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

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

Why Hospital Monopolies Are a Bad Idea

I recently read the article about Ballad Health by Brett Kelman and Samantha Liss regarding the Mountain States Health Alliance and Wellmont Health System merging to create Ballad Health, upon state approval (“These Appalachia Hospitals Made Big Promises to Gain a Monopoly. They’re Failing to Deliver,” Sept. 29). Well, it was approved, and here is another reason that monopolies are a bad idea. My husband is a teacher in Tennessee, and it complicated our open enrollment selections for 2024 insurance. We have used BlueCross BlueShield of Tennessee, a widely selected insurer in our state. We were sent notification that Ballad Health and BCBST were in negotiations and that there was a high probability that Ballad will soon be an out-of-network provider for those with BCBST plans. Luckily, the school district offers Cigna insurance as well, but not all providers accept that insurance (as I said, BCBST is a huge insurer in this area).

Please explain to me how it is OK for a monopoly to decide not to be in-network with any health plans. They should be required to be in-network with any insurer from this area. I find this very upsetting. I shouldn’t have to worry that if a catastrophic event were to happen that my insurance coverage would be reduced to 60%-40% from 80%-20%, all because my only option for emergency care (Ballad) chose not to negotiate with the largest insurance provider in my area. Just food for thought.

— Kimberly Ensor, Johnson City, Tennessee

On X, formerly known as Twitter, a user whose tagline is “a one-woman wrecking ball” had this to say about nursing home worker shortages:

This is DEVASTATING! If CMS is saying they cannot identify a safe nursing staff level for residents than how can surveyors hold homes accountable? It ain’t happening anyway. Biden’s policy is WEAK. CMS is a joke. The gov’t is throwing away $. Wash & repeat

— Politics, Policies & Pop Culture ✍️ (@out2sea90210) August 29, 2023

— Ashley Thomas, Cleveland, Ohio

The Crisis of Understaffed Nursing Homes

I wanted to thank you for providing a platform for discussion of nursing home staffing (“Exclusive: CMS Study Sabotages Efforts to Bolster Nursing Home Staffing, Advocates Say,” Aug. 29). As a nursing student entering my final semester at SUNY Downstate, I have seen firsthand the destitute conditions of understaffed nursing homes. Staffing ratios are abysmal and, as I see it, the only solution for the well-being of nursing home residents is a responsible staff-to-resident ratio.

I wholeheartedly agreed with the sentiment of the article: The Abt Associates study was a shameful attempt to undermine the movement toward standardized staffing ratios at nursing homes. People become residents at nursing homes for many reasons, but the fact is they are there, above all, because they need specialized care, which these homes need nurses to provide — services such as ventilator care, tube feedings, medication, continuous monitoring, and frequent interventions to prevent pressure injuries, and so much more. There is something terribly wrong when nursing homes cannot provide the services that define them, especially when families and residents depend on them to do so.

I do think there were some missed opportunities in the article. For example, Jordan Rau writes that “immobile residents are not repositioned in bed, causing bedsores that can lead to infection.” While this statement is true, it is rather vague. Infections are a life-threatening risk associated with pressure injuries, but the sores themselves are grotesque and painful, a point I think should have been included to emphasize the injustice of allowing pressure injuries to develop and worsen. Health care workers should make every effort to prevent them. And nurses should understand their roles as advocates in being a voice for patients who are unable to speak for themselves.

It’s easy for the public to imagine the residents of nursing homes as homogenous and stereotypical elderly people who have been forgotten as they became burdensome, which is not only false, but actively harmful and agist. People of all ages and backgrounds live in nursing homes, and their needs are as diverse as they are themselves. The only universal commonality they have is that they live in nursing homes and need respect, dignity, care, and an adequate number of nurses and staff to protect these needs.

— Tara L. Clark, Freeport, New York

A union activist who supports a national single-payer health system also weighed in on X:

CMS is the agency that is supposed to protect patients. But CMS, instead, follows the bidding of the nursing home industry. Shame! This is the same agency that presides over handing Medicare to the for-profit industry.

