BOOMER'S GUIDE
VOLUME 6 ISSUE 4
APRIL 2013
THE BOOMER'S GUIDE TO PLANET
RETIREMENT
DR. MARILYN BRUNO
WWW.GYNOSAPIENS.COM
VOLUME 6 ISSUE 4
APRIL 2013
IN THIS ISSUE: Page 1: A Cure for the Common Hangover
Page 2: Estate Planning
Page 5: 3-D Printer Made a Car!
Page 6: 3-D Printer Made Stem Cells!
Page 7: 3-D Printer to Make a Lunar Station!
Page 7: Tips for Extending Life
Page 8: Space Heaters
Page 9: Cephalopod to Keep Our Borders Safe
Page 9: Food Recalls
Page 9: Autism-Alzheimer’s Link
Page 10: The Future of Medicine is Now
Page 12: Medicare Update: Sequester, Rx denials, Bankruptcy, Dashboard
Page 13: Identity Theft
Page 14: Paraprosdokians
QUOTE OF THE MONTH:
TODAY IS THE OLDEST YOU'VE EVER BEEN, YET THE YOUNGEST YOU'LL EVER BE SO ENJOY THIS DAY WHILE IT LASTS.
Anonymous
A Cure for the Common Hangover
Finally, our tax dollars have funded a valuable scientific breakthrough we can all use – just in time for
Spring Break: an enzyme combination could be used as a preventative measure or antidote for
alcohol intoxication!
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A team of UCLA engineers has identified a method for speeding up the body's reaction to the
consumption of alcohol. They placed in mice two complementary enzymes in a tiny capsule to speed
up the elimination of alcohol from the body, mimicking the way the liver does. The blood alcohol
levels in mice that received the enzyme package fell more quickly than in mice that did not. Blood
alcohol levels of the antidote test group were 15.8 percent lower than the control group after 45
minutes, 26.1 percent lower after 90 minutes and 34.7 percent lower after three hours.
This is good news for the non-designated drivers out there.
For more info: http://www.bioresearchonline.com/doc.mvc/a-cure-for-the-common-hangover-
0001?sectionCode=TOC&templateCode=LifeScienceSponsor&user=2562089&source=nl:36464
ESTATE PLANNING
This is a topic that I have been researching lately because, since I moved recently to
California, I am trying to put all of my ducks in order in accordance with this State’s tax
and estate laws.
Updating your basic Estate Documents.
The four documents of the Estate Planning Holy Grail are your Will, Trust, Durable Power
of Attorney, and Advanced Health Care Directive (“Living Will”). Make sure that you
review these often. If you move to another State, as I did, these documents needed to
be revised and amended or totally re-written.
-Will. I have a “Pourover Will” that transfers all assets to my Revocable Living Trust,
which is the Beneficiary.
-The Revocable Trust is an agreement that covers three phases of your life: while you
are alive and well; if you become mentally incapacitated; and after you die. However, I
had to “fund the trust” – putting all of my assets (bank accounts, house, etc.) in the
name of my Trust. This is very do-able, but a big hassle. So I recommend that you
start early. My house title was easily transferred using a Quitclaim Deed (downloadable
for free) from my name to the name of my Revocable Trust. I only had to show the
deed to have my Homestead Tax exemption re-recorded in the name of the Trust. My
car title could be transferred by using a power of attorney on a form downloadable from
the State DMV’s website, etc.
Once the trust agreement is signed and the assets are titled in the name of the Trust,
the revocable living trust has become the record owner of your assets and will not have
to pass through Probate Court upon your passing. If any of your assets sit outside of
the trust at the time of your death, they will need to be probated unless they have a
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beneficiary designation or are owned with rights of survivorship with someone who
survives you.
-Durable Power of Attorney (POA) is a written document that remains valid even if you
should later become unable to make your own decisions. With a durable POA, you are able to appoint
an agent to manage your financial affairs, or conduct other business for you during your
incapacitation. A general durable POA may allow your agent to do every act which may legally be
done by you. A limited durable POA may cover specific events, like selling property or making
investments.
