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Avoiding Pain and Addiction After Sports-Injury Surgery

By Rich Holmes – HealthDay Reporter

WEDNESDAY, June 24, 2020 (HealthDay News) – With opioid addiction soaring in the United States, it should come as good news that an opioid painkiller may not be needed after a sports-injury repair.

A mix of non-addictive medicines may be safer and equally successful in managing pain after shoulder or knee surgery, a study from Henry Ford Hospital in Detroit indicates.

Concerned about the opioid abuse epidemic, doctors there tested a different regimen for pain relief. They treated post-surgical pain with a combination of non-opioid medications, including anti-inflammatories, muscle relaxants and nerve pain relievers.

“It’s a complete change,” said lead author and orthopedic surgeon Dr. Vasilios Moutzouros. He added that he was taught in medical school “the only mode of pain relief is opioid medication.”

Opioid overdose is the leading cause of accidental death in the United States, and orthopedic surgeons write a substantial number of opioid prescriptions, the authors said in background notes.

The study builds on earlier research showing use of opioids after orthopedic surgery can be reduced, but goes further in suggesting that the drugs may be eliminated. Changing how pain is treated could keep people from ever being introduced to opioids, Moutzouros said.

The study focused on 141 patients who underwent anterior cruciate ligament (ACL) reconstruction, or repairs for a torn knee meniscus or rotator cuff and shoulder injuries.

All received a combination of five drugs for pain relief before surgery. During surgery, a cocktail of three drugs was injected into surgical sites. Five drugs were given postoperatively, and icing of affected areas was encouraged.

Patients also were prescribed an opioid – 10 oxycodone pills (5 mg) – to be used if pain became too much. But they were asked not to take them, if possible, and to contact the on-call physician for help. One week after surgery, all of the patients said they were satisfied with pain management, and 45% avoided the available oxycodone. One patient required a prescription refill, the study authors noted.

Those who did use the oxycodone (OxyContin) were more likely to report more pain, be female, and have a history of anxiety or depression. Of the four surgeries studied, ACL reconstruction was found to be the most painful, and 30 of the 49 patients who had that surgery used their oxycodone prescription, the researchers said.

Moutzouros said the specific drugs used were less important than employing a range of non-opioid pain relievers. His next goal is to expand the method to all orthopedic surgeries at Henry Ford Hospital.

The approach “definitely makes sense,” said Dr. Joshua Dines, an orthopedic surgeon specializing in sports medicine at the Hospital for Special Surgery in New York City. He was not involved with the study. Opioids not only pose an addiction risk, he said, but have side effects. “Patients on opioids, they’re out of it, and constipated,” Dines said.

Doctors following the protocol would have to coordinate several pain relievers after surgery instead of one opioid, Moutzouros said. However, Dines pointed out that patients on opioids may end up also needing stool softeners, laxatives and anti-nausea medicines.

One potential concern was the protocol’s use of ketorolac and other nonsteroidal anti-inflammatory drugs (NSAIDS), which animal studies indicate may inhibit tendon healing, Dines said. Both Moutzouros and Dines said that patients have turned against extended use of opioids.

“People actually prefer the non-opioid approach,” Moutzouros said, urging patients to discuss pain relief options with their doctor. Part of managing pain is managing patient expectations, Dines said. There is going to be pain after surgery, especially in the first week or two.

Of the need for opioids after sports surgery, Dines said that “most people can get by with none.”

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When A Doctor No Longer Accepts Medicare, Patients Left Holding The Bag

By Carmen Heredia Rodriguez, Kaiser Health News

JUNE 9, 2020

Pneumonia. Heart problems. High cholesterol. Betsy Carrier, 71, and her husband, Don Resnikoff, 79, relied on their primary care doctor in Montgomery County, Maryland, for help managing their ailments. But after seven years, the couple was surprised when the doctor informed them she was opting out of Medicare, the couple’s insurer. “It’s a serious loss,” Resnikoff said of their doctor.