— Kay Tillow (@KayTillow) August 29, 2023

— Kay Tillow, Louisville, Kentucky

Avoiding Financial Ruin for Aging Elders

As Jordan Rau and Reed Abelson identify (“Facing Financial Ruin as Costs Soar for Elder Care,” Nov. 14), too many of today’s older adults are falling through the cracks. They may struggle with daily activities and declining health but don’t necessarily need 24/7 nursing home care.

Within the patchwork of long-term care, the Program of All-Inclusive Care for the Elderly is underutilized. PACE offers integrated care through its campus-based model, where participants can receive comprehensive, coordinated medical care and social services in a combined Medical Clinic and Day Center, while also receiving at-home support with essential tasks like dressing, bathing, and eating.

This care is free to our dually eligible participants who are never saddled with copays, out-of-pocket costs, or deductibles. PACE has saved states thousands annually per participant. Further, participants are grateful to stay at home and remain engaged with family and friends.

PACE acts as a critical safety net for low-income seniors, so they and their families aren’t forced into financial ruin. For those not Medicaid-eligible, it costs less than the nursing home alternative.

To close our system’s gaps and lower spending, programs like PACE need to become a more prominent part of the discussion. Policymakers should expand access to PACE services so more people can benefit from this successful model of senior care.

— Richard Fish, CEO of One Senior Care, Erie, Pennsylvania

JoAnne Dyer echoed the dire warning about the draining cost of long-term care in an X post:

Something scary that you’re probably not thinking about but you probably should be thinking about. Long-term care can bankrupt you. Yes, you. You with your savings account and your 401k.

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

— JoAnne Dyer, Seattle

More Power to Suzanne Somers

Age 76 is pretty long to fight an aggressive, metastatic breast cancer without chemotherapy (“Suzanne Somers’ Legacy Tainted by Celebrity Medical Misinformation,” Oct. 18). I’d say Suzanne Somers proved her point! None of us lives forever. I got a lumpectomy in 2015 and refused tamoxifen. Chemotherapy wasn’t needed. I refuse mammograms and gynecology. I am doing well. I found Ms. Somers’ book on cancer, called “Knockout,” very informative. I didn’t buy into the supplements angle, but it empowered me in my own fight, when there were no answers, to ask questions and research. Quality of life is more important.

— Kerry McCracken, Milan, Illinois

A Las Vegas reader reacted on X to the same article published by the Los Angeles Times, one of KFF Health News’ media partners:

Ruthless Progressives and their corporate media trolls will continue to hate you long after you’re dead and buried. #hate #corporatemedia #disinformation

— Grant David Gillham 🐎🗡️🌊🛩🔫🇲🇽🏍⛳🎸 (@CaptG2) October 19, 2023

— Grant David Gillham, Las Vegas

Over-the-Counter Narcan a Big Leap for Humankind

Thank you for sharing your article highlighting barriers to accessing Narcan (“Narcan, Now Available Without a Prescription, Can Still Be Hard to Get,” Oct. 11). While some experts have questioned the significance of making Narcan available over the counter, I firmly believe this development is a major milestone in our ongoing battle against opioid-related fatalities.

One may argue that this change is merely a “tiny, tiny baby step” and not deserving of applause; however, I would contend that every positive change, no matter how small or late in the game, is a vital part of a larger solution. Making Narcan available without a prescription is a tangible acknowledgment of the urgency of the opioid crisis and a recognition of the need for swift, accessible interventions.

Narcan’s OTC status can help reduce the stigma surrounding opioid overdose and encourage open conversations about addiction and harm reduction. It sends a message that saving lives is a priority, and it encourages individuals to be prepared to act in emergencies.

Still, there are certainly challenges related to affordability of OTC Narcan. While $45 isn’t an ideal price tag, community groups, first responders, state and local governments, and harm reduction groups — many of whom may purchase Narcan in bulk — can buy Narcan for a cheaper price, $41 per two-dose carton.

It is also important to continue educating pharmacists on the use of Narcan. Only 19 states require that pharmacists complete a training course prior to dispensing naloxone in any capacity. All pharmacists, especially those located in areas with high rates of opioid deaths, need to be firmly equipped with the necessary information on administering Narcan to be a trusted source among the public. Provider education is a key steppingstone to improving access.

