Letters to the Editor is a periodic characteristic. 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 Thought
I not too long ago 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 Massive Guarantees to Acquire a Monopoly. They’re Failing to Ship,” Sept. 29). Properly, it was authorized, and right here is one more reason that monopolies are a nasty thought. My husband is a instructor in Tennessee, and it sophisticated our open enrollment alternatives 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 chance that Ballad will quickly be an out-of-network supplier for these with BCBST plans. Fortunately, the varsity district provides Cigna insurance coverage as nicely, however not all suppliers settle for that insurance coverage (as I mentioned, BCBST is a big insurer on this space).
Please clarify to me how it’s OK for a monopoly to determine 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 possibility 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 house employee shortages:
That is DEVASTATING! If CMS is saying they can’t determine a protected nursing employees stage for residents than how can surveyors maintain houses 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 Properties
I needed to thanks for offering a platform for dialogue of nursing house staffing (“Unique: CMS Examine Sabotages Efforts to Bolster Nursing Residence Staffing, Advocates Say,” Aug. 29). As a nursing scholar getting into my ultimate 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 answer 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 research was a shameful try to undermine the motion towards standardized staffing ratios at nursing houses. Individuals turn into residents at nursing houses for a lot of causes, however the reality is they’re there, above all, as a result of they want specialised care, which these houses want nurses to supply — companies resembling ventilator care, tube feedings, remedy, steady monitoring, and frequent interventions to stop strain accidents, and a lot extra. There’s something terribly fallacious when nursing houses can’t 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 usually are not repositioned in mattress, inflicting bedsores that may result in an infection.” Whereas this assertion is true, it’s fairly imprecise. Infections are a life-threatening danger related to strain accidents, however the sores themselves are grotesque and painful, some extent 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 stop 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 ample variety of nurses and employees 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 a substitute, 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 at present’s older adults are falling by way of the cracks. They could wrestle 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 provides built-in care by way of 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 1000’s yearly per participant. Additional, members are grateful to remain at house and stay engaged with household and mates.
PACE acts as a essential security web for low-income seniors, so that they and their households aren’t pressured into monetary wreck. For these not Medicaid-eligible, it prices lower than the nursing house various.
To shut our system’s gaps and decrease spending, applications like PACE have to turn into a extra outstanding 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 in regards to the draining value of long-term care in an X put up:
One thing scary that you just’re most likely not desirous about however you most likely ought to be desirous 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 Movie star Medical Misinformation,” Oct. 18). I’d say Suzanne Somers proved her level! None of us lives ceaselessly. 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’ e book on most cancers, referred to as “Knockout,” very informative. I didn’t purchase into the dietary supplements angle, however 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 necessary.
— Kerry McCracken, Milan, Illinois
A Las Vegas reader reacted on X to the identical article printed by the Los Angeles Occasions, considered one of 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 limitations to accessing Narcan (“Narcan, Now Out there With out a Prescription, Can Nonetheless Be Exhausting to Get,” Oct. 11). Whereas some consultants have questioned the importance of constructing Narcan out there over-the-counter, I firmly imagine this improvement is a significant milestone in our ongoing battle in opposition to opioid-related fatalities.
One might argue that this transformation 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 sport, is an important half of a bigger answer. Making Narcan out there and not using 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 perfect price ticket, neighborhood teams, first responders, state and native governments, and hurt discount teams — lots of whom might buy Narcan in bulk — should purchase Narcan for a cheaper worth, $41 per two-dose carton.
It is usually necessary to proceed educating pharmacists on the usage of 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, have to be firmly outfitted with the required info 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 method to combating opioid overdoses, and it’s a step that deserves acknowledgment and help. Allow us to not underestimate the affect of this transformation and proceed working towards a future the place each particular person 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 manner as ibuprofen and cough remedy. https://t.co/fkzCZfwgFL
— HPTN (@HIVptn) October 11, 2023
A ‘Hit Piece’ on Rival Hospital Techniques
I not too long ago 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 virtually each well being care establishment or hospital has turn into for-profit. In truth, most anesthesiology teams are managed by firms like NorthStar Anesthesia, U.S. Anesthesia Companions, and so forth. 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 contemporary well being care has turn 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 skilled in a nonprofit — referred to 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 army for personal follow, I couldn’t imagine 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 dealing with decrease pay (“Again Ache? Bum Knee? Be Ready to Look forward to 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 because the Facilities for Medicare & Medicaid Companies not too long ago finalized one more yr of steep cost cuts to bodily, occupational, and speech remedy in its not too long ago launched Medicare Doctor Price Schedule Closing Rule for CY 2024.
CMS’ ultimate rule features a troubling pay minimize of not less than 3.4% to remedy suppliers in 2024. However in some geographic areas, that minimize may very well 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 latest bodily therapists getting into the sector, however it’s going to additionally put important monetary pressure on bodily therapists at the moment practising, hurting retention, and probably resulting in follow closings, which all negatively affect affected person entry to bodily remedy.
Bodily remedy care is a critically necessary non-pharmacological remedy possibility for our nation’s growing old inhabitants. It helps sufferers handle ache, enhance mobility, and defend 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 remedy possibility is 75% decrease than the whole 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 broaden entry to bodily remedy take care of sufferers.
— Nikesh Patel, government director of the Alliance for Bodily Remedy High quality and Innovation (APTQI), Washington, D.C.