HSC 310 Health Care Delivery

Patient medical condition, Payer Source, Policies, and Comparison Group 4

Patients Medical Condition

Multiple Sclerosis is a chronic inflammatory disease characterized by central nervous system lesions that can lead to severe physical or cognitive disability as well as neurological defects. In multiple sclerosis the immune system attacks the protective sheath that covers nerve fibers and causes communication problems between the brain and the rest of your body. Common symptoms of multiple sclerosis are different from person to person and the disease process. Symptoms that are affected in movement like numbness or weakness in one or more limbs, electric-shock sensations that occur with certain neck movements, and tremors. Vision is also affected with partial or complete vision loss, prolonged double vision, and blurry vision. A few other symptoms are slurred speech, fatigue, dizziness, tingling or pain, and problems with sexual, bowel and bladder function. Complications of multiple sclerosis vary on the person diagnosed. Some common complications include muscle stiffness, muscle spasms, paralysis in the legs, problems with bladder function, bowel function, sexual function, mental changes such as forgetfulness or mood swings, depression, and epilepsy. There is no specific diagnosis for multiple sclerosis, but ruling out other possible conditions with the same signs and symptoms. Multiple sclerosis has no cure, but treatment focuses on speeding recovery from attacks, slowing the progression of the disease, and managing the symptoms. Corticosteroids or plasma exchange can be used for treatment. Some other treatments for multiple sclerosis are physical therapy, muscle relaxants, medications to reduce fatigue, medications to increase walking speed, and other medications to help with whatever else is going on. People are able to live with multiple sclerosis, but could begin to have declining health. · Ghasemi, N., Razavi, S., & Nikzad, E. (2017). Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses, and Cell-Based Therapy. Retrieved September 2, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241505/

· Multiple Sclerosis. (2019, April 19). Retrieved September 25, 2019, from https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269

Payer Source(s)

The patient, Tara Schneider, uses Medicaid for her healthcare payer. This payer was enacted in 1965 and has since evolved to cover those individuals that are “low income, pregnant, those with disabilities and those who require long term care” (Medicaid.gov, n.d.). Medicaid has recently celebrated 50 years of providing health care coverage (Medicaid.gov, n.d.). Our patient is among 65.6 million other Americans to use Medicaid as their primary payer (Medicaid.gov, n.d.). Our patient is unable to work because of her diagnosis causing her to be on disability, which is a subset of Medicaid. Medicaid is administered by the state while being guided by the federal government (Medicaid.gov, n.d.). As of February of 2019, 37 states have opted for Medicaid expansion, meaning that almost 12.6 million more Americans will be eligible for Medicaid under the new guidelines (Rudowitz). The patient would be required to pay out of pocket for some costs. According to Medicaid.gov the maximum a patient would have to pay for in-paitent institutional care would be $75. This particular patient’s diagnosis would require prescription medications, which at most for a preferred medication the patient would be liable for $4. If the drug is not preferred or a name brand medication the patient would be liable for $8. · “Medicaid.” Medicaid.gov, www.medicaid.gov/medicaid/index.html.

· Rudowitz, Robin, et al. “10 Things to Know about Medicaid: Setting the Facts Straight.” The Henry J. Kaiser Family Foundation, 6 Mar. 2019, www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-setting-the-facts-straight/.

Health Care Policies

Medicaid is structured as a partnership between the federal standards and the flexibility that states have to determine covered services, methods for payment and the populations covered. All Americans that meet the requirements are guaranteed coverage and the federal government will match qualified services provided to enrollees. Tara has a progressive autoimmune disorder that prevents her from working and she has two children to support while living in women’s shelter. She is a prime example of who Medicaid was created to support. Under the original Medicaid law in 1965 provided cash assistance (Aid to Families with Dependent Children or federal Supplemental Security Income starting in 1972)for families, disabled and underprivileged. Congress also required Medicaid to help pay for premiums and allowed states to offer an option to “buy-in” to Medicaid for working individuals with disabilities (Rudowitz, 2019 p.2). This would allow Tara to use her money to support herself and her sons instead of paying for her insurance. Medicaid continued to expand with Children’s Health Insurance Program (CHIP) in 1997 to cover low income children and mark the beginning reforms of Medicaid. This allows Tara to have proper insurance coverage for her sons and keep them healthy. The Affordable Care Act (ACA) expanded Medicaid by eliminating categorical eligibility and allowed childless adults to access coverage (Rudowitz, 2019 p.3). The streamline of enrollment caused a decrease of unenrolled children and adults but causes burden to many working adults with no options for affordable coverage under the ACA.

