Latest news with #healthcareProviders
Medscape
3 days ago
- Health
- Medscape
Fast Five Quiz: Multiple Sclerosis and Depression
Depression is among the most common comorbidities of multiple sclerosis (MS), leading to psychological quality-of-life issues that can further exacerbate a patient's functional capacity. The significant burden of depression in patients with MS is typically associated with neuroinflammatory processes which are directly correlated to depression severity. Understanding the relationship between depression and MS is crucial for healthcare providers, to develop effective treatment strategies that address both the neurologic and psychological aspects of the disease. What do you know about the interplay of MS and depression? Check your knowledge with this quick quiz. The prevalence of depression in the general population is approximately 13%, according to the Centers for Disease Control and Prevention (CDC). Other data indicate that it falls between 25% and 54% in patients with MS. Depression, along with other disorders such as anxiety and fatigue, are among the most common comorbidities of MS. These comorbidities further degrade quality of life in patients who are already affected by the functional disabilities caused by the diseases. A multidisciplinary approach can help to holistically manage MS to ensure that quality of life is optimized across specific healthcare needs. Learn more about guidelines for MS. A recent systematic review reported that depression symptoms do not significantly improve after smoking cessation in patients with MS, although these patients do see improvements in anxiety. The same review noted that depression is associated with a 1.3- to 2.3-fold increased prevalence in patients with MS who also smoke tobacco. Although smoking cessation is known to cause short-term mood changes, a recent cross-sectional analysis of the NHANES study found that longer duration of cessation is associated with lower risk for depression. However, the persistence of depression in former smokers with MS might be due to depression's strong association with MS, and clinicians should not assume that depression symptoms will improve when a patient quits smoking. Learn more about tobacco product use and depression. Though depression and anxiety can occur in any subtype of MS, an extensive review and meta-analysis found that both were more prevalent in progressive MS (defined by the researchers as PPMS and SPMS) compared with RRMS. In contrast, the same meta-analysis reported that patients with MS and an Expanded Disability Status Scale (EDSS) score of less than 3 had higher rates of depression compared with patients with an EDSS score of greater than 3, while the prevalence of anxiety was higher in patients with an EDSS score greater than 3 compared with an EDSS score below 3. Proinflammatory cytokines in MS have been shown to disrupt the monoaminergic system, which is a component of the pathogenesis of depression. As such, treatments that enhance monoamine neurotransmission (such as SSRIs, SNRIs, and dopaminergic psychostimulants) are indicated for use in depression and MS-associated depression. Learn more about the pathophysiology of MS. Although comorbid depression in MS often presents similarly to fatigue, several characteristics can help clinicians distinguish between the two and guide appropriate treatment. According to a recent review, patients with depression typically have better functioning in the evening while those with fatigue typically have better functioning in the morning. Other characteristics of depression tend to include hypersomnia and hopelessness; patients with fatigue usually experience insomnia and strong hopefulness for recovery. Learn more about symptom management of depression and fatigue in MS. According to a systematic review and meta-analysis assessing exercise best practices for depression in MS, programs implementing ergometer training protocols had the largest effect size. The data reviewed indicated immediate improvements in depression scores with exercise, and depression symptoms were found to improve regardless of exercise frequency, duration, or activity. This is consistent with another review that cited a range of nonpharmacologic interventions for improving depression in MS, including exercise as well as cognitive-behavioral therapy, yoga, dietary habits, and sleep hygiene. Further, data on Hatha yoga, circuit training at moderate intensity, and resistance training with active rest periods in patients with MS and depression are limited. Learn more about exercise for depression. Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication.