One of the most important parts of creating a durable power of attorney is choosing an agent. The
agent is the person you choose to carry out the duties you have outlined, so should be someone you
trust to carry out your wishes. The agent is usually a family member or a friend, but you can choose
anyone.
-Advanced Health Care Directive
This is a legal document that a person uses to make known his or her wishes regarding
life prolonging medical treatments. It can also be referred to as an advance directive,
health care directive, or a physician's directive, or durable power of attorney for
healthcare. It is important to have this Directive in place, as it informs your health care
providers and your family about your desires for medical treatment in the event you are
not able to speak for yourself.
The requirements for a living will vary by State so you may want to have a lawyer
prepare your living will. Many lawyers who practice in the area of estate planning
include a living will and a health care power of attorney in their package of estate
planning documents. If you need to write or update a will or trust, you can take care of
your living will at the same time.
But be very careful before you sign this document. My mother had signed a Directive
with both Do Not Resuscitate and Do Not Feed provisions checked off, thinking that
these would be invoked only if she were unconscious. However, this was not the case.
Since Mom was deaf without her hearing aids and the nurse removed them, she was
unaware of what was being said to her. The end result was that the intake doctor wrote
a “Do Not Feed By Mouth” order, and Mom literally starved to death two and a half
weeks later. Even with all that I know about these things, there was absolutely nothing
I could do to change the Directive or have her change the Directive. I was almost
thrown out of the hospital on many occasions. Tragic.
More to keep in mind:
-Avoiding Probate
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As you can see, there are only a limited number of ways to avoid probate. What will
actually work for you will depend on your own unique family and financial situations, but
the bottom line is that by using one or more of the techniques described above to avoid
the probate of your property, you will be creating peace of mind for you as well as peace
of mind for your loved ones during a difficult time.
-Assets not titled to a Revocable Trust
If you own life insurance or assets held in a retirement account such as an IRA, 401(k)
or annuity, then you are already taking advantage of probate avoidance through the use
of beneficiary designations. Most States allow you to designate beneficiaries for your
bank accounts (this is referred to as a "payable on death" or "POD" account), and also
for your non-retirement investment accounts (this is referred to as a "transfer on death"
or "TOD" account). In addition, a handful of States allow you designate beneficiaries for
your real estate through the use of a transfer on death deed or beneficiary deed or
affidavit. In other States you can use a life estate deed to retain ownership of real
estate during your lifetime and then pass the property on to the beneficiaries of your
choice after you die without the need to probate the real estate.
Bur beware of relying on joint ownership with rights of survivorship or tenancy by the
entirety for bank accounts or property titles to avoid probate because there are several
downsides to doing so:
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In many cases adding a joint owner to an account or deed will be a taxable gift
that needs to be reported to the IRS on a federal gift tax return (IRS Form 709).
If a joint owner is sued or gets divorced, then a judgment creditor or divorcing
spouse may be able to take the assets in the joint account.
If a joint owner dies before you do, then 50% or even 100% of the joint account
could be included in the deceased owner's estate.
If you are in a second or later marriage, leaving your property to your spouse by
right of survivorship or tenancy by the entirety will mean that your spouse will be
free to do whatever he or she wants with your property after your spouse later
dies. This may not be what you want - in other words, you may want your spouse
to have use of your property after you die, but then after your spouse later dies
you may want your property to go to your own children. In this situation, joint
ownership with right of survivorship or tenancy by the entirety will not accomplish
your final wishes since your spouse may freely choose to leave your property to
your spouse's children instead of your children.
Joint Bank Account Ownership in Your Lifetime
Under Federal Deposit Insurance Corporation (FDIC) rules, a joint account is a deposit
account owned by two or more people who have equal rights to withdraw 100 percent of
the deposits, write checks, pay bills, and close the account. In addition, each co-owner
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is insured for up to $250,000 for his or her share in all joint accounts at an insured
bank. Considerations: trustworthiness, how limits on withdrawal rights could affect
your insurance coverage.
