All That Glitters…

 

iron_pyrite

Iron pyrite, aka “Fool’s Gold”

Jackie Oberst

Providers, as well as yours truly, are keeping a close watch on ACOs. While these programs pertain mostly to physicians and hospitals, a trickle-down effect is expected in the long term care field. But perhaps we should hold off from reading the tea leaves quite yet.

For those new to the lingo, ACOs, are CMS-sanctified collaborations among physicians, hospitals, and other providers who voluntarily work to give high-quality service to Medicare fee-for-service beneficiaries. Those who do exceptionally well—lowering their health care costs while meeting quality standards—receive remuneration.

How much moolah ACOs receive requires some math. Don’t click away just yet—the math portion of this blog will be over by the end of this paragraph (or two). ACOs have their choice of a one- or two-sided model. Regardless of the model chosen, if an ACO meets or exceeds the minimum savings rate (MSR, aka “amount of cost-cutting achieved”) AND receives a high-quality score, it gets back the money it saved, up to a performance payment limit. Similarly, ACOs with losses that meet or exceed the minimum loss rate have to pay these losses, also up to a loss-sharing limit.

CMS announced earlier this week that 20 Pioneer and 333 Medicare Shared Savings Program (MSSP) ACOs, both in their second year, generated net savings of more than $411 million in 2014. Additionally, 97 ACOs qualified for shared savings payments of more than $422 million by meeting their quality standards and savings threshold.

Yet these gemstone programs may have lost their glow, and providers may want to borrow a jeweler’s loupe. The good folks at The National Association of ACOs (NAACOS) issued a press release stating that while “pleased that the hard work of the nation’s Accountable Care Organizations (ACOs) continues to improve quality for Medicare patients,” they are “disappointed, but not surprised, that the financial results were not better.”

According to the release, “hundreds of organizations with thousands of doctors, hospitals, and other health care providers have invested over $1.5 billion of their money in the ACO program to date, but they have received only $656 million total in return. CMS has in turn received over $848 million in savings for a small investment.”

NAACOS head honcho Clifton Gaus warned, “This is not a sustainable business model for the long-term future. With Medicare cost growth at record lows, now is the time for the government to invest in and support a national effort for population-based coordinated care and not just take, or be satisfied with, savings from a minority of ACOs at the risk of the majority of ACOs abandoning the program.”

Slightly more than a quarter of the MSSP ACOs—92 out of 333—will receive payments, while the majority (241) will receive no return on their investment, claimed the press release.

“Consequently, they will struggle to stay in the program,” said the release. “We estimate that 40-50 ACOs will leave the program this year.” According to CMS game rules, ACOs must stay in the program for three years. As they are approaching year three, health care analysts are curious how many will stay or go.

As with most things, time will tell. CMS will announce new and renewing ACOs around the end of the year.

Perhaps providers should keep their eyes on the agency’s Bundled Payments for Care Improvement Initiative…

Jackie Oberst is Provider’s managing editor. Email her at joberst@providermagazine.com. Follow the magazine on Twitter @ProviderMag and @ProviderMyers.

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Big Time…

Parkinson-MHTop100-2

 

Jackie Oberst

Good Afternoon, ProviderNation.

Looks like AHCA President and CEO Mark Parkinson has made it to the big time.

For the first time, AHCA’s fearless leader has made it to Modern Healthcare’s 100 Most Influential People in 2015 Healthcare list. (Although this annual award is in its 14th year, it is the first year that Parkinson’s name was submitted.)

Every year, Modern Healthcare magazine selects 300 individuals from among thousands of submissions as nominees for this renowned list. The final list of 100 names is compiled based on voting by readers and featured in a special edition of the magazine.

Parkinson came in at No. 89. He joins such luminaries as Supreme Court Chief Justice John Roberts (No. 1, primarily for his written opinion in King v. Burwell) and President Obama (No. 2, for his signature Affordable Care Act).

In the top 10 are several major health system leaders (Bernard Tyson from Kaiser Permanente sits at No. 3, and Stephen Hemsley at UnitedHealth Group holds No. 5). Prominent physician and book author Dr. Atul Gawande from Harvard University perches on No. 10. His most recent book, “Being Mortal: Medicine and What Matters in the End,” challenges people, particularly doctors, to reexamine how we think about death and dying. (Provider did contact Dr. Gawande to participate in our most recent Twitter chat on hospice and dying well, but the busy doctor understandably had other time commitments.)