Patients can lose doctors for a variety of reasons, including a physician’s retirement or when either patient or doctor moves away. But economic forces are also at play. Many primary care doctors have long argued that Medicare, the federal health insurance program for seniors and people with disabilities, doesn’t reimburse them adequately and requires too much paperwork to get paid.

These frustrations have prompted some physicians to experiment with converting their practices to more lucrative payment models, such as concierge medicine, in which patients pay a fee upfront to retain the doctor. Patients who cannot afford that arrangement may have to search for a new physician. The exact number of physicians with concierge practices is unknown, health care experts said. One physician consulting company, Concierge Choice Physicians, estimates that roughly 10,000 doctors practice some form of membership medicine, although it may not strictly apply to Medicare patients.

Shawn Martin, senior vice president of the American Academy of Family Physicians, estimated that fewer than 3% of their 134,000 members use this model but the number is slowly growing. The move to concierge medicine may be more prevalent in wealthier areas.

Travis Singleton, executive vice president for the medical staffing company Merritt Hawkins, said doctors switching to other payment systems or those charging Medicare patients a higher price for care are likely “in more affluent, well-to-do areas where, frankly, they can get fees.”

It is far easier for physicians than hospitals to opt out of taking Medicare patients. Most hospitals have to accept them since they rely on Medicare payments to fund inpatient stays, doctor training and other functions.

The majority of physicians do still accept Medicare, and most people insured by the federal program for seniors and people with disabilities have no problem finding another healthcare provider. But that transition can be tough, particularly for older adults with multiple medical conditions.

A study of at least 2,200 older adults published in 2016 found that nearly 4 in 10 were taking at least five medications at the same time. Fifteen percent of them were at risk of drug-to-drug interaction. Primary care providers mitigate this risk by coordinating among doctors on behalf of the patient, said Dr. Kellie Flood, a geriatrician at the University of Alabama-Birmingham. “You really need the primary care physicians to serve as the quarterback of the health care team,” said Flood. “If that’s suddenly lost, there’s really not a written document that can sum all that up and just be sent” to the new doctor.

Finding a physician who accepts Medicare depends partly on workforce demographics. From 2010 to 2017, doctors providing primary care services to Medicare beneficiaries increased by 13%, according to the Medicare Payment Advisory Commission (MedPAC), a nonpartisan group that advises Congress. However, the swell of seniors who qualify for Medicare has outpaced the number of doctors available to treat them. Every day, an estimated 10,000 Americans turn 65 and become eligible for the government program, the Census Bureau reported. The impact: In 2010, MedPAC reported, there were 3.8 primary care doctors for every 1,000 Medicare enrollees. In 2017, it was 3.5.

Authors of a MedPAC report out last June suggested that the number of available primary care providers could be an overestimate. Their calculation assumed all internal medicine doctors provided these services when, in reality, many specialize in certain medical conditions, or accept only a limited number of Medicare patients into their practices.

But MedPAC concluded seniors are not at a disadvantage finding a doctor. “We found that beneficiaries have access to clinician services that is largely comparable with (or in some cases better) access than for privately insured individuals, although a small number of beneficiaries report problems finding a new primary care doctor,” the MedPAC researchers wrote.

The coronavirus outbreak has complicated the ability for many Americans to access care, regardless of their insurer. However, many older patients now have an opportunity to connect with their doctors virtually after the Centers for Medicare & Medicaid Services (CMS) broadened access to telemedicine services under Medicare.

Experts said the long-term effects of the virus on doctors and Medicare remain unknown. But Martin said the shortage of cash that many doctors are experiencing because of the coronavirus epidemic has revealed the shortcomings of how primary care doctors are paid. “The COVID crisis really brought to life the challenges of fee for service,” said Martin.

