Why a tax credit for Parkinson's disease makes sen
By Michael S. Okun MD
What positive benefits will a tax credit for Parkinson’s disease provide for you? Could we level the playing field for persons with Parkinson’s to access appropriate multidisciplinary services? Can society benefit from a strategic investment into a forward leaning, practical, preventative and proactive multidisciplinary care policy? I will explore the potential positive impacts of a U.S. tax credit for Parkinson’s disease, based on the freshly published paper in the Journal of Parkinson’s Disease.
Why consider a tax credit for Parkinson’s?
Simple. The American Healthcare System does not accommodate multidisciplinary care. Imagine if you could have a ‘captain for your care.’ Perhaps, this captain could be a licensed clinical social worker who would construct, monitor and implement an individual multi-disciplinary strategy. How about psychological counseling to directly address the burden of depression, anxiety and demoralization? Wouldn’t it be nice to have access to personal training which could be directed and maximized through coordination by physical and occupational therapists. A tax benefit would bring the potential for care directly into your home setting, through the implementation of both in-person and telemedicine services. How about access to a dietician?
What preventative care measures could be proactively employed?
Potential cost savings for hip fractures and reduction in hospitalizations associated with Parkinson’s disease.
A tax credit could be used to proactively identify early signs of aspiration (breathing food and secretions into the lungs) and urinary tract infections to ‘head off’ significant morbidity. The credit could provide proactive care for you to improve fall prevention, provide more care in the home setting, to reduce hospitalizations, to prevent serious depression, to reduce anxiety, to lessen demoralization, to improve diets, and to reduce the numbers of persons placed in nursing facilities. Failure to implement preventative care measures could lead to countless unrealized benefits in you including reduction in falls, hip fractures and nursing home placements.
Why a multidisciplinary approach is better?
There is increasing evidence supporting a multidisciplinary approach for the implementation of proactive preventative care for persons with Parkinson’s disease.
Additionally, implementation of multidisciplinary care has the potential to provide billions of dollars in economic and societal savings.
Why a tax credit?
Simple. The American Healthcare System is not easily bent ‘to accommodate practical proactive preventative care for Parkinson’s disease, thus we must think ‘out of the box’ and implement a more immediate and feasible solution for you, the person with Parkinson’s.
How much does Parkinson’s cost to the American Healthcare System?
The economic toll of Parkinson’s is devastating both for you and for the healthcare system. Total accrued expenses have the potential to cripple Medicare and to lead to devastation of the private payor system. Parkinson’s is the fastest growing neurological disease and happens to be one of the most expensive. In the US the combined economic burden is ~$51.9 billion dollars. Future costs will likely continue to mushroom when we weigh the increasing number of cases of early and later onset Parkinson’s disease and of course their projected future downstream care expenses.
What care services are not routinely available or reimbursed for Parkinson’s disease?
One disappointing part of the American Health Care System is that many critical services are not covered for you under Medicare, Medicaid or commercial insurance. The mobility challenges inherent in Parkinson’s when coupled with suboptimal transportation have increased the difficulty for you to access care. A tax credit could provide you licensed clinical social workers, mental health professionals (including counselors), personal trainers and dieticians.
Why are social workers great captains for the Parkinson’s voyage?
Regular consultations with social workers will connect persons with Parkinson’s disease and their families to current and emerging local, state and federal programs.
Social workers facilitate wellness.
Social wokers assist in navigating both the heatlhcare system and the disease.
Many social workers can provide counseling services, similar to what would be provided to you by counseling psychologists.
The rapidly changing landscape of Parkinson’s disease fits the skillset of a social worker. They are experts on navigating emerging challenges.
Regular access to a social worker will facilitate for you early and more timely referrals to neurologists and psychiatrists. Earlier referrals will translate into proactive identification and treatment of severe depression, anxiety and demoralization, all of which commonly contribute to Parkinson’s hospitalizations, morbidity (disability) and in some cases, even death.
Social workers are ideally suited to support emerging challenges in caregiver strain.
More frequent hospitalizations and emergency room visits are highly dependent on the skillset and disposition of the caregiver, so it is appropriate that we focus attention on caregiver empowerment and well-being.
