Understanding the Complex World of Medicare and Health Insurance: A Behind-the-Scenes Look

Written By: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist and Owner of Healthy Aging PT

As a physical therapist and owner of a private practice, I often have conversations with patients and clients about the state of healthcare and the challenges that come with it. Many people aren't aware of the complexities of Medicare and health insurance, and how these complexities impact the care they receive. I wanted to take a moment to provide some "behind the scenes" information about Medicare, health insurance, and the state of healthcare today.

The Reality of Medicare and Health Insurance Reimbursements

Let's start with Medicare. For those of you who aren't familiar, Medicare Part B is the part of Medicare that covers outpatient care, including physical therapy. While Medicare is an incredibly valuable resource for many, it's important to understand that the reimbursement rates for services provided under Medicare Part B have been decreasing steadily over the past two decades. This isn't a trend that's specific to Medicare; health insurance reimbursements, in general, have seen significant reductions over the years.

For example, due to legislative changes like the Balanced Budget Act of 1997, there have been continual cuts to Medicare reimbursements. Over the last 20 years, Medicare payments for outpatient physical therapy have been reduced by about 25%. These reductions are compounded by annual updates that often fail to keep pace with inflation or the rising cost of delivering care. In fact, it's projected that in the coming year, there will be another reduction in Medicare reimbursement rates, which could be as much as 4.5%.

In addition to the cuts in Medicare reimbursement, many therapy practices, including ours, are also going out of network with certain managed care plans. The reason for this is twofold. First, these plans often come with significant administrative burdens, requiring extensive authorization processes and paperwork just to begin or continue care. This not only takes time away from providing hands-on patient care but also adds to the overall cost of running a practice. Second, the reimbursement rates from many managed care plans are exceedingly low, often averaging only 60-70% of what Medicare reimburses, which is simply unsustainable for many practices. You may have seen recent news about large hospital systems going out of network with certain Medicare Advantage plans for similar reasons. These plans frequently offer even lower reimbursements and add layers of red tape that can hinder timely patient care.

However, even though we are out of network with these plans, we strive to remain as accessible as possible by accepting out-of-network coverage when your plan offers it. We frequently see patients with Tufts Managed Medicare, UHC/AARP, Humana, and other managed Medicare plans, and we currently remain in-network with BCBS. This approach allows us to continue providing high-quality care without the limitations imposed by the low reimbursement rates and administrative burdens of managed care plans. We encourage you to ask about what out-of-network benefits your plan may have, and we are always happy to check on this for you if you are interested in receiving care with Healthy Aging Physical Therapy.

The Impact on Private Practices

So, what does this mean for private practices like ours? Simply put, it's becoming increasingly difficult for practices to accept insurance and remain financially viable. Each year, while the reimbursement rates go down, the costs of running a practice—like rent, utilities, supplies, and fair wages for our staff—continue to rise. It's a challenging balance to strike.

Despite these challenges, we at Healthy Aging Physical Therapy have made the decision to continue accepting Medicare Part B. Why? Because we believe deeply in providing high-quality, concierge-level care to those who need it most. Our commitment is to serve our community, especially those who rely on Medicare for their healthcare needs. However, we also recognize the financial realities that come with running a small business in today's healthcare environment.

The Role of Cash-Based Services

This brings me to an important point about why you might see therapy practices, including ours, offering cash-based services like our Fitness and Wellness programming. I know it might seem surprising at first—after all, isn't insurance supposed to cover everything? The reality is that insurance often dictates not only how long we can see a patient but also what types of services we can provide. There are many scenarios where patients would benefit from additional or ongoing care that isn't covered by insurance.

By offering cash-based services, we are able to supplement our revenue, ensuring that we can continue to provide quality care, pay fair wages to our therapists, and keep our doors open. These services—whether it's our fitness coaching and personal training programs, therapy wellness sessions, or virtual and in-person fitness classes—allow us the flexibility to meet your needs beyond what insurance covers. They also empower us to provide long-term care that supports your overall health and wellness, beyond just your immediate therapy needs.

