JHC Jan 19

January 2019 • Vol.10 No.1

The ‘C’ Words ‘Cancer’ and‘chronic’ were rarely used in the same breath … until now

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CONTENTS »» JANUARY 2019

4 Supplier Diversity Symposium 6 PDPM: A ResidentCentered Plan

New reimbursement method will compensate SNFs for caring for medically complex residents

14 The ‘C’ Words

‘Cancer’ and ‘chronic’ were rarely used in the same breath … until now

20 Health news and notes

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The Journal of Healthcare Contracting | January 2019

3

SYMPOSIUM

of the People’s United Center for Innovation & Entrepreneurship, moderated panel discussions.

As in past years, the Symposium recognized industry leaders for their commitment to diversity with the Earl G. Reubel Awards. The awards were established by Owens & Minor in 2012 and named in honor of Earl G. Reubel, the late founder and CEO of Kerma Medical Products. The winners were chosen for excellence in three healthcare industry categories: civic leadership, large corporate leadership, and Left to Right: Earl G. Reubel Award Winners with O&M Teammates, Dr. Danni Green, O&M Director; Dr. Sam Ross, CEO Baltimore (Bon Secours Mercy Health) Large Corporation of the Year with Gloria Goins, CDO (Bon Secours Mercy Health); Tim Martin, Contracting Manager (CHRISTUS Health) - Civic Leader of the Year; Sam Kumar, CEO (MYCO Medical) - Diverse Enterprise of the Year with Michael Taylor, Sales (MYCO); Will Sapp, National Accounts (Medtronic) - HSDS Chairman’s Award for Excellence in Diversity & Inclusion; Geoff Marlatt, O&M SVP, Manufacturer Services

Supplier Diversity Symposium

diversity enterprise.

• The Earl G. Reubel Civic Leader of the Year Award was awarded to Timothy Martin, strategic sourcing manager for CHRISTUS Health in Dallas/Fort Worth, Texas.

• The Earl G. Reubel Diverse Enterprise of the Year Award was presented to MYCO Medical of Apex, North Carolina, a certified diversity supplier of medical devices specializing in single-use disposable

Owens & Minor hosted its 13th annual Healthcare Sup-

clinical preference items.

plier Diversity Symposium in Chicago this fall, to coincide with the

• The Earl G. Reubel Large Corporation

Health Industry Distributors Association’s Streamlining Health-

of the Year Award was presented to

care Expo & Business Exchange. Speakers, panelists, hospital and

Bon Secours Mercy Health in Balti-

healthcare executives, along with diverse suppliers, participated

more, a 100-bed facility licensed in

in the Symposium to encourage industry players to be intention-

the state of Maryland serving more

al about economic inclusion, according to Owens & Minor.

than 17,000 residents in the Balti-

Guest speakers included Daryl Mackin, founder and execu-

more area.

tive director of A Soldier’s Child Foundation; and Bill Strickland,

4

community leader, author, and president and CEO of the non-

In addition, the inaugural Chairman’s

profit Manchester Bidwell Corporation of Pittsburgh. Clarence

Award for Excellence in Diversity and In-

Page of the Chicago Tribune and Dr. Fred McKinney, director

clusion was awarded to Medtronic.

January 2019 | The Journal of Healthcare Contracting

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PATIENT CARE

ENVIRONMENT OF CARE

INTERVENTIONAL CARE

POST-ACUTE CARE

“It’s good for residents,” says Robin Hillier, RLH Consulting, Westerville, Ohio, and director of reimbursement and quality metrics for Welcome Nursing Home in Oberlin, Ohio. She spoke about PDPM at the annual Convention and Expo of the American Health Care Association and National Center for Assisted Living in San Diego.

“The current Prospective Payment System (PPS) used by CMS to pay for Medi-

PDPM: A ResidentCentered Plan New reimbursement method will compensate SNFs for caring for medically complex residents

care stays in skilled nursing facilities had the unintended consequence of leading to a ‘one size fits all’ approach to providing skilled care. The new Patient Driven Payment Model focuses more on the unique characteristics of each individual beneficiary, rewarding SNFs for focusing on the holistic, individualized plan of care that will help the person meet their

Effective Oct. 1, 2019, your SNF customers will receive Medicare reimbursement based on a new model of payment, called Patient Driven Payment Model, or PDPM. It’s designed to be budget-neutral and, in a global sense, it very well might be. But there will be winners and losers.

specific post-acute goals.”

