|Front row, left to right, Betsy Abramson (WIHA), Erin Parker (CDC), Kathryn Bowen (Peer Leader), Anne Hvizdak (WI-DHS), Shannon Myers (WIHA). Back row, left to right: Chuck Warzecha (WI-DHS), State Senator Luther Olsen (14th District), Becky Turpin (UW-Health), Dr. Kathleen Walsh (UW School of Medicine), Hilary Eiring (CDC)|
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Milwaukee Journal Sentinel
September is Falls Prevention Awareness Month, but the prevalence and high cost of falls in Wisconsin is a year-round problem. In fact, for adults age 65 and older, Wisconsin's death rate from falls is the nation's second highest and twice the national average. Falls are a public health crisis poised to become an epidemic as Baby Boomers enter the ranks of higher-risk age groups. The good news is that falls are not a normal part of aging and state efforts are underway to prevent them.
Medicare spending on older adults’ injuries from falls is on nearly as high as funds spent on cancer, according to national data from the Centers for Disease Control and Prevention (CDC). Medicare costs related to falls tops $31 billion annually in the U.S. In 2014, $771 million was spent on hospital costs related to falls in Wisconsin; over 70% is covered by government insurance programs mostly Medicare and Medicaid.
Identifying patients at highest risk for a fall is a key component in preventing them – yet only a small percentage of health care providers conduct falls risk assessments of their older patients. Medicare reforms under the Affordable Care Act, however, are pushing doctors and hospitals to make prevention a higher priority. "Medicare reimbursement used to be based on a fee-for-service model,” says Betsy Abramson, executive director of the Wisconsin Institute for Healthy Aging, a non-profit organization that promotes and spreads evidence-based healthy aging programs statewide. “Now with value-based payment systems in place, providers must show quality outcomes to receive the highest level of payment. The new value-based payments reward prevention as the foundation of good patient care."
A clinical falls risk assessment tool can make fall screening routine and protect thousands of Wisconsin's older adults from serious injuries like broken hips and traumatic brain injury. This type of tool is more critical than ever as fewer physicians are opting to specialize in geriatrics. Developed by Verona-based Epic Systems in cooperation with the CDC, University of Wisconsin, and Oregon Health and Sciences University, the Stopping Elderly Accidents, Deaths & Injuries (STEADI) Clinical Program evaluates patients’ fall risk and provides clinicians with tools and resources for reducing falls. “Epic's software is used by health care providers throughout the U.S.,” according to Erin Parker, Health Scientist with the Division of Unintentional Injury Prevention in the National Center for Injury Prevention and Control at the CDC, “and with STEADI incorporated into Epic's foundational product, its impact has the potential to be a game-changer for fall prevention.”
The CDC estimates that STEADI implementation has the potential to prevent over 1 million falls for every 5,000 providers. This staggering number translates into more than just dollars. “Falls lead to physical and social impacts that linger well beyond the injuries they cause have healed,” says Kathleen Walsh, MD, Associate Director, UW Faint and Fall Clinic and Hospital, an early adopter of the STEADI tool in clinical practice. “A significant number of people of who fall lose their self-confidence and subsequently avoid activities they feel may place them at risk for another fall. Inactivity, however, leads to social isolation, loss of muscle strength and worsening balance, which in turn, further increases their risk of falling. It is a vicious cycle. Through practical lifestyle adjustments, appropriate interventions, evidence-based programs, and community partnerships, the number of falls among seniors can be reduced substantially.”
“Many fall-related risk factors can be addressed by health care providers,” says Jane Mahoney, MD, a professor and geriatrician at the UW School of Medicine & Public Health, Division of Geriatrics and Chief Medical Officer at WIHA. “Without the STEADI tool, it's less likely patients will be referred to effective fall interventions like physical therapy, a vision test, or an evidence-based self-management program. Early treatment of fall risk factors can prevent later treatment for an injurious fall." Once a fall occurs, the costs in Wisconsin can average between $5,000 for an ED visit and $27,000 for a hospital stay.
Falls are also a leading cause of nursing home admissions, which often exhaust personal assets and increase the burden on Medicaid. Because Medicaid accounts for significant state spending, state officials are interested in finding ways to reduce Medicaid costs. In the 2015-2017 biennial budget, the Governor and Legislature approved a $200,000 annual healthy aging grant to promote prevention activities – including falls prevention – using evidence-based, community interventions. One such program – Stepping On – has been researched and proven to decrease the incidence of falls by 50%. WIHA is the national license-holder and administrator of the 7-week Stepping On program, which to date has been offered in 66 Wisconsin counties with nearly 12,000 people age 60 or older participating. That, according to Abramson, is a great start, but there’s plenty more to do. “We know that expanding local capacity to offer Stepping On translates to fewer falls,” says Abramson. “We’re grateful for the budget support and continue to look for ways to increase the number of workshops we’re able to offer.”
Funding evidence-based health promotion makes Wisconsin communities safer and more livable for citizens as they age and, at the same time, makes good fiscal sense according to State Senator Luther Olsen (R) Ripon – sponsor of the healthy aging grant state budget provision. “The more senior citizens are screened for and offered an evidence-based falls prevention intervention, the less chance they’ll fall, end up in a nursing home, and on Medicaid long-term care,” says Olsen. “The small investment we make now has the potential to save both money and prevent the catastrophic physical, emotional, and financial impact that falls can have on individuals and their families.”