Also on the esteemed list are HHS Secretary Sylvia Burwell (No. 6) and Acting Administrator for CMS Andy Slavitt (No. 20). Parkinson bested AMA head honcho Dr. James Madara (No. 90) and Acting FDA Commissioner Dr. Stephen Ostroff, who rounded out the last slot at No. 100.

A Web search finds the number 89 to be rather auspicious. Football jersey number 89 was retired by three NFL players—Gino Marchetti of the Baltimore (now Indianapolis) Colts, Bob Dee of the Boston (now New England) Patriots…way before Deflategate, and Mike Ditka of the Chicago Bears.

In mathematics, 89 is a number that is part of the Golden spiral, a shape that commonly appears in nature, such as an unfurling fern or a nautilus shell. Most importantly, it is a prime number, just like the folks on this list.

Jackie Oberst is Provider’s managing editor. Email her at joberst@providermagazine.com. Follow her on Twitter, @ProviderMag.

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AHCA Official Receives Total Consciousness…

James.Michel

Michel

Bill Myers

Washington, D.C.—Good morning, ProviderNation. The questions on all minds, of course, are, What did James Michel know, and when did he know it?

You’ll recall that Michel was one of the stars of last week’s Provider IGNITE panel (hat tip, again, to the fine folks at PharMerica for sponsoring). He told (warned?) the audience that the proposed rules to bundled payments for knee-and-hip surgery were merely the tip of the spear.

“It’s important because it sets a precedent by moving from a voluntary, demonstration style of alternative payments to a mandatory alternative payment,” he said. More than that, the fine folks at CMS had already done 130 alternative payment demonstrations, and he expected more such rules to come flying out of Washington over the next 16 months as the Obama administration attempts to “lock in” its health care reform legacy.

Faster than you can say “Nostradamus,” CMS has announced that some 2,100 acute care hospitals, skilled nursing centers, doctors’ practices, and other assorted provider types are now moving out of prep and into the “risk-bearing” section of the “Bundled Payments for Care Improvement” initiative.

“By focusing on outcomes for an episode of care, rather than separate procedures in care delivery,” CMS’ own Patrick Conway says in a statement, “we are incentivizing hospitals, doctors, and other providers to work together to provide high-quality, coordinated care for patients.”

So Michel seems to have received total consciousness, well before his deathbed, which is nice. But he ought to be careful: He keeps this up, and they’ll make him a senior director of Medicare reimbursement and policy at some health care organization or something.

Florida Makes Its Move

Meanwhile, the Sunshine State has announced what it’s calling the “Dementia Care and Cure Initiative.” The fine folks at the Florida Department of Elder Affairs (talk about your Sophisticated Policy Apparatus) say they want to “partner” with folks to “increase awareness of dementia, as well as the services and supports currently available; assist communities with becoming more dementia-friendly; and advocate for programs that provide care and promote research efforts toward a cure. Action-oriented work plans will be individualized for communities as they work for the designation of a Caring Community.”

Florida has the country’s second-highest population of people who suffer from dementia, so any help is good help.

Care Versus Cure

Speaking of caring and curing, that study we mentioned a while ago has finally posted. Read it, and weep.

Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.

 

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My Kind Of Town…

Bill Myers

Bill Myers

Bill Myers

Chicago—Hello, ProviderNation. Few things congeal the tissues more quickly than the phrase “panel discussion.” (Your Humble Correspondent will pay any price, bear any burden to avoid even staff meetings and has the performance evaluations to prove it.) But Wednesday’s inaugural edition of Provider’s IGNITE was one helluva toboggan ride.

Sponsored by the fine folks at PharMerica, IGNITE brought together naviHealth’s Chief Clinical Officer Dr. Clayton Ackerly, Signature HealthCARE CEO Joe Steier, Good Samaritan’s Divine Sharon St. Mary, and AHCA/NCAL’s own James Michel, who—despite having one of the most thankless jobs in Washington (running interference between members and regulators on payment reform? Have a chat with your guidance counselor, son…)—is perpetually so well dressed and coiffed some might wonder if he spends his spare time starching and ironing himself.