“PDPM is a resident-centered model,” says Nate Ovenden, senior Medicare and managed care consultant, Good Samaritan Society, Sioux Falls, South Dakota,

The winners? Skilled nursing facilities that accurately assess the

who also spoke at the recent AHCA/

needs of the resident upon admission, and tailor their care accordingly.

NCAL convention. “It will help us focus

The losers? Facilities that cling to the old reimbursement

on the resident as an individual, instead

method, which rewards SNFs that maximize the number of

of our current system, which relies on the

hours they spend providing physical therapy, occupational ther-

amount of therapy minutes delivered.”

apy or speech/language pathology therapy. In the new system, more therapy hours won’t add up to more reimbursement dol-

Existing method to fade out

lars. (That said, the level of therapy anticipated for each resident

Until October 2019, Medicare will con-

will continue be one factor in the new reimbursement scheme.)

tinue to pay SNFs a prospectively deter-

SNFs that admit medically complex residents, that is, those

mined rate for each day of care. That daily

who need higher levels of potentially expensive care (e.g., ex-

rate has three components: nursing, ther-

pensive drugs, ventilator care, care for residents with HIV/AIDS,

apy, and room and board.

etc.) will receive reimbursement that more closely reflects those higher costs.

6

The nursing and therapy portions of the payment for each patient are adjusted January 2019 | The Journal of Healthcare Contracting

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POST-ACUTE CARE

for differences in case-mix using a classification system called re-

RUG-IV calls for SNFs to perform five

source utilization groups, or RUGs. The current iteration – RUG-IV

scheduled assessments of the resident,

– classifies patients into one of 66 possible resource utilization

at Day 5 of the stay, Day 14, Day 30, Day

groups, depending on the resident’s nursing care needs; amount

60 and Day 90. In addition, SNFs are ex-

of therapy provided; other services furnished, such as respiratory

pected to perform unscheduled assess-

therapy and specialized feeding;

ments throughout the stay, depending on

the patient’s ability to perform activities of daily living; and certain medical conditions, such as pneumonia and depression.

The current RUG-IV system includes payment for staff time spent on nontherapy ancillary (NTA) services, but not the cost, which can be high for SNF residents who require expensive drugs, a ventilator, tracheostomy care, wound care, IV medication, etc. (“Nontherapy ancillary services” refers to any ancillaries a provider uses other than therapy services, such as drugs, supplies and equipment.)

“It will help us focus on the resident as an individual, instead of our current system, which relies on the amount of therapy minutes delivered.”

– Nate Ovenden

The patient-driven approach Under PDPM, residents will be classified into one group for each of the five case-mix-adjusted components:

the needs of the resident. Under PDPM, however, SNFs need only perform one scheduled assessment – at Day 5 – and unscheduled assessments as needed.

While PDPM will save SNFs time spent on assessments, it also will demand a higher degree of accuracy at that Day 5 assessment.

“For many – if not most – Part A beneficiaries, reimbursement will be based solely on the information captured on the initial (5-day) assessment,” says Hillier.

“Under certain circumstances, facilities will have the ability to complete an ‘Interim Payment Assessment’ to adjust the reimbursement rate if new conditions arise during the stay that would increase the payment rate. But accurate and complete coding on the initial assessment will be critical to a facility’s success.

“In order to achieve complete and ac-

• Physical therapy

curate initial assessments, facilities will

• Occupational therapy

need to evaluate their admissions pro-

• Speech/language pathology

cesses to ensure they are considering all

• Nontherapy ancillary services

relevant clinical information.”

• Nursing

Simplicity

8

And, whereas under RUG-IV, therapy minutes delivered is the

CMS hopes that PDPM will simplify the

primary determinant for reimbursement, under PDPM, therapy

payment system, says Ovenden. “We

minutes will have no impact on reimbursement.

currently spend so much time meet-

SNF administrators and staff will enjoy another benefit from

ing regulations and doing assessments

PDPM – less time spent completing assessments of their residents.

that our nurses don’t have as much January 2019 | The Journal of Healthcare Contracting

Rx Only ©2016 B. Braun Medical Inc. Bethlehem, PA. All rights reserved. 16-5430_JHC_5/16_RTS3

POST-ACUTE CARE

time to see residents face to face. With PDPM, we will get to

he says. Those residents are already be-

know our residents on a more personal basis, and our MDS

ing cared for. But PDPM will reduce the

[Minimum Data Set] assessments will be more accurate. We

incentive for some SNFs to pick and

will have the resources to focus on our clinical competency

choose residents who may require many

skills, and make sure we’re providing great care for our resi-

therapy minutes, but who do not pres-

dents with comorbidities.”

ent clinical complexities.

