HealthMatters
Letters to the Editor is a periodic characteristic. We welcome all feedback and can publish a range. We edit for size and readability and require full names.
Why Hospital Monopolies Are a Dangerous Concept
I just lately learn the article about Ballad Well being by Brett Kelman and Samantha Liss concerning the Mountain States Well being Alliance and Wellmont Well being System merging to create Ballad Well being, upon state approval (“These Appalachia Hospitals Made Large Guarantees to Acquire a Monopoly. They’re Failing to Ship,” Sept. 29). Properly, it was permitted, and right here is another excuse that monopolies are a foul thought. My husband is a instructor in Tennessee, and it difficult our open enrollment picks for 2024 insurance coverage. We’ve got used BlueCross BlueShield of Tennessee, a broadly chosen insurer in our state. We had been despatched notification that Ballad Well being and BCBST had been in negotiations and that there was a excessive likelihood that Ballad will quickly be an out-of-network supplier for these with BCBST plans. Fortunately, the varsity district affords Cigna insurance coverage as effectively, however not all suppliers settle for that insurance coverage (as I mentioned, BCBST is a large insurer on this space).
Please clarify to me how it’s OK for a monopoly to resolve to not be in-network with any well being plans. They need to be required to be in-network with any insurer from this space. I discover this very upsetting. I shouldn’t have to fret that if a catastrophic occasion had been to occur that my insurance coverage protection can be diminished to 60%-40% from 80%-20%, all as a result of my solely choice for emergency care (Ballad) selected to not negotiate with the most important insurance coverage supplier in my space. Simply meals for thought.
— Kimberly Ensor, Johnson Metropolis, Tennessee
On X, previously referred to as Twitter, a consumer whose tagline is “a one-woman wrecking ball” had this to say about nursing house employee shortages:
That is DEVASTATING! If CMS is saying they can not determine a protected nursing workers degree for residents than how can surveyors maintain houses accountable? It ain’t occurring anyway. Biden’s coverage is WEAK. CMS is a joke. The gov’t is throwing away $. Wash & repeathttps://t.co/1FZ0YRLfdm
— Politics, Insurance policies & Pop Tradition ✍️ (@out2sea90210) August 29, 2023
— Ashley Thomas, Cleveland, Ohio
The Disaster of Understaffed Nursing Properties
I needed to thanks for offering a platform for dialogue of nursing house staffing (“Unique: CMS Research Sabotages Efforts to Bolster Nursing Residence Staffing, Advocates Say,” Aug. 29). As a nursing pupil coming into my remaining semester at SUNY Downstate, I’ve seen firsthand the destitute situations of understaffed nursing houses. Staffing ratios are abysmal and, as I see it, the one resolution for the well-being of nursing house residents is a accountable staff-to-resident ratio.
I wholeheartedly agreed with the sentiment of the article: The Abt Associates examine was a shameful try to undermine the motion towards standardized staffing ratios at nursing houses. Individuals grow to be residents at nursing houses for a lot of causes, however the truth is they’re there, above all, as a result of they want specialised care, which these houses want nurses to offer — companies corresponding to ventilator care, tube feedings, remedy, steady monitoring, and frequent interventions to forestall stress accidents, and a lot extra. There’s something terribly improper when nursing houses can’t present the companies that outline them, particularly when households and residents rely on them to take action.
I do suppose there have been some missed alternatives within the article. For instance, Jordan Rau writes that “motionless residents are usually not repositioned in mattress, inflicting bedsores that may result in an infection.” Whereas this assertion is true, it’s slightly obscure. Infections are a life-threatening danger related to stress accidents, however the sores themselves are grotesque and painful, a degree I feel ought to have been included to emphasise the injustice of permitting stress accidents to develop and worsen. Well being care staff ought to make each effort to forestall them. And nurses ought to perceive their roles as advocates in being a voice for sufferers who’re unable to talk for themselves.
It’s straightforward for the general public to think about the residents of nursing houses as homogenous and stereotypical aged individuals who have been forgotten as they grew to become burdensome, which isn’t solely false, however actively dangerous and agist. Individuals of all ages and backgrounds reside in nursing houses, and their wants are as various as they’re themselves. The one common commonality they’ve is that they reside in nursing houses and want respect, dignity, care, and an sufficient variety of nurses and workers to guard these wants.
