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Inflation and money woes are forcing Americans to delay medical care : Shots

April 9, 2023 Dania

Substitute teacher Crystal Clyburn, 51, doesn’t have health insurance. She got her blood pressure checked at a health fair in Sarasota, Fla.

Stephanie Colombini/WUSF

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Stephanie Colombini/WUSF

Substitute teacher Crystal Clyburn, 51, doesn’t have health insurance. She got her blood pressure checked at a health fair in Sarasota, Fla.

Stephanie Colombini/WUSF

At a health-screening event in Sarasota, Florida, people milled around a parking lot waiting their turn for blood pressure or diabetes checks. The event was held in Sarasota’s Newtown neighborhood, a historically Black community.

Local resident Tracy Green, 54, joined the line outside a pink and white bus offering free mammograms.

“It’s a blessing, because some people, like me, are not fortunate and so this is what I needed,” she said.

Green said she wanted the exam because cancer runs in her family. And there’s another health concern: her breasts are large and cause her severe back pain. A doctor once recommended she get reduction surgery, she said, but she’s uninsured and can’t afford it.

In a recent Gallup poll, 38% of Americans surveyed said they had put off medical treatment last year due to cost, up from 26% in 2021. The new figure is the highest since Gallup started tracking the issue in 2001.

A survey by The Kaiser Family Foundation last summer showed similar results. It found people were most likely to delay dental care, followed by vision services and doctor’s office visits. Many didn’t take medications as prescribed.

The health screening event is part of an ongoing effort provide health services to low-income Floridians who are uninsured. Attendees could have their blood pressure checked or receive screenings for diabetes. A bus also delivered mammogram services.

Stephanie Colombini/WUSF

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Stephanie Colombini/WUSF

The neighborhood screening event in Newtown — organized by the non-profit Multicultural Health Institute in partnership with a local hospital and other health groups — is part of an effort to fill in the coverage gap for low-income people.

Tracy Green explained that her teeth are in bad shape too, but dental care will also have to wait. She doesn’t have health insurance or a stable job. When she can, she finds occasional work as a day laborer through a local temp office.

“I only make like $60 or $70-something a day. You know that ain’t making no money,” said Green. “And some days you go in and they don’t have work.”

If she lived in another state, Green might have been able to enroll in Medicaid. But Florida is one of eleven remaining states that haven’t expanded the program to cover more working-age adults. With rent and other bills to pay, Green says her health is taking a backseat.

“I don’t have money to go to the dentist,

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How to avoid the daylight saving time hangover : Shots

March 15, 2023 Dania

Early mornings may still feel dark and wintry, but the season is about to change. This weekend most of the U.S. will “spring forward” — setting clocks forward one hour — as daylight saving time begins.

Maja Hitij/Getty Images

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Maja Hitij/Getty Images

As clocks march ahead and daylight saving time begins this weekend, you may be anxious about losing an hour of sleep and how to adjust to this change.

Even though it’s technically just one hour lost due to the time change, the amount of sleep deprivation due to disrupted sleep rhythm lasts for many days and often throws people off schedule, leading to cumulative sleep loss.

Many studies have demonstrated that there is an increased risk of heart attack, stroke and high blood pressure associated with sleep deprivation. Workplace injuries increase and so do automobile accidents. Adolescents often find it harder to wake up in time to get to school and may have difficulties with attention and school performance or worsening of mental health problems.

Circadian Surprise: How Our Body Clocks Help Shape Our Waistlines

Is there something to be done to help to deal with this loss of sleep and change of body clock timing?

Of course.

We lead a sleep evaluation center at the University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh and regularly see patients who are dealing with sleep loss and whose internal clocks are not synchronized with external time. Our experience has shown us that it’s important to prepare, as much as possible, for the time shift that occurs every spring.

Here are some quick tips to prepare yourself for the time shift.

Don’t start with a “sleep debt”

Ensure that you and, if you’re a parent, your child get adequate sleep regularly, especially leading up to the time change each year. Most adults need anywhere from seven to nine hours of sleep daily to perform adequately. Children have varying requirements for sleep depending on their age.

Earlier to bed — and to rise

Going to bed — and for parents, putting your kids to bed — 15 to 20 minutes earlier each night in the week before the time change is ideal. Having an earlier wake time can help you get to sleep earlier.

Try to wake up an hour earlier than is customary on Saturday, the day before the time change. If you aren’t able to make changes to your sleep schedule in advance, then keep a very consistent wake time on weekdays as well as weekends to adjust to the time change more easily.

Use light to your advantage

Light is the strongest cue for adjusting the internal body clock. Expose yourself to bright light upon waking as you start getting up earlier in the week before daylight saving time starts. This resets your

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Long COVID diagnosis puts extra strain on family caregivers : Shots

February 25, 2023 Dania

Louise Salant (right), 72, and her aunt Eileen Salant (center), 86, both got very sick with COVID-19 in 2020. And as Eileen developed long COVID symptoms, so too did Louise, who struggled with fatigue and shortness of breath while also managing her aunt’s care. Nearly three years later, home health aides like Elfnesh Legesse (left) help Louise take care of her aunt.