The topic was payment reform and, while I don’t want to spoil the ending, it was awesome. Your Humble Correspondent live-tweeted the red hot, provider-on-provider action, and if you missed it, go to the box, you know, two minutes by yourself, and you feel shame. A few notes, though:

  • PharMerica CEO Greg Weishar kicks things off. Standing (literally) in the shadow of the John Hancock building at the Ritz Carlton, Weishar tells the crowd that he and his team picked Chicago for its symposium “because Chicago is cool.”
  • Cheering is heard from the press box.
  • Weishar takes the crowd through his own history: He started out in long term and post-acute care pharmacy, “hit a roadblock,” and left. Eight years ago, he came back, thinking, “The industry is ripe for change.”
  • Weishar and the fine folks at PharMerica have spent a lot of time (and money) on their own communications systems, and now they want to help providers to come along, too.
  • “We’re trying to do our part to move the industry into modern telecommunications,” Weishar says. The focus isn’t just internal, but on that glory of glories—“interoperability.” Partners (such as a certain pharmaceutical company) are critical in the new era of managed care/bundled payments, Weishar says.
  • Next up is our very own Greg Crist, whose handkerchiefs cost more than the GDP of several developing countries.
  • He wears his AHCA/NCAL hat first, telling the audience about how to manage public affairs in Washington (like “hunting a bear with a switch,” he says).
  • In the two decades that Crist has been in Washington, D.C., the place has changed in three significant ways, he says:
  • It’s become “hyperpartisan,” traditional media has had, um, problems, and a “sophisticated policy apparatus” has arisen.
  • Lobbyist-Americans are always whining about “partisanship,” Crist acknowledges, but consider: In 2002, 103 of 435 House races were close (i.e., the margin of victory was 5 percent or less). By 2016, there were only 29 close races.
  • This means that the “middle has dropped out” of the People’s House, Crist says.
  • The decline of traditional media means that “the rules of engagement” have changed.
  • The Interwebs and blogosphere reward “gotcha,” and a public official’s career can unravel faster than you can say, “Delete that Tweet,” Crist says.
  • As an example of the new rules, Crist shows that terrific video of former US. Rep. Michael Grimm threatening to throw a reporter off a balcony.
  • I’m sure Crist makes some very salient points after this, but I can’t hear him: It would take a heart of stone not to burst out laughing.
  • As to The Sophisticated Policy Apparatus (which shall evermore be part of Your Humble Correspondent’s lexicon), Congress and regulatory agencies are simply stuffed with PhDs, Masters’ degrees, and other forms of genii, Crist says.
  • All of the foregoing makes it hard out here for a flak, Crist says.
  • At long last, the panel is seated. All agree that fee-for-service is the T. Rex watching that pretty light ball coming at him.
  • Ackerly says it best: “We’re moving into a new world, but we don’t know what it’s going to look like.”
  • CMS’ rulemaking notice on bundled payments for joint replacements, AHCA/NCAL’s Michel says, is the canary in the coal mine.
  • “It’s important because it sets a precedent by moving from a voluntary, demonstration-style of alternative payments to a mandatory alternative payment,” he says.
  • The government isn’t just experimenting with alternative payment models anymore: “They’re the new normal.”
  • St. Mary is on the panel because she has dispatches from the front lines: Minnesota has been in managed care for decades, and Good Samaritan has been aggressive about experimenting with different payment models.
  • For her, data are key. All quality efforts will require careful definitions and tracking and analyzing of data, she says.
  • Signature’s Steier is doing his best Eeyore impression today. The alterative payments, especially managed care, “are just killing us,” he says. “They’re creating instability, driving us crazy.”
  • He’s not sure that many providers will be able survive the days to come. “We think a lot of guys will just have to shut down.”
  • Steier talks very fast. Imagine everyone at a crawfish boil spontaneously bursting into flames, and you get the idea.
  • Ackerly, ever the doctor, wants to give it to you straight. He agrees that the joint rulemaking notice means bundled payments are inevitable, and maybe not all that palatable, “but we have no choice.”
  • An audience member raises questions about whether regulators are over-relying on the Five Star system to judge quality, and there are nods and (slight) murmurs of approval.
  • Michel says he’s already seeing low-rated centers fold up.
  • In principle, “maybe bad centers should go out of business,” but given the, um, funny math behind Five Star, Michel is worried that some “low rated” centers that actually offer brilliant care are going to shuttered unfairly, which in turn, might jeopardize care.
