In the News

COVID-19 Updates (05/16/2022)

  • Coronavirus cases and hospitalizations are rising in a majority of American states, in what appears to be the first widespread increase since the peak of the Omicron surge in January.
  • The coronavirus, SARS-CoV-2, has had billions of chances to reconfigure itself as it has spread across the planet, and it continues to evolve, generating new variants and subvariants at a clip that has kept scientists on their toes. Two-and-a-half years after it first spilled into humans, the virus has repeatedly changed its structure and chemistry in ways that confound efforts to bring it fully under control.
  • Due to an updated analysis of the rare cases of thrombosis with thrombocytopenia syndrome (TTS), which typically occur 1 to 2 weeks after vaccination, use of the J&J vaccine should be restricted to those for whom mRNA vaccines are "not accessible or clinically appropriate," or who would not get vaccinated if not for the J&J vaccine, the agency said.
 

More COVID-19 Fallout: Social Isolation Associated with Poor Health and Emotional Distress

Commonwealth Fund

As a result of social distancing and other interventions, the COVID-19 pandemic has cut many people off from their emotional and social support systems. For older adults, this may have exacerbated feelings of isolation; the percentage of those who reported feeling isolated jumped from 27 percent in 2018 to 56 percent after the start of the pandemic. This is particularly concerning for older adults with high health care needs — that is, people with multiple chronic conditions or functional limitations who require assistance with daily activities. Feelings of isolation not only create emotional distress but also have the potential to further exacerbate their already complicated health problems and even contribute to early mortality. Social distancing was an effective approach to slowing COVID-19 transmission — especially among a population at increased risk of infection — but any resulting feelings of isolation may have contributed to new health and social risks for this medically vulnerable group.

To explore how isolation affects high-need older adults and examine their experiences during the pandemic, we analyzed data from the Commonwealth Fund 2021 International Health Policy Survey of Older Adults. We found, consistent with previous research, that high-need adults are significantly more likely to report social isolation; more than one of 10 (12%) high-need older adults reported often feeling isolated from others, compared to 5 percent of older adults without high needs.

In line with previous research, isolation appears to be associated with poorer health. High-need older adults who reported feeling isolated were more likely than those not feeling isolated to report they were in fair or poor health (rather than good or excellent health); these adults were also more likely to report going to the emergency room for care that could have been provided by their regular clinician.

Among high-need adults who feel isolated, nearly two-thirds reported having a mental health diagnosis or feeling emotionally distressed in the past year; this is a significantly higher rate than high-need adults who do not feel isolated. Experts report that the relationship between mental well-being and feelings of isolation are bidirectional, with isolation worsening an individual’s mental health conditions, and mental health conditions exacerbating feelings of isolation. It is possible the COVID-19 pandemic had a multifaceted impact on the mental well-being of older adults.

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National Women’s Health Week Resources from the NIH

It’s National Women’s Health Week—a time for women to focus on making good choices to promote their physical and mental health.  

We have resources that can help. Visit our website for information on:

Read more at https://www.nccih.nih.gov/health/womens-health-and-complementary-approaches?nav=govd

 

Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds

New York Times

Investigators urged increased oversight of the program, saying that insurers deny tens of thousands of authorization requests annually.

Every year, tens of thousands of people enrolled in private Medicare Advantage plans are denied necessary care that should be covered under the program, federal investigators concluded in a report published on Thursday.

The investigators urged Medicare officials to strengthen oversight of these private insurance plans, which provide benefits to 28 million older Americans, and called for increased enforcement against plans with a pattern of inappropriate denials.

Advantage plans have become an increasingly popular option among older Americans, offering privatized versions of Medicare that are frequently less expensive and provide a wider array of benefits than the traditional government-run program offers.

Enrollment in Advantage plans has more than doubled over the last decade, and half of Medicare beneficiaries are expected to choose a private insurer over the traditional government program in the next few years.

The industry’s main trade group claims people choose Medicare Advantage because “it delivers better services, better access to care and better value.” But federal investigators say there is troubling evidence that plans are delaying or even preventing Medicare beneficiaries from getting medically necessary care.

The new report, from the inspector general’s office of the Health and Human Services Department, looked into whether some of the services that were rejected would probably have been approved if the beneficiaries had been enrolled in traditional Medicare.

Tens of millions of denials are issued each year for both authorization and reimbursements, and audits of the private insurers show evidence of “widespread and persistent problems related to inappropriate denials of services and payment,” the investigators found.

The report echoes similar findings by the office in 2018 showing that private plans were reversing about three-quarters of their denials on appeal. Hospitals and doctors have long complained about the insurance company tactics, and Congress is considering legislation aimed at addressing some of these concerns.

In its review of 430 denials in June 2019, the inspector general’s office said that it had found repeated examples of care denials for medical services that coding experts and doctors reviewing the cases determined were medically necessary and should be covered.

Based on its finding that about 13 percent of the requests denied should have been covered under Medicare, the investigators estimated as many as 85,000 beneficiary requests for prior authorization of medical care were potentially improperly denied in 2019.

Advantage plans also refused to pay legitimate claims, according to the report. About 18 percent of payments were denied despite meeting Medicare coverage rules, an estimated 1.5 million payments for all of 2019. In some cases, plans ignored prior authorizations or other documentation necessary to support the payment.

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President's Message

Posted: May 2, 2022

For the first time in a while, I found myself traveling just to visit an old friend this past weekend. He has been going through some medical challenges lately, and we haven’t seen each other since sometime in 2019. We think. Maybe longer. We both have jobs and families, and all of the trappings that come along with those. But we agreed to find a weekend, clear the calendar, and just catch up.

The point is, whatever is going on in the world, we have to continue to do the things and see the people that are important to us. We have (mostly) made it through the pandemic, and we need to figure out what life after that looks like—for ourselves, our families, our friends, and our profession.

How will telehealth and digital health impact us? What will the 2023 Final Rule look like? What about OASIS-E? These are some of the important questions that we are looking at. While these are important to our profession and to APTA Home Health, we want you, our members, to ask yourself your own important questions, whatever they may be. And sometimes, you realize the answer is to just do that thing, whatever it is.

Sincerely, 

 


 Phil Goldsmith
 President
 APTA Home Health  

 
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