Narcan’s OTC availability represents a positive shift in our approach to combating opioid overdoses, and it is a step that deserves acknowledgment and support. Let us not underestimate the impact of this change and continue working toward a future where every person has access to the tools they need to prevent opioid-related fatalities.

— Sana Imam, master’s student at George Washington University, Washington, D.C.

The HIV Prevention Trials Network chimed in on X:

As an over-the-counter product, Narcan ideally would appear on store shelves in the same way as ibuprofen and cough medication.

— HPTN (@HIVptn) October 11, 2023

A ‘Hit Piece’ on Rival Hospital Systems

I recently read your article of a couple of years ago comparing for-profit versus nonprofit medical schools (“Montana Med School Clash Revives For-Profit Vs. Nonprofit Flap,” June 7, 2021). I am an anesthesiologist with 24 years of experience, and almost every health care institution or hospital has become for-profit. In fact, most anesthesiology groups are managed by corporations like NorthStar Anesthesia, U.S. Anesthesia Partners, etc. Hospitals have merged into gigantic multibillion-dollar corporations like Ascension, Universal Health Services, HCA Healthcare, and CHI Health.

So why is it so bad to have a for-profit medical school, exactly? Almost every aspect of modern health care has become for-profit, and those nonprofit institutions have colluded with larger systems to shut down smaller hospitals. So this clearly is a “hit piece” on the for-profit educational system by their competitor, Touro College and University System.

I am one of the few doctors truly trained in a nonprofit — called the U.S. Army, where I did my residency in anesthesiology at Brooke Army Medical Center. This is quite an uninformed and unreasonable article, especially given the state of the corporate health care industry that is pervasive in our country. When I left the military for private practice, I could not believe what was being passed for elective surgery outside the military.

So let’s not get the pot and kettle confused here. Calling out a for-profit medical school in an era dominated by large multibillion-dollar health care corporations is certainly the pot calling the kettle black. And the rural Montana area is just as much of a deserving area for any medical school — for-profit or nonprofit — as the rural state of West Virginia, where I practice.

— Lance R. Hoover, Morgantown, West Virginia

Medicare Cuts Harm Seniors’ Access to Physical Therapy Care

It’s disheartening to hear stories of physical therapists who are increasingly struggling to afford their training and cost of living while facing lower pay (“Back Pain? Bum Knee? Be Prepared to Wait for a Physical Therapist,” Nov. 28). No one should have to give up their dream of being a physical therapist because they worry the pay is unsustainable — especially at a time when many patients already have limited access to therapy care.

Unfortunately, that’s the reality for many — especially since the Centers for Medicare & Medicaid Services recently finalized yet another year of steep payment cuts to physical, occupational, and speech therapy in its recently released Medicare Physician Fee Schedule Final Rule for CY 2024.

CMS’ final rule includes a troubling pay cut of at least 3.4% to therapy providers in 2024. But in some geographic regions, that cut could be as high as over 4% because of the highly technical formula CMS uses to determine reimbursement. Not only will this cut weaken the pipeline of new physical therapists entering the field, but it will also put significant financial strain on physical therapists currently practicing, hurting retention, and potentially leading to practice closings, which all negatively impact patient access to physical therapy.

Physical therapy care is a critically important non-pharmacological treatment option for our nation’s aging population. It helps patients manage pain, improve mobility, and protect their independence, while avoiding reliance on powerful painkillers and preventing potentially deadly falls. It even saves CMS money: On average, Medicare spending for beneficiaries who receive physical therapy as the first treatment option is 75% lower than the total average spending for Medicare patients who undergo surgery first.

Though it’s disappointing that CMS did not listen to the patient and provider communities when finalizing yet more cuts, there’s still time for Congress to act. I urge our lawmakers on Capitol Hill to work together and swiftly reverse the serious cuts in the new rule to help stabilize our nation’s health care system and expand access to physical therapy care for patients.

— Nikesh Patel, executive director of the Alliance for Physical Therapy Quality and Innovation (APTQI), Washington, D.C.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.


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