BOSTON–The problem of hoarding used to be largely out of sight. Compulsive hoarders typically avoid visitors and rarely seek help. But television shows such as Hoarders and Hoarding: Buried Alive have increased public awareness by presenting vivid pictures of hoarding to millions of viewers. Mental health professionals are also taking a fresh look at the problem, reports the November 2011 issue of Harvard Women's Health Watch.

Compulsive hoarders acquire and accumulate objects in such large and disorderly quantities that their living space becomes dangerous or impossible to use for normal activities. Stockpiling paper is especially common. Vast stacks of old newspapers, magazines, books, mail, and lists pile up, leaving no space to sleep or eat. Worse, the piles may catch fire or topple over, causing injury or death.

Hoarding was once considered a symptom of obsessive-compulsive disorder, but mental health professionals now believe it's its own disorder and have come up with new criteria for diagnosing it.

Most hoarders need professional treatment, says Harvard Women's Health Watch, but there are several things concerned relatives and friends can do to help, including the following:

Listen. Let the hoarder tell her story. Respect her perspective and her attachment to her possessions. Don't tease or criticize.

Go slow. There's no need to rush changes unless the hoarder's living situation is unsafe or she needs to move to smaller quarters or a nursing facility.

Engage. Involve the hoarder in decisions about where to put things and what to throw out.

Provide structure and support. During the decluttering process, keep her company and help her stay focused on one area at a time.

Lift and tote. An elderly hoarder may need family, friends, or professional cleaners or movers to help with handling the clutter.

Work with others. Many communities have hoarding task forces that address psychiatric, legal, geriatric, and housing concerns. Check with your local Council on Aging.

Read the full-length article here: "When keeping stuff gets out of hand"

Also in this issue:

• What screening tests do you need after age 75?
• Even a little exercise helps a woman's heart
• Sleep apnea and dementia in older women
• Cholesterol-lowering foods versus low-saturated-fat diet
• Reclast and Prolia for osteoporosis

Harvard Women's Health Watch is available from Harvard Health Publications (www.health.harvard.edu), the publishing division of Harvard Medical School, for $28 per year. Subscribe at www.health.harvard.edu/womens or by calling 877-649-9457 (toll-free).

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MILWAUKEE, WI - With the increasing prevalence of childhood obesity and other health problems, it's important that parents encourage and teach kids about nutritious food options and physical activity.  The National PTA's (Parent Teacher Association) Healthy Lifestyles Month this November is an opportunity to use creative events and activities to show that living healthfully can be fun.  TOPS Club, Inc. (Take Off Pounds Sensibly), the nonprofit weight-loss support organization, provides advice to promote wellness at home and get involved with the PTA Healthy Lifestyles initiative.

The facts

According to the Centers for Disease Control and Prevention, children and adolescents should participate in 60 minutes of physical activity each day.  Today, there are more video games, less homemade meals, and a reduction of physical education and sports programs at school - trends that have contributed to a growing problem of decreased physical activity among children.  One in three children and adolescents are overweight or obese, and according to the American Diabetes Association, one in every 400 children has diabetes.

Although there has been an increase in childhood obesity, there has also been a rise in initiatives to temper this trend.  Michelle Obama's "Let's Move" campaign, a program that TOPS supports, is one such plan that ties into the goals and message of Healthy Lifestyles Month.

It starts at home

It's important to develop healthy habits at home, so children can go to school, friends' houses, and other places, ready to make sensible, healthy choices.

1. Physical activity - Get moving as a family and demonstrate to kids the necessity of exercise, which can also boost self-esteem and confidence and reduce stress.

• Take a group walk or bike ride around the neighborhood after dinner.
• Find free or low-cost physical activity areas in your community, such as a playground, bike trail, tennis court, or park.
• Take on active chores as a family, like raking leaves or shoveling snow.
• Use pedometers and have a contest to see who takes the most steps in a given week.
• Go to the gym as a family.  Many fitness centers offer discounted memberships.

2. Nutrition - While parents typically decide what their children eat, kids will often eat what is available to them.  Surround kids with healthy snacks and homemade meals to ensure that they're making good choices.

• Serve fresh, frozen, and canned fruits and vegetables.  Consider more unique snack ideas like homemade smoothies, a fruit salad, or vegetables and hummus dip.
• Offer water, fat-free milk, or 100 percent fruit juice with no sugar added.
• Since nuts and trail mix are often high in calories, serve them in small portions along with another healthy snack.
• Don't force kids to clean their plates if they are full.

3. Grocery shopping - Before going to the store, make a list of groceries your family needs.  Explain to the kids that you will only buy what's on the list to avoid unhealthy options slipping into the cart.  When making your way through the store, focus on the perimeters.  These areas contain healthier options, such as produce and dairy.  Also, never shop with an empty stomach, so you aren't vulnerable to buying extra foods.