  • Someone in the audience suggests that Five Star could be tweaked if regulators added a risk adjustment measure.
  • Ackerly gives the notion a hearty thumbs up.
  • “Risk adjustment is crucial,” he says. He says he’s worried about the frail, or otherwise high-risk patients, who might well be ignored if some centers feel they have to “cherry pick” to keep their quality ratings up.
  • St. Mary says that one obstacle is that different caregivers use different languages for care. The data will have to be streamlined along the entire spectrum of care.
  • “How can we have a successful outcome if no one’s talking with each other?” she asks.
  • Medicalodges’ own Fred Benjamin (a man of unimpeachable character, taste, and judgment, as so many exiled Chicagoans are) joins the discussion from the crowd.
  • He says that, watching previous government experiments with alternative payments, many providers “seem to have come out of nowhere” to succeed.
  • There’s a corollary, though: “A lot of guys are going to be left behind,” he says.
  • Steier agrees vigorously, and says that he worries that the fetish for data will have an unintended consequence: If a care center’s numbers seem bad, it’ll scare off potential new buyers and investors, he says.
  • He also has his own ideas about how (and what) to measure. “I would love to see metrics driven by empathy, connection with staff… the whole human experience,” he says.
  • A woman in the audience asks the panel about managed care, and there are more than a few choruses of mutiny, mutiny, mutiny, grumble, grumble, grumble in the crowd.
  • “Killing us,” Steier says, “just brutal.”
  • St. Mary, though, suggests that providers should rethink their goals.
  • “Are we trying to get someone home so they can run a marathon,” she asks, “or are we trying to get her home without her needing any further services, or limited services? Don’t we want to get them home as soon as possible?”
  • All this means, though, is that providers can no longer wait until patients get to their centers to start their work, St. Mary says.
  • “You need to be a case manager way before they get to you,” she says.
  • Michel also is not sure that managed care is any better positioned in the new world, either.
  • He says that many managed care companies are worried that accountable care organizations, for instance, “will lock them out.”
  • For Michel, the uncertainty means there are plenty of “opportunities for innovation” in managed care.
  • The discussion shifts to whether it’s relationships with hospitals or the quality of the care that are key.
  • Ackerly says that this might be a false opposition: If providers are going to offer quality care, they’re going to have to be well ahead of their residents’ needs.
  • That means, almost by definition, that providers will have to make relationships with case managers and practice managers long before someone is scheduled for surgery.
  • And, while Ackerly agrees that interoperability is important, it’s “not going to fix the things we need to fix. It’s not the substitute for good care.”
  • For Ackerly, there’s “simple math” behind quality care.
  • Assess the needs of people in a community, assess the capacity of caregivers in a community, and line up people who need care with the care that they need.
  • “Just get it right,” he says.
  • Crist announces that “we’re moving to the lightning round.”
  • Your Humble Correspondent, who has been live-tweeting this event, contemplates seppuku.
  • “Health care reform is here to say,” St. Mary says. “We’ve got to get our heads out of the sand.”
  • For Steier, training is the essential thing.
  • “Leadership is the toughest issue,” he says, adding that it’s not enough merely to train up an administrator and hopes that it trickles down.
  • Ackerly comes back to the question of managing expectations—including your own expectations.
  • “I know it’s hard, but you really have to resist that urge to be all things to all people,” he says. “Figure out what you’re doing today that you won’t do tomorrow.”
  • For Michel, not only is health care reform here, but it looks like it’s just warming up.
  • It’s clear, he says, that the Obama administration wants to lock as many reforms as possible before he leaves, 16 months from now.
  • The good news is, “providers are really engaged in this” already, Michel says, pointing out that regulators were pleasantly surprised when so many providers volunteered for alternative payment demonstrations.
  • “You clearly have a voice,” he says. “Get your feet wet—engage.”
  • The discussion wraps.
  • It went more than four hours.
  • No one uttered the words “stakeholders,” “buy-in,” “pushback,” “circle back,” “close the loop,” “this space,” or any other of Washington’s charmless bureaucratese.
  • And there was much rejoicing.
  • Chicago is cool.
  • (And I have the expense report to prove it.)

Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter (now!), @ProviderMyers.

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The Four Most Beautiful Words in Our Common Language…

The Great Dayne

The Great Dayne

Bill Myers

Good morning, ProviderNation. Gore Vidal famously said that the four most beautiful words in the English language were, “I told you so.” (The three saddest words, Vidal added, were “Joyce Carol Oates.”)

So you’ll just have to forgive the Great Dayne Duvall (who, like Vidal, manages to be everywhere, to say the most shocking things in the most charming way, and who has poured his art into his life rather than the other way about) if he sports a wintry, Vidalian smirk.

You’ll recall that, recently, Duvall broke a taboo by suggesting that—perhaps—the quest for a cure to Alzheimer’s was a tilt at windmills. “Families going through the toughest times of their lives aren’t interested in a cure that might be decades away,” quoth he. “Not when they can’t find help for their loved one, right now.”

The digital ink has barely (digitally) dried on the digital page, yet now comes a study led by the fine folks at the University at Buffalo which says, in essence, hear, hear. Last year, hundreds of millions of federal dollars were spent on “science and drug development,” but only “$10 million to care, services, and education,” University at Buffalo Professor Davian Porock writes in the as-yet-unpublished study. That “represents less than $2 per person for care-related support… are these the priorities that people and families living with dementia want? Their voices have not been heard over the clamor for research dollars.”

Surveying hundreds of families and friends who are caring for people with dementia, Porock and her colleagues found that their No. 1 concern was money and help “to support caregiving,” followed by financial aid and other help for long term care and “aging in place” and THEN research for a cure.

“I have known for a long time that there will be no cures in my lifetime,” one respondent tells Porock. “Maybe in my children’s, not sure now, not even sure if [a cure will come] in my grandchildren’s [lives]. So there has to be some more emphasis/support/help for caregivers, and some way has to be found to pay for care—in homes.”

There are several reasons why Porock’s study is important, and not just because it allows Dayne Duvall to claim, modestly, a rhetorical victory. First, Porock runs Buffalo’s Institute for Person-Centered Care, which is hoping to do for elder care what NASA has done for, well, everyone. Second, the survey for her study is “part of a larger project to develop a national advocacy group… providing an opportunity for people living with any type of dementia and their care partners to contribute to the national debate…”

Third, we seem to be witnessing what we Hegelians might affectionately call die Tendenzwende, or shift in the zeitgeist. Consider:

  • Last spring, several senators introduced the HOPE Act which, among other things, would link families and patients to “care coordinators,” who (ideally) will be a kind of advocate for hard-pressed families and friends;
  • Last month, presidential candidate Hillary Clinton called for federal programs to address what she called “a caregiving crisis.” (Whatever one thinks of Mrs. Clinton or her politics, can we agree that she doesn’t stake out positions because she thinks they’re unpopular?)
  • Last week, Advancing Excellence’s inestimable Doug Pace announced that he was heading over to the Alzheimer’s Association as the newly minted director of dementia care services and support.

These are mere tremors, perhaps. But even the grandest seismic events start as small tremors, too. In any case, if the dementia world really does start shaking, do as Vidal would have done (and Duvall undoubtedly does): “Sit next to a man in a turban. You get photographed more.”

Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.

 

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Medicare Makes It To 50…Now What?

Medicaid50

Jackie Oberst

Good afternoon, ProviderNation.

Today Medicare is now a nifty fifty. Besides being eligible for an AARP card, what does the future hold for this program? Our number-crunching allies at the American Academy of Actuaries, which also turned the big 5-O, today, released three of its Medicare@50 series of papers that are purported to be a CliffsNotes version for “actuarial analyses of public policy issues.”

“With 10,000 Americans now enrolling in Medicare every day, it’s more important than ever to take stock of the program,” said academy Senior Health Fellow Cori Uccello, adding that the series “identifies some of the most fundamental issues that policymakers and anyone concerned with the program’s future should be aware of, such as ‘How serious are Medicare’s financial challenges?’ and ‘What benefits does Medicare provide, and to whom?’ ”

In the first paper, “Is it Sustainable for 50 More Years?” Vicarious Risk Takers and the Academy of Calculating point out that the baby boomers outnumber the current and projected working population, so that “fewer workers will be paying into the system to support the growing number of retirees. In 1980 there were four workers for every Medicare beneficiary; by 2040 that ratio is expected to fall to about two workers for every beneficiary.”

As such, the benefit payments are expected to exceed payroll taxes, threatening the solvency of one of its major trust funds: the Hospital Insurance (HI) trust fund, which primarily pays for inpatient hospital and post-acute care services. Assets in the HI trust fund are projected to be depleted by 2030, according to the Medicare Trustees’ latest report. “Bringing the trust fund back into balance will require cuts in program spending, increased funding, or some combination of the two,” said the paper.

