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 Thought
I just lately learn the article about Ballad Well being by Brett Kelman and Samantha Liss relating to 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 Achieve a Monopoly. They’re Failing to Ship,” Sept. 29). Effectively, it was authorised, and right here is another excuse that monopolies are a foul thought. 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 had been despatched notification that Ballad Well being and BCBST had been in negotiations and that there was a excessive chance that Ballad will quickly be an out-of-network supplier for these with BCBST plans. Fortunately, the varsity district presents Cigna insurance coverage as nicely, 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 had 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 most important insurance coverage supplier in my space. Simply meals for thought.
— Kimberly Ensor, Johnson Metropolis, Tennessee
On X, previously generally known as Twitter, a consumer whose tagline is “a one-woman wrecking ball” had this to say about nursing dwelling employee shortages:
That is DEVASTATING! If CMS is saying they can not determine a secure nursing workers degree for residents than how can surveyors maintain properties 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 wished to thanks for offering a platform for dialogue of nursing dwelling staffing (“Unique: CMS Research Sabotages Efforts to Bolster Nursing Residence Staffing, Advocates Say,” Aug. 29). As a nursing scholar getting into my remaining semester at SUNY Downstate, I’ve seen firsthand the destitute circumstances of understaffed nursing properties. Staffing ratios are abysmal and, as I see it, the one answer for the well-being of nursing dwelling 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 and undermine the motion towards standardized staffing ratios at nursing properties. Individuals change 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 similar to ventilator care, tube feedings, remedy, steady monitoring, and frequent interventions to forestall strain accidents, and a lot extra. There’s something terribly fallacious when nursing properties can’t present the companies that outline them, particularly when households and residents rely on them to take action.
I do assume 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 quite imprecise. Infections are a life-threatening threat related to strain accidents, however the sores themselves are grotesque and painful, some extent I feel ought to have been included to emphasise the injustice of permitting strain accidents to develop and worsen. Well being care employees 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 simple 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. Individuals of all ages and backgrounds stay in nursing properties, and their wants are as numerous as they’re themselves. The one common commonality they’ve is that they stay in nursing properties and wish respect, dignity, care, and an enough 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 dwelling business. Disgrace! This is identical company that presides over handing Medicare to the for-profit business. https://t.co/xYpKySzkwJ
— Kay Tillow (@KayTillow) August 29, 2023
— Kay Tillow, Louisville, Kentucky
Avoiding Monetary Smash for Getting older Elders
As Jordan Rau and Reed Abelson determine (“Dealing with Monetary Smash as Prices Soar for Elder Care,” Nov. 14), too lots of right now’s older adults are falling by way of the cracks. They could battle with every day actions and declining well being however don’t essentially want 24/7 nursing dwelling care.
Throughout the patchwork of long-term care, the Program of All-Inclusive Look after the Aged is underutilized. PACE presents built-in care by way of its campus-based mannequin, the place contributors can obtain complete, coordinated medical care and social companies in a mixed Medical Clinic and Day Middle, whereas additionally receiving at-home help with important duties like dressing, bathing, and consuming.
This care is free to our dually eligible contributors who’re by no means saddled with copays, out-of-pocket prices, or deductibles. PACE has saved states hundreds yearly per participant. Additional, contributors are grateful to remain at dwelling and stay engaged with household and associates.
PACE acts as a important security web for low-income seniors, so that they and their households aren’t compelled into monetary damage. For these not Medicaid-eligible, it prices lower than the nursing dwelling different.
To shut our system’s gaps and decrease spending, applications like PACE must change into a extra outstanding a part of the dialogue. Policymakers ought to develop 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 in regards to the draining price of long-term care in an X put up:
One thing scary that you just’re most likely not excited about however you most likely ought to be excited about. 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 Celeb Medical Misinformation,” Oct. 18). I’d say Suzanne Somers proved her level! None of us lives eternally. I received a lumpectomy in 2015 and refused tamoxifen. Chemotherapy wasn’t wanted. I refuse mammograms and gynecology. I’m doing nicely. I discovered Ms. Somers’ ebook on most cancers, referred to as “Knockout,” very informative. I didn’t purchase into the dietary supplements angle, but it surely empowered me in my very own battle, when there have been no solutions, to ask questions and analysis. High quality of life is extra vital.
— Kerry McCracken, Milan, Illinois
A Las Vegas reader reacted on X to the identical article revealed by the Los Angeles Instances, one among KFF Well being Information’ media companions:
Ruthless Progressives and their company media trolls will proceed to hate you lengthy after you are lifeless 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 And not using a Prescription, Can Nonetheless Be Onerous to Get,” Oct. 11). Whereas some specialists 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 in opposition to opioid-related fatalities.
One could argue that this alteration is merely a “tiny, tiny child step” and never deserving of applause; nonetheless, I might contend that each optimistic change, regardless of how small or late within the sport, is an important half of a bigger answer. 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 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 a perfect price ticket, group teams, first responders, state and native governments, and hurt discount teams — lots of whom could buy Narcan in bulk — can purchase Narcan for a cheaper value, $41 per two-dose carton.
It is usually vital to proceed educating pharmacists on using Narcan. Solely 19 states require that pharmacists full a coaching course previous to shelling out 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 required data on administering Narcan to be a trusted supply among the many public. Supplier schooling is a key steppingstone to bettering 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 help. Allow us to not underestimate the impression 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 scholar 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 approach 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 faculties (“Montana Med College Conflict Revives For-Revenue Vs. Nonprofit Flap,” June 7, 2021). I’m an anesthesiologist with 24 years of expertise, and nearly each well being care establishment or hospital has change into for-profit. Actually, most anesthesiology teams are managed by companies like NorthStar Anesthesia, U.S. Anesthesia Companions, and so forth. Hospitals have merged into gigantic multibillion-dollar companies 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? Virtually each facet of recent well being care has change into for-profit, and people nonprofit establishments have colluded with bigger methods 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 docs actually 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 business that’s pervasive in our nation. After I left the navy for personal apply, I couldn’t imagine what was being handed for elective surgical procedure outdoors 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 companies 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 apply.
— 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 dwelling whereas going through 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 for the reason that Facilities for Medicare & Medicaid Providers just lately finalized yet one more yr of steep fee cuts to bodily, occupational, and speech remedy in its just lately launched Medicare Doctor Price Schedule Closing Rule for CY 2024.
CMS’ remaining rule features a troubling pay minimize of no less than 3.4% to remedy suppliers in 2024. However in some geographic areas, that minimize might be as excessive as over 4% due to the extremely technical components CMS makes use of to find out reimbursement. Not solely will this minimize weaken the pipeline of latest bodily therapists getting into the sector, however it’ll additionally put vital monetary pressure on bodily therapists at the moment working towards, hurting retention, and doubtlessly resulting in apply closings, which all negatively impression affected person entry to bodily remedy.
Bodily remedy care is a critically vital non-pharmacological therapy choice for our nation’s getting older inhabitants. It helps sufferers handle ache, enhance mobility, and shield 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 overall common spending for Medicare sufferers who bear 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 develop entry to bodily remedy take care of sufferers.
— Nikesh Patel, govt director of the Alliance for Bodily Remedy High quality and Innovation (APTQI), Washington, D.C.
