find primary care clinicians who go the extra mile for you and your loved ones.  If you are not content with your primary care team, I offer the following suggestions.    First, find a clinician (physician, nurse practitioner, or physician assistant) who enjoys listening to you and your stories.  The art of medicine is mostly about the art of listening.and believing what you share.  Listening and understanding build trust, essential for any good relationship.  Every city and small town in our country has such clinicians.     Second, appreciate that young nurse practitioners and physician assistants can listen to you and help sort out your problems every bit as well as a seasoned physician who is overworked and/or approaching retirement.  In my 40 + year career, Ive had the opportunity to train hundreds of NPs and PAs.  They gain the knowledge, expertise, and confidence to become great providers within 9-12 months of graduating from professional schools.  Often, they have more technical skills than older physicians.  This works to your advantage in the following ways.  Assume you have an unusual combination of symptoms.  They know how to explore the Internet and rely on specialists to find the best plan of care for you.  Now assume you need a steroid injection in a joint.  Many NPs and PAs can provide procedures that overworked physicians never learned.     Third, see the entire practice as your primary care provider.  A good practice has all members working together as a team.  The members include front office staff who greet you for in-person visits, medical assistants and nurses who answer your phone calls, and the clinicians who care for you in person or with tele-health visits.  If you find that any team member isnt respectful, you should feel free to discuss this with the office manager.  All good practices should welcome feedback.      Fourth, if you have the means and value extra attention, consider a concierge practice.  Unfortunately, concierge physicians are beyond the reach of the vast majority of seniors in our country.  Further, we are seeing a shortage of these physicians just as we are seeing a shortage of all primary care physicians.  This brings us back to my key message: you can find trust and comfort with a dedicated NP or PA.  When we consider the evolution of geriatric practice over the last 4 decades, we understand that it is NPs and PAs providing the vast majority of visits in nursing homes, assisted living facilities, and in-home visits.Finally, it is important to understand the pressure and demands on your primary care office.  The advent of the electronic health records in the 1990s added a massive burden to all practices.  The hope (and the myth) was that EHRs would lead to higher quality medical care.  The reality is that EHRs havent improved true quality.  EHRs are the main reason so many good clinicians are feeling burned out.  The clinicians feel they have to pay more attention to the EHR (and quality metrics) than to the patient in front of them.  When you express your understanding of this dilemma to your clinical team, they greatly appreciate this.  Again, building understanding and trust leads to the best quality of care and beneficial outcomes. The article was written by Dr. Don Murphy, Geriatrician and Hospice Physician who plans to run for Governor of Colorado, on behalf of. He can be reached at murphdoc@comcast.net, his cell, 720-490-6757, or his main YouTube channel, TheCrazyMurphys5560. 

The greatest challenge for all who practice geriatrics is reducing polypharmacy, the addition of medications that either provide no benefit or cause harm to seniors.  Millions of seniors end up on many medications that are not helping them and could be causing side effects.  Geriatricians are the experts in what we call de-prescription, cutting down on unnecessary medications.        The key reasons seniors end up on too many medications are the following.  First, all physicians, including young geriatricians (as I was 30 years ago), have hope that newer medications will actually benefit our seniors.  The four medications we have used to treat dementia turn out to provide no benefit at all.  We cant appreciate this until we have been in practice for decades and know how to review all of the studies that suggest there might be some marginal benefit.  Also, one must practice for many years to understand how all medications, including over-the-counter medications, can cause difficult to diagnose side effects.  For the dementia medications, we had hoped that they either alleviated symptoms, delayed the onset of dementia, or slowed the progression of dementia.  It takes years of practice and experience to realize that these medications fail to help our seniors.      Second, many primary care clinicians (say, family medicine physicians) and specialists (say, cardiologists) tend to overvalue medical benefit for medications used for the most common conditions.  The best example would be blood pressure medications.  All geriatricians know that we approach frail seniors differently than we approach a robust 70-year-old or a healthy 45-year-old.  Many clinicians will treat everyone the same, such as trying to keep the systolic blood pressure around 120 and the diastolic pressure around 80.  Often, these pressures are simply too low for frail seniors and even for some robust seniors.  The medications can cause lightheadedness, falls, and fractures (to name just a few side effects).      Third, clinicians in traditional medicine often fail to appreciate the value of alternative healing and the value of the placebo effect.  Lets return to medications for dementia.  