CNN
3 days ago
- General
- CNN
Covid-19 shots for healthy children remain on CDC vaccine schedule despite Kennedy's pledge to remove them
Vaccines Respiratory viruses Children's health Federal agenciesFacebookTweetLink Follow The US Centers for Disease Control and Prevention has updated its immunization schedule for children after US Health and Human Services Secretary Robert F. Kennedy Jr.'s announcement this week that Covid-19 vaccines would be removed from the list of recommended shots for healthy children and pregnant women. However, the vaccines remain on the schedule for kids, although with a slightly different designation. Instead of being listed as 'recommended' by the CDC, they are now listed as 'recommended vaccination based on shared clinical decision-making,' meaning healthy children – those who don't have an underlying condition that raises their risk of severe illness – can get the shots after consulting with a health care provider. According to the CDC, such a provider would be anyone who routinely administers vaccines, including doctors, nurse practitioners, nurses and pharmacists. A vaccine listed on the schedule in this category is required to be covered by insurance with no cost-sharing, meaning no co-pays for patients, according to the CDC. Many of the agency's information pages continue to recommend the Covid-19 vaccine for pregnant women, but the adult immunization schedule has been changed to specify that the recommendation applies only to adults who aren't pregnant. 'The old COVID-19 vaccine recommendations for healthy children under 18 and for pregnant women have been removed from the CDC vaccine schedule,' HHS press officer Emily Hilliard said in a statement Friday. 'The CDC and HHS encourage individuals to talk with their healthcare provider about any personal medical decision. Under the leadership of Secretary Kennedy, HHS is restoring the doctor-patient relationship. If a parent desires their healthy child to be vaccinated, their decision should be based on informed consent through the clinical [judgment] of their healthcare provider,' the statement said. The change to the vaccine schedule comes days after Kennedy posted a video on social media saying it had happened. 'As of today, the Covid vaccine for healthy children and healthy pregnant women has been removed from the CDC recommended immunization schedule,' Kennedy said in the video Tuesday, standing beside FDA Commissioner Dr. Marty Makary and National Institutes of Health Director Dr. Jay Bhattacharya. 'Last year, the Biden administration urged healthy children to get yet another Covid shot, despite the lack of any clinical data to support the repeat booster strategy in children.' The announcement was met with dismay from parents and pediatricians who feared that kids and pregnant women might lose insurance coverage for the vaccines. 'It's been a bit disheartening, to be honest,' said Fatima Ka, co-founder of the nonprofit grassroots group Protect Their Future, which advocated for kids' access to Covid-19 vaccines throughout the pandemic. 'A lot of parents right now have been doing everything they can. They've been calling their representatives, their health departments, anyone who will listen, anyone who is accountable to the public. And it just felt like today we were heard even if it was in a small way,' Ka told CNN. Kids can become severely ill with Covid-19, especially if they're younger than 5. Data presented at the last meeting of the CDC's independent vaccine advisers showed that children 4 and under were hospitalized with Covid at roughly the same rate over the past two respiratory seasons as they were with the flu, and it was a severe influenza season. Fewer than 5% of children hospitalized with Covid-19 last season were up to date on their Covid-19 vaccinations. Dr. Susan Kressly, president of the American Academy of Pediatrics, said the updated recommendation – which preserves insurance coverage for the vaccines – was a relief. 'After confusing, mixed messages from leaders at Health and Human Services (HHS) earlier this week, we are relieved to see today that the U.S. Centers for Disease Control and Prevention (CDC) updated its schedules for child and adolescent immunizations to allow families to maintain the choice to immunize their children against Covid in consultation with their doctor,' Kressly said in a statement. 'However, the deeply flawed process to reach the recommendation raises serious concerns about the stability of the nation's immunization infrastructure and commitment by federal leaders to make sure families can access critical immunizations, whether for Covid or other infectious diseases,' she added. Pregnancy is a risk factor for severe Covid-19 infections. Early in the pandemic, CDC studies found that pregnant women with Covid were three times more likely to need ICU care and nearly twice as likely to die compared with those who weren't pregnant. Covid infections during pregnancy have also been linked to fetal complications such as stillbirth and preterm delivery. The Society for Maternal-Fetal Medicine said it would continue to recommend that people who are pregnant be vaccinated against Covid-19. 'Maternal immunization remains the best way to reduce maternal, fetal, and infant complications from COVID-19 infection, and is safe to be given at any point during pregnancy. Maternal immunization is also associated with improved infant outcomes and decreased complications, including maternal and infant hospitalizations,' the group said in a statement.