Despite these challenges, the number of doctors choosing to opt out of Medicare has been on the decline, according to data from CMS. Singleton, of Merritt Hawkins, said concern about doctors leaving the Medicare system is part of larger workforce issues. Those include the need to recruit more medical students to concentrate on primary care.

One estimate predicts the nation will face a shortage of 23,600 primary care physicians by 2025. The majority of residents in internal medicine ― those who care for adults — are choosing a subspecialty such as cardiac care or gastroenterology, MedPAC reported.

In 2017, MedPAC reported, the median compensation for all doctors was $300,000 a year. Among primary care doctors, it was $242,000. Creative business models can make up that difference. Under the concierge model, the doctor charges patients an annual fee — akin to a gym membership ― to access their practice. The provider still bills the insurer ― including Medicare — for all patient care.

Another model ― called direct primary care — charges the patient an annual fee for access and care; doctors do not bill health insurance plans. Proponents say that the model enables them to take more time with their patients without dealing with the bureaucracy of getting paid by health insurers. “I think what is most attractive to direct primary care is that they just practice medicine,” Martin said.

The size of a physician practice can also determine whether it accepts Medicare. Large practices can better offset the lower Medicare payment rates by leveraging their influence with private insurers to raise those reimbursements, said Paul Ginsburg, director of the USC-Brookings Schaeffer Initiative for Health Policy. But small, independent clinics may not have the same clout.

“If you’re a large primary care practice, private insurers are really going to want to have you in their network,” he said. “And they’re willing to pay more than they might pay an individual solo practitioner who they’re not as concerned with because it’s only one physician.”

Luckily, after more than a dozen calls to physicians, Carrier and Resnikoff said they found another primary care doctor. They said she accepts Medicare and impressed them during their meet-and-greet with her knowledge of their medical history. She also met their criteria for age and expertise. “At this point in our lives, I’d be eager to find somebody who’s young enough that they might be in practice for the next 10 years,” Carrier said.

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Hospitals Continue to Struggle with Job Losses as Other Areas of Healthcare Rebound in May

Hospitals lost 27,000 jobs in May, showing they have yet to recover financially.

By Mallory Hackett, Associate Editor, Healthcare Finance

June 5, 2020

Healthcare employment increased by 312,000 in May, but hospitals still lost 27,000 jobs, according to a report issued from the U.S. Bureau of Labor Statistics.  Job losses continued for hospitals and also for nursing and residential care facilities, which lost 37,000 jobs.

WHY THIS MATTERS

The COVID-19 pandemic has affected the economy and unemployment in record numbers. The uptick in jobs announced today follows an historically high unemployment rate of 14.7% in April, the highest since the Great Depression.

The employment report shows an economy fighting to rebound. The overall unemployment rate declined by 13.3% in May, as 2.5 million jobs were added to the economy. The Bureau of Labor Statistics attributes this to the recent re-opening of many states’ economies.

However the numbers also show that hospitals have yet to recover financially from the surge of COVID-19 patients and the loss of revenue from postponed or cancelled elective procedures. Many were forced to furlough or lay off staff because the billions earmarked for hospitals in the Coronavirus Aid, Relief and Economic Security Act was not enough for most hospitals to operate at previous expense levels.

Hospital visits started to drop nationwide in March as state and federal officials called for postponing non-covid-19 treatments when possible to free up health-care resources. These cancellations included surgeries, outpatient procedures and even preventive services.

By mid-May, almost 94 million adults had delayed medical care because of the coronavirus pandemic, the Census Bureau reported in its Household Pulse Survey. Some 66 million of those needed but didn’t get medical care unrelated to the virus.

“Whether you have a lot of cases, or don’t have a lot of cases, you’re going to have a financial hit,” said Will Ferniany, chief executive of the UAB Health System. While covid-19 patients never came close to filling intensive care beds at its Birmingham, Ala., hospital, occupancy of other beds dropped to less than half. Ferniany’s system is losing $70 million a month in patient revenue, which it must try to make up with cost-cutting and federal aid.

Under the Cares Act, the Department of Health and Human Services says $175 billion was allotted for health-care providers, including hospitals in rural and high-impact areas and places treating uninsured covid-19 patients. But hospitals could miss out on some aid if they hadn’t treated a minimum of 100 covid-19 patients, despite the pandemic’s widespread financial damage.

THE LARGER TREND

Overall education and health services employment increased in May, adding 424,000 jobs, after suffering a decrease of 2.6 million in April.

Other industries that saw employment increase last month were leisure and hospitality, construction, education, and retail trade. Government employment, on the other hand, continued to decline.

It’s unlikely that all the lost hospital jobs will come back.  Instead, a future where hospitals continue to cut costs, eliminate duplicated services and cast a critical eye on their need for buildings is more likely.

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Medicare Advantage Enrollment and Quality Continue Upward Trend

Medicare Advantage enrollment has doubled in ten years and, in 2020, 16 percent more plans score four stars or more than did in 2015.

By Kelsey Waddill April 24, 2020

Medicare Advantage plans are continuing along a trend of burgeoning enrollment and rising quality, although costs for certain services may be more expensive than traditional Medicare, according to recent analysis from Kaiser Family Foundation (KFF).

Early in the coronavirus outbreak, CMS zeroed in on Medicare Advantage populations which, along with the rest of Medicare, promised to be among the most vulnerable populations in the US.

Kaiser Family Foundation’s analysis drew from CMS Medicare Advantage data to piece together the status of Medicare Advantage currently and the potential impacts of coronavirus as 2020 progresses.

MEDICARE ADVANTAGE ENROLLMENT, PENETRATION IS HIGHER THAN EVER

As of April 22, 2020, 36 percent of Medicare beneficiaries are in a Medicare Advantage plan. This comes after a 9 percent increase between 2019 and 2020. This enrollment is distributed unevenly across the country, with nine states holding over 40 percent of Medicare Advantage beneficiaries. Around ten percent of the Medicare population resides in metropolitan counties, consistent with recent trends.

There are three Medicare Advantage titans that are responsible for nearly 60 percent of all Medicare Advantage beneficiaries. UnitedHealthcare holds 26 percent of the Medicare Advantage population, Humana has 18 percent, and Blue Cross Blue Shield has 15 percent of Medicare Advantage enrollees.

However, the field is seeing some significant shifts as Humana’s plans begin to catch up with UnitedHealthcare’s and CVS Health’s 2018 purchase of Aetna spurred major growth extending into 2019 and 2020, as expected.

This growth is expected to continue, with Medicare Advantage plans accounting for over 50 percent of Medicare beneficiaries by 2030, KFF said, citing Congressional Budget Office predictions. Other sources, such as LEK Consulting’s estimates, have projected a 70 percent increase in Medicare Advantage enrollment between 2030 and 2040, although enrollment for dual eligible members lags.

MEDICARE ADVANTAGE BENEFITS AND QUALITY ARE EVOLVING

In 2020, Medicare Advantage enrollees will have more benefits than traditional Medicare enrollees. CMS expanded Medicare Advantage benefits to include more supplemental benefits. Nearly three-quarters of Medicare Advantage beneficiaries, for example, will have a dental benefit and the same percentage have a fitness benefit. Over 70 percent will have access to hearing aid benefits and 61 percent will have access to over the counter medication benefits.

Perhaps most relevant given the status of coronavirus, 77 percent will have a telehealth benefit. With many states imposing shelter-in-place orders and authorities enjoining residents to stay at home to prevent the spread of coronavirus, health plans have been relying heavily on telehealth to connect patients to care.

Most Medicare Advantage beneficiaries are now enrolled in a plan that scores well on Medicare Advantage Star Ratings. In 2015, 62 percent of Medicare Advantage beneficiaries were in plans that got four stars or higher, but in 2020, 78 percent will be in such plans.

