Sharon Smith

Nursing homes receive billions of taxpayers’ dollars every year to care for chronically ill frail elders, but until now, there was no guarantee that’s how the money would be spent. Massachusetts, New Jersey and New York are taking unprecedented steps to ensure they get what they pay for, after the devastating impact of covid-19 exposed problems with staffing and infection control in nursing homes. The states have set requirements for how much nursing homes must spend on residents’ direct care and imposed limits on what they can spend elsewhere, including administrative expenses, executive salaries and advertising and even how much they can pocket as profit. Facilities that exceed those limits will have to refund the difference to the state or the state will deduct that amount before paying the bill. The states’ mandates mark the first time nursing homes have been told how to spend payments from the government programs and residents, according to Cindy Mann, who served as Medicaid chi...

MODESTO, Calif. — Britta Foster and Minerva Tiznado are in different leagues as far as health care is concerned. Foster, who married into the family that owns the $2.5 billion Foster Farms chicken company, has Blue Shield coverage as well as a high-octane primary care plan that gives her 24/7 digital access to her doctor for a $5,900 annual fee that also covers her husband and two of their children. Tiznado is from Nayarit, Mexico, and has no insurance. She gets free primary care visits and steep discounts on prescription drugs, lab tests and imaging. But Tiznado, 32, and Foster, 48, go to the same place for their care: St. Luke’s Family Practice, in this Central Valley city of about 217,000 . St. Luke’s, a clinic with a staff of four in a nondescript shopping center, offers an unorthodox combination of concierge-style medicine for the well-off and charity care for the uninsured. The annual fees that St. Luke’s collects from Foster’s family and some 550 other paying patients help ...

When Teresa Nolan Barensfeld turned 65 last year, she quickly decided on a private Medicare Advantage plan to cover her health expenses. Barensfeld, a freelance editor from Chatham, New York, liked that it covered her medications, while her local hospitals and her primary care doctor were in the plan’s network. It also had a modest $31 monthly premium. She said it was a bonus that the plan included dental, hearing and vision benefits, which traditional Medicare does not. But Barensfeld, who works as a copy editor, missed some of the important fine print about her plan. It covers a maximum of $500 annually for care from out-of-network dentists, including her longtime provider. That means getting one crown or tending to a couple of cavities could leave her footing most of the bill. She was circumspect about the cap on dental coverage, saying, “I don’t expect that much for a $31 plan.” Through television, social media, newspapers and mailings, tens of millions of Medicare beneficiarie...

Can’t see the audio player? Click here to listen on Acast. You can also listen on Spotify , Apple Podcasts , Stitcher , Pocket Casts or wherever you listen to podcasts. President Joe Biden unveiled a purported compromise on his social-spending plan shortly before taking off for a series of meetings in Europe. But it remains unclear whether the proposal — which jettisons some of the president’s health priorities — will win the support of enough Democrats to push it over the finish line. Meanwhile, the Supreme Court on Monday will hear oral arguments in a case brought by the Biden administration trying to strike down the Texas law that has stopped most abortions in the state since it took effect in September. This week’s panelists are Julie Rovner of KHN, Joanne Kenen of Politico and Johns Hopkins, Sarah Karlin-Smith of the Pink Sheet and Rachana Pradhan of KHN. Among the takeaways from this week’s episode: The framework announced by the White House provides few details about hea...

The federal government’s effort to penalize hospitals for excessive patient readmissions is ending its first decade with Medicare cutting payments to nearly half the nation’s hospitals. In its 10th annual round of penalties, Medicare is reducing its payments to 2,499 hospitals, or 47% of all facilities. The average penalty is a 0.64% reduction in payment for each Medicare patient stay from the start of this month through September 2022. The fines can be heavy, averaging $217,000 for a hospital in 2018, according to Congress’ Medicare Payment Advisory Commission, or MedPAC. Medicare estimates the penalties over the next fiscal year will save the government $521 million. Thirty-nine hospitals received the maximum 3% reduction, and 547 hospitals had so few returning patients that they escaped any penalty. An additional 2,216 hospitals are exempt from the program because they specialize in children, psychiatric patients or veterans. Rehabilitation and long-term care hospitals are also ex...

Caitlin Wells Salerno knew that some mammals — like the golden-mantled ground squirrels she studies in the Rocky Mountains — invest an insane amount of resources in their young. That didn’t prepare her for the resources the conservation biologist would owe after the birth of her second son. Wells Salerno went into labor on the eve of her due date, in the early weeks of coronavirus lockdowns in April 2020. She and her husband, Jon Salerno, were instructed to go through the emergency room doors at Poudre Valley Hospital in Fort Collins, Colorado, because it was the only entrance open. Despite the weird covid vibe — the emptiness, the quiet — everything went smoothly. Wells Salerno felt well enough to decline the help of a nurse offering to wheel her to the labor and delivery department. She even took a selfie, smiling, as she entered the delivery room. “I was just thrilled that he was here and it was on his due date, so we didn’t have to have an induction,” she said. “I was doing grea...

Many patients dealing with mental health crises are having to wait several days in an ER until a bed becomes available at one of Georgia’s five state psychiatric hospitals, as public facilities nationwide feel the pinch of the pandemic. “We’re in crisis mode,’’ said Dr. John Sy, an emergency medicine physician in Savannah. “Two weeks ago, we were probably holding eight to 10 patients. Some of them had been there for days.” The shortage of beds in Georgia’s state psychiatric facilities reflects a national trend linked to staffing deficits that are cramping services in the public mental health system. The bed capacity problem, which has existed for years, has worsened during the covid-19 pandemic, creating backlogs of poor or uninsured patients as well as people in jails who are awaiting placement in state facilities. Many state workers, such as nurses, are leaving those psychiatric units for much higher pay — with temp agencies or other employers — and less stressful conditions. The ...