MedPAC Recommends MA Program ‘Overhaul’ in Report to Congress

McKnight’s Home Care | By Adam Healy

In its March report to Congress, the Medicare Payment Advisory Commission recommended policymakers make sweeping changes to address serious, ongoing issues with the Medicare Advantage program. 
 
“A major overhaul of MA policies is urgently needed,” MedPAC’s experts wrote in their report.
 
The commission outlined several issues that have plagued MA beneficiaries and other stakeholders in recent years. These include limited information regarding the quality of MA plans, payment disparities between MA and traditional Medicare beneficiaries, a lack of transparency surrounding private plans’ use of supplemental benefits, and more. And as MA enrollment continues to grow, these problems may only get worse, according to MedPAC.
 
Quality bonus program flaws 
 
One of the most pressing concerns is beneficiaries’ access to MA plans’ quality information, according to the commission. While these plans currently use the MA quality bonus program to help consumers distinguish between plans, this may not be enough to promote informed consumer decision-making. Many of the program’s quality measures do not actually reflect beneficiaries’ real outcomes or experiences, MedPAC said, giving customers an imperfect or incomplete picture of their potential health plan. 
 
“To make informed choices about enrolling in an MA plan, beneficiaries need good information about the quality and access to care provided by MA plans in their local market,” the report said. “Congress should replace the current MA quality bonus program with a new MA value incentive program.”
 
Despite these issues, Medicare spends roughly 22% more per beneficiary for MA enrollees compared to those enrolled in traditional Medicare, according to MedPAC. A significant portion of this money helps fund nonmedical supplemental benefits, which include in-home supportive services, but there is little transparency surrounding utilization rates and health outcomes resulting from these benefits. And, still, providers contracted with MA plans often see only a fraction of the reimbursement that they would have otherwise received from traditional Medicare for their services…

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https://www.mcknightshomecare.com/medpac-recommends-ma-program-overhaul-in-report-to-congress/

Why Don't We Stick to Home Physiotherapy Exercises?

MedicalXpress | By Ben-Gurion, University of the Negev

The lack of persistence in home physiotherapy exercises is a well-known problem hindering the effectiveness of treatment. It is especially evident in vestibular rehabilitation (exercises to treat dizziness and balance problems).

Researchers from the Ben-Gurion University of the Negev analyzed the barriers to conducting regular home exercises and have published recommendations to overcome them in The Journal of Neurologic Physical Therapy.

Vestibular rehabilitation addresses abnormalities in the vestibular system, such as dizziness, gait instability, sensitivity to movement, and blurred vision. Treatment is especially effective when consistently practiced at home.

To find a solution to the lack of consistent practice at home, a research group from the Department of Physiotherapy at Ben-Gurion University approached 39 patients doing vestibular rehabilitation and experienced physiotherapists to identify barriers.

They found six barriers: motivation (lack of confidence in the effectiveness of the practice, boredom, and lack of internal drive); increased symptoms during the practice (temporary worsening of dizziness during or after the exercises); difficulties in time management (difficulty integrating practice into daily routine); lack of feedback and guidance (patients' limited understanding of how exercises should be done and their effect); psychosocial factors (what will the environment think?); and related medical deficiencies (such as neck pain and migraines).

The research team formulated recommendations for clinicians, which can significantly improve treatment outcomes and patients' quality of life. Thus, for example, to increase motivation—personal interaction and follow-up by a clinician would allow for greater attention to the exercises, availability, and feedback conversations on the performance of the exercises—including initiated phone calls, text messages to patients in between visits to the clinic, would nurture motivation for the practice. Investing time and money should also increase motivation. In terms of time management—personalizing the exercises to fit into the patient's daily routine.

For example, practice a little bit at a time throughout the day and/or write in a daily diary. Patient guidance—the exercise instructions should include an explanation of the importance of the exercises, the expected symptoms, and the expected recovery time. Documenting improvement by providing quantitative and visual feedback, such as charts and graphs, should encourage continued practice.