You can also give someone limited access to a deposit account on an as-needed basis
without granting ownership rights through a power of attorney – the written
authorization for one or more people to represent or act on another’s behalf in financial
affairs or other personal matters. Powers of attorney can be broad, allowing unlimited
access, or narrow, limiting access to accounts.
Allowing others to access your safe deposit box. The rules and procedures for safe
deposit boxes can vary by State and by bank, so ask your bank about the options for
granting someone access and what you would have to do if you later change your mind.
The main consideration is trustworthiness.
Adding co-owners vs. “authorized users” to a credit card account. A co-owner is
financially responsible for all debt incurred, including any charges by an authorized user.
Depending on the cardholder agreement, authorized users may or may not be financially
responsible for any debt on the card. A card owner also may be able to place
restrictions on authorized users, such as limits on amounts that can be charged.
Co-signing a loan. If the other co-signer does not pay the debt, you will have to,
along with late fees and collection costs. Additionally, your credit rating could be
affected if this person fails to pay or pays late.
For more guidance, consult your attorney, accountant, or financial advisor.
3-D Printer Made a Car!
No wonder MoTown is bankrupt! You don’t need a Detroit assembly line any more to make a car!
You just need a warehouse of plastic-spraying printers producing light, cheap and highly efficient
automobiles!
Jim Kor, the engineer founder of Kor Ecologic, has created the “Urbee 2” – a car that maximizes
miles per gallon by using lightweight plastic construction. This is something that 3-D printing is
particularly well suited for. The designers were able to focus more on the optimal automobile
physics, rather than working to install a hyper efficient motor in a heavy steel-body automobile. As
the Urbee shows, making a car with this technology has a slew of beneficial side effects.
Kor Ecologic is also designing tractors, buses, even commercial swimming pools, and a three-wheel,
two-passenger vehicle on-demand at its 3-D printing facility. The printers he uses create ABS plastic
via Fused Deposition Modeling (FDM). The printer sprays molten polymer to build the chassis layer by
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microscopic layer until it arrives at the complete object. The machines are so automated that the
building process they perform is known as “lights out” construction, meaning Kor uploads the design
for a bumper, walk away, shut off the lights and leaves. A few hundred hours later, he’s got a
bumper. The whole car – which is about 10 feet long – takes about 2,500 hours.
Besides easy reproduction, making the car body via FDM affords Kor the precise control that would
be impossible with sheet metal. When he builds the aforementioned bumper, the printer can add
thickness and rigidity to specific sections. When applied to the right spots, this makes for a fender
that’s as resilient as the one on your Prius, but much lighter. That translates to less weight to push,
and a lighter car means more miles per gallon. And the current model has a curb weight of just 1,200
pounds.
To further remedy the issues caused by modern car-construction techniques, Kor used the design
freedom of 3-D printing to combine a typical car’s multitude of parts into simple unibody shapes. For
example, when he prints the car’s dashboard, he’ll make it with the ducts already attached without
the need for joints and connecting parts. What would be dozens of pieces of plastic and metal end up
being one piece of 3-D printed plastic.
With fewer parts, the car is even more light weight and exceptionally aerodynamic. The 10
horsepower hybrid engine, base chassis, and tubular metal cage around the driver will be metal for
versatility and safety. Kor’s goal is to get Department of Transportation approval. With three wheels
and a curb weight of less than 1,200 pounds, the Urbee is more motorcycle than passenger car. But
the head engineer is planning to take the latest prototype from San Francisco to New York on 10
gallons of gas, preferably pure ethanol!
For more on this: http://www.wired.com/autopia/2013/02/3d-printed-car/
3-D Printer Made Stem Cells!
A range of stem cell cultures based on human mesenchymal stem cells (hMSCs) can already be
grown in laboratory conditions. But to preserve cell and tissue viability and functions, a key
challenge has been the development of printing processes that are both controllable and less
harmful, and that could also work with human embryonic stem cells (hESCs), which have a greater
potential to generate a wide variety of differentiated cell types (pluripotency) than hMSCs.
