Homeless health care crisis: Will street teams remedy?

January 6, 2023 Vera

In summary

Homeless people often have sporadic or no access to health care, resulting in costly, chronic conditions. A new statewide effort encourages Medi-Cal insurers to partner with street teams to improve care.

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Living on the streets of California is a deadly affair. The life expectancy of an unsheltered person is 50, according to national estimates, nearly 30 years less than that of the average Californian. As homelessness spirals out of control throughout the state, so too do deaths on the street, but it’s those whose lives are the most fragile who are least likely to get medical care.

Now, the state Medi-Cal agency is endeavoring to improve health care access for people experiencing homelessness. Through a series of incentives and regulatory changes, the Health Care Services Department is encouraging Medi-Cal insurers to fund and partner with organizations that bring primary care into encampments.

They’re known as street medicine teams. There are at least 25 in California.

“Oh crap. This is where she was, and they just swept that,” said Brett Feldman on a Friday morning in November, looking at a green tent, crumpled and abandoned on Skid Row in Los Angeles. Feldman, a physician assistant, is searching for a female patient in her 40s with severe and unmanaged asthma. She cycles predictably in and out of the hospital, and Feldman knows she’s due for another hospitalization soon.

Physician’s assistant Brett Feldman asks a man in his encampment if he has seen a patient along Skid Row on Nov. 18, 2022. The patient was likely pushed out of the area as the Los Angeles sanitation department cleared the unhoused to clean the street near Skid Row. Photo by Larry Valenzuela for CalMatters

The road is streaked with water from a cleaning truck, and sanitation workers in fluorescent vests sweep up debris. Parking enforcement and police cruisers line the section of road where a homeless encampment once stood. Nearly 5,000 people live in the half-mile block infamous for the hypervisibility it affords the state’s unrelenting homeless crisis.

Burdened by disproportionate rates of addiction, mental health disorders and chronic disease, people experiencing homelessness are some of the state’s neediest patients, but few receive anything more than emergency services. Barriers like lack of transportation and cumbersome insurance rules keep most from getting regular health care. Instead, they drift through the emergency room during a crisis,

Medicare Pay Cuts Will Hurt Seniors’ Care, Doctors Argue

January 1, 2023 Vera

[UPDATED at 11 a.m. ET for news developments.]

Doctors are urging Congress to call off cuts scheduled to take effect on Jan. 1 in the reimbursements they receive from Medicare.

In what has become an almost yearly ritual, physician groups are arguing that patients will have greater difficulty finding doctors who accept Medicare if lawmakers allow the pay cuts to happen.

A more than 4,000-page draft government spending bill released by lawmakers early Tuesday morning proposed much smaller-than-planned cuts to Medicare payments. But the bill, which Congress hoped to pass by the weekend to keep the government funded and avert a shutdown, would not go as far as doctors wanted.

“Despite overwhelming bipartisan, bicameral support to stop the full Medicare physician payment cut, Congress failed once again to end the cycle of harmful Medicare cuts, showing a disregard for vulnerable seniors,” the Surgical Care Coalition, an organization representing surgeons and anesthesiologists, said in a statement.

The doctors’ lobbying campaign had gained traction on Capitol Hill. A bipartisan group of 115 House lawmakers rallied behind doctors in a letter to congressional leaders and President Joe Biden last week, urging them to prevent cuts that they argued would “only make a bad situation far worse” for Medicare patients.

In recent years, the Centers for Medicare & Medicaid Services scheduled the pay cuts to offset the cost of increasing payments for underpaid services, like primary care. Physicians also stand to see reductions tied to broad cuts implemented by Congress in recent decades to try to control government spending.

Some Republicans have pushed to wait on passing the spending package until their party controls the House of Representatives next year and can have a greater say over what they call out-of-control spending. One priority of the incoming House Republican majority is curbing Social Security and Medicare, a federal health insurance program for people age 65 and older, among others.

“We’re mortgaging our kids’ futures,” Sen. Ron Johnson of Wisconsin, a Republican on the Senate Budget Committee, told reporters, referring to overall spending. “This is killing us from a financial standpoint. It’s got to stop.”

Despite concerns about ballooning government spending, for years doctors have been successful in delaying or softening proposed pay cuts, arguing that there would be dire consequences if the cuts kicked in.

Physicians carry a lot of political weight in Washington. The American Medical Association, the professional organization that represents and

Health Care Shouldn’t Be This Expensive: How to Find Answers and Low-Cost Options

December 23, 2022 Vera

This story is part of Priced Out, CNET’s coverage of how real people are coping with the high cost of living in the US.