Supporting Local Healthcare and Small Businesses

I want to take a moment to thank each of you for your continued support of Healthy Aging Physical Therapy and other small businesses and private practices. We know that the healthcare landscape can be confusing and that there are many factors at play that affect both providers and patients. We hope this post has shed some light on the current state of healthcare and why practices like ours are making the decisions we do.

We're committed to continuing to provide the best possible care to our community, and we're excited to offer a range of wellness programs to support your health and wellness journey. Thank you for being a part of our community, and for supporting small, locally owned businesses that are dedicated to your well-being.

As I tell all of my Healthy Aging therapists when they start with us, I value kindness and transparency above all else, so hopefully this helped make our complicated healthcare landscape a little more transparent for you. If you have any questions or would like to learn more about our post-discharge wellness programs, please don't hesitate to reach out. We're here to help you live your healthiest life!

Exercise Intensity and Older Adults: Finding the Balance

Written By: Dr. Brittany Saia, PT, DPT, GCS and Healthy Aging Physical Therapist

You’ve done it! You started your exercise routine and you’re sticking with it (well, most of the time.) But are you getting the most out of yourself and the full impact that exercise can achieve? In this post, we’ll discuss exercise intensity, and if it’s safe when considering exercise in older adults.

The Changing Landscape of Aging

Aging brings about various physiological changes, including a decline in muscle mass, bone density, cardiovascular function, and metabolism. As a result, older adults are more susceptible to issues such as sarcopenia (muscle loss), osteoporosis (brittle bones), cardiovascular diseases, and metabolic disorders like diabetes. However, regular exercise has been shown to mitigate these age-related declines and improve overall health outcomes.

Understanding Exercise Intensity

Exercise intensity refers to the level of exertion during physical activity. It's commonly measured using parameters such as heart rate, perceived exertion, or metabolic equivalents (METs). For older adults, exercise intensity plays a crucial role in achieving desired health benefits. While low-intensity activities like walking or gentle yoga provide some benefits, higher-intensity exercises offer additional advantages that are particularly valuable for older adults.

Benefits of High-Intensity Exercise for Older Adults

1. Muscle Strength and Mass: High-intensity resistance training stimulates muscle growth and enhances strength, which is vital for maintaining mobility and independence as we age. Strong muscles also help support joints and reduce the risk of falls and fractures.

2. Bone Health: Weight-bearing and high-impact exercises promote bone density, reducing the risk of osteoporosis and fractures. Activities like jumping, running, or strength training with weights can help preserve bone health in older adults.

3. Cardiovascular Fitness: High-intensity aerobic exercises, such as cycling,

   swimming, or interval training, improve cardiovascular function, lower blood

   pressure, and enhance circulation. A robust cardiovascular system is essential for maintaining overall vitality and reducing the risk of heart disease.

4. Metabolic Health: High-intensity interval training (HIIT) and vigorous aerobic

   activities can improve insulin sensitivity, glucose regulation, and metabolic rate, thereby reducing the risk of type 2 diabetes and obesity-related complications.

5. Cognitive Function: Emerging research suggests that high-intensity exercise may benefit cognitive health by promoting neuroplasticity, improving brain function, and reducing the risk of cognitive decline and dementia.

Finding the Right Balance

While high-intensity exercise offers numerous benefits, it's essential to strike a balance and consider individual fitness levels, health conditions, and preferences. Older adults should consult with a physical therapist a PCP before starting any new exercise program, especially if they have pre-existing medical conditions or concerns.

Incorporating High-Intensity Exercise into Your Routine

1. Start Slow: Begin with low to moderate-intensity exercises and gradually increase the intensity as your fitness improves. Especially if you’re new to exercise, starting slow can help prevent overly sore muscles and help build confidence in your abilities.

2. Mix It Up: Incorporate a variety of activities, including strength training, aerobic exercises, and balance exercises, to target different aspects of fitness.

3. Interval Training: Incorporate intervals of higher intensity into your workouts,

   alternating between bursts of intense activity and periods of rest or lower

   intensity.

4. Listen to Your Body: Pay attention to how your body responds to exercise and adjust the intensity accordingly. It's essential to challenge yourself while also respecting your limits and avoiding overexertion.