The first hESCs were made by a group at the Heriot-Watt’s Biomedical Microengineering. Their
printers can create programmable patterns from two different bio-inks that can create delicate cells
that are spheroids of uniform size, The natural spheroid process yields microtissues that are more
similar to native tissue structures. The printed cells also better maintain their pluripotency. Tests
showed that 80-90% of the embryonic stem cells stayed viable.
In the longer term, the team envisages the technology being further developed to create viable 3D
organs for medical implantation from a patient’s own cells, eliminating the need for organ donation,
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immune suppression, and solving the problem of transplant rejection. For more info: Alan FaulknerJones et al., Development of a valve-based cell printer for the formation of human embryonic stem
cell spheroid aggregates, Biofabrication, 2013, doi:10.1088/1758-5082/5/1/015013
3-D Printer to Make a Lunar Station
This one is too ‘way too unworldly: making a habitable station made out of Moon dust!! The idea is
to build “SinterHab” near the lunar south pole by construction modules from lunar dust by microwave
sintering and contour crafting, built by a large NASA spider robot. This could be the start of a
housing bubble on the Moon! For more: http://www.kurzweilai.net/a-3d-printed-moon-base-baked-fromlunar-dust?utm_source=KurzweilAI+Weekly+Newsletter&utm_campaign=1311a2c5df-UA-9467421&utm_medium=email.
TIPS FOR EXTENDING LIFE
--Rotten Egg Gas
Bloomberg recently reported that, in the hunt for ways to extend life, Chinese scientist turned to the
gas that gives rotten eggs their distinctive foul smell -- hydrogen sulfide! This gas, which also has
toxic and explosive properties (it was used in the First World War as a chemical weapon) appears to
slow aging and block damaging chemical reactions inside cells in the cardiovascular and nervous
systems.
Hydrogen sulfide apparently activates a gene called “klotho” – named after the Greek Fate who
controls the length of human life. Klotho is implicated in longevity in a similar way to resveratrol, an
antioxidant in red wine, by promoting the production of the body’s own antioxidants. Unlike
resveratrol, however, hydrogen sulfide is made by the body.
Low levels of hydrogen sulfide are associated with high blood pressure, Parkinson’s disease and
Alzheimer’s disease. Higher levels of hydrogen sulfide can counteract free radicals, which is why
bathing in volcanic springs is beneficial to people suffering from inflammatory or autoimmune
diseases. Also, diets rich in onions, garlic and other Allium plants are loaded with potential
compounds that can release or generate hydrogen sulfide. Glasko SmithKline is experimenting with
a pill that boosts levels of the hydrogen sulfide in order to tap into the dietary supplement market
that’s worth $28 billion a year in the U.S. alone.
--Resveratrol
We’ve heard this before. Resveratrol—a compound found in grapes, red wine and nuts—may ward
off several age-related diseases, including certain metabolic diseases like type 2 diabetes and heart
disease. In animal studies, severely restricting calories can help prevent some of these diseases.
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Over a decade ago, researchers found that resveratrol can mimic calorie restriction in some ways and
extend the lifespans of yeast, worms, flies and fish.
Harvard Medical School researchers now show that resveratrol affects the activity of enzymes called
sirtuins, which control several biological pathways known to be involved in the aging process.
Resveratrol is only one of many natural and synthetic sirtuin-activating compounds (STACs) now
known. STACs directly interact with sirtuins and ultimately increase the activity of mitochondria, the
organelles that produce the cell’s energy. So, pass another flagon of Merlot around. This stuff can
energize us! For more on this: http://www.nih.gov/researchmatters/february2012/
02132012resveratrol.htm
Increasing longevity is one of humanity’s greatest goals. Babatunde Osotimehin, executive director
of the United Nations Population Fund, reported that there were almost 810 million people older than
60 years on the planet in 2012, up from 205 million in 1950.
Let’s see if we Boomers can push that number over 1 Billion!
SPACE HEATERS
On the cosmic level, space-based solar power (SBSP) has once again begun to attract attention with
projects emerging in the US, Russia, China, India and Japan, among others. All are driven by
increasing energy demands, soaring oil and gas prices, a desire to find clean alternatives to fossil
fuels and by a burgeoning commercial space industry that promises to lower the cost of entry into
space and spur on a host of new industries, says BBC Future.
