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The adoption of telehealth soared in response to the COVID-19 pandemic and has become an integral platform of healthcare for many—especially vulnerable populations.

Many older, low-income, disabled, and rural Americans, for instance, have appreciated the ease of virtual medical check-ins and immediate access to care when in-person visits weren’t necessary— one less trip to the doctor for those who have difficulties traveling outside of their homes, or who have a shortage of providers in their communities.

Can telehealth drive down healthcare costs and improve health equity and accessibility?

Recently, a New York-based managed care plan claimed that telehealth services led to fewer ER visits and lower healthcare costs for members with intellectual and/or developmental disabilities. Understanding the value of telehealth is especially important for long-term care programs such as home and community-based services (HCBS). Nearly every state expanded telehealth in HCBS delivery via Social Security Act §1915(c) Appendix K emergency waivers in response to the public health emergency. States centered changes to their telehealth policies around:

  • Relaxing requirements around level of care and person-centered plan development.

  • Expanding or redefining the role of providers, caregivers, and family members.

  • Conducting more training through audio and video conferencing.

  • Modifying methods for monitoring incident reporting requirements, medication management, and other patient safeguards to ensure individual health and welfare.

While these and other Appendix K waivers are temporary, telehealth has a critical future as federal and state agencies continue to integrate it within HCBS policies and settings. For instance, the American Rescue Plan Act included provisions to support the adoption of telehealth in HCBS.

States and community providers need long-term strategies to maintain HCBS integrity and oversight.

As states further expand efforts to adopt, normalize, and reimburse telehealth services for HCBS patients, agency stakeholders and community providers should align on five key areas.

1. Understand the Care Journey for Various Caregivers and Patients

 Stakeholder surveys, focus groups, town halls, and interviews can help states engage with providers and patients who have firsthand insights using telehealth during the pandemic. As with all Medicaid populations, satisfaction and uptake for telehealth HCBS is influenced by the ability of individuals with specific physical, intellectual, developmental, and mental health needs to adapt to telehealth service delivery. This also includes their caregivers’ access to technologies that support telehealth, knowledge of available resources, and willingness to interact through the technology.

State Medicaid agencies can use stakeholder forums as a platform to understand lessons learned and evaluate provider and patient satisfaction to build upon policies enacted during the pandemic. Stakeholder engagement can also help states navigate competing interests, prioritize intended outcomes, and create win-win situations to reinforce to telehealth caregivers and patients that their thoughts and concerns matter to the state’s HCBS program design.

2. Examine Payment Methods and Rates for Telehealth to Support Value-Based Care

 It is important for states to account for potential cost and utilization outliers resulting from the COVID-19 pandemic when studying telehealth data to gauge future demand trends. States must be diligent about tracking changes related to cost projections and service utilization for remote support services to evaluate whether changes will attract and maintain a qualified provider pool.

As states work to select, review, and document payment methodologies for telehealth HCBS, they will need to consider the expanded scope and coverage of remote support resulting from the pandemic, including the duration of service, provider qualifications, service delivery methods, and service locations.

States should also consider the role telehealth and virtual care delivery can more broadly support their market’s value-based goals. Offering tiered or bundled payments based on identified characteristics of patients and providers will support future reimbursement. Complete, consistent, and sufficiently documented information on states’ financing and payment methodologies for telehealth HCBS will be integral to CMS’s monitoring processes, as well as approval of federal matching funds.

3. Establish a Process to Monitor Fraud, Waste, and Abuse

 In September 2020, the Department of Justice, Health and Human Services, and the Drug Enforcement Administration partnered to charge 86 criminal defendants with $4.5 billion in alleged false and fraudulent claims involving telemedicine, highlighting the potential for unmonitored and unregulated use of telehealth.

Despite the benefits of widespread telehealth adoption and the bipartisan support for ensuring access to telehealth services, states must recognize the need to continually evaluate and implement policies and procedures that mitigate fraud, waste, and abuse. As such, to support the use of telehealth during the pandemic, many states waived certain Health Insurance Portability and Accountability Act guidelines around technology and safety requirements. Some states also waived out-of-state provider limitations, allowing for more relaxed rules regarding which providers are eligible to provide services to individuals.

Although states may not permanently adopt many of these changes, they will need to more closely monitor paid services to make sure that providers are not abusing or exploiting the flexibilities allotted during and after the pandemic, per the Government Accountability Office’s recent testimony to Congress. Continued abuse will rightfully weaken support for this critical service platform, leading all players to bear the responsibility for turning in abusers.

4. Leverage Telehealth as a Tool to Prioritize Equity and Access in Service Delivery

 States should consider how their guidance advancing the adoption of telehealth as a response to the pandemic can also bolster efforts to enhance equity and eliminate disparities in service delivery. By removing barriers such as physical distance and multiplying the number of providers able and available to deliver services, telehealth can level the options for people who may be seeking different methods or modalities of care.

Reviewing where disparities in service delivery, outcomes, patient satisfaction, and other metrics exist; where disparities may be accentuated by the pandemic; and where disparities can be mitigated by the wider adoption of telehealth is critical. States may need to make technology investments and develop training to accommodate those who need additional support.

Flexibility with provider choice (e.g., provider’s language aligns with individual’s preference) and methods of receiving telehealth (e.g., phone calls or asynchronous technologies) beyond the pandemic may help advance equity in availability of services. But more broadly, people in rural communities may not have access to any provider, let alone the service providers or workers who can best aid them.

5. Build on Existing Quality and Oversight Processes to Assure Patient Health and Welfare

 A major challenge for states will be to ensure that they have adequate policies and processes in place to identify or investigate adverse incidents. Due to decreasing face-to-face contacts in lieu of remote or virtual communication, current policies set by states may need to be modified to accommodate the new guardrails required for telehealth service delivery.

