The Journal Record
October 2, 2018
OKLAHOMA CITY – As America’s population ages and becomes more likely to develop Alzheimer’s disease, the unmet need for neurologists will grow, especially in Oklahoma.
Alzheimer’s is common, but it can be difficult to understand, and some local advocates say physicians don’t receive enough education on it. The disease causes many symptoms, most commonly dementia, which can harm memory, speech and motor skills. People develop Alzheimer’s disease when nerve cells in the parts of their brains that control cognitive function are damaged or destroyed. It is common for that damage to spread until symptoms are so severe, those patients die.
About 64,000 Oklahomans already have Alzheimer’s disease, according to the Alzheimer’s Association’s 2018 report on facts and figures, which the organization released in March. That is projected to grow by more than 18 percent by 2025, when a projected 76,000 residents will have the disease. Medicaid payments for related care are anticipated to grow from $481 million in 2018 to $600 million in 2025.
Although lawmakers have done some work on the issue and are raising awareness about it, the Oklahoma Senate Health and Human Services Committee held an interim study last week to talk about the growing problem, particularly in terms of access to care and what the Legislature can do to step in. State Sen. Adam Pugh, R-Edmond, said the speakers during the study discussed statistics that showed low access to health care statewide.
“Oftentimes you hear that story told in rural Oklahoma, but these were numbers that were also alarming in the metro area,” he said. “When your two greatest metro areas have this lack of medical care … you know that that pain is going to be felt even more so in rural Oklahoma.”
Pugh requested the interim study after working with the AARP on an unrelated bill last year. His connections there introduced him to people working in Alzheimer’s advocacy, and the fit seemed natural.
He said the group tried to focus on solutions. One of those included expanding and replicating programs such as the one that the Oklahoma State University Center for Health Sciences has launched. It’s known as Project ECHO, or the extension for community health care outcomes. Like the university’s extension offices that help local farmers by bringing in programming and lessons with professionals, this program offers telemedicine-like help with patients as well as seminars for and coordination with local providers. It has several programs, such as those for addiction services and hepatitis C, but it is expanding its program for Alzheimer’s.
Education is one of the top issues in expanding access to neuro care in Oklahoma.
“One of the things I think has been identified is the lack of residency slots we have,” Pugh said.
That is a problem regardless of the provider’s specialty.
Oklahoma ranked 41st in the nation for the number of graduate medical students per capita in 2017, according to the Association of American Medical Colleges. That year, the state had 873 students in fellowships or residencies after they graduated from medical school, about 22 per 100,000 people. Massachusetts ranks first in the nation for its proportion of medical residents and fellows, with about 83 per 100,000 people. That state’s health outcomes are consistently ranked in the top five.
As state officials call to increase those positions, the funding to pay for them has been getting less secure. Oklahoma had been using a waiver to help pay for physician training programs and residency clinics using Medicaid money since the Clinton administration. However, the agency began receiving notifications in the fall that the Trump administration would consider forgoing the agreement.
The federal agency overseeing Medicaid began clawing back payments, which cost the state $141 million. Beginning in 2020, it could cost the state about $60 million annually. The Legislature patched the programs’ funding for two years during the second special legislative session when they passed House Bill 1022 in February. That included about $30 million in state appropriations to the programs in fiscal 2018, which ended in June, and about $100 million for the current fiscal year. U.S. Sen. Jim Inhofe announced last month that current federal appropriations bills included $25 million for these programs moving forward.
State Rep. Cyndi Munson, D-Oklahoma City, co-sponsored legislation in 2018 that required further Alzheimer’s-related training for hospice workers as well as a resolution that designated the disease a public health issue as the sixth-leading cause of death among American adults.
Much like the rest of the nation, Oklahoma’s population is aging. The baby boomers are entering their elderly years. Over the past 20 years, the elderly population has grown by about 100,000 over the four-county area around Oklahoma City.