Readers Name on Congress to Bolster Medicare and Repair Loopholes in Health Coverage

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Occupational Therapists Alternate Lives. CMS Must Better Purple meat up Them.

Occupational therapists are necessary in serving to sufferers modify to original cases, empowering them with the tools they occupy to overcome barriers and decide up regulate over their lives. Whether you’re transitioning from homelessness into a dwelling (“In Los Angeles, Occupational Therapists Tapped to Aid Homeless Stop Housed,” Jan. 24) or relearning how to total day to day tasks following a stroke, OTs are key to sufferers’ care realizing.

Nonetheless the necessary care offered by OTs is being threatened by every other 300 and sixty five days of fee cuts imposed by Medicare, our nation’s health care program for of us age 65 and up. Many older sufferers handled by OTs entry insurance coverage thru Medicare, which customarily reimburses companies at a lower fee than inner most insurers. And now, with fee cuts that went into enact on Jan. 1 — despite warnings and backlash from lawmakers, sufferers, and companies — OTs are struggling to shriek care with lower Medicare fee.

Investing in occupational therapy improves health outcomes for sufferers, has the aptitude to lower the burden on hospitals and diversified health care clinicians, and keeps people wholesome and fair. Medicare’s fee cuts simplest compromise the flexibility of companies to shriek total, compassionate care. Medicare must sight the prolonged-term patient advantages occupational therapy has to give.

Fortunately, Congress is enthralling a pair of bill that would reverse these unsafe fee cuts. The Maintaining Seniors’ Access to Physicians Act of 2023 (HR 6683), would reverse the cuts that went into enact on Jan. 1, alleviating monetary stress for occupational therapists and maintaining patient entry. I strongly slouch lawmakers to prioritize and offer protection to occupational therapy products and companies and straight away trot HR 6683 for The US’s Medicare sufferers.

— Doug Fosco, an occupational therapist training at Two Trees Bodily Therapy in Ventura, California

An assistant professor at Ontario’s Western College weighed in on X.

— Carrie Anne Marshall, Sydenham, Ontario

Congress Must Enact the Job on Set-Neutral Funds

There’s an evident resolution to rein in executive spending and patient out-of-pocket costs: Pay an identical costs for an identical care (“In Fight Over Medicare Funds, the Hospital Foyer Exhibits Its Strength,” Feb. 13).

As a community oncologist, it is evident to me how Medicare favors hospitals by paying extra for products and companies offered in sanatorium outpatient departments (HOPDs) than the identical care delivered in community-essentially essentially essentially based facilities. Let’s instruct, final 300 and sixty five days, Medicare paid over 2.5 instances as valuable in an HOPD as in a free-standing teach of enterprise for drug administration products and companies. It’s no longer factual Medicare paying too valuable; sufferers also face increased out-of-pocket costs for care offered in HOPDs. If the Decrease Charges, Extra Transparency Act is signed into law, most cancers sufferers would straight away pay much less for treatments like chemotherapy.

One unintended ruin result of present fee disparities is consolidation. To leverage increased reimbursements, health programs scoop up fair practices — a rising teach that is terribly pronounced in oncology. From 2008 to 2020435 community most cancers clinics closed, while 722 reduced in dimension with or had been bought by hospitals. This consolidation is cutting back patient entry, namely in rural areas, where many fair clinics feature cramped satellite tv for laptop websites that are usually the principle to shut when hospitals have a community-essentially essentially essentially based allege.

It’s time for Congress to enact the job thru bills just like the Decrease Charges, Extra Transparency Act and the SITE Actwhich may perchance well lend a hand level the playing self-discipline as soon as and for all.

— Scott Speeding, Vancouver, Washington

The chief advertising officer of SKYGEN gash to the stride on X.

— Donald H. Well mannered, Milwaukee

The ‘Gold Card’ Depart

Prior authorization, by definition, creates delays in care and bureaucratic barriers for physicians — which is why it is so troubling that many insurers now require prior authorization for natty categories of procedures with out a evidence of overuse or execrable utilize. With health insurers increasingly extra imposing questionable prior authorization policies, teach and federal lawmakers are racing to erect safeguards that have determined sufferers’ entry to timely care (“States Procedure Health Insurers’ ‘Prior Authorization’ Purple Tape,” Feb. 12).

