Sleep apnea

Sleep apnea—more accurately, obstructive sleep apnea—is a condition in which your breathing stops during sleep for longer than 10 seconds and at least five times per hour. This condition occurs because something is blocking your upper airway, such your muscles or tongue. Here are the symptoms:

• Snoring that's interrupted with periods of quiet; snoring that resumes with a loud sound as breathing starts again.
• Morning headache
• Frequently falling asleep during the day.
• Depression; being easily irritated; difficulty remembering things.

The people I know with sleep apnea use a CPAP (continuous positive airway pressure) machine that provides a constant flow of air to help keep their airways open. If you have the condition, it also helps to avoid drinking alcohol or taking sedatives—behaviors that relax your muscles. If you do use a CPAP machine, I hope it's not made by Philips Respironics. The foam used inside those machines contain potentially cancer-causing particles that blow into the mouths and noses of users. After years of ignoring reports of cancer and other ailments, those machines have now been recalled.

One test of sleep apnea is called the Epworth Sleepiness Scale, which determines your level of daytime sleepiness.

0-10 is normal; 11-14 is mild; 15-17 is moderate; 18 or higher is severe. If you scored 11 or higher, you may have a problem. Studies have shown that people who have sleep apnea and who use the CPAP machine improve their scores..

I fall asleep during educational TV; never while talking to someone or when stopped in traffic while driving! I scored four on the sleepiness scale.

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Medicare Advantage rip-offs

Medicare Advantage is a private sector alternative to traditional Medicare. The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. By developing elaborate schemes to make their patients appear as sick as possible, the insurers get more money from the government. 

To maximize their profits, insurance companies employ firms to help them come up with money-making opportunities. A whistleblower uncovered an email that was sent by an insurance company executive to one of these consulting firms. It says, “You mentioned vasculatory disease opportunities, screening opportunities, etc with huge $ opportunities. Let’s turn on the gas!”

 Most of these private insurance companies, including ours, have been accused of fraud. Eight of the 10 biggest Medicare Advantage insurers have submitted inflated bills. For example, our insurer, Anthem (now called Elevance Health) pays more to doctors who said their patients were sicker. Executives at United Health Group told their workers to mine old medical records for more illnesses. When the workers couldn’t find enough, they were sent back to try again. 

In some of the schemes, patients are diagnosed with diseases that they don’t actually have. For example, one patient was diagnosed with bipolar disorder—which he didn’t have--giving Anthem an additional $2, 693.27.  Doctors and nurses have been pushed to document a range of diagnoses, including vertebral fractures, pneumonia and cancer they lacked the equipment to detect. And so on.  

Advantage companies also use deceptive marketing practices in order to sign up new customers. For example, they have posed as the IRS and other government agencies. They also prey on vulnerable people with dementia and cognitive impairment. Many people say they were enrolled in plans without realizing it.

In 2020, such fraudulent diagnoses cost the government $12 billion—enough to cover hearing and vision care for ever American over 65.

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Medicare vs. Medicare Advantage

I’d been under the mistaken impression that Medicare Advantage is a supplement to Medicare. I haven’t paid attention. It’s not. (You probably know better.)

Original Medicare—is federal health insurance for people 65 or older, some younger people with disabilities, and people with end-stage renal disease. It helps cover—

• Hospital, nursing facility, hospice, and home health care (Part A).
• Services from doctors and other health care providers; outpatient care; home health care; medical equipment such as wheelchairs; many preventive services, such as screenings, shots, and “wellness” visits. (Part B)

You can join a separate drug plan (Part D).

You usually pay 20% of the Medicare-approved amount after you meet your deductible. You can buy supplemental coverage (Medigap) to help pay out-of-pocket costs.

You can use any doctor or hospital that takes Medicare, anywhere in the U.S.

You don’t need a referral to see a specialist.

Medicare Advantage (Part C)

Medicare Advantage is a private sector alternative to traditional Medicare. The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients.  You can choose from 38 Advantage plans offered by private insurers such as Humana, CVS Health, Kaiser Permanente, and Cigna. These plans are “bundled,” meaning they include Part A, Part B, and usually Part D (a drug plan). Often you can also include vision, dental and hearing—one stop shopping.

Most Advantage plans allow you to go only to contracted providers— in-network providers. You may need to get a referral to see a specialist.

Researchers who have tracked Advantage users compared with similar patients in the same counties or ZIP codes, have found that 10 percent are less likely to enter the highest-quality hospitals, 4 to 8 percent are less likely to be admitted to the highest quality nursing homes and half as likely to use the highest-rated cancer centers for complex cancer surgeries. This, or course, shows the limitations of in-network and prior-authorization requirements.

Four of the five largest Advantage insurers have been accused in court of fraud, as I’ll discuss next week.

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Pigeons detecting breast cancer

Pigeons can detect breast cancer in microscope images as well as humans. Apparently, pigeons have excellent visual systems, similar to or better than ours. For one thing, they sense five different colors as opposed to our three.  Humans have receptors for green, blue, and red. The combinations of these three colors produce all the colors we can perceive, whereas pigeons can also detect ultraviolet and polarized light. Pigeons can distinguish letters of the alphabet, misshapen pharmaceutical capsules, and paintings by Monet versus Picasso. Also, pigeons don’t mentally fill in gaps, like we do, when an expected shape is missing.

To identify cancer cells, 16 pigeons received two weeks of training, which consisted of presenting them with magnified images of possible breast cancers.

They would identify a growth as benign or malignant by pecking one of two answer buttons. A correct identification earned them a pigeon pellet. Once trained, the pigeons’ average diagnostic accuracy reached 85 percent. But when the selections of four pigeons were pooled (“flock sourcing”), diagnostic accuracy reached 99 percent—what would be expected of a pathologist. What they weren’t good at was locating suspicious tissue densities that can signal malignant potential on a never-before-seen image.

While it is unlikely that pigeons will be playing a role in patient care, researchers believe the findings can help develop more effective training methods for budding clinicians. What would they use for rewards?  Potato chips? Hershey’s kisses? Money?

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.