5. Stay Consistent: Consistency is key to reaping the benefits of exercise. Aim for at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity exercise per week, spread across multiple days.

Embracing the Power of Exercise Intensity

In conclusion, exercise intensity is a critical factor in promoting health, vitality, and longevity in older adults. By incorporating high-intensity exercise into their fitness routine, older adults can enhance muscle strength, bone density, cardiovascular fitness, metabolic health, and cognitive function. However, it's essential to approach high-intensity exercise with caution, gradually increasing intensity and listening to your body's signals. With the right balance and guidance, older adults can harness the power of exercise intensity to thrive in their later years.

Essential Summer Exercise Tips for Older Adults: Stay Safe and Healthy in the Heat

Written By: Dr. Allison Leonard, PT, DPT and Healthy Aging Physical Therapist

With summer heat here to stay, it’s crucial to be prepared to avoid heat-related illnesses, especially for older adults. As we age, our bodies become more susceptible to dehydration and injury, making it important to take extra precautions when exercising in hot weather. Older adults may have a diminished sense of thirst, reduced sweat production, and often take medications that can affect hydration levels. Additionally, the body’s ability to regulate temperature decreases with age, increasing the risk of heat-related issues. To help you stay safe and active this summer, here are some valuable tips to keep in mind:

1. Exercise Early or Late: Schedule your workouts during the cooler parts of the day, such as early morning or late evening.

2. Stay Hydrated: Drink plenty of water before, during, and after your workout. Avoid alcohol and caffeinated drinks as they can dehydrate you.

3. Wear Lightweight Clothing: Choose loose-fitting, light-colored, and breathable clothing to help keep your body cool.

4. Use Sunscreen: Apply a broad-spectrum sunscreen with at least SPF 30 to protect your skin from harmful UV rays.

5. Take It Indoors: Consider indoor alternatives such as gyms, swimming pools, or home workouts. Indoor malls, big box stores like Target or Costco are great options for getting in your steps.

6. Lower the Intensity: Reduce the intensity of your workout to avoid overheating. Listen to your body and take breaks as needed. Use less weight/resistance, shorter periods of exercise and longer rest periods.

7. Acclimate Gradually: If you're not used to the heat, gradually increase the duration and intensity of your outdoor workouts over a week or two.

8. Know the Signs of Heat Exhaustion: Be aware of symptoms like dizziness, headache, nausea, excessive sweating, and rapid heartbeat. If you experience any of these, stop exercising, move to a cooler place, and hydrate.

9. Cool Down Effectively: Use cooling towels, take cold showers, or apply ice packs to lower your body temperature after exercising.

By following these guidelines, you can stay active and healthy even during periods of extreme heat. Stay cool AND stay active!

Enjoy Summer WITHOUT Back Pain: Effective Strategies to Reduce Back Pain in Older Adults

Written By: Dr. Tracey Berman, PT, DPT and Healthy Aging Physical Therapist

It is a beautiful summer day, and you bend over to grab your bag to go to the beach. Suddenly, ouch! You feel pain in your lower back. Back pain is never fun to deal with and can put a damper on your summer plans. But remember, you are not alone. According to the National Institute of Health, back pain is one of the most common reasons people visit their doctors. As we age, various factors can contribute to back pain. Sometimes it is muscular, and sometimes it is structural. Finding the cause of your back pain can direct your course of treatment, and most treatments will involve some type of therapeutic exercise.

Understanding the Causes of Back Pain in Older Adults

Osteoarthritis: A Common Structural Cause

As we age, one of the structural causes of back pain is osteoarthritis. This is the breakdown of cartilage, the tissue that covers the ends of bones where they form a joint. When this tissue breaks down, bones are left unprotected and rub together, causing inflammation and pain. Osteoarthritis can also narrow the small holes that direct the nerves of the spine, often resulting in tingling, numbness, and pain that can radiate down your leg, commonly known as sciatica.

Osteoporosis: Loss of Bone Mass

Another reason for back pain as we age is osteoporosis, or the loss of bone mass. Your vertebrae can weaken to the point that you lose height, develop a hunched posture, and experience back pain. In some cases, this weakening can lead to fractures in the vertebrae, which can be quite painful.