Space-solar-power pioneer John Mankins, CTO of Deep Space Industries, is the man behind a project
called SPS-Alpha, which aims to assemble a huge bell-shaped structure that will use mirrors to
concentrate energy from the sun onto solar panels. The collected energy would then be beamed
down to ground stations on Earth using microwaves, providing unlimited, clean energy and overnight
reducing our reliance on polluting fossil fuels.
The snag? It is unproven technology and he estimates it will take at least $15–$20 billion. However,
a 2011 report by the International Academy of Astronautics (IAA) found that SBSP could be
commercially viable within 30 years, driven in part by the rise of private space companies. For more
on this: http://www.kurzweilai.net/space-based-solar-farms-powerup?utm_source=KurzweilAI+Weekly+Newsletter&utm_campaign=b5da8de6ff-UA-9467421&utm_medium=email
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CEPHALOPOD TO KEEP OUR BORDERS SAFE
When the sequester kicked in, new ideas emerged to keep our borders safe, while reducing payrolls.
Here’s a weird one that may actually get funded using taxpayer’s money, thanks to the Small
Business Innovation Research (SBIR) Office in the Department of Homeland Security’s Science and
Technology Directorate (S&T): the Safe, Quick, Undercarriage Immobilization Device (SQUID). Yes,
just as Captain Nemo found out, giant squids can glom on to anything, so why not use squid
technology to stop vehicles remotely?
In 2010, engineers merged the characteristics of a squid’s sticky tendrils with the concept of fictitious
Spiderman’s super-strong webbing to create a prototype of the first remote device to stop vehicles in
their tracks. At the push of a button, spiked arms shoot out and entangle in a car’s axles—bringing a
vehicle to a screeching halt.
Sound like something “Q” would have come up with? Well, the engineers seem to have perfected
this technology, named Pit-BUL™ (something like a speed bump with embedded spikes and net) and
NightHawk™ (a remote-controlled spike strip disguised as a small suitcase). They can stop anything
from a compact car to a full-size SUV. The company is taking orders from every corner of the globe
about these products.
I guess the days of the high speed chases are over.
FOOD RECALLS
Sometimes I am shocked to see what is being recalled from our supermarket shelves.
The latest recalls are for Bumble Bee and Chicken of the Sea tuna fish cans – which have
not been properly sealed. Check out these sites to see the recalled dates:
http://content.govdelivery.com/bulletins/gd/USHHSFS-6f9529;
http://content.govdelivery.com/bulletins/gd/USHHSFS-6fa484
Be careful what you eat!
AUTISM-ALZHEIMERS LINK
I am pretty appalled that the number of children affected by autism in the U.S. is increasing in the
U.S. and nobody seems to know the cause.
Scientists at McGill University have now shown that abnormal brain development in high-risk infants
may be detected as early as age 6 months – before the appearance of autism symptoms at the age
of 2 or 3 years. The research focused on the brain’s white matter tract development — fiber
pathways that connect brain regions. After conducting MRI scans at 6 and 12 months of age of atrisk infants, at 24 months, 30% of infants in the study were diagnosed with autism. The symptoms
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of autism -- problems with communication, social interaction and behavior — can be improved upon
with early intervention. (For more on this: Jason J. Wolff. et al., Differences in White Matter Fiber
Tract Development Present From 6 to 24 Months in Infants With Autism, American Journal of
Psychiatry, 2012, DOI: 10.1176/appi.ajp.2011.11091447.)
But what about us Geezers? Are we also capable of making progress with intensive therapy?
The answer may be Yes!
New research in the FASEB Journal by NIH scientists suggests that a small molecule called TFP5
rescues plaques and tangles by blocking an overactive brain signal, thereby restoring memory in mice
with Alzheimer’s — without obvious toxic side effects. (See: Varsha Shukla et al., A truncated
peptide from p35, a Cdk5 activator, prevents Alzheimer's disease phenotypes in model mice, The
FASEB Journal, 2013, DOI: 10.1096/fj.12-217497.)
