Surprise medical bills rank as public's second-highest financial worry, survey finds

 

• Unexpected medical bills are the American public's second-highest financial worry, trailing gas prices, according to a new poll from the Kaiser Family Foundation.
• Despite 58% of the public saying they're worried about being able to afford surprise bills, the majority of people with private insurance — 56% — said they knew nothing about a federal law that took effect in January that prohibits patients being charged when they unknowingly receive out-of-network care. Just 22% said they knew "a little" about the law, while 18% know "some" and 3% know "a lot."
• Meanwhile, proposals to lower out-of-pocket costs for drugs tops the public's list of health priorities for Congress as Americans continue to cite high prices as a barrier to receiving care, KFF found. Half of respondents to the survey said they'd delayed or gone without healthcare in the past year because of cost.

The bipartisan No Surprises Act passed in 2020 started shielding patients from large surprise out-of-network bills in January, requiring payers and providers to arbitrate any billing disputes.

However, the law faces ongoing controversy over the specifics of its implementation that have sparked a number of legal challenges. There also are notable exceptions to its protections, including that it only cover privately insured patients and doesn't prohibit balance billing for ground ambulances, causing researchers to note it only covers a fraction of large medical bills Americans face. Now, similar shares of both Republicans and Democrats are saying they're unaware of the law.

The lack of clarity as to consumer protections already in place may be contributing to the high percentage of Americans that are worried about being able to afford surprise medical bills.

Exorbitant out-of-network bills have been a major contributor to healthcare costs and medical debt in past years. Despite 90% of the population having some sort of coverage, Americans owe at least $195 billion in medical debt, according to recent research from KFF and the Peterson Center on Healthcare.

The majority of Americans say inflation is the biggest problem facing the U.S., while the coronavirus pandemic ranked fourth. Just 6% of adults said COVID-19 is the country's biggest problem, the survey published Thursday found.

Likely due to rampant concerns about rising prices, the public most wants Congress to focus on what they're paying for medical products and services, according to the poll. This includes capping prescription drug price increases to the inflation rate, with 61% saying it's a top priority.

Drug costs continue to be a top issue for the public, with 29% of Americans saying they either didn't fill a prescription, cut pills in half, skipped doses or elected for an over-the-counter product instead of a prescription because of cost in the past year.

That percentage rose to 43% among people with annual household incomes under $40,000, KFF found.

Drug pricing legislation has been a key focus area for President Joe Biden and congressional Democrats, though legislators have been deadlocked on the scope and strategy for driving down costs.

Capping out-of-pocket costs for insulin, placing a limit on how much seniors pay for care and allowing the federal government to lower drug prices for Medicare beneficiaries also were cited frequently as top priorities for Congress, by 53%, 52% and 48% of respondents, respectively.

Fewer than half of people said expanding coverage to low-income Americans in states that didn't expand Medicaid under the ACA, upping funding for mental health services or improving safety and quality in nursing homes are top health priorities.

About a fourth of respondents said increasing spending for COVID-19 and making temporary subsidies for ACA plans during the public health emergency permanent are top priorities for legislators.

"The public's priorities in health reflect deep concern about the prices of everything right now, including drug prices," KFF CEO Drew Altman said in a statement. "That doesn't mean other things that have long been popular do not have public support too; they do. It just means prices are the preeminent concern."

https://www.healthcaredive.com/news/unexpected-medical-bills-public-financial-worry/621339/

Hospitals struggle to fill staffing holes in short, long term amid surge in nurse turnover

 Healthcare workforce shortages today are unprecedented. Some hospital leaders fear the worst is yet to come.

That's because as nurses quit in droves — with some leaving to take higher-paying traveling nurse positions or opting for early retirements — replacing them is becoming increasingly difficult. With many other nurses dropping the profession because of the mental of physical toll of being on front lines of the pandemic for two years, it's almost mission impossible for many health systems to fill staffing holes.

Projections from the Bureau of Labor Statistics estimate U.S. healthcare organizations will have to fill almost 200,000 open nursing positions every year until 2030, with many of those slots resulting from the need to replace nurses who leave for different occupations or retire.