— Tara L. Clark, Freeport, New York
A union activist who helps a nationwide single-payer well being system additionally weighed in on X:
CMS is the company that’s supposed to guard sufferers. However CMS, as an alternative, follows the bidding of the nursing house trade. Disgrace! This is similar company that presides over handing Medicare to the for-profit trade. https://t.co/xYpKySzkwJ
— Kay Tillow (@KayTillow) August 29, 2023
— Kay Tillow, Louisville, Kentucky
Avoiding Monetary Spoil for Getting older Elders
As Jordan Rau and Reed Abelson determine (“Going through Monetary Spoil as Prices Soar for Elder Care,” Nov. 14), too lots of right this moment’s older adults are falling by means of the cracks. They could battle with every day actions and declining well being however don’t essentially want 24/7 nursing house care.
Inside the patchwork of long-term care, the Program of All-Inclusive Look after the Aged is underutilized. PACE affords built-in care by means of its campus-based mannequin, the place individuals can obtain complete, coordinated medical care and social companies in a mixed Medical Clinic and Day Middle, whereas additionally receiving at-home assist with important duties like dressing, bathing, and consuming.
This care is free to our dually eligible individuals who’re by no means saddled with copays, out-of-pocket prices, or deductibles. PACE has saved states 1000’s yearly per participant. Additional, individuals are grateful to remain at house and stay engaged with household and pals.
PACE acts as a crucial security internet for low-income seniors, so that they and their households aren’t pressured into monetary damage. For these not Medicaid-eligible, it prices lower than the nursing house various.
To shut our system’s gaps and decrease spending, packages like PACE have to grow to be a extra outstanding a part of the dialogue. Policymakers ought to broaden entry to PACE companies so extra individuals can profit from this profitable mannequin of senior care.
— Richard Fish, CEO of One Senior Care, Erie, Pennsylvania
JoAnne Dyer echoed the dire warning concerning the draining price of long-term care in an X submit:
One thing scary that you just’re most likely not fascinated by however you most likely needs to be fascinated by. Lengthy-term care can bankrupt you. Sure, you. You along with your financial savings account and your 401k. https://t.co/OsaztigioN
— JoAnne Dyer (@7Madronas) November 15, 2023
— JoAnne Dyer, Seattle
Extra Energy to Suzanne Somers
Age 76 is fairly lengthy to battle an aggressive, metastatic breast most cancers with out chemotherapy (“Suzanne Somers’ Legacy Tainted by Superstar Medical Misinformation,” Oct. 18). I’d say Suzanne Somers proved her level! None of us lives without end. I bought a lumpectomy in 2015 and refused tamoxifen. Chemotherapy wasn’t wanted. I refuse mammograms and gynecology. I’m doing effectively. I discovered Ms. Somers’ e book on most cancers, referred to as “Knockout,” very informative. I didn’t purchase into the dietary supplements angle, nevertheless it empowered me in my very own battle, when there have been no solutions, to ask questions and analysis. High quality of life is extra essential.
— Kerry McCracken, Milan, Illinois
A Las Vegas reader reacted on X to the identical article revealed by the Los Angeles Occasions, one among KFF Well being Information’ media companions:
Ruthless Progressives and their company media trolls will proceed to hate you lengthy after you are useless and buried.https://t.co/BF3y1v1gki#Progressive #hate #corporatemedia #disinformation
— Grant David Gillham 🐎🗡️🌊🛩🔫🇲🇽🏍⛳🎸 (@CaptG2) October 19, 2023
— Grant David Gillham, Las Vegas
Over-the-Counter Narcan a Large Leap for Humankind
Thanks for sharing your article highlighting boundaries to accessing Narcan (“Narcan, Now Accessible With no Prescription, Can Nonetheless Be Laborious to Get,” Oct. 11). Whereas some consultants have questioned the importance of creating Narcan accessible over-the-counter, I firmly consider this improvement is a serious milestone in our ongoing battle in opposition to opioid-related fatalities.
One could argue that this alteration is merely a “tiny, tiny child step” and never deserving of applause; nevertheless, I’d contend that each optimistic change, irrespective of how small or late within the recreation, is an important half of a bigger resolution. Making Narcan accessible with no prescription is a tangible acknowledgment of the urgency of the opioid disaster and a recognition of the necessity for swift, accessible interventions.
Narcan’s OTC standing may help cut back the stigma surrounding opioid overdose and encourage open conversations about dependancy and hurt discount. It sends a message that saving lives is a precedence, and it encourages people to be ready to behave in emergencies.
Nonetheless, there are definitely challenges associated to affordability of OTC Narcan. Whereas $45 isn’t an excellent price ticket, group teams, first responders, state and native governments, and hurt discount teams — lots of whom could buy Narcan in bulk — should buy Narcan for a cheaper worth, $41 per two-dose carton.
Additionally it is essential to proceed educating pharmacists on using Narcan. Solely 19 states require that pharmacists full a coaching course previous to allotting naloxone in any capability. All pharmacists, particularly these positioned in areas with excessive charges of opioid deaths, have to be firmly geared up with the mandatory data on administering Narcan to be a trusted supply among the many public. Supplier schooling is a key steppingstone to enhancing entry.
