CMS – the Federal Agency that Administers Medicare and Medicaid – Recognizes Traumatic Brain Injury as a “Chronic Health Condition”
For more than a decade this blog has covered the growing recognition by policy makers and in the peer reviewed literature that traumatic brain injuries (TBIs) of all kinds should not be treated as a static event from which patients gradually recover over time.
In many cases, the TBI is the beginning of a disease process that can cause symptoms that change over time, in some cases getting better instead of worse, and that can impact multiple organ systems.
In 2009 this led a leading advocacy group, the Brain Injury Association of America (BIAA), to issue a position paper in favor of recognizing TBIs as a “chronic health condition.” The BIAA has continued to advocate this position. The Centers of Medicare and Medicaid Services (CMS), the federal agency that administers Medicare and Medicaid (the latter in cooperation with states) has now adopted this position as well, recognizing TBI as a chronic health condition effective January, 2025. This will lead to both increased public health resources – to address the lifelong impacts of brain injury – and to enhanced benefits from health insurance plans like Medicare and Medicaid.
As previously reported, one of the more prominent recent studies supporting this position was authored by Saef Izzy, a Harvard professor and neurologist at Brigham and Women’s hospital, and published in JAMA Network Open (associated with the American Medical Association.)
Dr. Izzy and his colleagues conducted a longitudinal cohort study using hospital-based patient registry data to examine the incidence of cardiovascular, endocrine, neurological and psychiatric comorbidities in TBI patients from 2000 to 2015. Patients were matched to an unexposed group without head injuries. The analysis included 4,351 patients with mTBI, 4351 patients with msTBI and 4,351 unexposed individuals.
The conditions where increased risk was found included:
- diabetes and other endocrine diseases
- coronary artery disease
- hyperlipidemia
- obesity
- dementia
- psychotic disorders
- anxiety disorders
- ischemic stroke
- hypertension, and
- seizure disorders.
In discussing the possible cause of this data the authors reference “recent clinical and experimental studies [that] suggest TBI may alter systemic metabolomic, gut and immune pathways” and also observe that TBI may lead to contributing behavioral and lifestyle changes. It concludes that “the high risk of comorbidities after TBI likely represents a combination of direct (hormonal and inflammatory changes caused by injury) and indirect factors (psychosocial factors.)”
In an interview discussing his findings, Dr. Izzy observed that “we are finding that TBI is not just an acute injury, but a chronic disease and multisystem condition that affects far more than just the brain. Comorbidities linked to TBI can complicate the course of recovery, increase mortality and add to overall healthcare costs.”
Historically, TBI victims have received good acute care, but have been mostly on their own when they leave the acute care setting. We hope this new recognition will help to ensure continuing support for TBI victims and their families.