"This is a bigger workforce shortage than we have ever dealt with," said Gay Landstrom, senior vice president and chief nursing officer of Trinity Health, a nonprofit system with 88 hospitals nationwide.

While some systems anticipate many nurses who are leaving now will eventually return, staff shortages — already forecast to occur over the next decade even before the pandemic began — likely will persist, driven mainly by an aging nursing population, hospital officials say.

A large chunk of the most experienced senior nurses are set to retire over the next two decades, as the average age of a registered nurse in the U.S. in 2020 was 51 years old, according to a survey from the National Council of State Boards of Nursing.

While interest in healthcare professions like nursing hasn't waned, shortages of nursing educators and sites to get clinical hours pose imminent challenges to the pipeline of new nurses in particular.

Some systems are boosting benefits and propping up their own internal staffing agencies to keep nurses in house at least for the short to medium term. Others are looking to bolster partnerships with academic institutions to better strengthen their pipelines in the years to come.

"The role of the nurse needs to be an enticing one," Landstrom said. "We need to have enticing jobs that aren't completely exhausting."

Nurses under attack

Throughout the pandemic, surveys have increasingly found widespread stress and burnout among the healthcare workforce. Some nurses say their jobs are now less satisfying, and for some it's untenable as persistent staffing shortages make it difficult to adequately care for patients.

More than a third of nurses recently surveyed by staffing firm Incredible Health said they plan to leave their current jobs by the end of this year, citing burnout and high-stress work environments. Higher pay elsewhere is the top reason for taking another position, the poll found.

Nurses in the survey also said verbal and physical violence is on the rise, with half attributing that to COVID-19 guidelines and the other half citing longer wait times and other issues caused by a lack of staffing.

Shortages of other ancillary staff like nursing assistants, patient care assistants and others are worsening the problem and restricting nurses from practicing at the top of their licenses, Landstrom said.

"We have to do a much better job of developing those nursing assistants and a steady flow of that pipeline, as well as the RNs," she said.

Nursing schools don't have enough teachers or slots

While the profession has been battered by the pandemic, the fallout from the outbreak didn't curb the number of students pursuing nursing degrees in 2020, the most recent year that data is available.

Entry-level baccalaureate, master's and Doctor of Nursing Practice programs saw enrollment increases in 2020 of 5.6%, 4.1% and 8.9%, respectively, according to a survey from the American Association of Colleges of Nursing. Enrollment in those programs has risen continuously for the past 15 years, according to the AACN.

At the same time, about 80,000 qualified applicants were turned away from nursing programs in 2020 because of resource constraints, namely shortages of clinical sites and faculty.

"I think we're going to have enough people who want to be nurses, but I think the challenge is going to be getting them through nursing school," said Rita Wise, director of the Pennsylvania College of Health Sciences' nursing program.

Faculty shortages are largely driven by the fact nursing educators need master's degrees, and master's-prepared nurses often choose to work in higher-paying roles in hospital settings or other clinical agencies rather than teach, Wise said.

In addition, nursing students need experience in actual clinical settings. Opportunities for student nurses to get clinical hours needed for graduation fell early in the pandemic as hospitals grappled with personal protective equipment shortages, though they've slowly returned.

Nursing schools reported a limited availability of clinical sites as the top reason they turned away qualified applicants, according to an AACN survey in late 2020.

At the same time, there's little incentive for hospitals and other practitioners to open their doors to students who require extra time and training, taking resources away from current staff, especially amid today's shortages, Wise noted.

Medicare currently helps some providers recover costs for taking students under their wings, though not all programs qualify, she said.

Provider groups like the American Hospital Association have called on Congress to expand those programs as pandemic-driven shortages persist.

Academic partnerships

Health systems still are seeking to form partnerships with nursing schools and other academic institutions two years after the pandemic began as concerns around their pipelines of future staff grow.

"We need to really be working in partnership with academic organizations beyond what we have done in the past," Trinity's Landstrom said.

Transitioning students from nursing programs to working for an organization can be jolting, especially amid increased staff turnover, and shouldn't be the case, she added.

In the past, hospitals and nursing schools worked together more closely than they do today, though the pandemic is spurring greater collaboration between the two, Craig Laser, clinical associate professor at Arizona State University's College of Nursing and Health Innovation, said.