Get involved at school

There are numerous ways to become engaged at your child's school.  Joining your local PTA can help you and other parents impact what's served at lunch, emphasize the importance of physical activity during the school day, and plan activities to promote health and wellness.  Here are some PTA program and activity ideas that will keep families moving and promote wellness:

• Create a document for parents about physical activity areas and resources within the community.
• Host a fundraiser for new fitness equipment.  Skip the candy bars and cookies and sell services, magazines, candles, cookbooks, or other alternatives to sweets.
• Plan a 5K run/walk or walk-a-thon event for the school district and encourage families to participate. 
• Hang up posters and other educational materials in the cafeteria to make students aware of the importance of a nutritious meal.
• Hold a seminar for parents with a health and wellness expert.
• Organize a healthy Family Fun Night with nutritious snacks, games in the gymnasium, such as basketball or kick ball, a dance, food trivia, and more.

It's also important to find out if your local school district has a wellness policy.  This should include nutrition education goals, physical activity objectives, guidelines for food available at school, opportunities for parents and students to get involved with the policy development, and plans for evaluation.  The best place to begin inquiring about a school wellness policy is at the district office.

TOPS Club Inc. (Take Off Pounds Sensibly) is the original weight-loss support and wellness education organization.  Founded more than 63 years ago, TOPS is the only nonprofit, noncommercial weight-loss organization of its kind.  TOPS promotes successful weight management with a "Real People. Real Weight Loss." philosophy that combines support from others at weekly chapter meetings, healthy eating, regular exercise, and wellness information.  TOPS has about 170,000 members - male and female, age seven and older - in nearly 10,000 chapters throughout the United States and Canada.

Visitors are welcome to attend their first TOPS meeting free of charge.  Membership is affordable at just $26 per year, plus nominal chapter fees.  To find a local chapter, view www.tops.org or call (800) 932-8677.

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October, 25, 2011

Senate Judiciary Committee Ranking Member Chuck Grassley made the following statement after the Federal Trade Commission (FTC) released a staff report that found drug companies entered into 28 potential pay-for-delay deals between October 1, 2010 and September 30, 2011.

Grassley, along with Senator Herb Kohl of Wisconsin, is the author of legislation that would end these settlements between generic and brand name drug companies that keep more affordable generics off the market.  The senators also sent a letter to the Deficit Reduction Committee encouraging them to use their legislation as a cost-saving measure.   The Congressional Budget Office estimated that the Grassley-Kohl bill will save the federal government - which pays approximately one-third of all prescription costs - $2.68 billion over ten years.  The Federal Trade Commission estimates that ending these settlements would save consumers who pay for prescription drugs through private insurance or on their own $3.5 billion per year.   The Washington Post also editorialized about the issue today.

Here's Grassley's comment.

"The pay-for-delay tactics employed by brand name and generic drug companies only benefit those companies that engage in such settlements.  It hurts consumers who don't have access to affordable medications, and it hurts taxpayers who pay for prescription drugs in both Medicare and Medicaid.  The FTC's study shows a remarkable continuation of a practice that puts the interests of drug companies above the interests of consumers.  No one has to engage in such deal making at the expense of consumers, and it's time to put an end to it."

According to the FTC staff report, companies reached 156 final patent settlements in fiscal 2011, and 28 of those settlements contained a payment to a generic manufacturer which restricted the generic company's ability to market its product. The FTC went on to say that "Of those 28 settlements, 18 involved generics that were so-called 'first filers,' meaning that they were the first to seek FDA approval to market a generic version of the branded drug, and, at the time of the settlement, were eligible to exclusively market the generic product for period of time." The FTC press release explains that "Because of the regulatory framework, when first filers delay entering the market, other generic manufacturers can also be blocked from entering the market, which makes such patent settlement deals particularly harmful to consumers."

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In Letter to HHS Secretary Sebelius, Senators ask why CMS is not utilizing tools in new health law to safeguard program

WASHINGTON -In a letter today, the top Republicans on the Senate Finance and Judiciary Committees, U.S. Senators Orrin Hatch (R-Utah) and Chuck Grassley (R-Iowa), asked Health and Human Services Secretary Kathleen Sebelius why the Centers for Medicare and Medicaid Services (CMS) is not utilizing some of the tools provided within the Patient Protection and Affordable Care Act (PPACA) to safeguard the Medicare program from waste, fraud and abuse.

Under PPACA, CMS can impose a temporary enrollment moratorium on new Medicare providers and suppliers when the agency determines that there is a significant potential for waste, fraud, or abuse by the applicant type or geographic area. While the final rule for this regulation was published more than eight months ago, CMS has failed to impose a single temporary moratorium. Today, the Department of Justice (DOJ) and the HHS-OIG are operating strike force initiatives in seven States (California, Florida, Illinois, Louisiana, Michigan, New York, and Texas), including Miami, Florida.  All of these areas, particularly Miami, have historically been vulnerable to Medicare fraud and are high risk areas for programmatic vulnerability. However, to date, CMS has failed to exercise its authority to protect against fraud. The National Health Care Anti-Fraud Association has estimated that as much as $60 billion is lost to fraud, waste and abuse across the Federal health care programs.