Muscular Changes and Their Impact on Back Pain

Decreased Flexibility

Flexibility, or how limber you are, diminishes as we go through life. Normal aging involves a loss of collagen, which increases stiffness in our spine and joints and reduces the elasticity of muscles and tendons. This stiffness can make us want to move less because some motions cause pain, creating a cycle of moving less and becoming stiffer.

Sarcopenia: Loss of Muscle Mass

Sarcopenia, the loss of muscle mass and strength, can begin as early as your 30s. Physically inactive people can lose as much as 3% to 5% of their muscle mass each decade after age 30. Weaker muscles make you more prone to injuries like back sprains and strains.

How Back Pain Affects Daily Activities

Back pain can significantly impact how we move throughout the day, interfering with activities like standing in line at the grocery store, sitting to watch TV, reaching up in cupboards, climbing stairs, or picking up grandchildren. This pain can cause us to move less to avoid discomfort, but sometimes movement can actually help reduce pain by increasing blood flow and fighting inflammation.

The Role of Exercise in Reducing Back Pain

Aerobic Exercise

Walking is a fabulous low-impact aerobic exercise that can help reduce back pain. Swimming and cycling, whether on the road or a stationary bike, are also excellent options. Aerobic exercise promotes blood flow, bringing nutrients to the spine and boosting endorphins, the body’s natural painkillers.

Strength Training

Strength training builds muscle strength and doesn’t require a gym membership or heavy weights. Your physical therapist can guide you through appropriate strength training exercises using body weight, resistance bands, and light weights. Strengthening your core muscles is crucial for protecting your spine. Core muscles include your obliques, transverse abdominals, and rectus abdominals, which form a “corset-like” support for your spine.

Stretching

Stretching improves flexibility and can alleviate pressure on joints, especially for those with osteoarthritis. Incorporating yoga poses like child’s pose and cat-cow, along with static stretching routines for your hamstrings, hip flexors, and trunk muscles, can be beneficial.

Balance and Stability Exercises

Balance exercises, such as standing on one leg or walking with slow head movements, activate the small postural muscles in your back that help you stay upright. Stronger postural muscles provide more support for your back, reducing pain. Tai Chi is an excellent exercise for improving balance and incorporating deep breathing, which helps decrease muscle tension.

Starting an Exercise Program Safely

Getting Started

First, get medical clearance from your doctor before starting any exercise program if you have any unstable medical conditions or other health concerns. Start slowly and for short periods, keeping a journal to track your progress. Listen to your body and recognize signs of overexertion, such as fast breathing, dizziness, or chest pain. Warm up before exercising, and cool down afterward to allow your heart rate and blood pressure to return to pre-exercise levels.

Avoiding Common Mistakes

Proper technique and form are crucial to prevent injury. Avoid bouncing in a position, ignoring your limitations, and lifting weights that are too heavy. Consult a physical therapist or reputable instructional videos for guidance.

Diet and Sleep: Supporting Your Back Health

Maintaining a Healthy Weight

Carrying excess weight can strain your back. Aim to maintain a healthy weight through a balanced diet and regular exercise. Incorporate anti-inflammatory foods like tomatoes, olive oil, green leafy vegetables, nuts, fatty fish, and fruits such as strawberries and blueberries. The Mediterranean diet is a great example of an anti-inflammatory diet.

Proper Sleep Positions

Supporting your back during sleep is crucial. If you’re a side sleeper, place a pillow between your legs to keep your spine aligned. If you sleep on your back, place a pillow under your knees to relax your back muscles. Try to avoid sleeping on your stomach, but if you must, place a pillow under your hips to reduce strain on your back.

Back pain doesn’t have to ruin your summer plans. By understanding the causes and implementing a comprehensive management plan that includes exercise, diet, sleep, and other pain management tools, you can ease the pain and enjoy your favorite summer activities. Talk to a physical therapist to develop a personalized plan to keep your back healthy and pain-free.

