2019-June-1 – Linda Watkins, the Injury Prevention Coordinator from the Trauma Center of Inova Fairfax Hospital and Dr. Melanie Bush, Doctor of Physical Therapy at Inova discussed fall prevention and led us in a fun exercise routine to prevent falls. We loved the Zumba music to do the routine!

With PN, the quickest route to disability is a FALL!  Via disability, PN becomes premature death.
Their presentation’s main points: <see PowerPoint PDF> 

• Don’t fool yourself! If you’re on the floor when you didn’t intend to, You Fell!

– when the someone asks “Have you fallen recently?”, be truthful with them (and yourself)

• With PN, Falls are a BIG DEAL 
  

– Broken Hips – 95% caused by falls. 50% dead within 1 year. Vertical good – Prone bad.- Traumatic Brian Injury (TBI) – falls are biggest cause. (Playing football is way down the list)- Falls represent 1% of all deaths in the US and PN (alone or co-morbidity) is a major factor- Trends are bad:     
* PN patients are older    
* US Population getting older (lower birthrate & lower immigration)
* Given above, money cost expected to grow from $50B to $68B in 5 years (2015-2020)    
* 75% paid by taxes – in a county with a $1 Trillion budget deficit!    
* Money costs under-estimate the cost in lost wages from families that care for disabled

• Fear of Falling – cause someone to stop activities that bring joy and health

– legs weaken, falls increase (not decrease), loneliness, depression

• Exercise and Movement are key
• See pages 11 through 22 of <PowerPoint PDF> for details about risk factors and what you should do about them
  

-Dr. Bush also talked of the difficulty patients currently have obtaining in-home exercise training by Physical Therapists. 

These changes are based on “interpretations” of policy by the Physical Therapy provider, who must seek reimbursement from Medicare. The provider will not provide the service unless they are confident that Medicare will agree to pay. Every time Medicare “gets tough” about approving PT treatments (as they are in 2019) the PT companies run scared.  They are tempted to refuse to initiate treatment if the PN patient is not “Homebound”.  Most PN patients with enough balance and strength to benefit from a typical exercise program are not Homebound. See the <blog entry> on customized home exercise.

• Medicare covers skilled therapy services—including … outpatient therapy services, ,,,, if the services are “necessary to maintain the patient’s current condition or prevent or slow further deterioration.”
• Medicare will reimburse therapists for “the establishment or design of a maintenance program,” “the instruction of the beneficiary or appropriate caregiver,” and the “necessary periodic re-evaluations…of the beneficiary and maintenance program.”
• Medicare Policy: “The services for teaching and training would be considered to be reasonable and necessary prior to the point that it became apparent that the teaching or training was unsuccessful, as long as such services were appropriate to the patient’s illness, functional loss, or injury.”

The principle is clear. In-home training is appropriate. Unfortunately, there is nothing simple and clear about the approval process. Hence, the patient and his “advocates” (typically, the primary care doctor) must jump though hoops to get the customization process approved. 
Bottom Line: Lace up your jumping shoes.