RESULTS ARE MIXED ON MEDICARE ADVANTAGE OUT-OF-POCKET SAVINGS

Medicare Advantage has long been touted as a cost-saving alternative to traditional Medicare, with recent statistics showing that Medicare Advantage costs 40 percent less than fee-for-service Medicare. In many ways this remains true for 2020. Medicare Advantage beneficiaries still tend to see much lower out-of-pocket healthcare spending than Medicare beneficiaries.

For example, 60 percent have no premium aside from Part B. For those who do, the average premium is $25 per month. This continues a downward trend in Medicare Advantage premium rates starting in 2015.

For coronavirus, Medicare Advantage plans received flexibility and guidance from CMS to cover both testing and treatment costs early on in the crisis. Medicare will cover hospitalizations, including if a patient is diagnosed with coronavirus and must extend their stay to quarantine in a hospital setting.

In contrast, according to a separate KFF report from mid-April 2020, beneficiaries on traditional Medicare are still responsible for the deductible for such a stay and susceptible to out-of-pocket costs as a result. This could mean up to $1,408 in out-of-pocket costs for a Medicare beneficiary.

However, the evidence points to one area in which many Medicare Advantage patients do not necessarily see greater savings than their Medicare counterparts: inpatient hospital stays. While nearly all Medicare Advantage patients saved money on three-day hospital stays, anything over a five-day stay meant a majority of Medicare Advantage patients were paying more than traditional Medicare patients in cost-sharing.

As payers evaluate their strategies for what is turning out to be a year full of uncertainties, the KFF report indicates that their Medicare Advantage plans remains on a trajectory to enhance and expand.

Greg Says can confirm the increasing Medicare Advantage enrollment trend.  It’s important however to consult with a licensed health insurance agent certified in Medicare Advantage products before deciding that Medicare Advantage is the right option for you.  There are circumstances where Original Medicare plus a Medicare Supplement is a better choice depending on one’s recent medical history and maintenance medications.

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Watch for Coronavirus Related Scams

With the recently enacted Coronavirus Aid, Relief, and Economic Security Act (CARES Act), many citizens will be eligible to receive an economic impact payment from the Internal Revenue Service (IRS).

These payments provide critical relief for many Americans, as the coronavirus pandemic has caused significant economic disruption and put many out of work. In these uncertain times, the IRS is urging taxpayers to be cautious and keep an eye out for a potential rise in phishing scams. 

The Department of the Treasury has developed a web-based portal for individuals to check on the status of their relief benefits and provide their banking information to the IRS in order to receive payments via direct deposit https://www.irs.gov/coronavirus/get-my-payment. It is important to be mindful of scammers posing as government entities who may want access to your personal information to obtain your economic impact payment. The IRS has issued guidance on this matter and Benefits.gov encourages those eligible to receive a check to take precautions in ensuring that they don’t fall into the wrong hands. To protect this vital resource during the coming weeks keep the following in mind: 

  • Do not provide financial information to anyone claiming to be working for the IRS or closely associated with the IRS in order to receive your economic impact payment. The IRS will not ask you to provide this information. 
  • Do not open any emails claiming to be from the IRS or click on attachments or links. 
  • Be mindful that text messages, websites, and social media can also be used by criminals to commit fraud.

If you receive unsolicited phone calls, emails, text messages or social media attempts to gather information that appear to be from either the IRS or an organization closely linked to the IRS, such as the Electronic Federal Tax Payment System (EFTPS), please forward it to phishing@irs.gov. You should not engage with potential scammers online or on the phone. Learn more about reporting suspected scams by going to: https://www.irs.gov/privacy-disclosure/report-phishing 

For all official information regarding the economic impact payments, please refer to the IRS website: https://www.irs.gov/coronavirus-tax-relief-and-economic-impact-payments. To read more about protecting yourself from scams, read the Benefits.gov article on being savvy about phone scams: https://www.benefits.gov/news/article/372