· Rudowitz, R., Garfield, R., & Hinton, E. (2019, March 6). 10 Things to Know about Medicaid: Setting the Facts Straight. Retrieved September 26, 2019, from https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-setting-the-facts-straight/.

Comparison with Another Nation

In the United States, Tara would be facing a multitude of obstacles concerning her MS treatment. First, she could apply for Medicaid, which would only pay for her medical necessities. She could then apply for disability from Social Security. Once she has been on disability for at least 2 years, and her MS has been carefully documented, she may apply for Medicare. All of these will help her out, but until she is approved for Medicare, she will have out of pocket expenses for her treatment and daily management. Being that she lives in South Dakota, she would not be eligible for the ACA’s Medicaid expansion that would allow her more and better treatment. She could apply for assistance through MS organizations to help her out with her daily living needs. If Tara were to live in the United Kingdom, she would not have to worry like her American counterparts. Tara would be able to call her Primary Physician and set up an appointment whenever she would have an issue, unlike in the US where she would have to see if that certain appointment would be covered. Tara would be able to see Specialists and obtain prescription drugs whenever she needed them. Tara is able to receive all of this due to the taxes that her, and her fellow countrymen pay to get the free health care. · Medicaid and Other Public Health Insurance Programs. (n.d.). Retrieved September 26, 2019, from https://www.nationalmssociety.org/Living-Well-With-MS/Work-and-Home/Insurance-and-Financial-Information/Health-Insurance/Medicaid-and-Other-Public-Health-Insurance-Program.

· Mssocietyuk. (n.d.). Getting treatment for MS. Retrieved September 26, 2019, from https://www.mssociety.org.uk/about-ms/treatments-and-therapies/getting-treatment-for-ms.

· Norris, L. (2019, July 24). South Dakota and the ACA's Medicaid expansion: eligibility, enrollment and benefits. Retrieved September 26, 2019, from https://www.healthinsurance.org/south-dakota-medicaid/.

· Pozniak, A., Hadden, L., Rhodes, W., & Minden, S. (2014). Change in perceived health insurance coverage among people with multiple sclerosis. Retrieved September 26, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204373/.

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Group 4 Brooke Lachmund, Briana Leber, Anthony Lund, Jacy McComsey

Facility and Service Assignment

Dr. Beauvais

Health Care Services

Tara would likely have a social worker that assists her with housing, treatment decisions and other challenges that may occur. They are also able to incorporate the care of her children including transportation for school. The social worker can serve as a liaison for other members on her healthcare team. Tara may also see a primary care physician who is concerned for her overall health. This could include any symptoms that may be overlooked due to her multiple sclerosis. This provider is able to keep a consistent record of care for her that can be utilized by her specialists. Both of these providers are covered by Medicaid because they are mandatory benefits for any participant. A physiatrist focuses on physical medicine and rehabilitation and focuses on unique treatment plans to allows Tara to have the highest level of function. This would include different exercises, assistive devices (walker, wheelchair, etc.) and medications to promote mobility. This specialized physician focuses on the best quality of life for the patient. This specialized doctor may not be covered under Medicaid and would be an option that Tara would discuss with her primary care doctor and social worker.

Facility Description

Our patient Tara Schneider is able to complete all of her ADL’s by herself, but it takes her quite a bit of time to complete them. Her kids and her are currently living in a shelter for women in Sioux Falls. After knowing where she is currently living and how her symptoms are getting worse looking into an assisted living that would allow her and her kids to live at could be key. With that being said it would make sure the kids are getting well balanced meals along with making sure their mom Tara stays safe from cooking accidents along with falling badly to where she will end up breaking something

too. Having her and her kids move into an assisted living could help benefit all of the other people living there too. The other people would be excited to have kids around along with knowing that the younger generation knows what it is like in a facility. Having kids there to be able to participate in games and gathering events. Moving into a facility would again benefit Tara and her kids to make sure she is staying safe along with getting help in cooking, avoiding falls, and allowing her to raise her kids and go to their events too.

