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Letters to the Editor is a periodic function. We welcome all feedback and can publish a variety. We edit for size and readability and require full names.
Why Hospital Monopolies Are a Unhealthy Concept
I 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 Massive Guarantees to Acquire a Monopoly. They’re Failing to Ship,” Sept. 29). Nicely, it was authorised, and right here is one more reason that monopolies are a foul concept. My husband is a instructor in Tennessee, and it sophisticated our open enrollment picks for 2024 insurance coverage. Now we have used BlueCross BlueShield of Tennessee, a extensively chosen insurer in our state. We have been despatched notification that Ballad Well being and BCBST have 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 college district provides Cigna insurance coverage as properly, however not all suppliers settle for that insurance coverage (as I stated, 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 have been to occur that my insurance coverage protection can be lowered to 60%-40% from 80%-20%, all as a result of my solely choice for emergency care (Ballad) selected to not negotiate with the biggest insurance coverage supplier in my space. Simply meals for thought.
— Kimberly Ensor, Johnson Metropolis, Tennessee
On X, previously often called Twitter, a person whose tagline is “a one-woman wrecking ball” had this to say about nursing residence employee shortages:
That is DEVASTATING! If CMS is saying they can’t establish a secure nursing workers stage for residents than how can surveyors maintain properties accountable? It ain’t taking place 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 Houses
I wished to thanks for offering a platform for dialogue of nursing residence staffing (“Unique: CMS Examine Sabotages Efforts to Bolster Nursing House Staffing, Advocates Say,” Aug. 29). As a nursing pupil coming into my last semester at SUNY Downstate, I’ve seen firsthand the destitute situations of understaffed nursing properties. Staffing ratios are abysmal and, as I see it, the one resolution for the well-being of nursing residence residents is a accountable staff-to-resident ratio.
I wholeheartedly agreed with the sentiment of the article: The Abt Associates research was a shameful try to undermine the motion towards standardized staffing ratios at nursing properties. Folks develop into residents at nursing properties for a lot of causes, however the reality is they’re there, above all, as a result of they want specialised care, which these properties want nurses to offer — companies resembling ventilator care, tube feedings, medicine, steady monitoring, and frequent interventions to forestall strain accidents, and a lot extra. There’s something terribly incorrect when nursing properties can not present the companies that outline them, particularly when households and residents rely upon them to take action.
I do assume there have been some missed alternatives within the article. For instance, Jordan Rau writes that “motionless residents will not be 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 threat related to strain accidents, however the sores themselves are grotesque and painful, a degree I believe ought to have been included to emphasise the injustice of permitting strain 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 properties as homogenous and stereotypical aged individuals who have been forgotten as they turned burdensome, which isn’t solely false, however actively dangerous and agist. Folks of all ages and backgrounds reside in nursing properties, and their wants are as numerous as they’re themselves. The one common commonality they’ve is that they reside in nursing properties and want respect, dignity, care, and an ample 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 residence 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 Growing older Elders
As Jordan Rau and Reed Abelson establish (“Going through Monetary Spoil as Prices Soar for Elder Care,” Nov. 14), too a lot of as we speak’s older adults are falling by the cracks. They might battle with day by day actions and declining well being however don’t essentially want 24/7 nursing residence care.
Throughout the patchwork of long-term care, the Program of All-Inclusive Take care of the Aged is underutilized. PACE provides built-in care by its campus-based mannequin, the place members can obtain complete, coordinated medical care and social companies in a mixed Medical Clinic and Day Heart, whereas additionally receiving at-home help with important duties like dressing, bathing, and consuming.
This care is free to our dually eligible members who’re by no means saddled with copays, out-of-pocket prices, or deductibles. PACE has saved states hundreds yearly per participant. Additional, members are grateful to remain at residence and stay engaged with household and pals.
PACE acts as a vital security internet for low-income seniors, so that they and their households aren’t pressured into monetary spoil. For these not Medicaid-eligible, it prices lower than the nursing residence different.