In addition, by recognizing 50 nontherapy ancillary services for which SNFs can be reimbursed, the PDPM model will more

Making adjustments

accurately reflect the time, effort and cost of caring for clinically

“Under PPS, providers are paid based

complex residents, rather than emphasizing therapy minutes,

on the amount of therapy they provide,”

says Ovenden.

says Hillier. “If two beneficiaries receive

That said, it would be a mistake to believe that PDPM will

the same level of therapy, the rate is the

lead to a flood of new clinically complex residents in SNFs,

same – regardless of their overall medical

Therapy hours don’t add up Study shows SNF patients near death receive more hours of therapy Nursing home residents are increasingly spending time in rehabilitation treatment during the last days of their lives, a University of Rochester study shows, according to an Oct. 9 Bloomberg report.

The proportion of nursing home residents who received “ultrahigh intensity” rehabilitation increased by 65 percent between October 2012 and April 2016, according to research published in October. Medicare defines “very high” therapy as almost nine hours per week, and “ultrahigh” therapy as more than 12 hours per week. Some residents were found to be treated with the highest concentration of rehabilitation during their last week of life.

The study analyzed data from 647 New Yorkbased nursing home facilities and 55,691 longstay decedent residents, with a specific focus on those who received very high to ultrahigh rehabilitation services – including physical, occupational and speech therapy –during the last 30 days of their life.

10

“There’s a possibility that nursing homes know a patient is approaching end of life, but the financial pressures are so high that they use these treatments so they can maximize revenue,” Helena Temkin-Greener, the lead author of the study and a professor at the University of Rochester Medical Center Department of Public Health Sciences, was quoted as saying. Alternatively, “if it’s being driven by a failure to recognize that a resident is approaching end-of-life, then it calls for improving the skills of nursing home teams.”

Medicare’s existing reimbursement method rewards SNFs that maximize the number of hours they spend providing physical therapy, occupational therapy or speech/language pathology therapy. A new payment system, called the Patient-Driven Payment Model, to become effective Oct. 1, 2019, more therapy hours won’t add up to more reimbursement dollars.

January 2019 | The Journal of Healthcare Contracting

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POST-ACUTE CARE

complexity. Under PDPM, providers who treat people with greater

as important, it may call for upgrading the

clinical complexity will finally be compensated for that care.”

clinical skills of the nursing staff. “You have

All facilities have the ability to be successful under PDPM

to make your clinical team comfortable

if they take the appropriate steps to prepare for it, says Hill-

and confident that they have the ability to

ier. Some will develop clinical programs that attract more

provide that type of care.

medically complex patients, since reimbursement will be available to properly care for them, she says.

“Providers and their suppliers should educate themselves about the new pay-

The first step for SNFs is to evaluate the need in their specific

ment system and understand the new

market for such programs, she says. They could start by identify-

incentives contained within. I encour-

ing patients whom hospitals are having difficulty placing, given

age strategic planning to identify op-

their medical complexity. Then they should focus on what they

portunities to provide skilled care in a

need to do to accommodate such residents.

way that is more patient-centered and

In some cases, that may mean making physical changes to the facility, or acquiring additional capital equipment, she says. Just

will achieve better outcomes with higher customer satisfaction.”

Nontherapy ancillary services Under the Patient-Driven Payment Model, SNFs will be reimbursed for their Medicare residents based – in part – on the nontherapy ancillary services needed. Medicare has assigned a certain number of “points” for 50 conditions. More points mean more reimbursement. The following 15 conditions receive the highest number of points.

Nontherapy ancillary service Points HIV/AIDS 8 Parenteral IV feeding: level high 7 Special treatments/programs: Intravenous medication post-admit code 5 Special treatments/programs: Ventilator or respirator post-admit code 4 Parenteral IV feeding: level low 3 Lung transplant status 3 Special treatments/programs: transfusion post-admit code 2 Major organ transplant status, except lung 2 Active diagnoses: multiple sclerosis code 2 Opportunistic infections 2 Active diagnoses: asthma, COPD, chronic lung disease code 2 Bone/joint/muscle infections/necrosis - except aseptic necrosis of bone 2 Chronic myeloid leukemia 2 Wound infection code 2 Active diagnoses: diabetes mellitus (DM) code 2 Source: American Association of Nurse Assessment Coordination