CNN
3 days ago
- General
- CNN
Covid-19 shots for healthy children remain on CDC vaccine schedule despite Kennedy's pledge to remove them
Vaccines Respiratory viruses Children's health Federal agenciesFacebookTweetLink Follow The US Centers for Disease Control and Prevention has updated its immunization schedule for children after US Health and Human Services Secretary Robert F. Kennedy Jr.'s announcement this week that Covid-19 vaccines would be removed from the list of recommended shots for healthy children and pregnant women. However, the vaccines remain on the schedule for kids, although with a slightly different designation. Instead of being listed as 'recommended' by the CDC, they are now listed as 'recommended vaccination based on shared clinical decision-making,' meaning healthy children – those who don't have an underlying condition that raises their risk of severe illness – can get the shots after consulting with a health care provider. According to the CDC, such a provider would be anyone who routinely administers vaccines, including doctors, nurse practitioners, nurses and pharmacists. A vaccine listed on the schedule in this category is required to be covered by insurance with no cost-sharing, meaning no co-pays for patients, according to the CDC. Many of the agency's information pages continue to recommend the Covid-19 vaccine for pregnant women, but the adult immunization schedule has been changed to specify that the recommendation applies only to adults who aren't pregnant. 'The old COVID-19 vaccine recommendations for healthy children under 18 and for pregnant women have been removed from the CDC vaccine schedule,' HHS press officer Emily Hilliard said in a statement Friday. 'The CDC and HHS encourage individuals to talk with their healthcare provider about any personal medical decision. Under the leadership of Secretary Kennedy, HHS is restoring the doctor-patient relationship. If a parent desires their healthy child to be vaccinated, their decision should be based on informed consent through the clinical [judgment] of their healthcare provider,' the statement said. The change to the vaccine schedule comes days after Kennedy posted a video on social media saying it had happened. 'As of today, the Covid vaccine for healthy children and healthy pregnant women has been removed from the CDC recommended immunization schedule,' Kennedy said in the video Tuesday, standing beside FDA Commissioner Dr. Marty Makary and National Institutes of Health Director Dr. Jay Bhattacharya. 'Last year, the Biden administration urged healthy children to get yet another Covid shot, despite the lack of any clinical data to support the repeat booster strategy in children.' The announcement was met with dismay from parents and pediatricians who feared that kids and pregnant women might lose insurance coverage for the vaccines. 'It's been a bit disheartening, to be honest,' said Fatima Ka, co-founder of the nonprofit grassroots group Protect Their Future, which advocated for kids' access to Covid-19 vaccines throughout the pandemic. 'A lot of parents right now have been doing everything they can. They've been calling their representatives, their health departments, anyone who will listen, anyone who is accountable to the public. And it just felt like today we were heard even if it was in a small way,' Ka told CNN. Kids can become severely ill with Covid-19, especially if they're younger than 5. Data presented at the last meeting of the CDC's independent vaccine advisers showed that children 4 and under were hospitalized with Covid at roughly the same rate over the past two respiratory seasons as they were with the flu, and it was a severe influenza season. Fewer than 5% of children hospitalized with Covid-19 last season were up to date on their Covid-19 vaccinations. Dr. Susan Kressly, president of the American Academy of Pediatrics, said the updated recommendation – which preserves insurance coverage for the vaccines – was a relief. 'After confusing, mixed messages from leaders at Health and Human Services (HHS) earlier this week, we are relieved to see today that the U.S. Centers for Disease Control and Prevention (CDC) updated its schedules for child and adolescent immunizations to allow families to maintain the choice to immunize their children against Covid in consultation with their doctor,' Kressly said in a statement. 'However, the deeply flawed process to reach the recommendation raises serious concerns about the stability of the nation's immunization infrastructure and commitment by federal leaders to make sure families can access critical immunizations, whether for Covid or other infectious diseases,' she added. Pregnancy is a risk factor for severe Covid-19 infections. Early in the pandemic, CDC studies found that pregnant women with Covid were three times more likely to need ICU care and nearly twice as likely to die compared with those who weren't pregnant. Covid infections during pregnancy have also been linked to fetal complications such as stillbirth and preterm delivery. The Society for Maternal-Fetal Medicine said it would continue to recommend that people who are pregnant be vaccinated against Covid-19. 'Maternal immunization remains the best way to reduce maternal, fetal, and infant complications from COVID-19 infection, and is safe to be given at any point during pregnancy. Maternal immunization is also associated with improved infant outcomes and decreased complications, including maternal and infant hospitalizations,' the group said in a statement.