Hospitals and nursing schools today are "talking much more than they were before about supply and demand," Laser said.

Pennsylvania College of Health Sciences' Wise knows firsthand that this type of cooperation can pay off. She graduated nursing school in the early 1990s and as a student had a paid internship at a local hospital, where she later went to work for 19 years.

"They definitely did get a return on the investment," she said.

https://www.healthcaredive.com/news/nursing-schools-covid-shortages-hospitals-partnerships/620662/

Fauci Says China Was 'Extremely Secretive' But 'Didn't Necessarily' Cover-Up Pandemic

 by Michael Washburn via The Epoch Times (emphasis ours),

White House chief medical advisor Dr. Anthony Fauci said that Chinese officials were “extremely secretive” about the possible origins of the COVID-19 pandemic, though he stopped short of accusing Beijing of deliberately covering it up.

The director of the National Institute of Allergy and Infectious Disease was asked on BBC’s “Sunday Morning” program on March 27 what his response was to claims by World Health Organization (WHO) investigators that China prevented them from “seeing key details and from speaking to key people” when they were probing the pandemic origins in Wuhan in early 2021.

“You know, I don’t want to create any or mention any disparaging remarks about that,” Fauci responded.

“But the Chinese are very closed, in a way of being very reluctant, particularly when you have a disease that evolves in their country, they become extremely secretive, even though there’s no reason to be secretive,” he continued.

Fauci then suggested that embarrassment over global reactions may have driven the Chinese regime to be less than totally forthcoming on the origins and spread of COVID-19.

“I think they were very concerned and maybe embarrassed that the virus evolved from their country but there’s nothing wrong with that,” he said.

“So when they see something evolving in their own country, they tend to have a natural reflex of not necessarily covering things up, but not being very open and transparent.”

U.S. officials and others have repeatedly decried Beijing’s denying access to key data and facilities amid ongoing investigations to find out the source of the pandemic.

In addition, the Chinese regime in the early stages of the initial outbreak in Wuhan suppressed information about the severity and spread of the disease, allowing the virus to transmit around the world that was still unaware of the dangers of the new coronavirus.

Many lawmakers and experts have accused the communist regime of covering up both the origins of the pandemic and the initial spread of the outbreak.

At the heart of the debate on the source of the outbreak is whether it leaked from a laboratory in Wuhan or if the virus was transmitted naturally before jumping to humans. While there are proponents for both theories, the Chinese regime’s refusal to allow independent scrutiny of the lab makes it extremely difficult to fully investigate the matter.

Admitting that he was “never certain” in the early days about when and where COVID-19 might have originated, Fauci said that the similarities he observed between Covid-19 and such earlier diseases as SARS CoV-1 in the early years of the millennium suggested a possible origin for the current pandemic.

“I said, as did many other virologists, that the most likely etiology was a jumping species from the animal to the human,” Fauci commented.

Fauci added that he does not see anything suspicious about the existence of a research laboratory in Wuhan and this fact does not influence his view of the Chinese regime’s conduct in the matter.

“It’s not at all surprising that there is a research lab there. The Chinese were trying to figure out, and did figure out, what the original etiology was of SARS CoV-1,” he said, referring to the SARS virus that spread from China from 2002 to 2003. Scientists ultimately traced that virus to horseshoe bats in China’s Yunnan, which jumped to the intermediary of Asian civets before spreading to humans.

“[The SARS outbreak] made it very very clear there would be a possibility we would have another pandemic outbreak from the animal-human interface, so it makes sense that the Chinese would be studying this to find out how you could prevent another outbreak,” Fauci said.

Emails disclosed earlier this year suggested that Fauci not only initiated efforts to cover up evidence pointing to a lab origin of COVID-19 but actively shaped a highly influential academic paper that excluded the possibility of a laboratory leak.

https://www.zerohedge.com/covid-19/fauci-says-china-was-extremely-secretive-didnt-necessarily-cover-pandemic

California auditors outline rampant fraud endangering LA County hospice patients

 Weak oversight and enforcement from state agencies likely enabled a boom of fraudulent hospice agencies within California’s Los Angeles County, according to an audit published to the public Tuesday.