Fundamental of the legislation to address this rising teach centers across the usage of “Gold Playing cards” that exempt companies whose old requests for prior authorization had been accepted for a determined length. In identical old, these laws are crucial for sufferers who can’t give you the cash for to now stay awake for care — namely within the self-discipline of gastroenterology where excessive abdominal pain or blood within the stool may perchance well well level to a necessary condition like most cancers.

Alternatively, some insurance corporations are co-opting the “Gold Card” term to justify original prior authorization requirements as a alternative of streamlining present ones. Rob exhibit of the case of UnitedHealthcare, which presented it could well well roll out a “Gold Card” prior authorization program this 300 and sixty five days for most colonoscopies and endoscopies. No diversified insurer has levied such a policy, nor does the compare imply there is an overutilization of these crucial products and companies. Regardless of just a pair of 300 and sixty five days of appropriate faith efforts to survey transparency and steering from UHC, the firm has did now not originate any files or justification that these products and companies are improperly utilized.

If one thing, diagnostic and surveillance colonoscopies and endoscopies can be underutilized. Fresh compare from the American Most cancers Society presentations an alarming spike within the different of youthful People being identified with and loss of life from colorectal most cancers. Since symptoms of colorectal most cancers don’t in general seem till the illness is at a extra improved stage, early detection is well-known. Any disruption to surveillance colonoscopies (which follow elimination of a precancerous polyp and are section of the screening continuum) ended in by UHC’s coming near prior authorization policy would be unsafe for the firm’s 27 million industrial beneficiaries.

The American Gastroenterological Affiliation strongly urges UHC to rescind its “Gold Card” prior authorization policy. Policymakers must video display how insurers are co-opting ideas supposed to guard sufferers, namely UHC’s fake “Gold Card,” which threatens patient entry to a plan proven to set apart lives.

— Barbara Jung, president of the American Gastroenterological Affiliation, Seattle

In an X post, a senior fellow on the Lengthy island Institute identified the price in requiring prior authorization.

— Chris Pope, a senior fellow on the Lengthy island Institute, Fresh York Metropolis

Hospice in Penal complex: A Transformative Assume

I used to be so impressed with Markian Hawryluk’s exceptionally neatly-written article “Demise and Redemption in an American Penal complex” (Feb. 21). I used to be privileged to lend a hand as an inaugural member of the American Hospital Affiliation’s Circle of Existence Award committee, from 1999 to 2004. The awards had been established to sight essentially the most prominent hospice and palliative care applications within the U.S. The very first 300 and sixty five days, we obtained an application from the country’s ultimate most-security detention center in Angola, Louisiana, the self-discipline of Mr. Hawryluk’s very good article. The detention center was one in every of the 5 finalists chosen for a house discuss over with in 2000. I volunteered to be on personnel to discuss over with and take into account the detention center’s hospice products and companies.

Twenty-four years later, I peaceful consider my dialog with one in every of the inmate volunteers who had factual returned from bathing and feeding a loss of life prisoner. He told me the inmate talked about, “I similar to you.” Then the inmate volunteer stated, “I by no technique heard those words sooner than — no longer from my father, who I by no technique met, nor from my mom.” In 2000, if one had been sentenced to life on the Louisiana Whisper Penal complex, there was no chance for parole. After we met with the warden, he talked about there was a waiting checklist of prisoners who wished to be hospice volunteers.

Please raise my deep appreciation to Mr. Hawryluk for his prominent article.

— Paul Hofmann, president of the Hofmann Healthcare Community, Moraga, California

A digital storyteller shared the article on X.

— Ameera Butt, Los Angeles

Feeling Petrified Attributable to of Social Security Ways

When will you continue your sequence on the overpayments to the Social Security Administration (“Overpayment Outrage”)? Of us are peaceful suffering with out advantages on story of the agency says of us had been overpaid and desires the cash abet. Why is no one else asking extra questions?

Of us on this country worked laborious and paid taxes. And when it is time to retire, the Social Security Administration refuses to pay if, all of a unexpected, it discovers you occupy gotten been overpaid. They’ve told me I owe them $30,000 from over twenty years ago, and I discontinue no longer know what they’re talking about, nonetheless they occupy to rob my retirement cash till it’s paid off. Or they need you to claim it is OK to rob a share out. Doing that would instruct you’re guilty and also you owe the cash — to me, that’s blackmail.

Fresh immigrants obtain free phones, medical care, debit playing cards, food assistance, training … that comes to extra than my cramped amount of retirement cash. It appears to be just like the chief can provide you the cash for to cope with up them, nonetheless no longer their occupy. Everyone who has had their Social Security taken away must be entitled to the free products and companies they obtain, as we are within the identical self-discipline — now we’ve got nothing either.

— Thomas Troy, Fresh York Metropolis

Lifelong Minnesotan and epidemiologist Eric Weinhandl chimed in on X.

— Eric Weinhandl, Victoria, Minnesota

A Balanced Assume of the Regulations Curbing Shock Bills

KFF Health News’ Elisabeth Rosenthal has prolonged advocated for quality, patient-centric medical care. Alternatively, her present article, “The No Surprises Act Comes with Some Surprises” ( Feb. 14), falls short in its analysis of surprise medical billing and the federal No Surprises Act (NSA). Whereas she areas blame on physicians, the actuality is extra sophisticated.

Patients with health insurance may perchance well well peaceful no longer be careworn with paying extra than their identical old in-network tag-sharing amount for astonishing out-of-network care. Here’s no longer controversial. The legislative debate was by no technique about whether or now to now not act on surprise billing, nonetheless quite how to act. Whereas insurers favored policies that would enable them to calculate the fee fee medical companies obtain, with the NSA, Congress as a alternative selected an skill supposed to guard sustainable fee charges that would preserve sufferers’ entry to care. The NSA removes sufferers from fee disputes between insurers and companies and is supposed to support negotiations between insurers and companies, with an option for fair arbitration.

Rosenthal’s article implies a “grasping physician” narrative, omitting discussion of insurers as contributing to the considerations with the NSA’s implementation. Whereas the article notes that many requests for arbitration came from inner most equity-associated provider organizations, it overlooked to exhibit that a single insurance firm (UnitedHealthcare) was desirous about nearly 40% of arbitration disputes. That is extra than the comfort of the head 5 insurance organizations mixed. The article also quotes and references papers by Zack Cooper, whose undisclosed connections with UnitedHealthcare came to light thru litigation. As reportedUnitedHealthcare no longer simplest offered files to Cooper, nonetheless helped frame the narrative of the work.

NSA rulemaking has financially incentivized insurers to leverage the NSA to unilaterally lower present reduced in dimension charges and push physicians out-of-network. As for the projected different of requests for arbitration in 2022 (which underestimated “companies’ ire by an expose of magnitude”), that projection overlooked present files. In just the principle six months of 2021, Texas by myself had extra than twice as many arbitration submissions for its teach law as the federal executive projected for the nation for a corpulent 300 and sixty five days. Extra importantly, the article ignores the venture of why doctors query arbitration. Since arbitration is baseball-vogue and “loser pays,” there is a noteworthy disincentive to query it with out a noteworthy cause. Within the 2nd quarter of 2023, companies obtained almost 80% of disputes, reflecting the undeniable truth that doctors are going to arbitration when insurers’ actions are unreasonable.

Further, while it is factual that sooner than the NSA too many sufferers had been receiving bills for astonishing out-of-network care, a chronicle from the Department of Health and Human Companies eminent that out-of-network billing was truly declining ahead of the NSA. Doctor compare files means that post-NSA out-of-network care is now rising because of about a insurers’ actions.

The bipartisan NSA is a balanced resolution to an improved teach. Difficulties with the law’s implementation, including the quantity of dispute submissions and backlog of instances, are because of unintended consequences from rulemaking. Addressing these challenges requires an factual dialog about their trigger. Going forward, rulemaking is wished to promote dazzling network contracting, limit the need for arbitration, and, most importantly, offer protection to sufferers’ entry to care.

— Rich Heller, a pediatric radiologist and the affiliate chief medical officer for health policy, Radiology Companions, Chicago

Anesthetist-emergency physician-family physician David Moniz, in an X post, warned of the “unseen consequences” of the No Surprises Act.

— David Moniz, Chilliwack, British Columbia