CNA
13-05-2025
- Health
- CNA
Commentary: Vending machines for healthcare seem strange, but they're a step in the right direction
SINGAPORE: One troublesome night, you're unable to sleep due to severe stomach pain. You've already had some antacids, but they're of no help. The nearest clinics and polyclinics are all closed, and you're not sure if your condition deserves a visit to a hospital emergency room, where you may have to face long wait times. What do you do? For many of us, the COVID-19 pandemic served as the catalyst for shifting away from the traditional model of primary care, typically involving an in-person visit to a general practitioner (GP) or polyclinic. We quickly embraced telehealth apps, which could connect us to a doctor nearly 24/7 within a matter of minutes, obtain a diagnosis for select ailments, and even get medication delivered – all from the comfort of our homes. Telemedicine not only helped us observe safe distancing measures and avoid overcrowding in healthcare facilities, it also ensured that non-emergency conditions could be promptly treated by a suitable physician. Five years on, while many of these benefits remain, even this level of technology remains inaccessible to some. For others, telemedicine has become little more than a convenient means of obtaining medical certificates (MCs), especially when getting out of bed to visit a GP feels impossible. This issue has come under scrutiny, with several telehealth providers facing enforcement action from the Ministry of Health (MOH) following investigations into suspected unethical activities such as MCs and prescriptions being issued after inappropriately brief consultations. Amid telehealth's growing notoriety, a Dr Kart kiosk in a Tampines petrol station made waves online and in headlines last year. Public scepticism about an unmanned healthcare "vending machine" is understandable – but how sceptical should we be? 'PHYSICAL' TELEMEDICINE CLINICS VS TELEHEALTH APPS CNA reporters visited the Dr Kart kiosk in December 2024 to better understand how it worked. Based on their trial, one can justifiably expect that these kiosks offer a different user experience from that of telemedicine apps on our phones. From a regulatory standpoint, however, they are basically the same. MOH's 2015 National Telemedicine Guidelines establish that telehealth services must meet a standard of care equivalent to that of traditional in-person consultations, within the inherent limitations of the virtual medium. These guidelines apply to teleconsultations, whether through a kiosk or apps on personal devices. It doesn't matter where the patient or the consulting healthcare professional is located, so long as they are not physically face-to-face. Other legal and ethical frameworks, including the Singapore Medical Council's Ethical Code and Ethical Guidelines (ECEG), the Healthcare Services Act and the Personal Data Protection Act, are similarly applicable across all modes of telehealth delivery. As for the specific question of MCs, MOH has reiterated multiple times last year the ECEG's requirement that MCs be issued to patients based on proper medical grounds, only after a thorough clinical assessment. This is irrespective of the mode or location of consultation. So, whether you see a doctor via your phone or a kiosk at the petrol station, you'll likely receive an MC only after you've been properly assessed, just as you would be by a GP in a physical clinic. The 2023 Healthcare Services (Outpatient Medical Service) Regulations (OMS) do introduce a degree of differentiation, largely in practical terms. For instance, Regulation 13 requires that remote service kiosks like the one in Tampines must meet specific standards for sanitation, maintenance, effectiveness and safety. THE RISE OF 'VENDING MACHINE HEALTHCARE' In truth, the Dr Kart kiosk is not the first of its kind. In 2023, developer SmartRx launched a fully-automated telemedicine 'clinic" at the Singapore University of Technology and Design in collaboration with healthcare group Minmed. Students and staff at the university could conveniently teleconsult with a doctor and check their vitals inside a private pod. Prescribed medication could also be obtained on the spot through an attached dispenser. Later that year, a similar kiosk was set up at Jalan Besar Stadium as well. Vending machines that can dispense competitively priced over-the-counter medication and other health supplies such as masks and first aid kits can now be found at various locations across the island, including the void decks of Housing and Development Board flats, condominiums and healthcare facilities. Some are even able to dispense pharmacy-only medication after the patient completes a mandatory on-site teleconsultation with a registered pharmacist. MORE INVESTMENT NEEDED – SUBJECT TO CONDITIONS At its core, this emergent tier of healthcare services aims to enhance access to such care, particularly for those who may not be technologically adept. Countries across the region including Malaysia, Thailand and India are similarly expanding their primary care infrastructure by deploying facilitated telehealth kiosks – especially in rural areas – to improve access to essential healthcare services. These initiatives also have the potential to dramatically change both how healthcare is delivered as well as sought by the public. Enabling the delegation of primary care services for non-emergency conditions can significantly reduce the burdens on acute hospitals and polyclinics. In addition to shorter wait times and round-the-clock access, telemedicine also empowers patients to take charge of their own health by increasing the range of options from which they can seek timely care that best fits their needs. Incidentally, this is also in alignment with the goals of Healthier SG. However, as self-service health technologies and telemedicine gain traction, their expansion must be accompanied by robust oversight to safeguard patient welfare. For instance, the OMS mandates that providers should protect patients' privacy and confidentiality during consultations. Teleconsultation kiosks raise concerns in this aspect, as onlookers in the vicinity can potentially observe consultations and access sensitive personal data. A practical solution could be to incorporate private consultation pods as with other telemedicine clinics, so that patients can securely access care without compromising their personal data. To ensure telehealth fulfils its promise, adherence to ethical and regulatory frameworks must take precedence over profit-driven motives. When implemented responsibly, these innovations can be transformative and must be encouraged. The challenge is not just to embrace telehealth, but to shape it into a system that prioritises care over mere convenience, and integrity over expediency.
