Long COVID: New Info on Who Is Most Likely to Get It

Medscape | By Solarina Ho

The COVID-10 pandemic may no longer be a global public health emergency, but millions continue to struggle with the aftermath: Long COVID. New research and clinical anecdotes suggest that certain individuals are more likely to be afflicted by the condition, nearly 4 years after the virus emerged. 

People with a history of allergies, anxiety or depression, arthritis, and autoimmune diseases and women are among those who appear more vulnerable to developing long COVID, said doctors who specialize in treating the condition.

Many patients with long COVID struggle with debilitating fatigue, brain fog, and cognitive impairment. The condition is also characterized by a catalog of other symptoms that may be difficult to recognize as long COVID, experts said. That's especially true when patients may not mention seemingly unrelated information, such as underlying health conditions that might make them more vulnerable. This makes screening for certain conditions and investigating every symptom especially important. 

The severity of a patient's initial infection is not the only determining factor for developing long COVID, experts said.

"Don't judge the person based on how sick they were initially," said Mark Bayley, MD, medical director of the Toronto Rehabilitation Institute at University Health Network and a professor with the Temerty Faculty of Medicine at the University of Toronto. "You have to evaluate every symptom as best you can to make sure you're not missing anything else." 

Someone who only had a bad cough or felt really unwell for just a few days and recovered but started feeling rotten again later — "that's the person that we are seeing for long COVID," said Bayley…

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CDC Urges Nursing Home Vaccinations

The Hill | By Nathaniel Weixel and Joseph Choi 

Its’ the height of respiratory virus season, but some of the country’s most vulnerable people remain at risk. 

According to the Centers for Disease Control and Prevention (CDC), most nursing home residents haven’t received an updated COVID-19 vaccine or the new respiratory syncytial virus (RSV) vaccine.

COVID-19, influenza and RSV activity are still below levels seen last year at this time, according to the CDC. But only 35 percent of nursing home residents have gotten the updated COVID-19 vaccine, and just 10 percent had received an RSV shot. 

RSV can cause severe illness and death in older adults. The Food and Drug Administration estimated that the virus hospitalizes 60,000 to 160,000 people over age 65 each year and causes 6,000 to 10,000 deaths. 

This is the first year there’s been a vaccine available to prevent RSV– and there are two on the market. Arexvy, the shot from GlaxoSmithKline, was 94 percent effective against severe illness in older adults. Pfizer’s shot, called Abrysvo, was 86 percent effective against severe illness. 

Both shots are fully covered by Medicaid, Medicare Part D prescription drug coverage, and most private insurance plans.

Nursing homes are encouraged to collaborate with state, local and federal public health and long-term care pharmacy partners to address barriers contributing to low vaccination coverage, CDC said. 

Vaccine fatigue, inaccurate health information and vaccine hesitancy contribute to lack of vaccine demand, the CDC said. 

For the COVID-19 vaccine, lower uptake might be related to challenges to vaccine access, as well as cost and payment barriers associated with the vaccine’s commercialization, the agency said.  

Older people are also receiving messaging for multiple seasonal vaccines (in many cases three or four), and it can be overwhelming. The relative newness of the RSV shots may also confuse providers, who then give inaccurate information to their patients.

Another possible barrier is the CDC’s recommendation of “shared decisionmaking.” That means the vaccine was recommended only after a conversation between a patient and their provider, rather than a blanket recommendation like the one for flu shots.  

Medicare Physician Fee Schedule Cuts Coming in January. Is Help on the Way?

APTA

A new bipartisan bill provides full relief to the 3.4% cuts, but nothing can happen until Congress comes back from recess.

Despite strong advocacy from APTA, the American Medical Association, and more than 100 other patient and provider groups, Congress is likely to leave Capitol Hill without addressing a 3.4% cut to payment under Medicare Part B, closing the last window that would've prevented the cuts from taking effect Jan. 1. With the cuts now almost certain to be implemented, the next opportunity to provide relief will come in January, when Congress must act on government funding by Jan. 17. Fortunately, groundwork has been laid for a needed change, thanks to a recently introduced APTA-supported bipartisan bill that would fully offset the reductions.

The bill, H.R. 6683, introduced in the U.S. House of Representatives, would provide full relief from the cuts, and make that relief retroactive to the Jan. 1 implementation date. APTA has joined with AMA and other provider groups to urge lawmakers to include the legislation in whatever package Congress adopts to fund the government in 2024, and the association is urging members and supporters to voice support for the bill with their lawmakers though the APTA Patient Action Center or Legislative Action Center. Both resources make the process fast and easy.

Support for the legislation in the House is growing. Recently, more than 190 representatives signed onto a letter urging congressional leaders to prevent the cuts, writing that "physicians and other healthcare providers, who are confronting inflationary pressures and workforce shortages, need Congress to prevent this cut, which will add significant burdens to the healthcare infrastructure and the communities they serve."

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Is AI Making Claim Denials in Error? What Does It Matter if We Don't Appeal?

APTA | By Wanda Evans, PT, DPT, MHS

These days, it's hard to escape the attention being paid to artificial intelligence, or AI. The technology is making its way into what seems like every corner of our lives, including in our professional capacities as PTs and PTAs, and in the ways payers make care decisions.

Unfortunately, it's not all good news: This year, two behemoth commercial payers, UnitedHealthcare and Cigna, were challenged with potential class-action lawsuits alleging misuse of AI in ways that negatively impacted patient care. In Cigna's case, the allegations are that the insurer relied too heavily on an algorithm that resulted in a high rate of claim denials. UnitedHealthcare is facing a similar allegation that its algorithm denied needed extended care for older adult patients.

Of course, media coverage of these suits focuses on the use of AI — and to a large extent, that makes sense. But for health care providers and patients, the real issue here isn't about the use of algorithms, no matter how sophisticated. The real issue is about the importance of appealing denials…

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