Challenges for Health Care Systems and Providers

Our patient may face many obstacles or challenges with her healthcare. These are challenges that the patient might not even be aware off transpiring between her healthcare providers and her insurance. One such battle is between the recent transparency requirements that have been placed by the ACA on providers. These requirements were meant to “give consumers information related to quality and cost, much as online websites like Kayak enable consumers to compare different travel options. Such transparency, many experts have argued, not only enables consumers to make better choices, but also stimulates competition and performance improvement among all providers” (Hochman and Lavander, 2018). The top issue found with these requirements meant that the clinics/offices would have to maintain more sophisticated equipment and technology that many Medicaid preferred offices lacked. This has skewed the metrics and could quite possibly “a shortage of healthcare providers, and some stakeholders fear that additional pressures to deliver high quality care for challenging populations might serve as a deterrent to working in vulnerable communities, potentially worsening provider shortages” Hochman and Lavander, 2018).

This might cause unforeseen consequences for our patient if she is unable to find a provider/office in her community that maintains records to facilitate the patient to able make informed decisions about her healthcare provider. A way to detour from this path would be for providers in the Medicaid sector to receive grants to help with technology updates to provide the correct and quality measurements needed for the transparency requirements. A second challenge that healthcare providers face to provide exceptional care is when a patient experiences a gap in insurance coverage. An occurrence that could happen to our patient. Medicaid “policies that take coverage away from people who don’t meet work requirements or pay premiums, impose cost-sharing, or create complex health savings accounts lead to coverage gaps for a large share of the affected beneficiaries” (Katch, 2019). Having a gap in coverage can be detrimental to a patient such as ours. “Periodic gaps in coverage trigger a cascade of negative health effects. Even the short-term uninsured are consistently and significantly less healthy than the insured” (Katch, 2019). A solution to this, might be to allow patients who experience a gap in coverage, if they can show proof of consistent doctor visits and pharmacy use, to be able to receive refills on medication without a new doctor visit. Another option would be to allow more of a retroactive reimbursement window, to allow a patient to get funds back for a bill they had to pay out of pocket for a medical bill. A third issue that might cause a discrepancy for a healthcare provider and our patient would the acceptance rate of new Medicaid patients to said provider. “Among physicians accepting new patients, providers were less likely to accept new patients with Medicaid than new patients with Medicare or private insurance” (Holgash and Haberlein, 2019). If a provider is not accepting new patients to care for in their practice, then there is a lack of

coverage between patients and available practitioners. “With Medicaid enrollment in expansion states increasing by 13.6 million people between 2013 and 2018, many raised concerns about whether enough doctors would be available to treat those newly enrolled and if there would be negative effects on those who already had Medicaid” (Holgash and Haberlein, 2019). This is a major concern for our patient. If the providers in the area do not accept new Medicaid patients, then she might not get quality care for her new diagnosis. Due to the low provider participation in Medicaid, this might become a problem for patients across the nation. A simple fix would be for more provider to establish that participation with Medicaid, unfortunately, private practices are not obligated to the state-run insurance and can deny patients with said insurance. A way to entice more providers could be to have better reimbursement from the state for services provided. This would help to ease the provider into accepting more patients because they would not have to recoup as much costs.

Challenges for Policymakers

The challenge to policymakers is to respond to the growing need for long term services and supports, and assure safeguards are in place to protect beneficiaries across the various care settings. Some of the current issues’ policymakers are facing consist of rapid growth, incentives to expand, and fraud and abuse. Costs have grown so rapidly because health services are provided free with little or any copayments, and policymakers have expanded eligibility and benefits numerous times. One possible solution to this, is to start raising the minimum limits to people who actually need it and start a copayment program to make people think if they really need the service provided. An implication would be that not everyone will be covered like they are now,

but it would eliminate the ones who don’t really need it. State governments have received incentives to expand the program. Since Medicaid is an open-ended federal matching grant, the states receive additional federal cash when they expand eligibility. One possible solution to this, is to end the incentive program to get states to join and make it mandatory. Doing this will ensure the same coverage no matter what state the patient is in. An implication would be some states would lose the extra benefits. Fraud and abuse exist partly because of the federal structure. States don’t have strong incentives to eliminate fraud and abuse because federal pays most of the program's costs. For every two or more dollars of fraud that a state can cut, the state budget saves only one dollar. One possible solution is to end the federal matching nature and provide states with a fixed block grant. An implication would be that the states would have to be more aware of what is happening and crack down on fraud and abuse.