Researchers have also discovered a molecule (called Dickkopf-1 or Dkk1) that accumulates with age
and inhibits the formation of new neurons. Adding the molecule to aged mice neural stem cells
showed the self-renewal and re-generation of immature neurons in the hippocampus (involved in
memory). The finding might help scientists design therapies to postpone the onset of those Senior
moments! The treatment apparently also helped to block the development of acute stress-induced
depression in mice (don’t ask me how they measured that!!!), which suggests that, in addition to
slowing memory loss during aging, neutralizing Dkk1 (which is also present in human brains) could
be beneficial in counteracting symptoms of depression. For more on this:
http://www.kurzweilai.net/blocking-this-molecule-in-the-brain-could-prevent-age-related-cognitivedecline?utm_source=KurzweilAI+Weekly+Newsletter&utm_campaign=02fe75facd-UA-9467421&utm_medium=email
Additionally, a new drug is entering clinical trials that has been designed to prevent the early stages
of Alzheimer’s disease. The drug blocks the clumping of amyloid-β (Aβ) into plaques in the brain,
which have been identified in early-stages of nerve cell damage leading to memory loss and
confusion. The drug reduced the number of senile plaques by a third and more than doubled the
number of new nerve cells in a particular region of the brain associated with memory. It also
markedly reduced the amount of brain inflammation and oxidative damage associated with the
disease. Alzheimer’s is the most common type of dementia, expected to more than double by 2050.
One in three people over 65 will die with dementia. For more on this:
http://www.kurzweilai.net/treatment-to-prevent-alzheimers-disease-moves-a-stepcloser?utm_source=KurzweilAI+Weekly+Newsletter&utm_campaign=02fe75facd-UA-9467421&utm_medium=email
The future of medicine is now
Six medical innovations are poised to transform the way we fight disease, The Wall Street
Journal reported last December:
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Surgeons at Boston Children’s Hospital have developed a way to help children born with half a
heart to essentially grow a whole one — by marshaling the body’s natural capacity to heal and
develop.
Oxford Nanopore Technologies has unveiled the first of a generation of tiny DNA sequencing
the size of a cell phone.
A test developed by Foundation Medicine Inc. enables doctors to test a tumor sample for 280
different genetic mutations suspected of driving cancerous tumor growth.
MK3475, being developed by Merck & Co., is among a new category of drugs that unleash an
army of immune cells to hunt down a cancer.
Last November, the FDA cleared a new iPhone add-on that lets doctors take an
electrocardiogram just about anywhere. Other smartphone apps help radiologists read medical
images and allow patients to track moles for signs of skin cancer.
Gene therapy is poised to become a viable option for a variety of often life-threatening medical
conditions, especially those resulting from a single defective gene.
Glad we are around to see these breakthroughs!
And there is a lot more around the corner. IBM’s Watson Solutions, WellPoint, and Memorial Sloan
Kettering Cancer Center have developed “cognitive computing.” This is important for two reasons:
first, of course to allow doctors worldwide to interpret complex clinical information assess patients
with cancer and other diseases and prescribe appropriate treatments; and second, because it
attributes to Watson the ability to think!
Over the past two years, clinicians and technology experts spent thousands of hours “teaching”
Watson how to process, analyze and interpret the meaning of complex clinical information using
natural language processing, all with the goal of helping to improve health care quality and efficiency.
Watson ingested more than 600,000 pieces of medical evidence, two million pages of text from 42
medical journals and clinical trials in the area of oncology research, has the power to sift through 1.5
million patient records representing decades of cancer treatment history, such as medical records and
patient outcomes, and provide to physicians evidence-based treatment options all in a matter of
seconds. In less than a year, Memorial Sloan-Kettering has immersed Watson in the complexities of
cancer and the explosion of genetic research which has set the stage for changing care practices for
many cancer patients with highly specialized treatments based on their personal genetic tumor type.
