Why a tax credit for Parkinson's disease makes sense
By Michael S. Okun MD
What positive benefits will a tax credit for Parkinson’s disease provide? 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. In this months parkinsonsecrets.com blog I will explore the 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 the 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 and urinary tract infections to ‘head off’ significant morbidity. The credit could provide proactive care 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 will lead to countless unrealized benefits 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.
How much does Parkinson’s cost to the American Healthcare System?
The economic toll of Parkinson’s is devastating. 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 under Medicare, Medicaid or commercial insurance. The mobility challenges inherent in Parkinson’s when coupled with suboptimal transportation have increased the difficulty to access care. A tax credit could provide 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 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 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 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. A tax credit to promote a proactive preventative strategy placing appropriate emphasis on continuous symptom monitoring could be powerful in improving outcomes and reducing cost. If we can keep folks 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 to better outcomes. Providing a tax benefit will incentivize persons with Parkinson’s 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 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 medication absorption, the microbiome and various symptoms in Parkinson’s disease.
Reduction or timing of 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 Parkinson’s symptoms.
Slow continuous weight loss in Parkinson’s disease
Higher risk for bone fractures.
Dieticians can help neutralize and turn around weight loss and facilitate appropriate referrals for bone health.
Access to a dietician just twice a year has the potential 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.
How impactful could a $6200 a year tax benefit be for Parkinson’s disease?
Access to a licensed clinical social worker once a month at an approximate cost of ~$100 per visit would add up to ~$1200 a year.
A tax credit of ~$100 per visit applied every other week to access psychological counseling services through telemedicine would cost ~$2400 a year and reduce the burden of depression, anxiety, and demoralization. Frequent visits to counseling therapists will serve as a monitoring tool for triggering earlier referrals to psychiatrists and neurologists. Earlier treatment, translates into an opportunity to reduce hospitalizations, attempted suicides, and deaths.
The use of a tax credit for personal trainers twice a month at an approximate cost of ~$2400 a year will have a strong potential to reduce falls, fractures, hospitalizations, morbidity, and mortality. Regular meetings with personal trainers will provide the reinforcement and monitoring of exercise; a powerful and underutilized evidence-based treatment.
Finally, adding a benefit for twice a year dietician services at an approximate cost of ~$200 ($100 per visit) will address the delicate balance of nutrition with medication absorption, as well as address constipation, tackle the perils of frailty and facilitate faster referrals and coordination in cases of rapid weight loss.
Social workers, counselors, personal trainers, and dieticians can all be trained to proficiency in inquiring about coughing when eating and in identifying early signs of aspiration and urinary tract infections.
Can a tax credit pay for itself?
The conservative cost of a tax credit with a price tag of ~5 billion dollars a year has the potential to pay the system back by reducing of hospitalization and preventing of hip fractures. One-third of folks with Parkinson’s disease will experience a hospital encounter each year, and one-half of those will experience a repeat encounter. Preventing hospitalizations in Parkinson’s disease will translate into billions of dollars in healthcare savings.
What are the benefits of a $6200 tax credit for Parkinson’s?
Michael Okun is the author of this month’s blog and co-editor of parkinsonsecrets.com and author of the recent article on Tax Credits for Parkinson’s Disease.
Jonny Acheson is the parkinsonsecrets.com artist, a physician and a person with Parkinson’s.
More fall prevention
More care provided in the home setting.
Less hospitalizations.
Less depression.
Less anxiety.
Less demoralization.
Better diets.
Less persons placed in nursing facilities.
Billions of dollars in savings to the healthcare system.
“We need to promote a practical preventative and proactive strategy that will advantage both this generation and the next.” - Michael Okun
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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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.
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