12

January 2019 | The Journal of Healthcare Contracting

The distributor’s role in PDPM Repertoire readers might be especially interested in resources to facilities for treating potentially vulnerathe variable rate adjustment (or “tapering”) that ap- ble populations, such as ventilator, infection isolation, plies to the nontherapy ancillary services (NTA) com- end-stage renal disease (ESRD), diabetes, wound inponent of Medicare reimbursement under PDPM, fections, IV medication, bleeding disorders, behavioral issues, chronic neurological condisays Robin Hillier, RLH Consulting, tions, and bariatric care. The initial Westerville, Ohio, and director of admission assessment will set the reimbursement and quality metcase-mix reimbursement level and rics for Welcome Nursing Home in will be important for manufacturOberlin, Ohio. ers and distributors to support their “Nontherapy ancillary services” SNFs in driving the best outcomes refers to any ancillaries a provider for the residents’ care.” uses other than therapy servicHaywood notes that SNFs can es, such as drugs, supplies and gain a better understanding of the equipment – but not labor.

For the first three days of the stay, providers will receive 300 “The initial admission assessment will set percent of the calculated NTA paythe case-mix reimbursement level and ment component. Starting on Day will be important for manufacturers and 4, this will drop to 100 percent.

CMS has created a list of condistributors to support their SNFs in driving ditions or diagnoses that call for the best outcomes for the residents’ care.” higher-cost supplies or equipment.

– Deborah Haywood, vice president of sales and strategic development, Each is assigned a certain number McKesson Medical-Surgical of points (with more complex conditions earning more points). The financial impact of PDPM from their current RUG more points, the greater the reimbursement. “[Repertoire] readers can play an important role data from CMS. “McKesson’s partner Pathway Health in helping providers identify clinical conditions offers providers tools, such as the PDPM Financial Imand needs that contribute to the NTAS scoring early pact Analysis Tool, which can help them understand in the stay, so they can be captured on that ini- their current data, potential impact and clinical imtial assessment,” she says. “This will give providers pact to their organization.” In addition, SNFs can use more money at the beginning of the stay, which automated tools such as McKesson Quality One to can be used to pay for additional supplies and focus on continuous performance improvement to equipment needed as a result of those conditions. quality care, performance outcomes and resident “It’s important that whatever is applicable to the satisfaction, she says.

“SNFs that adopt technology, drive training resident gets captured right away.”

Deborah Haywood, vice president of sales and competencies on the new PDPM model and prostrategic development for McKesson Medical-Surgi- vide improved patient outcomes will be successcal, says the industry is “very early into understanding ful,” she says. “Those facilities that do not have the full financial impact that PDPM will have for our some type of adoption will struggle with the new SNF providers. The NTA case mix provides additional PDPM change.”

The Journal of Healthcare Contracting | January 2019

13

The ‘C’ Words Editor’s note: Demographics are

changing. Venues of care are changing. Reps’ call points and the products in their bags are changing too. In this issue, Repertoire continues its series of articles on chronic care management.

Chronic diseases and conditions – such as heart disease, stroke, cancer, type 2 diabetes, chronic obstructive pulmonary disease, obesity and arthritis – are among the most common, costly and preventable of all health problems. As of 2012, about half of all adults – 117 million people – had one or more chronic health conditions. One in four adults had two or more chronic health conditions. Seven of the top 10 causes of death in 2014 were chronic diseases.

14

‘Cancer’and‘chronic’were rarely used in the same breath … until now

By David Thill

Chronic disease isn’t just for old people. Conditions like osteoporosis can hit much earlier than a person’s golden years, and for former cancer patients, the risk is often higher.

What’s more, as cancer treatment advances, patients live longer, and their cancer conditions often become “chronic” themselves.

This means caregivers – from primary care doctors to oncologists – must consider more factors now when administering treatment to former and current patients with cancer than they have in the past. It also means they have to coordinate their efforts more closely.

January 2019 | The Journal of Healthcare Contracting

CHRONIC CARE MANAGEMENT

Caring for survivors

a bone marrow transplant early in life, they’ll be at

“My primary concern is secondary prevention,” says

higher risk for osteoporosis in young adulthood.

Aarati Didwania, an internist and director of the STAR

Doctors face a small challenge in reading test

Program at Chicago-based Northwestern Medicine.

results for younger patients, says Didwania. Since

STAR – which stands for Survivors Taking Action &

those tests were often developed to screen older

Responsibility – serves childhood cancer patients

adults, she has to interpret results in light of the

who are now adults, as they transition from cancer

patient’s age.

care to long-term follow-up care.

