The U.S. Centers for Medicare and Medicaid Services (CMS) has proposed compensating doctors for telemedicine and overhauling decades-old Medicare billing standards, reports Modern Healthcare . In a proposed rule, the agency said it would pay doctors for their time when they contact beneficiaries virtually to determine whether an in-person visit or other service is necessary. "This is a big issue for senior and disabled population for which transportation can be a barrier to care," CMS Administrator Seema Verma said. "We're not intending to replace office visits but rather to augment them and create new access points for patients." Most physicians bill Medicare for patient visits under a set of codes that distinguish level of complexity and site of care, known as evaluation and management visit codes, which CMS has used since 1995. CMS proposed allowing practitioners to designate the level of a patient's care needs using their medical decisionmaking or time they spent with the patient instead of applying the old documentation guidelines. In addition, the agency wants to remove the requirement to justify the medical necessity of a home visit in place of an office visit and is considering ending a policy that bars payment for same-day visits with multiple practitioners in the same specialty within a group practice. The proposed rule also includes some major changes to administration of MACRA, including an opt-in option for physicians with a low volume of Medicare Part B enrollees or reimbursements and a waiver for clinicians who participate in a new Medicare Advantage demonstration.

A study published in Science Translational Medicine found the TORC1 pathway involved in immune responses is inhibited by a combination drug therapy that improves the health of seniors, reports The Scientist . One or two cancer-fighting drugs or a placebo were administered for six weeks to 264 people 65 years or older. After 12 months, the researchers determined subjects who received the combination therapy exhibited a 40 percent reduction in colds and respiratory infections. The drugs also enhanced the body's response to a flu vaccine by producing 20 percent more antibodies against the influenza virus. "I think this study raises the real possibility that most middle-aged adults could benefit from short-term treatments with mTOR inhibitors," says Matt Kaeberlein with the University of Washington's Healthy Aging and Longevity Research Institute. Diarrhea was the most frequent observed side effect of the treatment. "It is premature, in my opinion, to rule out major negative effects of the pharmacological agents used in this study among subset of human subjects," notes the University of Washington's George Martin.

A study published in Nature Digital Medicine details how a wearable device can predictively determine older adults' risk of falling, reports EurekAlert . Participants included 67 women older than 60 who were tested on their walking ability and asked about the number of falls they had experienced in the past 12 months. They wore a small device equipped with accelerometers that measured their walking patterns for seven days. The researchers learned that data extracted automatically from the devices could accurately predict participants' risk of falling, as measured by physical analyses in standing and walking. "Our prediction showed that we could very accurately tell the difference between people that were really stable and people that were unstable in some way," says Bruce Schatz with the University of Illinois College of Medicine at Urbana-Champaign. He envisions the successful results of the study as a indication that more wearable devices, or even smartphone apps, will in the future be able to measure walking patterns and alert users of their risk of falling.

A study published in Neurology suggests a connection between high blood pressure in older adults and brain lesions and markers associated with Alzheimer's disease, reports U.S. News & World Report . Investigators tracked 1,288 older adults until their deaths at an average age of 89 years old. They determined the risk of brain lesions was higher in people with elevated average systolic blood pressure over the years of the study. The average systolic blood pressure for the study participants was 134 millimeters of mercury (mmHg) while the average diastolic was 71 mmHg. Two-thirds of participants had a history of high blood pressure and 87 percent were taking medications for high blood pressure. Forty-eight percent of the subjects had one or more brain infarcts. The higher the participants' blood pressure, the greater the odds of brain lesions. Persons with a systolic reading of 147 instead of the group average of 134 had a 46 percent higher risk of having one or more large brain lesions, as well as a 36 percent elevation in the risk of having very small lesions. A higher average diastolic blood pressure also raised the risk for brain infarct lesions, as participants with diastolic pressure of 79 mmHg, above the group average of 71 mmHg, were 28 percent more likely to develop one or more brain lesions. Post-mortem brain examination turned up a link between average systolic blood pressure in the years before a person's death and a higher number of tangles in the brain that are associated with Alzheimer's.

A study published in ACS Chemical Neuroscience describes a new biosensor under development that could be used for early non-invasive diagnosis of Alzheimer's disease using magnetic resonance imaging, reports Medical Xpress . The team characterized the presence of accumulated iron and the iron-storing protein ferritin in a hippocampal area of transgenic mice for Alzheimer's disease. These accumulations are seen around the amyloid plaques, and the contrast agent is based on the functionalization of magnetic particles with an antibody that identifies ferritin. The team demonstrated that, via histological analysis, the new nanoconjugate binds to the ferritin accrual in a specific way in transgenic mice for Alzheimer's disease. "The accumulation of functionalized nanoparticles in the specific area cause a significant decrease in certain values obtained through magnetic resonance, this indicates that the new contrast agent can be useful in the future for an early and non-invasive diagnosis of this pathology through magnetic resonance," says Milagros Ramos from the Center for Biomedical Technology.