Staying Hydrated: A Vital Guide for Older Adults During the Summer Heat

While it may be ‘hot girl summer’ everywhere else you look, here over at Healthy Aging, we’re entering ‘hot patient summer’ season. Last week, as temperatures climbed, I challenged my Parkinson’s class to a drinking contest - except instead of chugging beers, we tried to finish a bottle of water between exercises. While for most people, summer heat brings thoughts of bathing suits, pool parties and barbeques, for me, and most of my home health colleagues, we go to thoughts of dehydration, low blood pressures and passing out. So, as the summer heat approaches, I want to talk to you today about staying hydrated. Hydration over the summer is crucial for everyone, but especially older adults. Dehydration can lead to serious health complications, but with a few simple strategies, it’s easy to stay hydrated and healthy throughout the season. 

Why Are Older Adults More Prone to Dehydration?

Several factors make older adults more susceptible to dehydration. Older adults tend to have a reduced thirst sensation combined with lower kidney function. With aging kidneys becoming less efficient at conserving water, while we lose more water, we also have less drive to replace it. Older adults also often take medications that impact hydration like diuretics that lead to increased urination, or anticholinergic drugs that lead to reduced sweat production. Many older adults have mobility limitations, and try to avoid the ‘extra walks’ or nighttime waking to use the bathroom that they fear may come with increased hydration. Lastly, you may also notice that you sweat less when you get older. It’s not all in your head! Older adults sweat less as they age due to reduced sweat gland function and impaired thermoregulation - this means that on top of reduced hydration, they are less able to internally cool themselves down! All these factors combined make dehydration one of the most common causes for hospitalizations in older adults - especially in the summer months.

How do I know if I’m dehydrated?

While younger adults may be able to quickly identify the signs of worsening dehydration and take quick action, the signs in older adults can be a little tricker, often leading to delayed treatment. The most common signs we see when we suspect a patient may be dehydrated are dizziness, especially when coming to stand, and confusion. Orthostatic hypotension, a drop in blood pressure related to changing position when coming from laying down to sitting, or from sitting to standing, can happen at any time, but dehydration can make this worse. Confusion or irritability, or any other changes in mental status can also be a confusing symptom especially in an older adult who may already have some form of dementia, but look for worsening confusion from their norm. Other common signs of dehydration in older adults include reduced urine output, increased muscle cramping, dry skin and a rapid heart beat.

How do I prevent dehydration?

The easiest way to treat dehydration is to PREVENT IT! Try to drink 8 glasses of water a day, choose fluid-rich fruits like watermelon and oranges, veggies like cucumbers and other foods like soup and smoothies that can give you a little extra hydration throughout the day. Keep an eye on drinks that make you LOSE fluid and avoid excessive caffeine, soda and alcohol - or at least pair them with a glass of water to off-set the fluid loss. Stay cool by dressing in light, ‘flowy’ clothes and carry a bottle of water with you wherever you go to sip on throughout the day. Try to drink BEFORE you feel thirsty, even if it’s just a few sips at a time. Prevention can make a world of difference.

How do I treat dehydration?

If you are already feeling the signs of dehydration, don’t panic! Try to move to somewhere cool and rehydrate. Rest for 30-60 minutes and see if you start to feel better. If the symptoms don’t improve, or you experience any fainting, fevers, changes in heart rate or chest pain, nausea, vomiting or diarrhea, it’s time to get some help. Call your PCP for further instruction or go to your local urgent care or emergency department. While mild dehydration may be easy to treat at home, severe or ongoing dehydration can lead to serious medical complications like kidney failure, urinary tract infections and heat stroke. The faster you get the proper care, the better!

Challenge a friend to a drinking contest!

Now that you know the signs, symptoms and treatment of dehydration - let’s have some fun. Challenge the next person (or patient) you see to a drinking contest! Suggest you both take sips of water between conversation, exercises or along a walk and see who can empty their bottles first. Try flavoring water with hydration tabs or fresh fruit or make it fun by using a special glass, straw or turning it into a summer mocktail. Want a fun recipe to try? Here’s my favorite thirst-quenching mocktail: Fill half your glass with coconut water, and top it off with a flavored seltzer or fruit juice. The cool coconut flavors will take you to a warm, sandy beach in your mind - and your body will be hydrated. Win-win:)