Gabriela Bhaskar for NPR

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Gabriela Bhaskar for NPR

For Louise Salant, long COVID has meant new stress, new responsibilities, and multiple medical crises to manage. It’s transformed her life.

But there’s a twist. She’s had to deal with this condition not just as a patient but also as a caregiver for her 86-year-old aunt Eileen Salant, who has coped with long COVID’s disabling symptoms for almost three years.

Eileen and Louise both caught an acute bout of COVID-19 in March of 2020. Eileen had been taking care of her brother, who was admitted to a New York City hospital with heart failure during those dark days of the early pandemic. He got COVID there, and died from his infection with the virus. Both aunt and niece also became very ill.

It was early days of the pandemic in New York, and hospitals were so crowded that Louise was told to stay home and fight out the illness on her own. Meanwhile, Eileen was hospitalized and stayed there all spring, including two months on a ventilator. After that, she spent five months at a rehab hospital. She finally came home to her apartment in Riverdale, the Bronx, the day before Thanksgiving in 2020 — but she was very weak.

Eileen and Louise both got COVID-19 in the early days of the pandemic in New York. Eileen ended up on a ventilator for two months and then spent five months in a rehab hospital. Louise fought the illness at home as hospitals started filling up.

Gabriela Bhaskar for NPR

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Gabriela Bhaskar for NPR

“She could barely sit up in bed, couldn’t hold a fork,” says Louise, who lives a 10-minute taxi ride away.

Over the years, Louise, now 72, has worked at various times as an art therapist, taught piano to children and adults and done medical interviewing for a cancer research team. But when COVID hit,

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To prevent medical debt, the U.S. could learn from Germany’s health care system : Shots

December 20, 2022 Dania

Dr. Eckart Rolshoven examines a patient at his clinic in Püttlingen, a small town in Germany’s Saarland region. Although Germany has a largely private health care system, patients pay nothing out-of-pocket when they come to see him.

Pasquale D’Angiolillo for KHN

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Pasquale D’Angiolillo for KHN

PÜTTLINGEN, Germany — Almost every day, Dr. Eckart Rolshoven sees the long shadow of coal mining in his clinic near the big brownstone church that dominates this small town in Germany’s Saarland.

The region’s last-operating coal shaft, just a few miles away, closed a decade ago, ending centuries of mining in the Saarland, a mostly rural state tucked between the Rhine River and the French border. But the mines left a difficult legacy, as they have in coal regions in the United States, including West Virginia.

Many of Rolshoven’s patients battle lung diseases and chronic pain from years of work underground. “We had an industry with a lot of illnesses,” said Rolshoven, a genial primary care physician who at 71 is nearing the end of a long career.

The Saarland’s residents are sicker than elsewhere in Germany. And like West Virginia, the region faces economic hurdles. For decades, German politicians, business leaders and unions have labored to adjust to the mining industry’s slow demise.

How banks and hospitals are cashing in when patients can't pay for health care

But this is a healthier place than West Virginia in many respects. The region’s residents are less likely to die prematurely, data shows. And on average, they live four years longer than West Virginians.

There is another important difference between this former coal territory and its Appalachian counterpart: West Virginia’s economic struggles have been compounded by medical debt, a burden that affects about 100 million people in the U.S. — in no state more than West Virginia.

In the Saarland, medical debt is practically nonexistent. It’s so rare in Germany that the federal government’s statistical office doesn’t even track it.

The reason isn’t government health care. Germany, like the U.S., has a largely private health care system that relies on private doctors and private insurers. Like Americans, many Germans enroll in a health plan through work, splitting the cost with their employer.

But Germany has long done something the U.S. does not: It strictly limits how much patients have to pay out of their own pockets for a trip to the doctor, the hospital or the pharmacy.

Rolshoven’s patients pay nothing when they see him. That not only bolsters their health, he said. It helps maintain what Rolshoven called social peace. “It’s really important not to have to worry about these problems,” he said.

German health officials, business leaders and economists say the access to affordable health care has also helped the Saarland get back on its feet economically, bolstered by the assurance that workers

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Medical debt soars for consumers with hospital credit cards : Shots

December 5, 2022 Dania

Many hospitals are now partnering with financing companies to offer payment plans when patients and their families can’t afford their bills. The catch: the plans can come with interest that significantly increases a patient’s debt.

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Patients at North Carolina-based Atrium Health get what looks like an enticing pitch when they go to the nonprofit hospital system’s website: a payment plan from lender AccessOne. The plans offer “easy ways to make monthly payments” on medical bills, the website says. You don’t need good credit to get a loan. Everyone is approved. Nothing is reported to credit agencies.