But the earlier she detects it, the better the out-

Many of Didwania’s patients come to her hoping

comes. “I’m a big fan of talking about secondary

they’re finished with cancer treatment, she says.

prevention,” she says. “I can’t take away your past

They may have been referred by their oncologist,

treatments, but I can try to find things before they

but they’re not actively being treated for cancer.

become a problem.”

‘Even though we would like to believe that we cure cancer patients with a minimum of side effects, we are learning that cancer causes long-term morbidity.’

Cancer as a chronic disease “Even though we would like to believe that we cure [cancer] patients with a minimum of side effects, we are learning that cancer causes long-term morbidity,” says Wui-Jin Koh, an oncologist and chief medical officer at the Nation-

She wants to keep it that way by looking out for

al Comprehensive Cancer Network. The longer pa-

any adverse effects they may experience as a result

tients live, the more time they have to manifest mor-

of the treatment they received, which was often

bidities potentially caused by their cancer therapies.

years before they arrived at the STAR Program.

This is partly why oncologists like Koh are particularly

Patients aren’t typically screened for many chron-

concerned about pediatric and young adult patients.

ic conditions until later in life. But this isn’t the case

Doctors also focus on quality of life in cancer sur-

for patients with a history of cancer. If they received

vivors now more than they did decades ago, he says,

cancer treatment as a child, they may be more at risk

referring to “quality-adjusted survival”: “You’re not

depending on how they were treated. Before she

just surviving; you’re surviving with a good quality

meets her patients, Didwania tries to learn as much

of life.” Part of this practice involves considering pa-

as she can about their previous treatment, so that

tient-reported outcomes – factors that weren’t mea-

she knows what to look for.

sured as much in the past, like the person’s sexual

For example, if a person received cranial radia-

16

function, Koh says.

tion as a child, Didwania might monitor them for

But cancer doesn’t just increase the risk of chronic

hypothyroidism. If they received steroids as part of

disease. Sometimes, cancer itself is a chronic disease, January 2019 | The Journal of Healthcare Contracting

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CHRONIC CARE MANAGEMENT

or at least very similar to one. “In some cases, we may

treatment plan,” says Koh. Now, he might send that

not be able to completely eliminate a cancer, but pa-

report to the primary care physician, the cardiologist,

tients live longer and have functional lives,” says Koh.

the endocrinologist and any other specialist the pa-

This is especially true as treatment technology advances. For example, breast and prostate cancer patients can undergo continuous therapy, and while their cancers aren’t necessarily “cured,” they can be managed, he says. “In that case, cancer as a chronic disease is maybe more similar to dia-

tient might see.

You’re not just surviving; you’re surviving with a good quality of life.’

betes and other chronic diseases.”

There’s an increased role in cancer treatment for primary care providers, he says. “I don’t think we’ve completely defined all the roles, but I think we’re beginning to evaluate how to educate primary care doctors and how to give them the tools to manage cancer patients.”

He also sees a role for primary care doctors in pal-

The intersect

liative care – which he clarifies is different from end-

Cancer care has traditionally been “somewhat of

of-life care. “I think [palliative care] has gotten this

a silo,” Koh says: The patient gets treated by their

bad connotation,” he says, when really, it’s meant for

oncologist, and other doctors don’t have much of a

pain control and maximization of function. He notes

role in the process. But treatment now is so multifac-

that starting palliative care with curative cancer

torial that other providers need to be involved in the

treatment can improve patients’ cure rates.

patient’s cancer care, he says.

As all these techniques evolve, says Koh, “I think

“It used to be that when I saw a referral, I made sure the referring surgeon got a copy of my evaluation

there will be a lot more communication” between primary care doctors and oncologists.

David Thill is a contributing editor to Repertoire.

18

January 2019 | The Journal of Healthcare Contracting

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HEALTH NEWS

Health news and notes Flu season is coming. If you live in a large city, it may stretch longer than elsewhere, study says

milligrams a day. It appears that the more

If you live in a large city, flu season may last longer than it does

says. This research is reminiscent of other

elsewhere, and if you live in a small city, flu season may be shorter

studies, including an Arkansas State Uni-

but with a more explosive spread, a new study shows. The study

versity study that showed plant-based di-

doesn’t indicate that a person’s risk of contracting influenza var-

ets may be linked to lower pain sensitivity.

caffeine a person consumed, the greater their tolerance for pain, the Times article

ies depending on community size, an October STAT News article the right atmospheric conditions to spread effectively.” Jacco

Do longer maternity leaves hurt women’s careers?