In the report, delivered to Gov. Gavin Newsom and state legislative heads, acting California State Auditor Michael Tilden highlighted a nearly 1,600% increase in Los Angeles County hospice agencies since 2010 while the area’s senior population only increased by an estimated 40% during the same time.

As of 2019, Los Angeles County had roughly 1,600 aged persons living in the area per hospice agency, according to the report. Additionally, the rest of the state excluding Los Angeles County had one hospice agency per 5,900 seniors—still well above that of other states such as New York (one hospice per 72,000 aged persons) and Florida (one hospice per 95,000).

Alongside sheer volume, the audit spotted high concentrations of hospice agencies within a single area, including “a single building in the community of Van Nuys as having more than 150 licensed hospice and home health agencies—a number that exceeds the structure’s apparent physical capacity.”

The county’s hospice agencies also had “unusually long durations of patient care and high rates of patients being discharged alive,” a red flag for what are supposedly end-of-life care agencies, and multiple cases where medical professionals were affiliated with Los Angeles hospice agencies “without their knowledge or consent, thereby obtaining hospice licenses under false pretenses,” according to the report.

“These indicators strongly suggest that a network or networks of individual perpetrators in Los Angeles County are engaging in a large and organized effort to defraud the Medicare and Medi-Cal [the state’s federal Medicaid program],” Tilden wrote to state leaders. “Such fraud places at risk the extremely vulnerable population of hospice patients.”

The audit laid blame on the state’s Department of Public Health, the primary agency responsible for hospice licensing and oversight.

Auditors found that the department has not issued regulations around its licensing processes, did not deny licenses in cases where it was aware of possible fraud, has not promptly comprehensively investigated complaints of patient abuse and, since 2015, “has never suspended a hospice license and has revoked a hospice license only once.”

Further, the Department of Public Health, the Department of Health Care Services and the Department of Justice in California have each failed to coordinate fraud investigations and other regulatory efforts surrounding hospice agencies, leading to “gaps in the system” protecting against patient harm and fraud, per the report.

“For example, Health Care Services and Public Health do not coordinate with each other to comprehensively assess fraud risks, such as those we found in Los Angeles County,” auditors wrote in the report. “These siloed and disjointed efforts by state agencies are not sufficient to address the large‑scale fraud that is likely occurring in the hospice industry.”

Auditors noted that fraudulent hospice care “can be lucrative,” as agencies billing Medicare and Medi-Cal “at the most common rate” can bring in about $122,000 each month.

To clamp down on these trends and protect patients, auditors advised California legislators to require the public health department to “immediately” develop emergency hospice licensing regulations. Lawmakers could also revise state law so that the agency can levy monetary fines and other sanctions against hospice agencies that do not comply with licensing requirements, they wrote.

All three state departments should also convene a task force to spot and prosecute hospice agency fraud as well as establish a working group for statewide annual hospice program risk assessments, according to the report.

“We acknowledge that there are several opportunities for improvement in the oversight of hospice agencies,” Director and State Public Health Officer Tomás J. Aragón, M.D., wrote in a March 11 response to Tilden. “Public health has already begun or will soon begin to operationalize several of the recommendations made in the audit in advance of regulations and/or legislative initiatives. These include shoring up referrals made to other state departments where possible fraud may exist, training public health staff to better detect fraudulent activities, and adjusting our public website to improve reporting of ownership information for hospice agencies, among other things.

https://www.fiercehealthcare.com/providers/california-hospice-fraud-los-angeles-county-audit-auditors-outline-rampant-fraud

State-based ACA exchanges make backup plans in case Congress fails to act on enhanced ACA subsidies

 The Biden administration and states across the country celebrated record-breaking enrollment gains for the Affordable Care Act (ACA) this year.

But state-run exchanges are eyeing backup plans for outreach and marketing in case Congress doesn’t extend beyond this year a major driver for those enrollment gains: enhanced income-based subsidies. Some officials have warned that people could drop off coverage—and consumers may shift to less-generous plans—if Congress doesn't act in time.

“If we are still in this stage of uncertainty, we will have to anticipate either outcome and ramp up planning efforts … with both scenarios in mind,” said Zachary Sherman, executive director of the exchange called Pennie, in an interview with Fierce Healthcare.

