Traumatic Brain Injury Now Recognized as a Chronic Condition by Medicare and Medicaid

Most cyclists who’ve experienced a traumatic brain injury (TBI) as a result of a crash know that the effects can be lasting, but that getting extended care is often difficult. For some patients, that may soon change. The U.S. Centers for Medicare and Medicaid Services (CMS) is now recognizing TBI as a chronic condition that may require specialized and prolonged care.

The designation, which occurred in July, is an encouraging sign for patients who have experienced a TBI and live with the continuing effects of their injury.

“This is an important first step in our fight to expand coverage for brain injury beyond acute care and helps us to make our case that brain injury should be treated by healthcare providers as a chronic condition like heart disease or diabetes,” says Rick Willis, president and CEO of the Brain Injury Association of America (BIAA), in an organization news release.

The association earlier this year submitted a position paper calling for CMS to make the policy change, explaining that “research has shown time and time again that brain injury can evolve into a lifelong health condition that impairs the brain and other organ systems and may persist or progress over a person’s lifetime.”

What is a traumatic brain injury?

TBIs can vary dramatically and are caused by trauma to the head. This can be in the form of a bump, jolt, or a foreign object entering the brain. TBI is a leading injury for cyclists. According to the Centers for Disease Control and Prevention (CDC), bicycling leads to the highest number of sport and recreation–related emergency department visits for TBIs in the U.S.

As cycling popularity increases, the CDC says emergency departments expect to see more TBI cases.

Often, concussions are considered “mild” TBIs but they still can have devastating impacts on long term health. Severity is determined by the Glasgow Coma Scale, which assesses a patient’s level of conscience. However, even when a person remains conscious after trauma to the head, they can still suffer serious symptoms.

Signs you may have experienced a mild TBI:

• Sensitive to light or noise
• Headaches
• Vision problems or dizziness
• Problems sleeping or sleeping more than usual
• Brain fog
• Trouble concentrating
• Memory problems
• Nausea or vomiting (in the beginning)
• Change in mood, such as feeling more anxious, sad or nervous than usual

In moderate cases of TBI, a person might experience the same mild symptoms as well as:

• Loss of consciousness for several minutes or hours or coma
• Loss of coordination
• Profound confusion
• Slurred speech
• Dilated pupils

Long-term effects from TBIs

Getting the proper compensation for care is crucial, especially since the need for care can possibly last years. Bay Area Bicycle Law attorneys often see cases in which a client with a TBI shows symptoms for months, even years, after the accident.

Scientists are also beginning to reveal hard data that shows a TBI may have side effects much longer than previously known. Last June, researchers from the Medical College of Wisconsin published a study in the journal Neurology showing that TBIs are more of a “chronic condition,” as recovery can last years and patients may have several high and low points throughout that duration.

“Our results dispute the notion that TBI is a discrete, isolated medical event with a finite, static functional outcome following a relatively short period of upward recovery (typically up to one year),” lead investigator Benjamin Brett, PhD, told Medscape Medical News of the study.

Over the course of the study researchers found that 21% of people with mild TBIs and 26% with moderate to severe TBIs experienced a decline in overall cognitive test scores compared to the 15% decline of people who had no head injury at all. Researchers noted that most of the decline was in the ability to function during daily activities.

The researchers also noted that about 22% of patients with mild TBIs and 36% with moderate to severe TBIs showed improvement over time. It’s not clear what factors may have contributed to a person’s decline or improvement.

Between new research and recognition from CMS, advocates are hoping there’s more to come for patients.

The Brain Injury Association of America notes that chronic pain affects about 60% of people living with a TBI, some experiencing symptoms three decades after the event that caused the injury. Additionally, about half of people with a TBI experience depression within the first year after injury. Two-thirds are affected within seven years following the injury.

While there is still much to learn about the lasting effects of TBI, the new CMS designation represents progress.

“There is a lack of understanding amongst the general public as well as within much of the medical field about the long-term effects and chronic nature of brain injury, particularly amongst those survivors living with invisible disabilities,” BIAA leaders say. “But designating brain injury as a chronic health condition that can require lifelong management of symptoms would go a long way toward correcting misconceptions about a condition that impacts millions of Americans.”