Wallinga, an infectious disease expert in the Netherlands, tells

Evidence indicates that the longer a new

STAT that these results indicate health agencies in small cities

mother’s maternity leave, the less likely

should work on surge capacity – the ability to handle many sick

she is to be promoted, move into man-

patients in a short amount of time – while agencies in larger cities

agement or receive a pay raise after her

should try to find ways to reduce transmission.

leave ends, according to a September

explains. “Rather, it argues that in less populous places, flu needs

Harvard Business Review article. To find out

20

Caffeine may increase pain tolerance

why this is, Harvard researchers examined

Caffeine may increase a person’s pain tolerance, according to a

perceptions of working women’s agency

study by researchers at the University of Alabama at Birmingham.

– in other words, to what degree others

The researchers asked 62 women and men, between 19 and 77

consider them ambitious and career-fo-

years old, to record their daily caffeine consumption over seven

cused – in three complementary studies

days. On the seventh day, participants reported to a laboratory

of Canadian employers and employees.

where scientists measured their pain sensitivity to heat and pres-

In the first experiment, they found that

sure. Participants averaged 170 milligrams of caffeine a day –

employers perceived potential female

about the amount in two cups of coffee, according to The New

job candidates whose resumes noted

York Times – but 15 percent of them consumed more than 400

12-month maternity leaves (common in January 2019 | The Journal of Healthcare Contracting

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MC14605

HEALTH NEWS

corporate Canada) as less desirable for the job than candidates

One possible reason for this outcome is that

who reported one-month leaves. However, they found in the sec-

the arm in the cast experiences small “mir-

ond study that when the job candidates brought a recommenda-

ror” contractions when the person exercises

tion letter from a former supervisor, there was no perceived dif-

their opposite arm. Farthing acknowledges

ference between candidates with longer and shorter leaves. And

these findings require further research be-

finally, they found that “keep-in-touch” programs, which allow

fore standard rehabilitation practices can

parents on leave to stay in contact with their workplaces, help

change. Nevertheless, he writes, “we can

improve employer perceptions of female applicants.

still recommend that if you ever experience

HPV Vaccine Gardasil now approved for adults ages 27 to 45

your opposite limb.”

(HPV), for women and men ages 27 to 45. Previously, the vaccine

Being overweight or obese in your 20s and 30s could cut life expectancy by up to 10 years

was only approved for people between the ages of 9 and 26, ac-

New research indicates that life expec-

cording to BuzzFeed. The Centers for Disease Control and Preven-

tancy decreases more the younger a

tion website explains that HPV is a common sexually transmitted

person with overweight or obesity is.

disease that most people get at some point in their life. The virus

Researchers in Australia predicted the re-

usually clears on its own but can lead to several types of cancer.

maining life expectancy for people from

HPV causes more than 33,700 cancer cases annually in men and

their 20s to 60s, ranging from a healthy

women, according to the CDC. Vaccines like Gardasil can prevent

weight to severely obese. They found

90 percent of those cases – 31,200 – the agency’s website says.

that while healthy men and women in

BuzzFeed notes that after Gardasil’s 2006 approval, it was recom-

their 20s could expect to live another

mended in the U.S. for girls and women ages 9 to 26, before be-

57 and 60 years, respectively, women in

ing approved for men in that age group. “So there’s an entire gen-

their 20s who are classified as severely

eration of adults who missed out on Gardasil,” the article says. The

obese lose an expected eight years, and

expanded age range could help them.

men in the same group lose an expected

The Food and Drug Administration has approved the use of Gardasil, a vaccine that protects against human papillomavirus

Exercising healthy limb may fight atrophy in broken one

22

a limb fracture, you might consider training

10. That number decreased the older participants were. For example, women in their 40s classified as obese experience a

If you have a broken arm, you may benefit from exercising your oth-

reduction of 4.1 years of life expectancy,

er arm, researchers at the University of Saskatchewan found. Muscle

and men lose 5.1, while women in their

atrophy is a common side effect when wearing a cast for an extend-

60s lose 2.3 years and men 2.7. “We know

ed length of time. But Jonathan Farthing, a U of S professor, writes

that excess weight has an impact on

in The Conversation that a study performed in his lab found that for

your health, but to have excess weight as

college students who wore casts on their left wrist for four weeks,

a young adult is really significant on life

those who exercised their right arm aggressively during that time

expectancy,” lead study author Thomas

maintained strength and muscle volume in the immobilized wrist.

Lung told the Philippine Daily Inquirer.

January 2019 | The Journal of Healthcare Contracting

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