New Tests May Finally Diagnose Long COVID

Medscape / By Sara Novak

One of the biggest challenges facing clinicians who treat long COVID is a lack of consensus when it comes to recognizing and diagnosing the condition. But a new study suggests testing for certain biomarkers may identify long COVID with accuracy approaching 80%. 

Effective diagnostic testing would be a game-changer in the long COVID fight, for it’s not just the fatigue, brain fog, heart palpitations, and other persistent symptoms that affect patients. Two out of three people with long COVID also suffer mental health challenges like depression and anxiety. Some patients say their symptoms are not taken seriously by their doctors. And as many as 12% of long COVID patients are unemployed because of the severity of their illness and their employers may be skeptical of their condition.

Quick, accurate diagnosis would eliminate all that. Now a new preprint study suggests that the elevation of certain immune system proteins are a commonality in long COVID patients and identifying them may be an accurate way to diagnose the condition.

Researchers at Cardiff University School of Medicine in Cardiff, Wales, United Kingdom, tracked 166 patients, 79 of whom had been diagnosed with long COVID and 87 who had not. All participants had recovered from a severe bout of acute COVID-19.

In an analysis of the blood plasma of the study participants, researchers found elevated levels of certain components. Four proteins in particular — Ba, iC3b, C5a, and TCC — predicted the presence of long COVID with 78.5% accuracy.

"I was gobsmacked by the results. We’re seeing a massive dysregulation in those four biomarkers," says study author Wioleta Zelek, PhD, a research fellow at Cardiff University. "It’s a combination that we showed was predictive of long COVID." 

The study revealed that long COVID was associated with inflammation of the immune system causing these complement proteins to remain dysregulated. Proteins like C3, C4, and C5 are important parts of the immune system because they recruit phagocytes, cells that attack and engulf bacteria and viruses at the site of infection to destroy pathogens like SARS-coV-2. 

In the case of long COVID, these proteins remain chronically elevated. While the symptoms of long COVID have seemed largely unrelated to one another, researchers point to elevated inflammation as a connecting factor that causes various systems in the body to go haywire.

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Managed Medicare Plans: Update on Requirements for Prior Authorization

Used with Permission - ©2023 Elizabeth E. Hogue, Esq. All rights reserved.

No portion of this material may be reproduced in any form without the advance written permission of the author.

Many providers are bedeviled by the practices of Medicare Advantage Plans. Problems include:

• Rates that do not cover providers’ costs
• Requests for prior authorization that require enormous amounts of time and energy
• Denials of payments for care
• Slow pay
• Subsequent audits and recoupments

These activities have caused providers to discontinue relationships with such Plans.

Attempts by Plans to address these issues have largely fallen flat. Providers, for example, describe promised reductions in requirements for prior authorization as “payor antics.” The American Hospital Association (AHA) recently reported that denials by Medicare Advantage Plans have spiked by 56% and revenue reductions increased 55.7%. Chris Van Gorder, President and CEO of Scripps, summed up the situation in Beckers as “a game of delay, deny and not pay.”

A key problem for providers is, of course, that approximately 50% of Medicare beneficiaries are enrolled in such Plans. Despite all of the above, providers question whether they can afford to discontinue relationships with Medicare Advantage Plans.

Recently, however, UnitedHealthcare has decided to update its prior authorization review process for home health services effective on January 1, 2024.

Here are key aspects of the new process:

• Start of care visits will not require prior authorization.
• Providers must notify Home and Community Care of the initiation of home care services.
• Providers are encouraged to notify United within five days after a start of care visit to help avoid potential payment delays.
• Prior to the 30th day of care, providers must request prior authorization for days 30-60 of care.
• Requests for prior authorization described above must be submitted by discipline.
• Documentation that supports requests for prior authorization must be provided to Home and Community Care at United.
• Providers must request prior authorization for each subsequent 60 day periods of care during days 56 to 60 of care.
• Subsequent requests for prior authorization must also be submitted by discipline and documentation to support requests must also be provided.

It is entirely unclear how this new process will affect providers. It looks like providers will be paid for start of care visits and for thirty days of care after start of care visits, but will they actually be paid? It is also possible that prior authorization will be extremely burdensome for providers.  Submissions must be made for each discipline and it is unclear how much documentation will be required to support provision of additional services.

All types of providers may view United’s latest efforts to improve the prior authorization process for home health agencies in a positive light. Perhaps United will expand these efforts to them, but the jury is still very much out!

Not All Exercise Is Beneficial: The Physical Activity Paradox Explained 

Medscape / By Marilynn Larkin

In the pursuit of optimal health, regular physical activity (PA) is recommended to protect against dementia, cardiovascular disease (CVD), cancer, and other noncommunicable diseases. A significant body of research suggests the benefits of PA are positively correlated with higher frequency and intensity — with more often deemed better. This research has spawned a focus on increasing step counts and investing in standing desks and other interventions aimed at keeping people active.

But for many people, PA is a work requirement over which they have little control, and emerging evidence suggests that these workers not only do not reap the benefits associated with leisure-time PA, but they also actually experience an increased risk for the very conditions that PA is intended to prevent.

A study published recently in The Lancet Regional Health – Europe used registry data from more than 7000 adults in Norway, following them from age 33 to 65 years, to assess PA trajectories and risks for later-life mild cognitive impairment (MCI) and dementia at age 70 or older.

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2024 Home Care Industry Outlook

Home Health Care News

December 14, 2023 (10:00 AM – 11:00 AM MT)

Join Home Health Care News as we look ahead at 2024 with our Home Care Industry Outlook webinar.

In a conversation moderated by HHCN, home care leaders will share their visions for next year while addressing the major headwinds and tailwinds likely to shape the space. Speakers will also touch on emerging M&A opportunities, technology trends and more.

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