References:

- Abrahms, S. (2016, April 2). Kids in Assisted Living: Everyone Wins. Retrieved October 17, 2019, from https://blog.aarp.org/take-care/sally-abrahms-family-that-lives-in-assisted-living.

- Developing a Healthcare Team. (n.d.). Retrieved October 17, 2019 from https://www.nationalmssociety.org/Treating-MS/Comprehensive-Care/Deveoping-a-health-care-team.

- Hochman, Michael, and Michelle Levander. “Medicaid Providers Operating Under the Radar.” Medicaid Providers Operating Under the Radar | Health Affairs, 18 Dec. 2018, www.healthaffairs.org/do/10.1377/hblog20181217.506070/full/.

- Holgash, Kayla, and Martha Heberlein. “Physician Acceptance Of New Medicaid Patients: What Matters And What Doesn't.” Physician Acceptance Of New Medicaid Patients: What Matters And What Doesn't | Health Affairs, 10 Apr. 2019, www.healthaffairs.org/do/10.1377/hblog20190401.678690/full/.

- Katch, Hannah. “Medicaid Restrictions Impede Innovation to Improve Care, Reduce Costs.” Center on Budget and Policy Priorities, 14 Mar. 2019, www.cbpp.org/blog/medicaid-restrictions-impede-innovation-to-improve-care-reduce-costs.

- Medicaid Reform. (n.d.). Retrieved October 19, 2019 from https://www.ahcancal.org/advocacy/solutions/Pages/Medicaid-Reform.aspx.

- Priority Medicaid Issues for New State Officials. (2019, July 26). Retrieved October 19, 2019 from https://www.rwjf.org/content/rwjf/en/library/research/2019/02/priority-medicaid-issues-for-new-state-officials.html.

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Group 4 Brooke Lachmund, Briana Leber, Anthony Lund, Jacy McComsey

Health Care Barriers

Dr. Beauvais

Our patient Tara Schneider may have travel expenses and barriers. She may need to take the bus transit to be able to get to her healthcare appointments. In the information we were given above it does not state whether or not she has transportation or not. With Tara currently living in the women’s shelter in Sioux Falls she would need to be picked up and dropped off at her appointments. Our patient may not have the money to pay for the bus ride to and from her appointment too since she is unable to work and sleeps most of the day with more frequent falls.

This will affect our patient a little bit from receiving excellent health care. With getting excellent health care our patient will have to plan what she is doing with her kids when she has an appointment unless they are in school then it makes her life easier. If the patient has to take her kids along, they could misbehave causing disruption for providers and make the care she is receiving not top notch. Being able to have a one to one visit with the providers without any interruption is what Tara needs so they can decide her plan of care.

Tara shouldn’t have any difficulties in overcoming her barriers. There are many organizations and foundations to aid her in her road to recovery. The South Dakota Department of Social Services is more than capable of helping her get the assistance that she needs. The DSS can assist her in finding a behavioral health program to help her get through and deal with her domestic violence that she has dealt with. This would help with what seems like her depression episode, napping all of the time for example.

Tara can also get help through a program by DSS and the Department of Labor, Temporary Assistance for Needy Families (TANF), which is a temporary public assistance work program designed to provide temporary assistance and economic self-

sufficiency. Recipients are required to participate in work activities. Adult TANF recipients are expected to become self-sufficient within 60 months. If the program rules aren’t followed, the participant will be penalized, which may affect their monthly payments as well as their eligibility. Some of the rules are as listed:

● TANF assistance is temporary.

● TANF is a work program.

● It is your responsibility to find and keep work.

● You will accept responsibility for yourself and your children.

● You will follow all program conditions such as developing a work plan, keeping appointments, participating in a work activity, completing and submitting time sheets, and making sure your children attend school.

● TANF benefits are intended to assist individuals and their families in meeting their basic needs such as food, clothing, shelter, utilities, household items, and personal care items.

● TANF benefits are NOT to be used for alcohol, illegal drugs, gambling, or other purposes not intended to meet basic needs.

Tara can also apply for the Child Care Assistance Program which will help pay childcare costs to providers who meet certain criteria. The family may be required to make a co-payment based on the household income and family size. She can use this while she is working.