To shut our system’s gaps and decrease spending, packages like PACE have to develop into a extra distinguished a part of the dialogue. Policymakers ought to broaden entry to PACE companies so extra folks 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 simply’re most likely not interested by however you most likely ought to be interested 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 struggle 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 ceaselessly. I acquired a lumpectomy in 2015 and refused tamoxifen. Chemotherapy wasn’t wanted. I refuse mammograms and gynecology. I’m doing properly. I discovered Ms. Somers’ ebook on most cancers, known as “Knockout,” very informative. I didn’t purchase into the dietary supplements angle, nevertheless it empowered me in my very own struggle, when there have been no solutions, to ask questions and analysis. High quality of life is extra necessary.
— 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 Massive Leap for Humankind
Thanks for sharing your article highlighting obstacles to accessing Narcan (“Narcan, Now Obtainable And not using a Prescription, Can Nonetheless Be Laborious to Get,” Oct. 11). Whereas some consultants have questioned the importance of creating Narcan out there over-the-counter, I firmly imagine this improvement is a serious milestone in our ongoing battle towards opioid-related fatalities.
One might argue that this modification is merely a “tiny, tiny child step” and never deserving of applause; nevertheless, I might contend that each constructive change, regardless of how small or late within the recreation, is a crucial half of a bigger resolution. Making Narcan out there with out a 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 scale back the stigma surrounding opioid overdose and encourage open conversations about habit 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 a super price ticket, group teams, first responders, state and native governments, and hurt discount teams — a lot of whom might buy Narcan in bulk — should purchase Narcan for a cheaper value, $41 per two-dose carton.
It’s also necessary to proceed educating pharmacists on using Narcan. Solely 19 states require that pharmacists full a coaching course previous to meting out naloxone in any capability. All pharmacists, particularly these positioned in areas with excessive charges of opioid deaths, must be firmly outfitted 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 constructive shift in our method to combating opioid overdoses, and it’s a step that deserves acknowledgment and help. Allow us to not underestimate the affect of this modification 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 medicine. https://t.co/fkzCZfwgFL
— HPTN (@HIVptn) October 11, 2023
A ‘Hit Piece’ on Rival Hospital Methods
I 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 develop into 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 Providers, 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 develop into for-profit, and people nonprofit establishments have colluded with bigger techniques to close down smaller hospitals. So this clearly is a “hit piece” on the for-profit instructional system by their competitor, Touro Faculty and College System.
I’m one of many few medical doctors actually skilled in a nonprofit — known as the U.S. Military, the place I did my residency in anesthesiology at Brooke Military Medical Heart. 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 navy for personal follow, I couldn’t imagine what was being handed for elective surgical procedure exterior the navy.
So let’s not get the pot and kettle confused right here. Calling out a for-profit medical faculty in an period dominated by massive 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 value of residing whereas dealing with decrease pay (“Again Ache? Bum Knee? Be Ready to Await 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 fact for a lot of — particularly because the Facilities for Medicare & Medicaid Providers lately finalized one more 12 months of steep fee cuts to bodily, occupational, and speech remedy in its lately launched Medicare Doctor Charge Schedule Last Rule for CY 2024.
CMS’ last rule features a troubling pay minimize of at the least 3.4% to remedy suppliers in 2024. However in some geographic areas, that minimize could possibly be as excessive as over 4% due to the extremely technical formulation CMS makes use of to find out reimbursement. Not solely will this minimize weaken the pipeline of recent bodily therapists coming into the sector, however it can additionally put vital monetary pressure on bodily therapists at present working towards, hurting retention, and doubtlessly resulting in follow closings, which all negatively affect affected person entry to bodily remedy.
Bodily remedy care is a critically necessary non-pharmacological therapy choice for our nation’s getting older inhabitants. It helps sufferers handle ache, enhance mobility, and defend their independence, whereas avoiding reliance on highly effective painkillers and stopping doubtlessly 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 whole 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, govt director of the Alliance for Bodily Remedy High quality and Innovation (APTQI), Washington, D.C.
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