Sherman said Pennsylvania’s exchange signed up more than 110,000 new customers compared to the last open enrollment, and 35,000 of those customers are getting subsidies that they typically would not be eligible for. 

The American Rescue Plan's (ARP's) enhanced subsidies ensured that anyone making more than 400% above the federal poverty level wouldn’t pay more than 8.5% of their income on healthcare. Previously, that was the cutoff for eligibility for income-based subsidies. The enhancements also ensured that some consumers qualified for zero premiums or $10 a month premiums. 

According to a recent Assistant Secretary for Planning and Evaluation report, an estimated 3.4 million Americans currently insured in the individual market would lose coverage and become uninsured if the ARP’s premium tax credit provisions are not extended beyond 2022. Kaiser Family Foundation determined premiums would more than double for many. 

Pennie isn’t the only exchange that saw massive gains thanks to the subsidies. 

Washington’s exchange saw nearly 60,000 residents sign up for coverage for 2022, and 73% of all customers were eligible for subsidies, up from 61% in 2021, the exchange told Fierce Healthcare. 

It added that over 100,000 of the exchange customers (42% of total enrollment) pay $100 or less a month, compared to 29% before the ARP was signed into law.

Customers signing up on state-run exchanges saw average premium savings of 7% to 47% for 2022, according to a report from the National Association for State Health Policy. The report added that at least eight exchanges had 20% or more of their customers paying less than $25 a month for coverage. 

Overall, there were 14.5 million people who signed up for coverage for 2022 when considering both the state-run exchanges and the federally run HealthCare.gov, a record number.

Now, though, states are grappling with how many people could lose coverage if the extra subsidies go away.

Plans likely will start finalizing rates this summer and open enrollment will start in the fall, creating even greater pressure on Congress to act.

Minnesota’s exchange, MNSure, told Fierce Healthcare it expects 70,000 enrollees will lose some benefits and 10,000 would lose all of it. 

“Most of them will still get some subsidy. All of them will see a reduced subsidy,” said Libby Caulum, senior director of public affairs for MNSure.

Sherman said 90% of customers get financial assistance and will also see some adjustment, requiring key outreach if the subsidies don’t get extended. 

“We will have to do a considerable amount of planning and communication to those populations to help them understand what that means,” he said. 

This includes helping consumers understand the automatic renewal process and how to make plan adjustments. 

Sherman said that customers took the opportunity to buy more expensive plans than they otherwise would. A consumer that normally would buy a bronze or silver tier plan would instead buy a gold plan. 

“If the subsidies go away and the purchasing power of the subsidies is less going into 2023, we will want to make sure people understand that,” he said. 

Some of the people who were earning too much to qualify for subsidies before could drop out. 

“We will do a lot of education around the value and importance of staying covered about the options available to consumers,” Sherman said. “Maybe you are not in a gold plan but there are other options for you and the implications of buying a less expensive plan.”

Caulum added that predicting consumer behavior could be tricky, and it is difficult to pin down how many enrollees could drop off. 

“Once people get coverage it could be sticky for them. They realize the benefit and they don’t want to drop It,” she said.

It isn’t just consumers, however, that could be forced to rethink their available benefits. 

Massachusetts Health Connector Authority, for example, applied state funds otherwise allocated for premium assistance to help “reduce cost-sharing for critical services including primary care, mental health visits and prescription drugs,” said Executive Director Louis Gutierrez in a release from the National Association for State Health Policy.

The Biden administration, meanwhile, has been relatively mum on its plans on what happens if the enhanced subsidies aren’t extended. 

Administration officials said they believe Congress will extend the subsidies. However, Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure recently told reporters the agency can move quickly to implement rules and change outreach efforts in case Congress doesn’t act. 

It remains unclear whether lawmakers will extend the subsidies. The $1.75 trillion Build Back Better Act, which extended the subsidies through 2025, was nixed in the Senate after objections from Sen. Joe Manchin, D-West Virginia. But Biden had said late last year the goal is to pass the social spending package in chunks. 

