Together Patient Advocates Blog

I

For a moment, I would like you to imagine yourself in the following situation.

You are in the exam room for your diabetic check-up, expecting to see a familiar face. But instead of your primary care physician, a stranger walks in.  This individual is not a physician but is a nurse practitioner (NP). Do you know the difference between the two?

Whether your health insurance is through your employer, a private policy, or Medicare, you’re headed for open enrollment. This is when insurers make cost and benefit changes that will be effective January 1^st. Your insurer is required to notify you in writing of upcoming plan benefit changes. Take the time to study those changes and the benefit details in any plan you are considering for your 2021 coverage. The choice you make will be in effect through December 31, 2021 unless you have a qualifying event, such as loss of coverage, that allows you to change coverage mid-year.

The recent death of 43 year-old actor Chadwick Boseman is raising much needed awareness about the rise rates of colon cancer among young adults.  

Flu season is just around the corner. Influenza or "the flu" is a contagious upper-respiratory illness that can cause severe illness, and at times, lead to death. The Centers for Disease Control (CDC) estimate that during the 2018-2019 flu season, the flu was associated with 490,600 hospitalizations and 34,200 deaths. Symptoms include fever, chills, cough, congestion, headaches, fatigue, and muscle aches.

Don’t expect the number of cases in the U.S. to be lower this year because countries in the Southern Hemisphere, like Australia and New Zealand, experienced a very mild flu season . Their flu season happened at the same time their citizens were abiding by very strict stay-at-home orders due to COVID-19. Since the U.S. is not enforcing similar regulations, experts in the U.S. do not expect a similar decrease in the number of flu cases.

If anything, because Americans are also at risk of contracting COVID-19, this flu season presents a greater-than-normal risk to your health. That means getting a flu shot is more important than ever. Stacy Schultz-Cherry, a researcher at St. Jude’s Children’s Research Hospital explains it this way , “We really don’t know what a co-infection would look like.” Schultz-Cherry adds, “I wouldn’t want to have the lungs that would find that out.” You don’t want those lungs either.

By Have you ever mistaken an insurance claim form for a puzzle in which none of the pieces are clear and the final “picture” makes no sense? The words seem have no connection to your medical treatment or benefits you’re entitled to receive. The definitions that supposedly explain why amounts weren’t paid must have been lifted from a lawyer’s notebook of phrases that sound good but have no apparent meaning.

When you hear the phrase, “surprise medical bills,” it usually means that medical treatment you thought was in-network was actually out-of-network.  As a result, your bill is significantly higher than you anticipated – thus, the ugly surprise.

A slice of good news found within the COVID-19 statistics is that the majority of people with the virus are not sick enough to warrant hospitalization. Johns Hopkins estimates about 80 – 90% of COVID-19 cases are “not severe and many may be asymptomatic.”  Even though people experience varying levels of symptoms and recovery times, there are things that patients or their caregivers can do at home to manage mild to moderate COVID-19 symptoms and help the recovery process.

As of July 2, 2020 Johns Hopkins University placed the number of recovered COVID-19 patients in the U.S. at over 729,900.  But what does "recovered" really mean?    Patients can be struggling to recover from the virus's multi-organ damage as well as the mental and physical challenges resulting from long-term Intensive Care Unit (ICU) stays and numerous days on a ventilator.                                              

Assessing the psychological toll of COVID-19, Dr. Lindsay Lief, a pulmonologist at Weill Cornell, says that lengthy ICU stays during “ordinary times” can result in cognitive deficits, anxiety, depression or symptoms of post-traumatic stress disorder. She expects those issues to be magnified for COVID-19 patients. 

Based on a study previously conducted on patients who recovered from Severe Acute Respiratory Syndrome (SARS),survivors "showed worrying levels of depression, anxiety, and post-traumatic symptoms" one year after the outbreak.   

Even though SARS cases were generally more severe than COVID-19 cases,  researchers use SARS for potential insights into transmission, treatment, and outcomes because there are many similarities between the two coronaviruses including how they are spread (coughing, sneezing, and touching contaminated surfaces); symptoms, such as shortness of breath, cough, fever, and headaches; and both can become serious illnesses.

Recovery for COVID-19 patients typically takes place in a post-acute care setting, such as a skilled nursing facility, long-term care hospital or rehab center, as it did for Charlie Blueweiss, a 33 year-old COVID-19 survivor.   He spent just over four weeks in a COVID-19 recovery ward overcoming multiple issues: muscle weakness that prevented him from sitting up, hands so swollen he couldn’t use his phone, burning pain in his foot, a bedsore, and learning how to walk more than six feet with a walker before needing to rest. 

Unfortunately, both the length of Mr. Blueweiss’s rehabilitation stay and his symptoms are common for recovering COVID-19 patients.  Gregg Garfield, a 54-year-old avid skier, was hospitalized for 64 days, including 31 days on a ventilator.  He suffered kidney damage, collapsed lungs, and had to learn how to walk again.  He is on a “long road to full recovery.”

Brian Robinson, a 53-year-old man from Pennsylvania, experienced kidney failure, had to relearn how to walk, talk, swallow and eat.  He spent 42 days in the hospital and other medical facilities.

Akhink Omer, a 31-year-old woman, is described as feeling "...perfectly fine [one day], and the next she was hit with fever, diarrhea, fatigue, coughing fits, severe body aches, and 'the worst headache of my life for the first few days.'" It took Ms. Omer six weeks from the onset of her symptoms to resume her previous activity level.  She spent eight days in the hospital “fighting to breathe,” then left the hospital with, among other things, abnormal liver tests, a cough that lasted for weeks, and continued weakness.  

But just when COVID-19 patients need a place to recover from their severe symptoms, post-acute care facilities may not have enough beds for recovering patients. In April, a Brigham and Women’s Hospital analysis  based on the SARS-CoV epidemic, projected at least 700,000 Americans would require some type of inpatient post-acute care over the following six months.  Yet there are only approximately 345,000 available skilled nursing facility beds in the U.S.    

Some hospitals, like Weill Cornell where Mr. Blueweiss was hospitalized, have created special COVID-19 recovery wards. Likewise, some nursing homes have created new wings for recovering COVID-19 patients. But challenges still exist. Not all facilities have the required space and funds to create safe, fully-staffed, fully-equipped COVID-19 care units.

Portions of the care may be transferred to patients’ homes. But that requires a home environment that is safe for both the recovering patient and others who live in the home, funding for home health aides (HHAs), and someone to assist the patient when HHAs are not there.

As with many aspects of the pandemic, this issue is being addressed city-by-city, facility-by-facility, and family-by-family. Ideally, soon there will be policies and funding to resolve the logistical and financial challenges of COVID-19 recovery. Until then, the best course of treatment is prevention. Only go out for essential tasks, and when you do, wear a mask, practice social distancing, and wash your hands frequently.

COVID-19 is an elusive, yet persistent part of our lives.  We want to understand the virus as much as possible in order to avoid becoming one of its statistics.  Daily updates are readily found online, on television and in print.  Discoveries, theories, statistics, and predictions abound.  Yet how do you know which sources to trust? 

 While people struggle with the life-threatening effects of COVID-19, the chaos of sky-high emergency room bills plays out in a way that is sadly familiar to anyone who has ever received a surprise medical bill: