It’s appalling that an article like this even must be written. Our “healthcare” system is damaged.The right way to do away with medical debt — or keep away from it within the first place https://t.co/EIo7lHps8k
— Karin Wiberg (@kswiberg) July 1, 2022
— Karin Wiberg, Raleigh, North Carolina
I simply wish to thanks from the underside of my coronary heart for the work you do this exposes the utter brokenness of America’s well being system (“Analysis: Debt: The right way to Get Rid of Medical Debt — Or Keep away from It within the First Place,” July 1). You’re serving to to repair it!
— Ruth Worley, Athens, Ohio
Recovering from being sick or caring for a sick cherished one mustn’t wreck any American’s funds. Listed below are some ways to navigate the system. https://t.co/ykvDkUecj0
— Bayeté (@BayeteKenan) July 10, 2022
— Bayeté Ross Smith, Harlem, New York
Sufferers Left Holding the Bag
Your “Analysis: Debt” articles are attention-grabbing and function additional examples of how the well being care business is about up for the well being care system and never the individuals who use it.
Within the USA, medical debt shouldn’t be a problem, however we don’t train individuals the best way to save or perceive the best way to navigate the system. I’m a nurse blogger/advocate and see the repercussions of what individuals undergo who’ve insufficient insurance coverage and lack financial savings or the power to grasp what is going on to them when they’re thrust into the complicated well being care system. However, in actuality, none of us actually take into consideration our well being or the well being care system until we’re in the midst of a disaster. If we’re trustworthy, none of us are actually ready for a catastrophic occasion, and that is what we have to work on going additional by way of training and advocacy.
I’ll proceed to teach the general public in my small manner so individuals can perceive their position in our well being care system so they’re ready for a medical occasion and know that they’ll use their voice to talk up and advocate for themselves.
— Anne Llewellyn, Plantation, Florida
Portland has turn out to be a wasteland! The place are the environmentalists at the least? Oh yeah, they’re all of their gated communities, worrying about local weather change and plastic straws for the remainder of us. (hope you may see this LA Instances article)https://t.co/WrboM9vtPs
— Bob Beddingfield (@bobbeddingfield) June 23, 2022
— Bob Beddingfield, Houston
Vacation spot: Catastrophe
We visited Portland, Oregon, a yr in the past for a trip and we are going to by no means return: shops that don’t give baskets as a result of individuals use them to steal. Shops that put poles on carts to maintain individuals from racing out of the shop with them stuffed with merchandise. Closed storefronts. Homeless individuals all over the place (“Sobering Classes in Untying the Knot of a Homeless Disaster,” June 21).
It was like a Third World nation. I’m not a Republican, very removed from it, however accepting the concept that anybody who desires can reside on the streets, dump their trash, and get backed by the town can not finish effectively. And this drawback shouldn’t be restricted to Portland. San Francisco is in a really comparable scenario with crime, drug abuse, and homelessness.
There is no such thing as a one-size-fits-all answer. Throwing cash on the drawback after which ignoring the persevering with unresolved drawback hasn’t labored and, I feel, by no means will.
The concept a metropolis can host a vast variety of drug and alcohol addicts at public expense gained’t work.
The concept shoplifting, automobile break-ins, robberies, and many others. are allowed, not arrested, not prosecuted, not punished can by no means work out effectively.
And folks marvel why the Democrats are in such deep, deep hassle regardless of the horrible concepts the Republicans promote.
This won’t finish effectively.
— David Alexander, Palo Alto, California
Fairly doable the perfect information story about our native homeless challenges I’ve learn lately. ‘Not protected anymore’: Portland confronts the boundaries of its assist for homeless companies #homless #Portland https://t.co/Ujr5KzhYAi
— Ben Brown Jr. (@BenBrownJunior) June 22, 2022
— Ben Brown Jr., Beaverton, Oregon
On Wheelchair Repairs, Steering Away from Error
Because the CEO of Nationwide Seating & Mobility (NSM), I applaud the work of KHN in offering in-depth reporting about necessary points in well being care, together with the complicated rehabilitation know-how (CRT) business.
Nevertheless, the latest article “Regardless of a First-Ever ‘Proper-to-Restore’ Legislation, There’s No Straightforward Repair for Wheelchair Customers” (June 2) offered a number of inaccuracies, misrepresentations, and errors in its characterization of NSM and our work.
The article acknowledged that NSM and different CRT suppliers have restricted their investments in service and restore to extend earnings. NSM management has constantly invested in our service and restore enterprise, together with establishing a profession path and certification program to professionalize the service technician position, bettering onboarding and ongoing coaching packages, reorganizing our funding crew to introduce repair-specific funding specialists to raised help purchasers within the restore course of, investing in market evaluation on aggressive wages that resulted in a 15%-20% hourly pay improve for technicians, and extra. In 2022, NSM has nearly 500 service technicians on employees, which is 22% extra technicians per depend of client-delivered orders versus 2019. Our funding in service and restore is long-standing and can proceed.
The article additionally urged that Medicare’s use of aggressive bidding favors giant firms, usually on the expense of high quality and customer support. NSM was not a part of the earlier bidding session for sturdy medical tools (DME) to ascertain present charges and was not awarded any Medicare contracts because of this. Many of the merchandise we offer are thought of CRT and are exempt from the aggressive bid course of and pricing. Attributable to part 16005 of the twenty first Century Cures Act and Home Invoice H.R. 1865, product codes that can be utilized for CRT or fundamental DME are paid on the regular fee for CRT as a substitute of aggressive pricing.
Lastly, the article makes false assumptions about our firm: that we preserve a restricted stock of elements, and we have now little incentive to rent technicians or pay for coaching as a result of we lose cash with repairs.
Every mobility answer — and due to this fact every restore—is very personalized to a consumer’s wants. This customization means elements which might be changed much less regularly throughout our consumer inhabitants aren’t prone to be stocked versus these elements which might be regularly changed. The present world provide chain disruption has additionally affected our stock; the quantity of inventory we have now available is solely dependent upon availability. Moreover, the labor scarcity our nation is experiencing has created a problem throughout all industries, ours included.
Restore reimbursement is a loss-leader for the CRT business, exacerbated lately resulting from inflation within the provide chain and labor markets. Whereas different firms are compelled to show down repairs resulting from these challenges, NSM continues to supply repairs as a result of it’s the proper factor to do.
NSM is a customer support enterprise, incomes our enterprise in each consumer interplay. We acknowledge enhancements are wanted, and we’re dedicated to investing in advocacy, packages, and collaborative business efforts to guide our business in a brand new course to enhance the lives of these we serve.
— Invoice Mixon, CEO of Nationwide Seating & Mobility, Franklin, Tennessee
— W. Ron Adams (@WRonAdams) June 11, 2022
— W. Ron Adams, Erlanger, Kentucky
These of us have additionally labored so onerous to get landmark laws handed throughout the nation, together with a very necessary first step in Colorado on the fitting to restore wheelchairs: https://t.co/xaZPRnaYDD
— Hayley Tsukayama (@htsuka) June 3, 2022
— Hayley Tsukayama, San Francisco
Clearing the Air on Vaping vs. Smoking
I simply listened to your piece on the FDA banning Juul (“KHN’s ‘What the Well being?’: The FDA Goes After Nicotine,” June 23). One among your panelists talked about she’d learn (truly, she stated she’d learn solely the headline) about diacetyl (she didn’t wish to even attempt to pronounce this) and popcorn lung.
I imagine it’s irresponsible for so-called scientific specialists to touch upon issues they haven’t learn correctly and issues they clearly don’t have any information about. Diacetyl is current in cigarette smoke in concentrations a whole bunch of occasions larger than in vape merchandise and but there hasn’t been a single case of popcorn lung attributed to smoking. Something to do with the toxicity of a chemical current should certainly make reference to the concentrations, placing it in context. The truth that a chemical is detectable clearly doesn’t imply that it’s dangerous within the concentrations current.
There’s a horrible misunderstanding amongst shoppers and certainly well being care professionals relating to the relative harms of vaping vs. smoking — provided that the overwhelming majority of vapers are ex- or present cigarette people who smoke, that is the related level.
I counsel that the scientific credibility of your program is compromised by such sloppy and inaccurate commentary.
— Mark Dickinson, Twickenham, Middlesex, United Kingdom
Be cautious when large firms are available in to “save” native establishments, whether or not it’s the hometown newspaper, native training or the hospital.https://t.co/gV4ZJDkR71
— Dave Gragg (@DaveGragg) June 15, 2022
— Dave Gragg, Republic, Missouri
Shoring Up Rural Care
Since 2010, 138 rural hospitals have closed, leaving many communities with out entry to well being care. In rural areas, this may create a domino impact of different hardships — a hospital usually serves as the biggest employer, and when these amenities shut down, the ironmongery shop or eating places usually face comparable fates. Put merely, when a rural hospital shutters, it turns into tougher for the city itself to outlive (“Sufferers for Revenue: Purchase and Bust: When Personal Fairness Comes for Rural Hospitals,” June 15).
Then there may be probably the most essential side: With out hospitals, rural Individuals lose well timed entry to lifesaving medical care. On common, the gap between a rural hospital and the closest facility with 100 or extra acute care beds is 28.9 miles. Preserving entry to care in our rural communities and making certain hospitals stay the cornerstone of the economic system is crucial. For this reason addressing the hospital closure disaster have to be a prime precedence in Congress.
To find out what must be finished, it may be useful to look at the reason for the disaster. A number of components have contributed to the excessive variety of rural hospital closures over the previous decade, with two main components being slim or unfavorable hospital working margins and workforce shortages. The covid-19 pandemic has additional strained the well being care business, resulting in elevated ranges of supplier burnout and perpetuating the workforce scarcity.
On prime of this, rural suppliers proceed to really feel the pressure of Medicare sequestration, which reduces eligible funds to rural hospitals from Medicare by 2%. Reduction from Medicare sequestration throughout the pandemic expired on April 1, contributing to the monetary burdens rural hospitals already face. With many rural hospitals already working on unfavorable margins, these decreased reimbursements may very well be disastrous.
Additional, resulting from latest statutory modifications, provider-based rural well being clinics affiliated with small rural hospitals are usually not eligible for cost-based reimbursement as they traditionally have been. Except Congress addresses this shortcoming, it might not be financially possible for small rural hospitals to supply main care in these settings, and care gaps in rural communities might widen.
Reps. Sam Graves, a Republican from Missouri, and Jared Huffman, a Democrat from California, labored collectively to introduce the Save America’s Rural Hospital Act. This laws will assist rural well being care suppliers preserve their doorways open and guarantee rural communities have entry to the care they want and deserve.
For instance, it’ll completely eradicate Medicare sequestration for rural hospitals, permitting these amenities to be reimbursed for the whole lot of their eligible price. It’s going to make everlasting elevated Medicare funds for floor ambulance companies in rural and tremendous rural areas. Additional, this invoice will reauthorize the Medicare Rural Hospital Flexibility Program to supply new grants to assist eligible rural suppliers transition to new fashions and evolve to fulfill neighborhood wants of their altering well being care environments.
To deal with potential main care shortages, it’ll additionally create a voluntary high quality measure reporting program for provider-based rural well being clinics. If these amenities select to take part, they are going to obtain elevated reimbursement in trade.
Well being care entry is essential to preserving the agricultural lifestyle for greater than 60 million rural Individuals. This laws have to be thought of to make sure stability in our communities, which is able to in the end profit the nation as an entire.
