1. 72: The percent of caregivers reporting mental stress and physical health declines. In our initial study on caregiver health we found that 91% of those caring for a senior family member with a condition like dementia, Alzheimer’s or cancer report mental stress, 75% report depression, 27% say they have gained weight, 19% say they have lost it, and 25% say they have been to the hospital or urgent care at least once for their own health event. 72% say their overall physical and mental health has declined since becoming more responsible for their mom or dad or relative, partly impacted by things like reduced wages, having to change jobs or lose their position at work. There are some positives, says Brigid Byrne, who cares for her 90-year-old mother who has cancer and her grandson, a toddler. ‘Lots of stress and worries, yes, but lots of laughter,’ Byrne says, noting that while there is essentially no support from health providers or insurers there are local and national networks online to support caregivers, like the Caregiver Action Network. Insurers like Humana, Anthem, and United who continue to see an increase in there Medicare Advantage enrollment will likely to need to think about how their networks and benefits can help address this growing issue.
2. Alzheimer’s Awakening: First Billy Jean’s win over Bobby Riggs, now this. New research has arisen on why women are more likely than men to develop Alzheimer’s, and it’s not just because women live longer than men. Scientists offered new evidence that the disease may spread differently in women’s brains than in men because of several newly identified genes that seem related to the disease called APOE-4. Vanderbilt University researchers found that women do better than men on verbal tests for Alzheimer’s leaving them undiagnosed. A protein called ‘tau’ that destroys nerve cells is spread more in women’s brains than in men’s. The female advantage masks early signs of Alzheimer’s and delays diagnosis because of better brain metabolism. Researchers have received a grant from the National Institute on Aging to complete an international study on 100,000 people to try to validate and extend the results, NBC reports.
3. Taking From Peter to Feed Paul & Mary: In a poll of 17 network contracting directors this month, we have learned that there is a renewed effort amongst nearly all of them to find ways to ‘chip away’ at specialist reimbursement to help support the growing need to increase payments and incentives and bonuses for high quality primary care related providers.
4. Vaping’s Impact on Respiratory: 3.62 million middle and high school students have reportedly used e-cigarettes in 2018, a 78% increase among the high school group. In Wisconsin this week, vaping is suspected to be the cause of serious lung damage in 8 teens according to hospital officials there who alerted the state’s health department. The hospital announced that some of the teens even needed to be put on breathing assistance. An exact cause is unknown but with the increase of teen e-cigarette and vaping use, parents and teens need to be aware of the potential danger. Our poll earlier this month found that a majority of teens in one high school had tried or been asked to vape. The FDA says 3.62 million middle school and high school students were reported using e-cigarettes in 2018 and a 78% increase among high school students.
5. Reimbursement Stop: Starting in November, Anthem will no longer reimburse two codes that have been used traditionally by healthcare providers to report the 5+ minutes of time they spend calling other doctors or nurses, writing a report to a peer with an opinion about a patient, or analyzing a chart as part of this interprofessional communication. According to Anthem, the new Interprofessional CPT codes 99451 and 99452 are not eligible for reimbursement when they are reported with another service or reported as a standalone service.
6. Site of Service Musculoskeletal Review: Arthroscopic and foot surgery procedures will require a site of service review for UnitedHealthcare patients starting in November. This basically means that UHC will evaluate not just medical necessity but whether the procedures should be done, or could be done, outside of a hospital outpatient setting. This change will impact commercial and exchange patients.
7. Medicaid PT Targeted in Tennessee and Louisiana: PT, OT and speech services for United Healthcare Medicaid patients will require both a medical necessity review and a site of service review to make sure they’re not happening in the hospital outpatient setting, starting in October.
8. Spectrum Indicator: Recent research shows women who are exposed to solvents on the job may be more likely to have children on the spectrum, according to the National Institute for Occupational Safety and Health in Morgantown, WV. This research was completed before and during pregnancy on 750 mothers and 891 fathers that had occupational exposure and have been linked to neurological or congenital abnormalities in children. The agents can include medicines, metals, pesticides, anesthetics, asphalt, brake fluid, plastics and polymers, radiation, cleaners/disinfectants and paint chemicals and degreasers. Exposed mothers were 50% more likely to have a child on the spectrum and the solvent exposure was linked to an 85% higher autism risk. The study was not completed in a controlled environment so other factors could be involved.
9. Airport ASD: Pittsburgh international airport unveiled one of the world’s largest, most comprehensive airport sensory spaces designed for travelers on the autism spectrum. The space includes a first-of-its-kind jet cabin and jetway replica to help those on the spectrum get comfortable with the space constraints of an airplane. Sensory rooms can make all the difference for a person on the spectrum because they are sound-proof and can have calming lights, and private areas for families to decompress before flights. Airports in Atlanta and Birmingham have also recently constructed sensory rooms.
10. Correction, Falling Down: Last week I reported how falls were named as the number one risk of injury and hospitalization for seniors and unexpected medical costs that can impact a risk-taking, senior-focused primary care group. I noted that the root cause of falls is not poor balance or drinking or slippery conditions, but dehydration or malnutrition stemming from often untreated anxiety, grief and loss, PTSD. But as one reader, Bruce Gordon, pointed out, there are counter forces that can definitely help mitigate fall risk and have benefits for osteoporosis, such as exercise and weights. Gordon, an older endurance distance runner, says this type of exercise doesn’t guarantee you won’t fall, particularly if you’re running in nature, but the benefits outweigh the risks. As risk taking groups try to understand their patient’s home environment and what drives behaviors – learn not just about their medical history, says Nancy Feller, MSW, who does home visits for physicians taking risk, but learn about their ‘social’ history too.
11. Extra Point: Somehow I finished the 100-mile Pan Mass Challenge bike ride for Dana Farber Cancer Institute last week in record time – 6 hours, better than my usual Eeyore-style clip. I hadn’t trained, so my neck, back and thighs didn’t feel so good but the muscle rub at the 20 and 50 mile marks helped. And what I saw along the way was nothing short of amazing. Carole, an 81-year-old retired nurse from Tewksberry Massachusetts, was riding a tandem bike with 9-year-old Desean from Dorchester who has been in out of treatment for AML, one of the most common types of leukemia in kids, since he was about 6. Desean was standing near a sign cheering on riders at about the 75-mile marker. He had a Red Sox bike helmet but was not in the ride. Carole was riding by herself but borrowed the tandem and took Desean with her. They rode for about 3 miles to the next stop to rising, if not chilling, cheers along a crowded stretch near the harbor of Onset. Carole managed to get Desean safely to the next stop. I unclicked my shoes to watch as Carole broke into tears. I was maybe 10 feet from them at this point. Desean, frail and shy for a kid his age, reached out and grabbed Carole’s arm and said ‘are you okay?’ Carole hugged the boy, then began to ride off toward the finish line. I caught up with Carole after the finish. She said she was an oncology nurse for 22 years so moments like that were more common than not, but ‘I’ve never had a kid ask me if I was okay…’