You may have been hearing a lot about the Independent Payment Advisory Board, or IPAB, in the media lately. Maybe you’ve been wanting to learn more about the Board and what it could mean for Medicare beneficiaries.  The IPAB was established by the 2010 Affordable Care Act, and it is charged with making recommendations to reduce the growth in Medicare spending, if Medicare exceeds a certain growth rate. The Board consists of 15 members nominated by the President and confirmed by the Senate.

More needs to be done to ensure sustainable healthcare costs, but there are flaws with IPAB that patient advocates believe will ultimately limit seniors’ access to quality healthcare.  The way that IPAB is currently designed will give the Board the ability to dramatically cut payments to healthcare providers and physicians who provide services to Medicare beneficiaries. Great concern has been expressed that doing so may result in fewer providers being willing to accept Medicare patients, ultimately, limiting seniors’ access to quality providers.

Advocates are concerned by the lack of oversight of IPAB. The Board has the power to change laws previously enacted by Congress. When IPAB puts forth proposals, the Secretary of the Department of Health and Human Services is required to implement the board’s recommendations unless Congress passes a law with the same cost savings. If Congress fails to adopt a substitute proposal, IPAB’s proposal must be implemented, meaning that IPAB’s proposal does not need Congressional approval to go into effect.

Furthermore, the Secretary’s implementation of IPAB’s recommendations is exempt from judicial and administrative review. Patient advocates are also troubled that there is no patient representation on the Board and that IPAB is not required to hold public meetings where the voices of patients, caregivers and families can be heard. Important health care decisions that can dramatically impact patients will be made by an unelected Board without accountability to the public.  Efforts are underway to explore repeal options within the United States Congress.

Source: http://www.womenagainstprostatecancer.org/2011/07/ipab-limiting-access-for-seniors/

A study from Japan presented at the 17th European Sleep Research Society suggests that ingestion of an amino acid extract from tea, L-theanine, may improve sleep quality. About 30% of US adult men report insomnia in the course of any year and it is estimated that over 50 percent of US adults aged 65 and older report some sleep disruption, while about 20 percent suffer from chronic insomnia. As men age from 16 to 50, they lose about 80% of their deep sleep and after 44 years of age, REM and total sleep reduce and wakefulness increase. The US leads in the world in cases of insomnia, followed by Germany and England, and sleep problems add an estimated $15.9 billion to US national health care costs.

L-Theanine, a derivative of the major excitatory brain neurotransmitter L-glutamate, is an amino acid found in the tea plant Camellia sinensis. Studies have shown L-theanine to inhibit LDL oxidation, counteract the stimulatory effects of caffeine, and lower blood pressure. In its anti-stress capacities, L-theanine increases dopamine and serotonin production, decreases norepinephrine concentrations, and induces alpha-brain wave activity. It reduces cortisol levels and increases relaxation associated with recovery from a stressful task. L-theanine also directly provides neuroprotection against glutamate neurotoxicity through blockade of the N-methyl-d-aspartate (NMDA), and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors.

The Japanese study was a blind crossover design involving 22 healthy men (12 daytime workers with an average age of 28 years, and 10 students with an average age of 26 years). After a three-day acclimatization period, the subjects were given 200mg of L-theanine or a placebo, one hour before bedtime for six days and were then crossed over to the other treatment group. Sleep quality was assessed by interviews upon awakening, self reported questionnaires and a wrist actigraph, to record bodily movements during sleep. All subjects reported a significant absence of feeling exhausted and a reduced need for sleep when administered L-theanine, compared to placebo. Seven of the 10 students had improved sleep efficiency and these same subjects reported a superior mental state prior to sleep and a decreased occurrence of nightmares. Total sleeping time did not alter between the two groups.

L-theanine may be a safe, effective treatment for sleep disorders such as insomnia either alone or in combination with prescription medications. Additionally, L-theanine typically does not result in increased morning drowsiness or impaired concentration.

Reference: Shirakawa, S. Theanine supplementation and sleep quality. 17th European Sleep Research Society. 2004.