In recent years, we havent seen any commercials for the four medications I referred to above.  Weve seen many advertisements for Prevagen and Neuriva.  These medications have not been studied extensively like the four that required many studies and FDA approval.  If seniors feel more comfortable on these OTC medications, its probably from the placebo effect.  That is, they feel that they are at least doing something to counter the onset or progression of dementia.  The cost is affordable, and these individuals dont need a prescription from their doctor.  If the individual thinks Prevagen isnt helping, or may be causing side effects, he or she can stop it at any time.  They dont need permission from their physician.        Fourth, the pharmaceutical industry has specialized in direct-to-consumer advertising.  These are entertaining and convincing ads.  It doesnt matter what disease condition we are considering.  Every expert in marketing knows that these creative, subliminal messages get through.and result in more prescriptions.        Before sharing my suggestions for cutting down on your medications, let me share a story about Elsie, a 90-year-old woman I took care of in 1992.  She was feisty and funny.  She was on the 6 medications our team had prescribed for her.  Benign positional vertigo was one of her conditions.  One of my most memorable clinic visits was the one when Elsie reported that she followed that Harvard newsletter you gave me, Dr. Murphy, and it worked.  She did this complex maneuver all on her own, and it eliminated her dizziness.  Then she added, oh, and by the way, doctor, I threw all those doggone pills in the garbage.and I feel great now. So be it.  This approach worked well for Elsie, but I dont recommend it for others.  Here is what I suggest.       First, find the courage to question your clinicians.  Its not easy when you have put so much trust in your doctors recommendations.  Try the soft approach.  For example, you could say, Doctor, Im on a lot of medications and I worry that one of them might be causing some problems. You could mention a symptom youve been wondering about.  Then you ask, could I cut down on the dose of one of these medicines to see how I do?  If your physician agrees with this trial of dose reduction, you could ask which medication he or she would select to reduce the dose.        Second, you continue with the honest communication you have established.  You dont need to let your doctor know how you are doing a week or two later.  However, you should report that you are doing fine by calling the office staff that can document your success with the dose reduction.  Believe it or not, you are educating your primary care office about the value of dose reductions.        Third, when you have more confidence in the dose reduction approach, you can specify which medication(s) you would eventually like to discontinue.  You can share feedback youve received from family members and friends or from the research you or they have done.         Ever since the 1950s we have been moving from a paternalistic approach to health care (i.e., the doctor decides everything for your health) to a more patient-centered approach to health care.  This makes sense.  You know whats best for your overall health, including physical, psychological, social, spiritual, and any other dimensions of health.  Your clinicians job is to reflect your preferences.  Dose reductions of useless or harmful medications is just part of this evolution in health care.     Dr. Don Murphy, MD, FACP The article was written by Dr. Don Murphy, Geriatrician and Hospice Physician who plans to run for Governor of Colorado. He can be reached at murphdoc@comcast.net, or calling 720-490-6757, or his main YouTube channel, TheCrazyMurphys5560.  

Congress recently made significant changes to Medicare's Part D prescription drug benefit as part of the Inflation Reduction Act. While some changes aim to help seniors afford their medications, others may have unintended consequences.On the positive side, insulin costs are now capped at $35 per month for Medicare beneficiaries. This has already provided relief for many seniors with diabetes.Starting in 2025, out-of-pocket Part D drug costs will be capped at $2,000 annually. Seniors will also have the option to spread these costs throughout the year through the new Medicare Prescription Payment Plan. These changes can benefit seniors who rely on multiple brand-name medicines or have fixed incomes.However, awareness of the new payment plan is low. Medicare could do more to inform seniors about this option, which requires opting in. Seniors should consider contacting their Part D insurers during open enrollment if they would benefit from spreading out pharmacy costs.The law's drug price negotiation provision has led to some unintended effects on drug development. At least 36 research programs and 22 experimental drugs have been discontinued as a result.Part D premiums have also increased. This year, standalone Part D plans were set to cost 21% more on average compared to last year. Many seniors switched to lower-cost options as a result. The number of available plans has decreased by about 25% since 2020.Some insurers have moved certain medications to tiers requiring higher out-of-pocket costs, restricting access to previously covered drugs. New rules like step therapy requirements have also been implemented, potentially making it harder for patients to access drugs their doctors recommend.It's important for seniors to understand these changes and their potential impacts on drug access before Medicare's open enrollment period begins in October.  Contact Carleen Lachman, Independent Insurance Specialist at 724-571-4688 to learn more.