While Tara is in her time of need, she can apply for Medicaid. Through Medicaid, she will be able to receive medical equipment (to safeguard her living arrangement to

prevent falls), receive mental health coverage (to assist her in dealing with domestic violence), and transportation through the Community Transportation program. This program provides transportation to medical appointments.

We as a society can help Tara and her boys get through this rough time in their lives by giving a hand up, and not a handout. Tara can be shown organizations and support groups that will help her. People volunteering to help her would also greatly help. The biggest thing that will help her and others like her is emotional support.

Impact of the Affordable Care Act

Detailed description of how this legislation impacts care (Brooke)

The affordable care act as impacted all areas of health care. The Act was able to expand on the already in place structure of Medicaid and Medicare to improve them. “The Act fundamentally restructures Medicaid to cover all citizens and legal U.S. residents with family incomes less than 133% of the federal poverty level (as measured through a new “modified adjusted gross income” test) and to streamline enrollment (Rosenbaum).” Before the Affordable Care Act was enacted the wait for Medicaid was up to “five years” (Rosenbaum). This revision directly correlates to help our patient, Tara. If she would have had to wait for five years to receive her insurance, she would not have survived.

In addition to improving the structure of state insurance, creating a market of affordable plans for purchase without an employer, and setting strict rules and regulations for insurance; the Affordable Care Act also facilitated changes in the health care system itself. According to Sara Rosenbaum the Act did this in three ways, “(1)

nudge the health-care system into behaving in different ways in terms of how health professionals work in a more clinically integrated fashion, (2) measure the quality of their care and report on their performance, and (3) target for quality improvement serious and chronic health conditions that result in frequent hospital admissions and readmissions” (Rosenbaum). In creating these changes, the health care system has seen improvements because it is regulated and monitored.

Benefits from implementation of the ACA (Affordable Care Act) for disabled patients include expansion of Medicaid programs and improvement of coordination and quality of care for those with chronic conditions. Tara suffers from an autoimmune disease that prevents her from performing daily activities of living. She is a prime example of a patient who may visit the doctor more often and require more care at home. Many Medicare beneficiaries can still receive benefits from the ACA, including coverage for wellness visits and coverage of colonoscopies and mammograms with no deductible (HIGH POTENTIAL, 2014). The ACA creates expansion for Medicaid, such as the Community First Choice and Independence at Home. These programs create incentive for home and community-based care instead of institutionalization for patients that qualify. This could allow Tara to receive many routine exams with no out of pocket costs. This expansion of Medicaid under the ACA has filled in the gaps of many programs that only covered part of the services needed for proper healthcare. This access to affordable healthcare only creates more incentive for healthcare under ACA.

The benefits of the ACA seem to overshadow the negative impact it has on patients and healthcare. But Tara does experience some of the negative effects of the ACA. Under the AHCA (American Healthcare Act of 2017), states could re-enable

insurance providers to increase rates on those with preexisting conditions, which would price most people with disabilities out of coverage in the individual market (Kennedy, 2017). This would mean that those who are disabled could not afford private insurance to fill in the areas where Medicaid does not. This could leave Tara with gaps in her healthcare and for her two sons. These cuts in insurance could cause premiums to jump by as much as 750%. Those with disabilities are much more likely to rely on Medicaid (37.7% vs 10.0%), Medicare (27.1% vs 0.5%), or military benefits (6.0% vs 2.3%), and less likely to have private insurance coverage than their nondisabled counterparts (36.1% vs 73.1%) (Kennedy, 2017). According to Rand Healthcare if the Affordable Care Act were to be repealed without replacement decided upon “the number of insured Americans would drop by 19.7 million to 231.9 million.” Our patient would be one of the individuals affected by this. One revision that would benefit our patient directly would to expand or increase funding in programs as discussed earlier in this work. Programs that help individuals back to their feet and when the person is no longer in need of the program moves on to help others in need.

In order to redirect funds, a stipulation could be put into place, one that requires those on Medicaid (in certain income brackets) to pay more of a premium or be required to pay a larger portion of the cost or co-pay of healthcare provided, instead of the whole portion being placed on the state. An example would be, instead of Medicaid paying for a prescription of Naproxen 500mg the patient pays out of pocket. This is a generic drug that in most quantities prescribed by the ER totals to be about $11.99. The state would

be able to allocate the $10 dollars to different funds or programs. This would be a case for certain income brackets of course or for those without dependents.