"It is deeply disconcerting that CMS has failed to act in the best interest of the American taxpayers and Medicare beneficiaries and prevent fraud before it occurs by exercising its moratoria authority," wrote the Senators.  "It is not reasonable to suggest that CMS needs more time to study whether there is need to impose a temporary moratoria in certain geographical areas for certain provider and supplier types when ample evidence exists from the strike force activities to justify moratoria in these high fraud areas."

The text of the letter to Secretary Sebelius is below and a signed copy can be found HERE:

October 25, 2011

The Honorable Kathleen Sebelius
Secretary
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201

Dear Secretary Sebelius:

As the Ranking Members of the Senate Finance and Judiciary Committees, we are writing to request that as Secretary of the Department of Health and Human Services (HHS), you exercise the discretionary authority granted to you through Section 6401(a)(6) of the Patient Protection and Affordable Care Act (PPACA) regarding the imposition of temporary moratorium on the enrollment of new providers and suppliers.  Specifically, we urge you to determine why the Centers for Medicare & Medicaid Services (CMS) is failing to use this tool provided in PPACA to prevent waste, fraud and abuse.

On February 2, 2011, CMS published a final rule with comment entitled, "Medicare, Medicaid, and Children's Health insurance Programs (CHIP); Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers" in the Federal Register. In part, this regulation allows CMS to impose a temporary enrollment moratorium on new Medicare providers and suppliers when CMS determines that there is a significant potential for fraud, waste or abuse with respect to a particular provider or supplier type, geographic area or both.

Today, more than year after the publication of a proposed rule and more than 8 months after publishing the aforementioned final rule with comment, CMS has still not imposed a single temporary moratorium.  In addition, despite a specific recommendation by the HHS Office of the Inspector General (HHS-OIG) to impose a temporary moratorium on independent diagnostic testing facilities in Los Angeles, California, CMS refused.

Additionally, the Department of Justice (DOJ) and the HHS-OIG are operating strike force initiatives in seven States (California, Florida, Illinois, Louisiana, Michigan, New York, and Texas), including Miami, Florida.  All of these areas, particularly Miami, have historically been vulnerable to Medicare fraud and are high risk areas for programmatic vulnerability.  Therefore, it is deeply disconcerting that CMS has failed to act in the best interest of the American taxpayers and Medicare beneficiaries and prevent fraud before it occurs by exercising its moratoria authority in some of these areas.  It is not reasonable to suggest that CMS needs more time to study whether there is need to impose a temporary moratoria in certain geographical areas for certain provider and supplier types when ample evidence exists from the strike force activities to justify moratoria in these high fraud areas.  To better understand CMS's failure to act, please:

1.      Explain why CMS decided not to impose a temporary moratorium on independent diagnostic testing facilities (IDTFs) in Los Angeles, California despite the OIG recent recommendation and previous work by the OIG that indicated $71.5 million in improper payments to IDTFs.

2.      Explain what steps CMS is taking to address the concerns raised by the OIG with respect to IDTFs in Los Angeles, California.  Please include a detailed timeline.

3.      Explain why CMS has not imposed a temporary moratorium of "high" or "moderate" categorical risk providers/suppliers in HHS-OIG strike force cities or other high-risk areas.

4.      Explain why CMS decided not to impose a temporary moratorium for durable medical equipment suppliers in south Florida when Daniel R. Levinson, the Inspector General for HHS-OIG, stated in his March 9, 2011 Congressional Testimony that there is "rampant fraud" among durable medical equipment suppliers in south Florida.

5.      Describe the program changes that CMS is considering to strengthen the provider enrollment process for "moderate" and "high" screening risk providers and suppliers, such as IDTFs, home health agencies, and suppliers of durable medical equipment, orthotics, prosthetics, and supplies.

6.      Provide all materials used to develop and finalize the temporary moratorium provisions found in CMS-6028-P and CMS-6028-IFC.

7.      Consistent with 42 CFR 424.570(a)(2)(i)(A), provide a list of providers and suppliers with a highly disproportionate number of providers and suppliers in a category relative to the number of beneficiaries for each State.

8.      Consistent with 42 CFR 424.570(a)(2)(i)(B), provide a list of providers and suppliers and location (city and state) where a rapid increase in the number of enrollment applications has occurred within the past twelve months.

9.      Consistent with 42 CFR 424.570(a)(2)(ii), provide a list of State Medicaid programs who have imposed a moratorium on a group of Medicaid providers or suppliers that are also eligible to enroll in Medicare.

10.  Consistent with 42 CFR 424.570(a)(2)(iii), provide a list of State-imposed moratoria on enrollment in particular geographic areas or on a particular providers, supplier types, or both.

We understand that we are requesting a substantial amount of information, but appreciate your understanding Congress' role in overseeing that taxpayer dollars are carefully spent. Thank you for your timely attention to this matter and we request a response by December 2, 2011.

Sincerely,

HATCH
GRASSLEY

cc: Administrator Donald Berwick, M.D., Centers for Medicare & Medicaid Services
Principal Deputy Administrator and Chief Operating Officer Marilyn Tavenner, Centers for Medicare & Medicaid Services

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