Watson will do in seconds what used to take years for the latest medical developments to reach all
practice settings. As a result, IBM, Memorial Sloan-Kettering and WellPoint are introducing the first
commercially based products based on Watson, including the Interactive Care Insights for Oncology,
WellPoint Interactive Care Guide and Interactive Care Reviewer. Coming soon is a first of-its-kind
Watson-based advisor, available through the cloud that is expected to assist medical professionals
and researchers worldwide by helping to identify individualized treatment options for patients with
cancer, starting with lung cancer.
On our level, we can expect shortening pre-authorization approval times for treatments. WellPoint
has deployed Interactive Care Reviewer to a select number of providers in the Midwest, and believes
more than 1,600 providers will be using the product by the end of the year. For more on this:
http://www.kurzweilai.net/watson-provides-cancer-treatment-options-to-doctors-in11
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seconds?utm_source=KurzweilAI+Weekly+Newsletter&utm_campaign=a44cb04dd3-UA-9467421&utm_medium=email
MEDICARE UPDATE
What the Sequester means for Healthcare:
The impact of the sequestration (mandatory budgetary cuts) will be manageable, according to the
3/4/13 edition of UBS’ Weekly Guide. The 2% across-the-board cuts in Medicare reimbursement
beginning 1 March will generate an annualized reduction of $11 billion, and will have a direct effect
on healthcare providers — namely physicians, hospitals, skilled nursing and home healthcare — but a
more subdued effect on most other healthcare subsectors. Managed Care Organizations (MCOs)
that enroll Medicare beneficiaries (via Medicare Advantage) will pass their 2% rate cut through
providers, mitigating the bottom line impact on MCOs. Many MCOs may have already anticipated
these cuts and already adjusted provider payments, patient premiums and patient benefits to
minimize or even eliminate the impact to earnings. Other healthcare product and service companies
will be indirectly influenced by the Medicare rate cuts, mostly through price pressure from providers.
Not too bad but, given the budget deficit debates currently underway and the significant portion of
healthcare costs within the federal budget (approximately 25% over the next ten years), analysts
expect that additional healthcare cuts are forthcoming.
Prescription Drug Denials:
It happens. Your prescription is denied at the pharmacy for any number of reasons:

Your drug isn’t on your plan’s formulary (list of covered drugs).

You have to get prior authorization, meaning that you must formally ask your plan for
permission before your plan will consider covering your drug.

You have to try step therapy, meaning that you must try a different, less expensive drug first,
before your plan will cover your drug.

Your drug has a quantity limit, meaning that your plan will cover only a certain amount of your
drug over a period of time.
Find out the reason and tell your doctor what is going on. Your pharmacist may give you a notice
called “Medicare Prescription Drug Coverage and Your Rights.” This notice will give you information
on how you or your doctor can re-contact your plan to submit a formal written or verbal request for
exception to the plan’s coverage rules. In addition, your doctor must fill out a form called a Coverage
Determination Request Form. You or your doctor can get this form by contacting your plan or by
visiting your plan’s website.
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If you plan denies your request, they will send you a Notice of Denial of Medicare Prescription Drug
Coverage. This letter will explain how you can appeal the plan’s decision. Oftentimes, your doctor
will send these documents directly to the plan for you. If your doctor can’t do this, you can send
these documents in yourself. Contact your plan to find out where to fax or mail these documents.
Keep copies of everything that you send and use certified mail to confirm that your plan receives the
information.
Your plan must give you or your doctor a decision, responding to the exception request within 72
hours of receiving your doctor’s statement. If you need your drugs sooner, you can request a fast, or
expedited, exception request and your plan should respond to your request within 24 hours. You can
also go to your pharmacy and ask if you have the option of paying the full cost of your drug.
What to do if your Health Insurance Company Goes Bankrupt
Yes, this happens too. Just last week in Florida, Universal Health Care Insurance and Universal Health Care, Inc.
closed their doors and were placed in receivership. The Centers for Medicare & Medicaid Services (CMS) held a
conference call for the 40,000 Seniors affected by the closing and is following up with letters outlining options to
switch to other plans. When in doubt, call your local S.H.I.P. counselor.