A change like this could also affect Tara, she would benefit from the funds being shifted to programs that help her and her children function from day to day. She might be obligated to pay a higher copay, depending on her income, but a higher co-pay would be a far better alternative than having no insurance at all to help with costs of healthcare.

Resources: - Gibson, J., & Frank, A. (2002, December). Supporting individuals with disabling multiple sclerosis. Retrieved November 16, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1279282/.

- HIGH POTENTIAL: The affordable care act for individuals with special needs. (2014, 01). The Exceptional Parent (Online), 44, 36-38. Retrieved from https://search-proquest-com.ezproxy.usd.edu/docview/1507274907?accountid=14750

- Kennedy, J., Wood, E. G., & Frieden, L. (2017). Disparities in insurance coverage, health services use, and access following implementation of the affordable care act: A comparison of disabled and nondisabled working-age adults: The journal of health care organization, provision, and financing the journal of health care organization, provision, and financing. Inquiry, 54 doi:http://dx.doi.org.ezproxy.usd.edu/10.1177/0046958017734031

- Rosenbaum, Sara. “The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice.” Public Health Reports (Washington, D.C. : 1974), Association of Schools of Public Health, 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3001814/.

- South Dakota Medicaid Recipient Handbook. (n.d.). Retrieved November 15, 2019, from https://dss.sd.gov/formsandpubs/docs/MEDSRVCS/MedicalAssistanceRecipientHdbk.pdf. - “The Future of U.S. Health Care.” RAND Corporation, www.rand.org/health-care/key-topics/health-policy/in-depth.html.

The Affordable Care Act, often known as Obamacare, has caused a lot of controversy. Much of the act could be repealed soon. But in making decisions about future health policy, the act’s successes shouldn’t be overlooked. One of these is reducing the percentage of people who, after being discharged from the hospital, end up back there within 30 days.

The Hospital Readmissions Reduction Program (HRRP) is a provision of the Affordable Care Act (ACA) that seeks to link hospital payments for inpatient admissions with quality of hospital care. In short, the HRRP requires the Secretary of the Department of Health and Human Services to reduce payments to hospitals when they are found to have excess readmissions.

Several elements of the Affordable Care Act, such as Medicaid expansion and tax penalties for not having health insurance, have prompted much debate. But payment reform to improve quality and value, including this quieter but critically important element of health reform, has attracted support from both parties.

According to Enrico G. Ferro, MD [#1] “Our main finding is that Medicaid readmissions, which were not the intended target of the HRRP, declined at a significantly faster rate for target conditions after implementation of the HRRP – in addition to Medicare readmissions, the actual intended target of the HRRP. These findings suggest that the effect of the interventions taken by hospitals to reduce readmissions for Medicare patients may have spilled over to Medicaid patients, and resulted in readmission reductions for the Medicaid population.”

In the most common disease course in MS, acute flareups are followed by remissions as the inflammatory process gradually comes to an end. Going into remission doesn’t necessarily

mean that the symptoms disappear totally, some people will return to feeling exactly as they did before the flareup began, while others may find themselves left with some ongoing symptoms. Not all flareups require treatment. Mild sensory changes or bursts of fatigue that don’t significantly impact a person’s activities can generally be left to get better on their own. For severe flareups which interfere with a person’s mobility, safety or overall ability to function, most neurologists recommend a short course of high-dose corticosteroids to reduce the inflammation and bring the relapse to an end more quickly. [#2]

“The natural history of the disease involves intermittent relapses and/or accrued baseline disability overtime especially in older patients contributing to frequent hospitalizations. The readmission metrics for patients with MS have not been studied. The common causes of readmission were MS exacerbation, respiratory complications, and sepsis.” [#4]

#1 - https://www.bidmc.org/about-bidmc/news/2019/04/federal-hospital-readmissions-reduction-program-intended-to-address-readmission-rates #2 - https://www.nationalmssociety.org/Treating-MS/Managing-Relapses #3 - https://annals.org/aim/article-abstract/2594952/readmission-rates-after-passage-hospital-readmissions-reduction-program-pre-post

#4 - Patel, S., SirDeshpande, P., Desai, R., Desai, N., Mistry, H., Patel, N., ... Garg, N. (2019). Thirty-day readmissions in multiple sclerosis: An age and gender-based US national retrospective analysis. Multiple Sclerosis and Related Disorders, 31, 41-50. https://doi.org/10.1016/j.msard.2019.03.012