However, so far none of those chunks have made significant progress through Congress, despite widespread support from Democrats. 

https://www.fiercehealthcare.com/payers/state-based-aca-exchanges-make-backup-plans-case-congress-fails-act-enhanced-aca-subsidies

Meta says employees no longer need Covid boosters to come to U.S. offices

 Facebook parent Meta Platforms will stop insisting that employees have Covid booster shots in order to come to its facilities in the U.S., a spokesperson confirmed to CNBC on Friday.

Technology companies have begun the process of luring their workers back to their corporate campuses. Meta, as well as Microsoft, held broad U.S. office reopenings on Monday.

“We updated our requirements in early March to align with CDC guidance, and now Covid-19 boosters are no longer required for entry, though strongly recommended,” the spokesperson wrote in an email. “The primary vaccination requirement (one or two-shot series) remains in place.”

The about-face comes less than three months after the social network operator announced rules for a return to the office.

The Meta spokesperson did not provide an explanation for the change.

In California, where Meta has its headquarters, 71% of the population is fully vaccinated, while 35% has received a booster shot, according to New York Times data. Case counts have fallen since January, the newspaper’s data shows.

Apple, also based in California’s San Francisco Bay Area, requires employees to show proof they have received a booster shot, technology news website the Verge reported in January.

The U.S. Food and Drug Administration on Tuesday authorized a second Pfizer-BioNTech or Moderna booster shot for people who are 50 or older at least four months after receiving an initial booster.

https://www.cnbc.com/2022/04/01/meta-says-employees-wont-need-covid-boosters-to-come-to-us-offices.html

Judge Ousts Five School Board Members After Pennsylvania Parent Petition

 by Beth Brelje via The Epoch Times (emphasis ours),

A Pennsylvania judge on Tuesday ordered five elected school directors be immediately kicked off the nine-member West Chester Area School board.

On Wednesday the same judge, William P. Mahon in the Chester County Court of Common Pleas, vacated Tuesday’s order and scheduled an argument for Friday.

It is all in response to a February petition filed by West Chester Area School District parent Beth Ann Rosica. In the petition, Rosica calls for the removal of five school board members, Sue Tiernan, Joyce Chester, Karen Herman, Kate Shaw, and Daryl Durnell.

Students returning to in-person classes after two years of remote learning in response to the COVID-19 pandemic were required to wear masks over their mouth and nose. When Pennsylvania ended mandatory school masking, the West Chester Area School District was among a handful of schools that kept masking in place.

“When that was lifted, all of us parents started emailing, calling, showing up at school board meetings, asking our school board to amend their health and safety plan and allow for optional masking,” Rosica told The Epoch Times.

“They didn’t lift it for the West Chester School District, so we began to work on a petition to remove school board members because we believed that their actions were illegal and unconstitutional.”

Eventually, the district did lift the mask mandate, but the petition request remained relevant because, in August, the board passed a new health and safety plan which allows the board to impose future mandatory masking at various levels of COVID-19 transmission.

“For high levels of transmission, our current approved health and safety plan still requires masking, and we believe that that is illegal. We want this answered because we don’t want them to impose it come next fall, or any point in time when cases start growing up again,” Rosica said.

The petition was based on a seldom-used Pennsylvania education statute that allows for the removal of school directors for “failure to organize or neglect of duty.”

The statute says any ten resident taxpayers in the district may present a petition to the court to have them removed. But that argument was not addressed in Tuesday’s decision.

The court favored for Rosica, citing West Chester Area School District’s failure to respond. It also ordered Rosica and the four remaining board members to each submit a list of five proposed replacements for the board, to be appointed by the court to fill out the exiting board members’ terms.

Attorney Kenneth Roos of the Wisler Pearlstine law firm in Bule Bell, Penn. represents the school board. He told The Epoch Times in a phone call that he filed a motion for reconsideration of Tuesday’s decision, late Tuesday night. He had no other comment on behalf of the school board.

The motion disputes the time frame that the school had to respond, arguing it should have had until April 4 to answer. The judge agreed and allowed the board members to stay in place while the petition is argued on Friday.

Rosica is more than a mother of two students in the district. She is executive director of Back to School PA, a political action committee that advocated for reopening schools closed by COVID-19 mitigation measures. It aims to get pro-parent and pro-student candidates elected to school boards.

https://www.zerohedge.com/covid-19/judge-ousts-five-school-board-members-after-pennsylvania-parent-petition