Medicare Chronic Conditions Dashboard
CMS announced this new service, which furthers the Affordable Care Act’s goals for health promotion and the
prevention and management of multiple chronic conditions (heart disease, diabetes, etc.), which affect 2/3 of
Medicare beneficiaries. In 2011, spending for Medicare beneficiaries with two or more chronic conditions was
about $276 billion, about 93 percent of all Medicare spending. The Dashboard offers researchers, physicians, public
health professionals, and policymakers an easy-to-use tool to get current data on where multiple chronic conditions
occur, which services they require, and how much Medicare spends helping beneficiaries with multiple chronic
conditions. This is perceived as a step in transforming Medicare from a fee-for-service based payer to a value-based
purchaser of care that links payments to quality and efficiency of care, rather than sheer volume of services. See:
http://www.ccwdata.org/business-intelligence/chronic-conditions/index.htm; CMS’s Medicare Chronic Conditions
Chartbooks and other reports may be accessed at http://www.cms.gov/Research-Statistics-Data-andSystems/Statistics-Trends-and-Reports/Chronic-Conditions/index.html; Information on HHS’s Initiative on Multiple
Chronic Conditions may be viewed at http://www.hhs.gov/ash/initiatives/mcc/index.html.
Identity Theft Alert
I was throwing out documents from 2007 (bank stuff, etc.) and was shocked to see my date of birth
and Social Security Number on everything. Well, this is still the case on medical records, so be
especially careful when storing and disposing them. LifeLock provides the following tips for taking
precautions with your personal info:
--Password-protect your sensitive file on your computer
--Don’t send any info in an email. Look for the “s” after “http” for secure websites.
--Report fraudulent activity to Medicare and the IRS (1-800-908-4490).
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BOOMER'S GUIDE
VOLUME 6 ISSUE 4
APRIL 2013
Paraprosdokians
Winston Churchill loved paraprosdokians -- figures of speech in which the latter part of a sentence or
phrase is surprising or unexpected. Here are some examples, courtesy of a dear friend of mine:
1. Where there's a will, I want to be in it.
2. The last thing I want to do is hurt you. But it's still on my list.
3. Since light travels faster than sound, some people appear bright until you hear them speak.
4. If I agreed with you, we'd both be wrong.
5. We never really grow up; we only learn how to act in public.
6. War does not determine who is right - only who is left.
7. Knowledge is knowing a tomato is a fruit. Wisdom is not putting it in a fruit salad.
8. They begin the evening news with 'Good Evening,' then proceed to tell you why it isn't.
9. To steal ideas from one person is plagiarism. To steal from many is research.
10. Buses stop in bus stations. Trains stop in train stations. On my desk is a work station.
11. I thought I wanted a career. Turns out I just wanted paychecks and benefits.
12. In filling out an application, where it says, 'In case of emergency, notify: ' I put 'DOCTOR.'
13. I didn't say it was your fault...I said I was blaming you.
14. Women will never be equal to men until they can walk down the street with a bald head and a
beer gut... and still think they are sexy.
15. Behind every successful man is his woman. Behind the fall of a successful man is usually also a
woman.
16. A clear conscience is the sign of a fuzzy memory.
17. You do not need a parachute to skydive. You only need a parachute to skydive twice.
18. Money can't buy happiness, but it sure makes misery easier to live with.
19. There's a fine line between cuddling and holding someone down so they can't get away.
20. I used to be indecisive. Now I'm not so sure.
21. You're never too old to learn something stupid.
22. To be sure of hitting the target, shoot first and call whatever you hit the target.
23. Nostalgia isn't what it used to be.
24. Change is inevitable, except from a vending machine.
25. Going to church doesn't make you a Christian any more than standing in a garage makes you a
car.
26. Where there's a will, there are relatives.
And my favorite is...
I'm supposed to respect my elders, but it is getting harder and harder for me to find one now.
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BOOMER'S GUIDE
VOLUME 6 ISSUE 4
APRIL 2013
Please let me know how topics you would like covered in our next
Newsletters! E-mail:DrBruno@gynosapiens.com.
All previous Newsletters are posted online on the homepage of
www.gynosapiens.com
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