Readers Slam Hospital Monopolies and Blame the Feds for Understaffed Nursing Houses


Letters to the Editor is a periodic function. We welcome all feedback and can publish a range. We edit for size and readability and require full names.

Why Hospital Monopolies Are a Unhealthy Concept

I not too long ago 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). Properly, it was permitted, and right here is another excuse that monopolies are a foul concept. My husband is a trainer in Tennessee, and it difficult our open enrollment alternatives for 2024 insurance coverage. We now 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 presents Cigna insurance coverage as effectively, 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 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 decreased 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 generally known as Twitter, a consumer 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 protected 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 & repeat

— Politics, Insurance policies & Pop Tradition ✍️ (@out2sea90210) August 29, 2023

— Ashley Thomas, Cleveland, Ohio

The Disaster of Understaffed Nursing Houses

I needed to thanks for offering a platform for dialogue of nursing residence staffing (“Unique: CMS Research Sabotages Efforts to Bolster Nursing House Staffing, Advocates Say,” Aug. 29). As a nursing scholar getting into my ultimate 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 residence 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 and undermine the motion towards standardized staffing ratios at nursing properties. Folks change into residents at nursing properties for a lot of causes, however the truth is they’re there, above all, as a result of they want specialised care, which these properties want nurses to supply — providers equivalent to ventilator care, tube feedings, remedy, steady monitoring, and frequent interventions to stop strain accidents, and a lot extra. There’s something terribly mistaken when nursing properties can not present the providers that outline them, particularly when households and residents depend 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 should not repositioned in mattress, inflicting bedsores that may result in an infection.” Whereas this assertion is true, it’s somewhat obscure. 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 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 properties 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. 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 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 residence business. Disgrace! This is similar company that presides over handing Medicare to the for-profit business.

— Kay Tillow (@KayTillow) August 29, 2023

— Kay Tillow, Louisville, Kentucky

Avoiding Monetary Wreck for Growing older Elders

As Jordan Rau and Reed Abelson establish (“Going through Monetary Wreck as Prices Soar for Elder Care,” Nov. 14), too a lot of immediately’s older adults are falling by the cracks. They might battle with each day actions and declining well being however don’t essentially want 24/7 nursing residence care.

Inside the patchwork of long-term care, the Program of All-Inclusive Take care of the Aged is underutilized. PACE presents built-in care by its campus-based mannequin, the place contributors can obtain complete, coordinated medical care and social providers 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 1000’s yearly per participant. Additional, contributors are grateful to remain at residence and stay engaged with household and buddies.

PACE acts as a vital security web for low-income seniors, in order that they and their households aren’t pressured into monetary spoil. For these not Medicaid-eligible, it prices lower than the nursing residence various.

To shut our system’s gaps and decrease spending, packages like PACE must change into a extra distinguished a part of the dialogue. Policymakers ought to broaden entry to PACE providers 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 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 fascinated about however you most likely needs to be fascinated about. Lengthy-term care can bankrupt you. Sure, you. You together with your financial savings account and your 401k.

— JoAnne Dyer (@7Madronas) November 15, 2023

— JoAnne Dyer, Seattle

Extra Energy to Suzanne Somers

Age 76 is fairly lengthy to combat 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 acquired a lumpectomy in 2015 and refused tamoxifen. Chemotherapy wasn’t wanted. I refuse mammograms and gynecology. I’m doing effectively. I discovered Ms. Somers’ ebook on most cancers, known as “Knockout,” very informative. I didn’t purchase into the dietary supplements angle, however it empowered me in my very own combat, 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 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 lifeless and buried. #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 Accessible With no Prescription, Can Nonetheless Be Exhausting to Get,” Oct. 11). Whereas some consultants have questioned the importance of creating Narcan obtainable over-the-counter, I firmly imagine this improvement is a significant milestone in our ongoing battle towards opioid-related fatalities.

One could argue that this modification is merely a “tiny, tiny child step” and never deserving of applause; nevertheless, I’d contend that each constructive change, regardless of how small or late within the sport, is a crucial half of a bigger answer. Making Narcan obtainable 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 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 really perfect price ticket, neighborhood teams, first responders, state and native governments, and hurt discount teams — a lot of whom could buy Narcan in bulk — should purchase Narcan for a cheaper worth, $41 per two-dose carton.

It’s also vital to proceed educating pharmacists on the usage of 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, should 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 enhancing entry.

Narcan’s OTC availability represents a constructive 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 modification and proceed working towards a future the place each particular person has entry to the instruments they should stop 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 method as ibuprofen and cough remedy.

— HPTN (@HIVptn) October 11, 2023

A ‘Hit Piece’ on Rival Hospital Methods

I not too long ago 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 change into for-profit. In reality, most anesthesiology teams are managed by companies like NorthStar Anesthesia, U.S. Anesthesia Companions, and many others. Hospitals have merged into gigantic multibillion-dollar companies like Ascension, Common Well being Companies, HCA Healthcare, and CHI Well being.

So why is it so dangerous to have a for-profit medical faculty, precisely? Virtually each side of contemporary well being care has change 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 academic system by their competitor, Touro Faculty and College System.

I’m one of many few medical doctors really skilled in a nonprofit — known 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. Once I left the navy for personal observe, 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 giant 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 observe.

— 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 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 for the reason that 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 Charge Schedule Remaining Rule for CY 2024.

CMS’ ultimate rule features a troubling pay reduce of at the least 3.4% to remedy suppliers in 2024. However in some geographic areas, that reduce 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 reduce weaken the pipeline of latest bodily therapists getting into the sphere, however it can additionally put vital monetary pressure on bodily therapists at the moment working towards, hurting retention, and probably resulting in observe closings, which all negatively impression affected person entry to bodily remedy.

Bodily remedy care is a critically vital non-pharmacological remedy possibility for our nation’s growing older 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 remedy possibility is 75% decrease than the entire 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 take care of sufferers.

— Nikesh Patel, govt director of the Alliance for Bodily Remedy High quality and Innovation (APTQI), Washington, D.C.

KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working packages at KFF—an unbiased supply of well being coverage analysis, polling, and journalism. Study extra about KFF.


This story could be republished without cost (particulars).


Leave a Comment