Guidehouse assessed the impact of COVID-19 on incident management and encourages states to:

  • Capitalize on changes made to incident reporting and investigation requirements.

  • Improve the processes for reporting incident management quality findings to CMS.

  • Conduct a gap analysis of incident management systems based on Appendix K changes.

Now is the time for states to adopt long-term strategies to define, implement, and expand remote and telehealth procedural changes within HCBS delivery systems.

If your sinus headache won’t go away, odds are you are dealing with a type of discomfort that you just can’t wait to be rid of. On top of the nasal congestion, facial pressure, and overall grogginess, a painful headache is just the cherry on top of an already unpleasant sinus infection. 

Do you suffer from chronic sinus headaches? Do over-the-counter medications not seem to do the trick? If the answer is yes, then you may have underlying sinus issues that need to be addressed by a professional.

The sinus specialists at Kaplan Sinus Relief are here to explain potential reasons why your sinus headache won’t go away, how long is too long for a sinus headache, and what your sinus headache treatment options are!

Why won’t my headache go away?

First things first: If you have a persistent headache, you need to figure out if it’s sinus-related or something else entirely. Some people confuse a migraine* with a headache caused by sinus issues and get treatment that doesn’t align correctly with their symptoms. If your headache is caused by a sinus-related issue and isn’t getting better over time, you likely have an underlying sinus condition that needs to be treated by a professional.

Sinus headaches are caused by a buildup of pressure in sinus cavities that have become inflamed and are blocking regular mucus drainage. Sinus headache symptoms can include (but may not always be present) the following:

  • Congestion 

  • Facial pressure and/or throbbing around your sinuses (cheeks, forehead, browline) 

  • Sinus drainage (with or without nausea)

  • Increased pain upon bending over 

  • Fatigue

  • Tooth and jaw pain

What does a sinus headache feel like? Often, different types of headaches can be felt in different areas of the head. A sinus headache will have you feeling pain in the forehead, the area around your sinus, your teeth, and your jaw. Sinus headaches can range from mildly irritating to debilitating depending on the severity of your sinus issues. 

When should I be concerned about a sinus headache?

If a sinus headache won’t go away, it is a sign that your sinus infection may be more serious than you thought and should be examined by a sinus specialist such as Dr. Kaplan of Kaplan Sinus Relief. If home remedies or medications from the drugstore aren’t kicking your headache to the curb, and you’re still feeling symptoms after the infection should have run its course, it’s time to seek treatment, especially if these other factors are present:

  • High fever

  • Nausea or vomiting 

  • Fainting 

  • Difficulty with speaking or motor function 

Leaving a sinus infection untreated comes with potential complications, including the spread of the infection, loss of smell, and in extreme cases, meningitis and brain abscess. 

How long do sinus headaches last?

Typically, a sinus headache should last as long as the sinus infection lasts, which is usually less than a week. Do sinus headaches go away on their own? In most cases, yes, the sinus headache should go away after the infection runs its course — but this is typically only the case for those who don’t suffer from chronic sinusitis or frequent infections. 

How long is too long for a sinus headache? 

If your sinus headache lasts longer than 10 days and your symptoms don’t seem to be improving, it may be time to seek medical attention to address your underlying sinus issues.


Sinus headache treatment: How do you treat a sinus headache?

Most people know exactly what to do to treat a regular headache — take an ibuprofen, grab a hot or cold compress, and rest. Treating a headache caused by sinus pain, however, is a little different. Unfortunately, ibuprofen won’t unblock your sinuses or get rid of your facial pain entirely. 

So, what is the best way to stop a sinus headache? Sinus headache relief can be found at home with a few simple remedies: 

  • Taking a hot shower

  • OTC antihistamines, decongestants, or saline sprays  

  • Using a humidifier

  • Massaging your temples, nose, and cheeks

  • Drinking plenty of fluids 

If you have chronic sinus infections, though, these options will only provide short-term solutions. If you want sinus headache relief that is long-lasting, we recommend scheduling an appointment with your doctor. 

In January 2018, the National Academies of Science, Engineering and Medicine1 released a consensus study report that reviewed over 800 different studies.

That report made clear: using e-cigarettes causes health risks. It concluded that e-cigarettes both contain and emit a number of potentially toxic substances. The Academies' report also states there is moderate evidence that youth who use e-cigarettes are at increased risk for cough and wheezing and an increase in asthma exacerbations.

  • A study from the University of North Carolina found that the two primary ingredients found in e-cigarettes—propylene glycol and vegetable glycerin—are toxic to cells and that the more ingredients in an e-liquid, the greater the toxicity.2

  • E-cigarettes produce a number of dangerous chemicals including acetaldehyde, acrolein, and formaldehyde. These aldehydes can cause lung disease, as well as cardiovascular (heart) disease.3

  • E-cigarettes also contain acrolein, a herbicide primarily used to kill weeds. It can cause acute lung injury and COPD and may cause asthma and lung cancer.4

  • Both the U.S. Surgeon General and the National Academies of Science, Engineering and Medicine have warned about the risks of inhaling secondhand e-cigarette emissions, which are created when an e-cigarette user exhales the chemical cocktail created by e-cigarettes.

  • In 2016, the Surgeon General concluded that secondhand emissions contain, "nicotine; ultrafine particles; flavorings such as diacetyl, a chemical linked to serious lung disease; volatile organic compounds such as benzene, which is found in car exhaust; and heavy metals, such as nickel, tin, and lead."

  • The Food and Drug Administration has not found any e-cigarette to be safe and effective in helping smokers quit. If smokers are ready to quit smoking for good, they should call 1-800-QUIT NOW or talk with their doctor about finding the best way to quit using proven methods and FDA-approved treatments and counseling.

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