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Their brains had the telltale signs of Alzheimer's. So why did they still have nimble minds? Print E-mail
Written by Sharon Begley | STAT   
Tuesday, 15 November 2016 19:06

The defective proteins that are widely thought to kill brain neurons and cause, or at least indicate, Alzheimer's disease do not always have that calamitous result, scientists reported on Monday, raising more doubts about conventional approaches to diagnosing and finding treatments for Alzheimer's.
The researchers analyzed the brains of eight people who died in their 90s and who had excellent recall until then. Three of the eight brains had the defining amyloid plaques and tau tangles of Alzheimer's, yet somehow were "immune to [their] effects," said neurologist Changiz Geula, of Northwestern University Feinberg School of Medicine, who led the study and presented the results at the annual meeting of the Society for Neuroscience in San Diego. "What's significant about these findings is that they show there can be high densities of plaques and tangles in the brains of some elderly individuals who are cognitively normal or even superior."

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Bending the Curve: Boynton Beach based Accountable Care Options Looks to the Future Print E-mail
Written by Jeffrey Herschler   
Tuesday, 08 November 2016 00:00

With 40 member medical practices and slightly more than 12,000 patient lives under management, Boynton Beach based Accountable Care Options ( isn’t the largest Accountable Care Organization (ACO) in Florida, nor does it strive to be. “Certainly that’s one strategy,” concedes Richard Lucibella, MHS, MBA, Director and CEO of the four year old company. “You could try to get real big, real fast with a goal of achieving economies of scale. For us though, it just made sense to grow steadily with quality-focused, like-minded physician partners.”

This strategy appears to be paying off. Three contract years are in the books (2012/2013, 2014 and 2015) and all have resulted in shared savings. “Our PCPs split $7 million in shared savings with the network last year and we are on track for continued success this year,” states Mr. Lucibella. Talk about the Triple Aim among healthcare professionals and you will often be greeted with a cynical look of resignation or perhaps outright derision. Not so with Mr. Lucibella who enthusiastically states that “The Triple Aim is not a pie in the sky goal. We are expanding the definition of medicine to what it should be.” A graduate of University of Pennsylvania’s Wharton School, Mr. Lucibella began his career with the Health Care Financing Administration (Medicare) and was directly involved in the original Medicare HMO risk projects. He has been active in South Florida Medicare risk programs since the mid 1980’s.

As to the future, Mr. Lucibella is quite blunt. “We are aggressively taking on risk. Payer’s don’t want it and most practitioners can’t bear it. But we know how to manage it and profit from it,” he states. Although many primary care doctors fear the good old days are over, the shift to value based care will be a boon to primary care practitioners, according to Mr. Lucibella. “This is revenge of the PCP,” he asserts. Taking additional risk allows Accountable Care Options a SNF waiver, a tele-health waiver and potentially a post acute care waiver. These concessions create resources that can be devoted to expanding chronic care management programs that end up reducing cost in the long run. “If it serves the Triple Aim, the government is going to OK it. This is the smartest CMS we’ve had in thirty years,” states Mr. Lucibella.

Mr. Lucibella is particularly excited about their newly developed ‘Chronic Care Management Program on Steroids’ that targets the 5% of their patient population at highest risk. The full arsenal of resources, including physicians, NPs/PAs, nurses, MAs, behavioral health professionals, pharmacists (through a partnership with Nova Southeastern University), paramedics, palliative care professionals and (soon) nutritionists, is deployed. 

With skepticism rampant in today’s health industry I had to ask Mr. Lucibella if he really believed we could bend the cost curve. “Absolutely,” was his immediate reply. “We are also going to bend the quality curve.”

EDITOR’S NOTE: We first interviewed Mr. Lucibella in  2014. You can read that article HERE>>

Last Updated on Wednesday, 09 November 2016 11:14
What's the one word cancer patients don't want to hear? Print E-mail
Written by Don Dizon, MD | KevinMD   
Tuesday, 01 November 2016 11:51

She had come to see me in consultation. A professor at a local university, she was well until four years earlier when she developed abdominal bloating and pain - telltale signs of ovarian cancer. Surgery followed, then adjuvant chemotherapy with intraperitoneal treatments. ("Terrible regimen," she said.) She was fine for two years, until the bloating recurred heralding recurrent disease. Surgery followed and she sought out a second opinion about more therapy. "My oncologist recommended more of the same - carboplatin and paclitaxel. But it didn't cure me the last time, so it doesn't make sense to me that this would be the best treatment for me now. I wanted to know what else was out there," she told me.

We talked about well-established concepts in the approach to recurrent ovarian cancer, such as platinum sensitivity, and how that predicts success to retreatment with carboplatin. I explained why I thought her doctors were right in their suggested treatments, and reviewed other platinum-based combinations she could receive. We also reviewed clinical trials and novel treatments, such as bevacizumab.

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Last Updated on Tuesday, 01 November 2016 11:52
Spike in heroin overdoses treated at Jackson Memorial prompts pilot rehab program Print E-mail
Written by FHI's Week in Review   
Monday, 24 October 2016 16:00

In a 10/19/16 Miami Herald post by Daniel Chang (Login/Registration may be required):
Over the past three years, physicians at Jackson Memorial Hospital's emergency room have seen a dramatic spike in patients who overdose on a combination of heroin and the synthetic drug, fentanyl...

The deaths related to fentanyl and similar synthetic drugs have also overwhelmed toxicologists at the Miami-Dade Medical Examiner's Office.
So far in 2016, those drugs have been tentatively identified in 180 overdose victims in Miami-Dade - with 52 in September alone, according to the office. That's nearly double the number of cases from 2015.

Read more in the current issue of Week in Review>>

Last Updated on Friday, 11 November 2016 18:39
OIG report finds claims filed on behalf of the dead Print E-mail
Written by Vitale Health Law   
Tuesday, 18 October 2016 18:54

With Halloween just around the corner the HHS' Office of the Inspector General just released a report showing that during a two-year period The Centers for Medicare & Medicaid Services (CMS) paid out nearly half a million dollars for claims made on dead people.

Federal law requires CMS to establish policies and implement claim edits to ensure that payments are not made for Medicare services ostensibly rendered to deceased individuals. However, in its most recent report, the watchdog agency identified $426,000 in "improper payments for 427 Medicare claims" between 2013 and 2015 related to claims for the deceased. It identified another $1.48 million in potentially improper payments for 1,047 Medicare claims with dates of service that were after the individuals' dates of death.

These "zombie claims" if you will, are nothing new. In 2013, the OIG found that Medicare had paid out $23 million in benefits in 2011, for 17,403 people who were dead. In 2014, the OIG issued another report that found CMS had paid nearly $300,000 for HIV drugs for dead people.

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