Health Line
13-05-2025
- Health
- Health Line
Medicare Nonparticipating Providers: What You Should Know
A Medicare nonparticipating provider is a healthcare professional, facility, or supplier that doesn't accept Medicare assignment in all cases and may charge more than the Medicare-approved amount for certain services. When a healthcare professional accepts Medicare assignment, it means they agree to charge the Medicare-approved amount for all medically necessary services. Nonparticipating providers don't agree to these terms. While they still accept payment from Medicare, they may charge more for covered services. As a Medicare enrollee, receiving healthcare services from a nonparticipating provider has certain drawbacks. Learn more about what nonparticipating providers are and what to consider when getting care. Understanding Medicare assignment For Medicare billing purposes, there are three primary types of healthcare professionals: participating providers who accept Medicare assignment nonparticipating providers opt-out providers When a healthcare professional, facility, or equipment supplier 'accepts assignment,' it means they agree to charge the Medicare-approved amount for all services covered by Original Medicare (Part A and Part B). These providers can only bill Medicare enrollees for the deductible and coinsurance amounts. On the other end of the spectrum are opt-out providers. These providers don't participate in Medicare at all. If you receive services from a provider who opts out of Medicare, you must pay the full cost — except in emergencies. Nonparticipating providers are the middle ground. They may accept assignment in some cases, but they may also charge more than the Medicare-approved amount. Medicare nonparticipating providers Medicare nonparticipating providers can decide whether to accept the Medicare-approved amount for covered services on a case-by-case basis. If they don't accept the Medicare-approved amount, they can charge up to 15% more than the approved amount. This is called a limiting charge. The limiting charge amount can vary by state. In New York, it's 5%. Limiting charges may apply to services covered by Part B, but they may not apply to durable medical equipment (DME). Suppliers of DME may charge more than the limiting charge. When nonparticipating providers submit a claim to Medicare, Medicare pays them 5% less than the amount allowed under the Medicare physician fee schedule. This means nonparticipating providers get paid less than participating providers when they agree to accept assignment. At the end of each calendar year, physicians can decide whether to change their Medicare participation status or leave it as is. You can search for healthcare professionals in your area and learn whether they accept assignment using the provider search tool on Considerations when using a nonparticipating provider If you anticipate contacting a healthcare professional who is a nonparticipating provider, there are a few things to consider. Up-front payment Participating providers typically bill Medicare before asking people to pay a deductible or coinsurance amount. Nonparticipating providers may have you pay the full cost up front. Then, they submit a claim to Medicare on your behalf for any covered services. If a provider files your claim, you typically receive a Medicare summary notice that includes reimbursement for covered services or equipment. The reimbursement is 80% of the Medicare-approved amount for services covered under Part B. Limiting charges You typically pay more when receiving care from a nonparticipating provider, as these providers can charge up to 15% more than the Medicare-approved amount for covered services. Some states have rules governing how large this limiting charge may be. While a typical Medicare coinsurance is 20% of the Medicare-approved amount, if a person uses a nonparticipating provider with a 15% limiting charge, they are responsible for paying this 15% on top of their 20% coinsurance. Summary Medicare nonparticipating providers may choose to accept Medicare assignment on a case-by-case basis. This means they may charge up to 15% more than the Medicare-approved amount for covered services. The disadvantages of using a nonparticipating provider include paying higher costs for covered services, paying up front for care, and waiting for reimbursement. The downside for providers is that when they accept assignment, Medicare pays them 5% less than participating providers. You may wish to factor potential higher costs into the equation when deciding whether to get care from a nonparticipating provider.