Narcan’s OTC availability represents a optimistic shift in our strategy to combating opioid overdoses, and it’s a step that deserves acknowledgment and assist. Allow us to not underestimate the influence of this alteration and proceed working towards a future the place each individual has entry to the instruments they should forestall opioid-related fatalities.
— Sana Imam, grasp’s pupil at George Washington College, Washington, D.C.
The HIV Prevention Trials Community chimed in on X:
As an over-the-counter product, Narcan ideally would seem on retailer cabinets in the identical means as ibuprofen and cough remedy. https://t.co/fkzCZfwgFL
— HPTN (@HIVptn) October 11, 2023
A ‘Hit Piece’ on Rival Hospital Programs
I just lately learn your article of a few years in the past evaluating for-profit versus nonprofit medical colleges (“Montana Med Faculty Conflict Revives For-Revenue Vs. Nonprofit Flap,” June 7, 2021). I’m an anesthesiologist with 24 years of expertise, and virtually each well being care establishment or hospital has grow to be for-profit. In truth, most anesthesiology teams are managed by firms like NorthStar Anesthesia, U.S. Anesthesia Companions, and so on. Hospitals have merged into gigantic multibillion-dollar firms like Ascension, Common Well being Companies, HCA Healthcare, and CHI Well being.
So why is it so unhealthy to have a for-profit medical faculty, precisely? Nearly each facet of recent well being care has grow to be for-profit, and people nonprofit establishments have colluded with bigger programs to close down smaller hospitals. So this clearly is a “hit piece” on the for-profit academic system by their competitor, Touro School and College System.
I’m one of many few medical doctors really educated in a nonprofit — referred to as the U.S. Military, the place I did my residency in anesthesiology at Brooke Military Medical Middle. That is fairly an uninformed and unreasonable article, particularly given the state of the company well being care trade that’s pervasive in our nation. After I left the army for personal follow, I couldn’t consider what was being handed for elective surgical procedure exterior the army.
So let’s not get the pot and kettle confused right here. Calling out a for-profit medical faculty in an period dominated by giant multibillion-dollar well being care firms is definitely the pot calling the kettle black. And the agricultural Montana space is simply as a lot of a deserving space for any medical faculty — for-profit or nonprofit — as the agricultural state of West Virginia, the place I follow.
— Lance R. Hoover, Morgantown, West Virginia
Medicare Cuts Hurt Seniors’ Entry to Bodily Remedy Care
It’s disheartening to listen to tales of bodily therapists who’re more and more struggling to afford their coaching and price of residing whereas going through decrease pay (“Again Ache? Bum Knee? Be Ready to Watch for a Bodily Therapist,” Nov. 28). Nobody ought to have to surrender their dream of being a bodily therapist as a result of they fear the pay is unsustainable — particularly at a time when many sufferers have already got restricted entry to remedy care.
Sadly, that’s the truth for a lot of — particularly for the reason that Facilities for Medicare & Medicaid Companies just lately finalized one more yr of steep cost cuts to bodily, occupational, and speech remedy in its just lately launched Medicare Doctor Payment Schedule Remaining Rule for CY 2024.
CMS’ remaining rule features a troubling pay reduce of at the very least 3.4% to remedy suppliers in 2024. However in some geographic areas, that reduce could possibly be as excessive as over 4% due to the extremely technical system CMS makes use of to find out reimbursement. Not solely will this reduce weaken the pipeline of latest bodily therapists coming into the sector, however it is going to additionally put important monetary pressure on bodily therapists at present training, hurting retention, and probably resulting in follow closings, which all negatively influence affected person entry to bodily remedy.
Bodily remedy care is a critically essential non-pharmacological therapy choice for our nation’s getting old inhabitants. It helps sufferers handle ache, enhance mobility, and shield their independence, whereas avoiding reliance on highly effective painkillers and stopping probably lethal falls. It even saves CMS cash: On common, Medicare spending for beneficiaries who obtain bodily remedy as the primary therapy choice is 75% decrease than the overall common spending for Medicare sufferers who endure surgical procedure first.
Although it’s disappointing that CMS didn’t take heed to the affected person and supplier communities when finalizing but extra cuts, there’s nonetheless time for Congress to behave. I urge our lawmakers on Capitol Hill to work collectively and swiftly reverse the intense cuts within the new rule to assist stabilize our nation’s well being care system and broaden entry to bodily remedy look after sufferers.
— Nikesh Patel, government director of the Alliance for Bodily Remedy High quality and Innovation (APTQI), Washington, D.C.
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