"Our study provided a broad perspective for data analysis by both patients and treating physicians," explained Prof. Shelly Levy-Tzedek, who led the research. "Identifying the common barriers to practice allowed us to build strategies that could improve adherence to home practices and, as a result, the effectiveness of treatment. This is a study that can be applied in any clinic and to any patient, and therefore an important guide for therapists."

More information: Liran Kalderon et al, Barriers and Facilitators of Vestibular Rehabilitation: Patients and Physiotherapists' Perspectives, Journal of Neurologic Physical Therapy (2024). DOI: 10.1097/NPT.0000000000000470

This Could Be Key to Motivating Older Patients to Exercise

Medscape Medical News | By Sean Hyson

Starting an exercise regimen with others can be a powerful fitness motivator, and new research spotlights the strategy's particular importance for older adults.

In a randomized clinical trial in JAMA Network Open, older adults who talked with peers about their exercise program were able to increase and sustain physical activity levels much better than those who focused on self-motivation and setting fitness goals.

Such self-focused — or "intrapersonal" — strategies tend to be more common in health and fitness than interactive, or "interpersonal," ones, the study authors noted. Yet, research on their effectiveness is limited. Historically, intrapersonal strategies have been studied as part of a bundle of behavioral change strategies — a common limitation in research — making it difficult to discern their individual value.

"We're not saying that intrapersonal strategies should not be used," said study author Siobhan McMahon, PhD, associate professor and codirector of the Center on Aging Science and Care at the University of Minnesota, in Minneapolis, Minnesota, "but this study shows that interpersonal strategies are really important."

Low physical activity among older adults is linked with "disability, difficulty managing chronic conditions, and increased falls and related injuries," the authors wrote. Exercise can be the antidote, yet fewer than 16% of older adults meet the recommended guidelines (150 minutes of moderate aerobic activity and two muscle-strengthening sessions per week).

The study builds on previous research that suggests interpersonal strategies could help change that by encouraging more older adults to move…

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Muscle Health May be Informed by Activity Level Rather than Aging Process

MedicalXpress | By King’s College London

A new study comparing muscle structure between active and inactive people has found that older people who regularly do endurance exercise maintain similar muscle characteristics to younger counterparts.

Researchers learned that, when compared to inactive people, those who regularly do endurance exercise maintain muscle fiber size better. In older active people, the arrangement of muscle fiber nuclei, which act as the control centers for muscle tissue, was also more similar to younger counterparts.

Endurance exercise refers to any aerobic exercise sustained over an extended period of time that improves the endurance of the cardiovascular or muscular system. Examples include cycling, running, and even walking.

The study, published in Experimental Physiology and led by Dr. Matthew Stroud, Senior Lecturer at the School of Cardiovascular and Metabolic Medicine & Sciences, used advanced 3D microscopy imaging to analyze the structure of muscles.

Samples were taken from people who do and do not regularly do endurance exercise in both younger and older people for an analysis and comparison. For untrained individuals, the aging process affected muscle fiber size and the myonuclei. However, there was found to be zero correlation between aging and these aspects of the muscles for people who exercised.

These findings suggest that inactivity has a more pronounced effect on muscle fibers and myonuclear parameters than simply getting older. This means that if people stay active as they age, the size of their muscles are more likely to be maintained, and the distribution of myonuclei, which control muscle function, might not deteriorate as much as they would if they were inactive.

"Maintaining muscle fiber size, and control of the cell via myonuclei, might contribute to maintaining muscle function, which could be particularly beneficial as part of the body's response to the natural decline in muscle mass during aging. This may ultimately help to maintain the function of muscle into older age, thereby improving independence and quality of life," says Dr. Edmund Hugh Battey, former Ph.D. student in Dr. Stroud's lab at King's.

"The association between endurance exercise and these potential muscular benefits suggests a possible avenue for mitigating age-related muscle deterioration, though further research is necessary to fully understand this relationship."

By discovering a new potential mechanism in which exercise support healthy muscles, particularly into old age, the authors hope that it can help the scientific community understand how to maintain good muscle health as we get older.

More information: Edmund Battey et al, Muscle fibre size and myonuclear positioning in trained and aged humans, Experimental Physiology (2024). DOI: 10.1113/EP091567

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