The second paper, “Who are the Beneficiaries?” Medicare is touted as “not a one-size-fits-all program.” There are many flavors of beneficiaries, not just those who turn 65, including younger individuals with permanent disabilities, individuals diagnosed with end-stage renal disease or amyotrophic lateral sclerosis, and those with low incomes who are also eligible for Medicaid (“dual eligibles”).

Medicare spending varies by subgroups. On average it is “higher for disabled beneficiaries than healthier beneficiaries aged 65 and older and for dual eligibles than for non-dual eligibles.” Here are more mind-boggling stats from this paper:

  • The most costly 5 percent of Medicare’s traditional fee-for-service (FFS) program beneficiaries account for nearly 40 percent of Medicare FFS spending.
  • The most costly 25 percent of beneficiaries account for over 80 percent of spending.
  • The least costly 50 percent of beneficiaries account for only 5 percent of spending.

In sum, the paper says, “when evaluating whether and how the program is meeting the needs of the beneficiaries, it is important to consider not just the average beneficiary, but also the entire range of beneficiaries.”

The last paper poses the critical question, “Does it Meet the Needs of the Beneficiaries?” Since Medicare’s enactment in 1965, its traditional fee-for-service benefit package has remained mostly unchanged. However, beneficiaries now are faced with supplemental coverage options (Part D prescription drug plans, MediGap, Medicare Advantage), which can be overwhelming at best.

Medicare does not cover long term care services and supports such as skilled nursing facilities, however. Other services–vision, dental, and hearing care–are typically not covered under the traditional Medicare program either. Again, beneficiaries will need to turn to supplemental coverage options.

Another fatal flaw in the program is that patient “cost-sharing” requirements, such as deductibles, copayments, and coinsurance, do not have an annual limit or cap (as seen in private health insurance programs), which can leave beneficiaries “unprotected against catastrophic health costs.”

“Proposals have been suggested that would combine a new cost-sharing limit with a unified Part A and Part B deductible,” the paper says. “The copayment and coinsurance requirements also could be restructured.”

Essentially, a program that started off as socialistic may be turning more corporate as it ages.

Jackie Oberst is Provider’s managing editor. Email her at joberst@providermagazine.com. Follow her on Twitter, @ProviderMag.

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The Alzheimer’s Hydra…

The Hydra of legend: cut off one of its heads, and it just grows back.

The Hydra of legend: Cut off one of its heads, and it just grows back.

Bill Myers

Washington, D.C.—Good afternoon, ProviderNation. The Alzheimer’s International Conference has come and gone, and my colleague Jackie Oberst (known affectionately ’round here as “The Managing Editor”) has done the hard work for us all.

Oberst, who has her PhD in some kind of science stuff, leads with the new promise of preventative treatments before those ghastly proteins do their dirty work. But her piece also raises a critical, if often unanswered, question: Who gets the check?

As Oberst puts it, “It costs $4 billion to $11 billion to develop one drug and takes an average of 12 years for it to travel from bench to bedside, according to the InnoThink Center for Research in Biomedical Innovation. Only five in 5,000 drugs that enter preclinical or animal testing progress to human testing—of those five drugs, only one is approved, according to the FDA.”

If you think that’s bad, don’t worry, it gets worse. According to “Generation Boomer,” a report by the fine folks at the Alzheimer’s Association, the U.S. government spends more than $6 billion a year on cancer research, $4 billion per year on heart disease, and more than $3 billion for HIV/AIDS. Alzheimer’s research gets $480 million.

It’s notorious that we live in an era of austerity, and not everyone thinks that it’s gummit’s role to pay the bills in the first place. But, if you agree that Alzheimer’s is a public health crisis, then the money has got to come from somewhere.

And here we come to another dilemma. Even if you could turn on the cash spigot tomorrow, there are tens of thousands of families and friends who won’t be able to enjoy a cure a decade from now: They need help immediately, says Dayne Duvall, chief operating officer of the National Certification Board for Alzheimer Care.

“It’s important that the government figures out how to provide care to families who are at the end of their tether,” Duvall tells us. “Families going through the toughest times of their lives aren’t interested in a cure that might be decades away. Not when they can’t find help for their loved one, right now.”

Supporting families and friends doesn’t have to mean advanced training (although that would certainly be a huge help), Duvall says. It can be as simple as giving someone an afternoon off.

But that, too, costs money. And it’s yet another venomous face of the Alzheimer’s hydra.

Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.

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