Daily Rounds: New ADHD Guidelines; MassHealth Cheats; Medical Identity Theft; Not Really Sybil

New ADHD guidelines could increase treatment in preschoolers and high schoolers (Boston Globe) — "New guidelines for diagnosing and treating attention deficit hyperactivity disorder could lead pediatricians to diagnose the condition in kids as young as four and to continue treating teens through high school on stimulant drugs like Ritalin and Adderall. The recommendations, released today at the American Academy of Pediatrics annual meeting in Boston, state that primary care physicians should do a diagnostic workup and initiate treatment for ADHD for any child aged 4 through 18 who has academic or behavioral problems and has trouble with inattention, hyperactivity, or impulsivity." (boston.com)

AG Targeting Medical Cheats (Boston Herald) - "With indictments mounting in multimillion-dollar health-care fraud cases, Attorney General Martha Coakley said she’s putting MassHealth providers on notice: The gavel of justice will come down on medical cheats. Two managers of post-detox sober houses in Malden and the South Coast area will be arraigned today on charges of taking kickbacks in what Coakley has charged is a $3.8 million health-care scheme. Tomorrow, a Weymouth woman will be indicted on charges she bilked $600,000 from MassHealth. Medicaid fraud and kickback convictions can carry sentences of up to five years on each count."

Medical Identity Theft A Growing Problem (amednews.com) -- "One-third of health care organizations, including physician practices, insurers and pharmacies, have reported catching a patient using the identity of someone else to obtain services, according to a report from the professional services firm PwC. The report, "Old Data Learns New Tricks," by PwC's Health Research Institute, said the problem — and consequences — of medical identity theft could get worse as electronic sharing of patient data increases. Physicians unwittingly could end up using information obtained during a visit with an identity thief in deciding how to treat a patient, for example. Medical identity theft is still a small percentage of the total amount of identity theft that occurs, but it's the fastest-growing segment, said Jim Koenig, director and leader of PwC's identity theft practice."

A Girl Not Named Sybil (New York Times Magazine) _ "As far back as 1994, Herbert Spiegel, an acclaimed psychiatrist and hypnotherapist, began telling reporters that he occasionally treated Shirley Mason when her regular psychiatrist went out of town. During those sessions, Spiegel recalled, Mason asked him if he wanted her to switch to other personalities. When he questioned her about where she got that idea, she told him that her regular doctor wanted her to exhibit alter selves. And yet, in the popular imagination, Sybil and her fractured self remained powerfully tied to the idea of M.P.D. and the childhood traumas it was said to stem from. “Mamma was a bad mamma,” Wilbur declares in the transcripts. “I can help you remember.” But countless other records suggest that the outrages Sybil recalled never happened. If Sybil wasn’t really remembering, then what exactly was Wilbur helping her to do?" (nytimes.com)

How Medicare Fails The Elderly (THe New York Times) — "Yet Medicare, which pays for all of the above, does not, except in rare instances, pay for long-term care in a supervised, safe place for frail or demented old people, or for home aides to help with shopping, transportation, bathing and using the toilet. Nationwide, the median annual cost of a nursing home in 2010 was $75,000; room and board in an assisted living facility, with no additional help, was $37,500; and the most basic category of home health aide, who can perform no medical tasks, like the dispensing of medication, was $19 an hour. These expenses are left to the elderly (and their adult children) to pay for out of pocket until their pockets are all but empty." (nytimes.com)

And from Friday but important:
Administration drops long-term care provision of overhaul (NPR - Shots) — After a 19-month review, the Obama administration has concluded that it can't implement the CLASS Act, the community-based long-term care program that was the late Sen. Edward Kennedy's most heartfelt contribution to the Affordable Care Act.It's not quite right to say the administration has pulled the plug on the measure, which is supposed to provide a modest cash benefit to the elderly for the purchase of long-term care services at home. It's more like they've put it in a medically induced coma while officials try to figure out if a cure can be found for what ails CLASS, or the Community Living Assistance Services and Supports program.
The biggest problem, of course, is the fact that the CLASS program, which is voluntary, could wind up with only people most likely to need the benefit signing on. That would drive the premiums sky high. (NPR)