— Alan Morgan, CEO of NRHA, Kansas Metropolis, Missouri
In brief, our system shouldn’t be arrange for the distinctive wants of rural hospitals, making them financially stretched. Personal fairness swoops in, buys the hospital, takes the COVID-19 reduction cash, closes the hospital, then runs. #ruralhealth https://t.co/qZBHG7yeeH
— Whitney Zahnd (@WhitneyZahnd) June 15, 2022
— Whitney Zahnd, Iowa Metropolis, Iowa
A Pitch for Built-in Behavioral Well being
I’m a scientific psychologist who works at a big, safety-net educational well being middle in Colorado. I’m writing about your latest article “Sufferers Search Psychological Well being Care From Their Physician however Discover Well being Plans Standing within the Manner” (June 8). I admire the main focus of this text on among the limitations sufferers face in attempting to entry psychological well being care within the U.S. Nevertheless, I used to be a bit involved that your article didn’t point out the quickly rising subject of built-in behavioral well being. Though I perceive that not all main care suppliers’ places of work make use of an built-in behavioral well being clinician, the numbers are rising rapidly throughout the nation. For instance, within the hospital the place I work, there may be at the least one IBH clinician in each neighborhood main care middle, and in many of the specialty clinics (e.g. oncology, OB-GYN) as effectively.
Whereas I feel PCPs are definitely in a position to dispense basic-level psychological well being recommendation (e.g., belly respiration workout routines for nervousness), I don’t suppose the reply is to show over psychological well being care to medical professionals, any greater than I imagine it could be a good suggestion to show over a affected person’s diabetes administration to a psychologist, even when that psychologist had some fundamental coaching in the best way to deal with diabetes. As an alternative, I imagine it’s in sufferers’ finest pursuits to proceed to advocate and nurture a team-based method that features each medical and psychological well being specialists throughout the similar clinic.
— Trina Seefeldt, Denver
This insanity should cease. Most of us in main care do tackle/deal with psychological well being issues. #insurance coverage #healthcare #SinglePayer would resolve this. Sufferers Search Psychological Well being Care From Their Physician However Discover Well being Plans Standing within the Manner https://t.co/YyAzJ0GylL by way of @khnews
— Andrea DeSantis DO (@adesantisb) June 10, 2022
— Dr. Andrea DeSantis, Charlotte, North Carolina
In Protection of Free Clinics
I used to be studying with curiosity — after which dismay — at your article revealed June 23 on the Hispanic insurance coverage hole (“Trump’s Legacy Looms Massive as Colorado Goals to Shut the Hispanic Insurance coverage Hole”). Within the opening paragraphs, you reference a person who had signs that “free clinics advised him have been hemorrhoids however have been truly colon most cancers.”
In that one phrase, you single-handedly and forcefully implied that free clinics ship poor care and are to not be trusted. With the following sentence about his tragic demise, you solidify that implication.
As a charitable clinic with greater than 26 years of serving the uninsured in our neighborhood, I take nice exception to this careless mischaracterization of a sector that has delivered high-quality care to tens of millions of people that have fallen by way of the cracks.
Most free and charitable clinics take care of individuals with completely no insurance coverage. This may considerably restrict the quantity of outdoor testing and diagnostics that may be finished with sufferers, even when they’re symptomatic. Up till this yr, our clinic had completely no choice for sending somebody to a gastroenterologist for a colonoscopy except they have been prepared to pay out-of-pocket — upward of $5,000. We’ve to commonly inform people who we do not need any good choices for them as a result of we can not entry sure specialists or assessments. Do they want it? Sure. Can we offer it to them? No. Does this unbelievable inequity and frustration with the well being care system that stops our sufferers from getting the superior care they want weigh on us every single day? Completely.
Free and charitable clinics are usually not a part of the issue. They’re a part of the answer. And the broad generalization you made impacts how the general public perceives this extremely necessary piece of the well being care sector.
For extra data on free and charitable clinics, I invite readers to study in regards to the Nationwide Affiliation of Free and Charitable Clinics at https://nafcclinics.org/.
— Suzanne Hoban, govt director of Household Well being Partnership Clinic, Crystal Lake, Illinois