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The Morning Report provides a quick look at today’s medical news, research and features.  









Docs Mystified By Paralysis in Dozens of Kids
More than 50 children in 23 states have had mysterious episodes of paralysis to their arms or legs, according to data gathered by the CDC. The cause is not known, although some doctors suspect the cases may be linked to infection with enterovirus 68, a respiratory virus that has sickened thousands of children in recent months.

Some of the affected children have lost the use of a leg or an arm, and are having physical therapy to keep their muscles conditioned. Others have sustained more extensive damage and require help breathing. The prognosis for affected children is uncertain. ”At the moment, it looks like whatever the chances are of getting this syndrome are less than one in a million,” said Mark A. Pallansch, the director of the division of viral diseases at the CDC.

More than 100 cases have been brought to the attention of the CDC. But only half fit the agency’s strict definition: a case of sudden-onset limb weakness since August in a patient younger than 21 who has certain spinal cord lesions.

Not all of the children with limb weakness have tested positive for enterovirus 68. Children’s Hospital of Philadelphia has treated five children with limb weakness and the characteristic spinal lesions. Yet none tested positive for enterovirus 68, said Dr. Brenda Banwell, the hospital’s chief of neurology. (NYT)

Medicare May Force ALS Patients To Lose Communication Technology
Starting Dec. 1, people with ALS – a disease that impairs motor function so people often can’t talk or even move – could lose access to technological advances that allow them to better communicate, thanks to a federal review of what Medicare is allowed to cover.

Historically, Medicare has covered 80 percent of the cost for basic speech-generation devices – the machines many ALS patients use – while permitting patients to pay out of pocket for upgrades that allow the devices to connect to the internet and perform services such as opening doors. But in February, the Centers for Medicare & Medicaid Services posted a ”coverage reminder” making clear that the program does not cover the cost of upgradable devices, based on a much earlier national coverage determination.

This notice is part of a review by Medicare contractors to make sure devices do in fact “comply with our coverage rules and the Medicare law,” CMS spokesperson Aaron Albright wrote in an email. This review, he added, has been “suspended” until December to address advocates’ concerns. ALS groups have said the change will effectively bar patients from the machines they have been able to obtain through Medicare for years. “Now all of a sudden the door is closing for them,” said Kathleen Holt, associate director at the Center for Medicare Advocacy. (Full story at Physicians News)

Docs Making Housecalls Proves Successful
Although for some doctors, the idea of home visits seems antiquated, one practice has so much success that even Medicare is taking notice. In a little over a decade, the practice has exploded in popularity — with more than 40 providers in North Carolina.

The practice, called Doctors Making Housecalls, has tracked patient outcomes and costs for 2 years as part of a Medicare demonstration project exploring at-home care for complex and elderly patients. In that time, patients have spent less time in hospitals, had fewer emergency room visits and have spent less on healthcare overall. Shohreh Taavoni, MD, said that although she built the practice for patient convenience, she now sees it as a solid solution to both provider burnout and the rising cost of consumer health.

Although today Taavoni and her husband, Alan Kronhaus, MD, both say they make “above average” pay for a family practice physician, that wasn’t always the case. It took 4 years before the team cut their first paycheck, living off savings to pursue their dream. Kronhaus founded KRON Medical, the country’s first locum tenens staffing firm, in 1980.

Before they could open, they had to sort through a number of issues. Chief among them: how to bill for services, which turned out to be simpler than the team expected. The vast majority of housecall services can be billed with CPT codes similar to those used in the office. One of the biggest differences is the amount of time spent with the patient: instead of 8 to 10 minutes in an exam room, Taavoni spends nearly an hour with each of her patients. Taavoni’s practice adds a flat $95 fee to each call, a price most patients happily pay.

Although she didn’t anticipate it when she first started making housecalls, the majority of Taavoni’s patients — and those of her 45 fellow doctors in the practice — live at residential care facilities. When Taavoni visits an assisted or independent living home, she waves the $95 fee, and can often spend an entire day rounding from one patient’s room to the next. (MedPage Today)


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