A study published in Alzheimer's & Dementia: Diagnosis, Assessment, & Disease Monitoring found repeated testing of middle-age men generates a "practice effect" which obscured true cognitive decline and delayed detection of mild cognitive impairment, reports UC San Diego Health . Researchers re-tested 995 men in a six-year follow-up of an earlier study, while a second cohort of 170 age-matched males were tested for the first time. The team noticed significant practice effects in most cognitive domains, and diagnoses of MCI rose from 4.5 percent to 9 percent after correcting for practice effects. "In other words, some men would have declined to levels indicating impairment on follow-up testing had they not been exposed to the tests before," says UCSD Professor William S. Kremen. The researchers note the clinical significance is that Alzheimer's treatment is shifting increasingly toward prevention strategies that are dependent on early identification. They say their findings strongly hint at the value of correcting for practice effects in longitudinal studies of older adults, such as using similar replacement persons taking the test for the first time.

Doctors in Louisiana are a case study for the deployment of technology to connect people in need of medical attention with their healthcare providers, reports the Washington Post . Louisiana's Ochsner Health System is a nonprofit healthcare delivery system with 30 hospitals. When Ochsner launched a digital hypertension program in 2015, the health system covered the cost of blood pressure cuffs, the care team, and the digital infrastructure. Within three months, more than 66 percent of those receiving the digital intervention had their blood pressure under control, versus 31 percent in a group that received traditional care. Ochsner has enrolled 2,500 persons in its digital hypertension program and has expanded its platform to other areas, including pregnancy and diabetes. Ochsner obstetrician and gynecologist Rajiv Gala participates in a program that gives pregnant women a wireless scale, a blood pressure cuff, and urine tests, with results to be reported through an app. The program enables women to skip up to three appointments. Although the ability to collect data is not a new development, technology can allow the healthcare system to surmount bottlenecks in routine care, most apparently on the medical side, as well as coax enrollees to alter behaviors.

The House Committee on Appropriations has begun to consider a bill to slash discretionary spending for the Department of Labor (DOL) and the National Labor Relations Board (NLRB), reports BNA . The bill would allocate DOL $12.1 billion in discretionary appropriations, an $88.8 million markdown from current funding levels, while cutting NLRB funding by $12.8 million to $261.3 million. The DOL funding reductions would stem from the elimination of certain job training programs deemed less effective. The bill also would raise funding for some apprenticeships and veteran training programs. Rep. Rodney Frelinghuysen (R-N.J.) has praised the legislation for including measures that "prioritized funding for career and technical education and other job training programs that will help our nation train and support a 21st Century workforce." Some Democratic appropriators targeted sections of the legislation, including labor-related policy riders such as a provision to impede the NLRB from exercising jurisdiction over tribal governments, rescinding their right to unionize under the National Labor Relations Act. "It even includes riders that will strip away essential protections that keep Americans safe at work," warned Rep. Nita Lowey (D-N.Y.). The Senate bill's proposed discretionary appropriation for the DOL is very similar to the House version, but it would not cut NLRB funding for fiscal 2019 or include any of the House measure's policy riders.

A study published in Environmental Health Perspectives has determined that a loss in cognitive functions expected as part of the aging process is slightly reduced in residents of more environmentally friendly neighborhoods, reports EurekAlert . The investigators conducted a decade-long follow-up of 6,500 people aged 45 to 68 in Britain, and at three different timepoints participants completed a series of cognitive tests evaluating verbal and mathematical reasoning, verbal fluency, and short-term memory—and the decline in these functions. Neighborhood greenspace for each participant was calculated via satellite imagery. "There is evidence that the risk for dementia and cognitive decline can be affected by exposure to urban-related environmental hazards (such as air pollution and noise) and lifestyle (such as stress and sedentary behavior)," says Carmen de Keijzer with the Barcelona Institute for Global Health. "In contrast, living near green spaces has been proposed to increase physical activity and social support, reduce stress, and mitigate exposure to air pollution and noise." De Keijzer notes the decline in cognitive score after the 10-year follow up was 4.6 percent smaller among greener neighborhood residents. "Interestingly enough, the observed associations were stronger among women, which makes us think that these relations might be modified by gender," she says.

The National Alzheimer's and Dementia Resource Center will on July 31 host a web seminar in which dementia specialist Andrea Garr will provide an overview of the United Family Caregivers project in Milwaukee, Wisconsin, and insights from the project, reports the Administration for Community Living . Garr also will talk about best practices when working in cross-cultural environments with African American caregivers. Meanwhile, Rush University Professor Lisa Barnes will concentrate on disparities in Alzheimer's dementia and cognitive impairment as it relates to African Americans, discussing some of the most widely cited reasons for these disparities and detailing findings on risk factors for cognitive decline from the Minority Aging Research Study. Registrants can sign up for and learn more about the webinar here .