Focus on preventing falls and aspiration pneumonia.
Prevention of falling, early intervention for infections and prevention of aspiration pneumonia are all achievable goals for you. A tax credit to promote a proactive preventative strategy for you placing appropriate emphasis on continuous symptom monitoring, could be powerful in improving your outcomes and reducing your cost. If we can keep you in outpatient and home settings this will increase satisfaction and drive down costs.
What about exercise and home based training?
Collective research strongly supports the idea that consistent exercise with appropriate supplementation by physical, occupational and speech/swallow therapy will lead you to better outcomes. Providing a tax benefit will incentivize you to integrate an ‘alternating week personal trainer strategy’ into a proactive Parkinson’s disease plan. Many personal trainers will meet persons with Parkinson’s disease in their homes, thus this strategy has an added benefit of improving access. Additionally, regular visits with certified personal trainers will reinforce the crucial importance and benefits of continuous exercise for Parkinson’s disease. Finally, personal trainers can provide you a link to physicians and rehabilitation services and can be utilized to facilitate more timely referrals to treat emerging issues, which if left unaddressed, may lead to falls, fractures, hospitalizations, morbidity and in some cases mortality.
How about access to a dietician?
Emerging evidence has revealed that:
Diet impacts your medication absorption, the microbiome and various symptoms in Parkinson’s disease.
Reduction or timing of your protein intake has a potential to improve absorption of Parkinson’s medications.
Timing and coordination of nutrition with medication is important and underappreciated.
Mediterranean and other diets may impact your Parkinson’s symptoms.
Slow continuous weight loss occurs in Parkinson’s disease and no one is immune from it.
There is a higher risk for you to have bone fractures and osteopenia (double the risk).
Dieticians can help neutralize and turn around your weight loss and facilitate appropriate referrals for bone health.
Access to a dietician just twice a year provides the potential for you to address one of the most disabling Parkinson’s disease symptoms; constipation.
How far could a $6200 a year tax credit go?
From the recent Journal of Parkinson’s Disease article.
Billions of dollars in savings to the healthcare system.
“We need to promote a practical preventative and proactive strategy for each of you that will advantage both this generation and the next.” - Michael Okun
Michael Okun is coauthor of the books The Parkinson’s Plan and Ending Parkinson’s. He is also author of the PDplan.org and parkinsonsecrets.com blog.
Selected References:
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2. van der Marck MA, Bloem BR, Borm GF, Overeem S, Munneke M, Guttman M. Effectiveness of multidisciplinary care for Parkinson's disease: a randomized, controlled trial. Mov Disord. 2013;28(5):605-611.
3. Bloem BR, Henderson EJ, Dorsey ER, et al. Integrated and patient-centred management of Parkinson's disease: a network model for reshaping chronic neurological care. Lancet Neurol. 2020;19(7):623-634.
4. Dorsey R ST, Okun MS, Bloem BR. Ending Parkinson’s Disease: A Prescription for Action. New York: Public Affairs; 2020.
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7. Maraki MI, Yannakoulia M, Xiromerisiou G, et al. Mediterranean diet is associated with a lower probability of prodromal Parkinson's disease and risk for Parkinson's disease/dementia with Lewy bodies: A longitudinal study. Eur J Neurol. 2023;30(4):934-942.
8. Yao L, Liang W, Chen J, Wang Q, Huang X. Constipation in Parkinson's Disease: A Systematic Review and Meta-Analysis. Eur Neurol. 2023;86(1):34-44.
9. Zeldenrust F, Lidstone S, Wu S, et al. Variations in hospitalization rates across Parkinson's Foundation Centers of Excellence. Parkinsonism Relat Disord. 2020;81:123-128.
10. Shahgholi L, De Jesus S, Wu SS, et al. Hospitalization and rehospitalization in Parkinson disease patients: Data from the National Parkinson Foundation Centers of Excellence. PLoS One. 2017;12(7):e0180425.
11. Hassan A, Wu SS, Schmidt P, et al. High rates and the risk factors for emergency room visits and hospitalization in Parkinson's disease. Parkinsonism Relat Disord. 2013;19(11):949-954.