In Minnesota, Allina Health encourages its patients to sign up for an account with MedCredit Financial Services to “consolidate your health expenses.” In Southern California, Chino Valley Medical Center, part of the Prime Healthcare chain, touts “promotional financing options with the CareCredit credit card to help you get the care you need, when you need it.”

As Americans are overwhelmed with medical bills, patient financing is now a multibillion-dollar business, with private equity and big banks lined up to cash in when patients and their families can’t pay for care. By one estimate from research firm IBISWorld, profit margins top 29% in the patient financing industry, seven times what is considered a solid hospital margin.

Why Black Americans are more likely to be saddled with medical debt

Hospitals and other providers, which historically put their patients in interest-free payment plans, have welcomed the financing, signing contracts with lenders and enrolling patients in financing plans with rosy promises about convenient bills and easy payments.

For patients, the payment plans often mean something more ominous: yet more debt.

Millions of people are paying interest on these plans, on top of what they owe for medical or dental care, an investigation by KHN and NPR shows. Even with lower rates than a traditional credit card, the interest can add hundreds, even thousands of dollars to medical bills and ratchet up financial strains when patients are most vulnerable.

Robin Milcowitz, a Florida woman who found herself enrolled in an AccessOne loan at a Tampa hospital in 2018 after having a hysterectomy for ovarian cancer, said she was appalled by the financing arrangements.

“Hospitals have found yet another way to monetize our illnesses and our need for medical help,” said Milcowitz, a graphic designer. She was charged 11.5% interest — almost three times what she paid for a separate bank loan. “It’s immoral,” she said.

Robin Milcowitz signed on to a no-interest payment plan to pay off $3,000 she owed for a hysterectomy in 2017. When the medical center switched her account to AccessOne, she began receiving late notices, though she was making payments. Turned out her payments were only being applied to the surgery, leaving an account for medical appointments past-due.

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Medicare Advantage plans overcharged Medicare, audits show : Shots

December 5, 2022 Dania

A photo illustration shows four images separated by bars. The first image is of money and a Medicare card, the second is an older man sitting in a chair, the third is a closeup of money, the fourth is of a spreadsheet of overpayments totaling over $8 million.

Eric Harkleroad/KHN /Getty Images/ Unsplash/ Centers for Medicare & Medicaid Services Data

Newly released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage health plans, with some plans overbilling the government more than $1,000 per patient a year on average.

Summaries of the 90 audits, which examined billings from 2011 through 2013 and are the most recent reviews completed, were obtained exclusively by KHN through a three-year Freedom of Information Act lawsuit, which was settled in late September.

The government’s audits uncovered about $12 million in net overpayments for the care of 18,090 patients sampled, though the actual losses to taxpayers are likely much higher. Medicare Advantage, a fast-growing alternative to original Medicare, is run primarily by major insurance companies.

Officials at the Centers for Medicare & Medicaid Services have said they intend to extrapolate the payment error rates from those samples across the total membership of each plan — and recoup an estimated $650 million from insurers as a result.

But after nearly a decade, that has yet to happen. CMS was set to unveil a final extrapolation rule Nov. 1 but recently put that decision off until February.

Ted Doolittle, a former deputy director of CMS’ Center for Program Integrity, which oversees Medicare’s efforts to fight fraud and billing abuse, said the agency has failed to hold Medicare Advantage plans accountable. “I think CMS fell down on the job on this,” said Doolittle, now the health care advocate for the state of Connecticut.

Doolittle said CMS appears to be “carrying water” for the insurance industry, which is “making money hand over fist” off Medicare Advantage plans. “From the outside, it seems pretty smelly,” he said.

GAO Audit: Feds Failed To Rein In Medicare Advantage Overbilling

In an email response to written questions posed by KHN, Dara Corrigan, a CMS deputy administrator, said the agency hasn’t told health plans how much they owe because the calculations “have not been finalized.”

Corrigan declined to say when the agency would finish its work. “We have a fiduciary and statutory duty to address improper payments in all of our programs,” she said.

Enrollment in Medicare Advantage plans has more than doubled in the last decade

The 90 audits are the only ones CMS has completed over the past decade, a time when Medicare Advantage has grown explosively. Enrollment in the plans more than doubled during that period, passing 28 million in 2022, at a cost to the government of $427 billion.

Seventy-one of the 90 audits uncovered net overpayments, which topped $1,000 per patient on average in 23 audits, according to the government’s records. Humana, one of the largest Medicare Advantage sponsors, had overpayments exceeding that $1,000 average in 10 of 11 audits, according to the records.

CMS paid the remaining plans too little on average, anywhere from $8 to $773 per patient.

What constitutes an overpayment?

Auditors flag overpayments when a patient’s records fail to document that the person had the medical condition the

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