Giffords’s office seeks to close gap in traumatic brain-injury care

April 21, 2011

Staff members for Rep. Gabrielle Giffords (D-Ariz.) have emerged as key advocates in a campaign to ensure the new health-care law guarantees more Americans who suffer traumatic brain injuries the high quality of care the congresswoman is receiving to recover from a January shooting.

Earlier this month, Giffords’s chief of staff, Pia Carusone, released a letter urging Health and Human Services Secretary Kathleen Sebelius to make it a goal as she defines the minimum package of “essential benefits” the law will require insurance plans for individuals and small businesses to include in 2014.

Members of Giffords’s staff also plan to join advocates encouraging Defense Secretary Robert M. Gates to expand the range of cognitive rehabilitative therapies that Tricare, the military’s insurance program for nearly 4 million active-duty and retired service members, covers in case of brain injury.

In her letter to Sebelius, Carusone noted the disparities in the intensity, sophistication and duration of rehabilitative care that insurance plans provide the roughly 1.7 million Americans who annually suffer such injuries, as well as the tens of thousands of service members who have been wounded in recent years.

Susan Connors, president of the Brain Injury Association of America, which organized a news conference on the issue with Giffords’s office, said a person with a moderate to severe injury would likely need at least a month of continuous therapy at a rehabilitative hospital such as TIRR Memorial Hermann in Houston, where Giffords is recovering. Exercises would focus on restoring muscular and other physical functions, speech, psycho-social capacity and cognitive functions, such as forming memory and maintaining attention.

Next, a patient might spend six to eight weeks at a transitional rehabilitation unit, regaining life skills such as bathing and cooking. Once home, Connors said, he might need rehabilitative therapy three times a week for at least another month.

Such comprehensive rehabilitative care is expensive — $8,000 per day for hospital-based acute rehabilitation, up to $2,500 for post-acute residential care and as much as $1,000 per day for nonresidential treatment programs.

But Connors argued that intensive comprehensive rehabilitation is still “a bargain” compared with the long-term costs of caring for someone who remains severely disabled because of incomplete early intervention.

She said this may explain why workers’ compensation insurance, which generally is responsible for paying the cost of a work-related injury for the rest of a worker’s life, tends to provide generous coverage of brain-injury rehabilitation. Giffords, who was critically wounded by a gunman Jan. 8 while meeting with constituents in Tucson, is covered under such a plan.

By contrast, Connors said, it is not uncommon for patients with the most bare-bones insurance coverage to be discharged “to your couch” after a week or two in the hospital.

“As a result, you experience significant medical complications: Your muscles might begin to contract; you may have seizures,” Connors said.

Even Americans with more substantial insurance often get shortchanged, she added, reducing their likelihood of returning to work or otherwise making as complete a recovery as possible.

Tricare, which is not affected by the new health-care law, does not cover services billed under the umbrella term “cognitive rehabilitative therapy,” or CRT, citing a controversial 2009 study that the Defense Department commissioned to assess the efficacy of the therapy.

However, Tricare covers many of the component therapies that constitute CRT — memory training, for example.

C.J. Karamargin, Giffords’s communications director, said the congresswoman’s staff would be pushing the Defense Department to revise Tricare’s rules on CRT and to investigate other aspects of the military’s treatment of traumatic brain injury.

“This is a signature wound of current military conflict, and it’s unfortunately something we’ve gotten to know quite a bit about,” he said.

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