Evan Stewart has epilepsy, so going a day without health insurance isn’t an option. When he left his job in the medical field to tour with his musical band, he was able to keep his benefits through COBRA. That meant a large part of his income — $800 a month — went toward keeping that coverage until he qualified for another insurance plan with his new employer.

Brandon Douglas/CNET

The cost wasn’t bad considering the alternative. “If a seizure lasts me more than five minutes, an ambulance has to come to my house, and then I’ll probably go to the emergency room,” said Stewart, who lives in Seattle. “Without insurance, the ambulance ride would bankrupt me, and the hospital stay would keep me in medical debt for the rest of my life.”

Stewart was nervous about switching his job because he didn’t want to give up his health care benefits. That’s fairly common in the US: One out of every six adult workers who get medical insurance through an employer stay in their jobs out of fear of losing coverage, according to a recent Gallup poll. While the majority of larger employers offer health benefits, annual premiums have soared in the last decade, reaching a yearly average of $7,911 for single coverage and $22,463 for family coverage. Many of these plans also have costly copays and high deductibles, requiring employees to pay even more.

Even with a good insurance policy like Stewart’s, Americans often find themselves paying insurmountable out-of-pocket medical expenses.

“We have an incredibly complex health care system,” said Amy Niles of the PAN Foundation, a nonprofit that helps underinsured patients in need. “And unfortunately, at the end of the day, a lot of the cost gets shifted onto the patients.”

That’s why, according to Niles, it’s important to understand the price tag when considering your own health needs. Getting affordable medical care isn’t impossible, but it means sifting through an array of options: from private short-term plans to the Affordable Care Act’s marketplace tiers to government- or state-based insurance, all with different rules, requirements, enrollment dates, premiums and deductibles. It also means becoming a strong self-advocate. If a household can’t afford health insurance, there are other resources that provide

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

December 20, 2022 Vera

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

Health care organizations urge COVID & flu vaccination and treatment

December 1, 2022 Vera

Statement from: American Academy of Family Physicians, American Association of Nurse Practitioners, American Academy of Physician Associates, American College of Emergency Physicians, American College of Physicians, American College of Obstetricians and Gynecologists, American Geriatrics Society, American Medical Association, American Osteopathic Association, Council of Medical Specialty Societies, Infectious Diseases Society of America, and AMDA – The Society for Post-Acute and Long-Term Care Medicine

WASHINGTON November 21, 2022 – Given the anticipated increase in COVID-19 and influenza cases this fall and winter, America’s health care professional organizations are coming together to remind the public of the importance of vaccinations and early treatment. A strong recommendation from a trusted clinician is one of the most effective strategies to increase vaccine uptake. We encourage our members to use every interaction with patients as an opportunity to make strong vaccine recommendations, educate and answer questions about prevention and treatment options, encourage vaccination, and where feasible provide vaccination.

We strongly recommend that everyone who is eligible, especially those at higher risk, urgently receive their updated COVID-19 booster (or COVID-19 primary series if not yet vaccinated) and influenza vaccine. We expect that the updated COVID-19 vaccine will help reduce severe illness, hospitalizations and death for our most vulnerable patients, including older adults, those who are pregnant and recently pregnant, and those from historically minoritized communities. We urgently ask all clinicians to be vigilant and prioritize vaccination in the coming months. To maximize uptake of vaccines after counseling, our organizations will continue to advocate for access to vaccines and evidence-based treatments for everyone.

Given the higher morbidity and mortality among older people, those who are pregnant and recently pregnant, and immunocompromised people, we strongly recommend that health care professionals increase their timely use of effective treatments. While newer variants may not respond to some existing treatments, health care professionals must be ready and able to prescribe life-saving oral antiviral treatments for COVID-19 and influenza, to those at highest risk. It is critical that everyone, especially those at risk for serious illness, understand the importance of testing and early communication with their clinicians to seek treatment as soon as they test positive.

We commit to continue working with federal partners to provide usable and consistent information and emerging evidence-based tools that we can rapidly push to our members. The time to act is now, and the nation’s organizations of health care professionals are ready and willing to do all

Attacks on Health Care Bi-Monthly News Brief: 02 – 15 November 2022 – World

November 26, 2022 Vera

SHCC Attacks on Health Care

The section aligns with the definition of attacks on health care used by the Safeguarding Health in Conflict Coalition (SHCC).

Africa

Burkina Faso

03 November 2022: In Bondokuy village, Mouhoun province, Boucle du Mouhoun region, an ambulance and a motorcycle were seized by suspected JNIM militants. Source: ACLED1

Cameroon

03 November 2022: In Batibo town and subdivision, Northwest region, unidentified perpetrators abducted nine health workers from a government-run hospital. Sources: FX Empire and Reuters

Democratic Republic of the Congo

22 October 2022: In Some village, Mambasa territory, Ituri province, suspected members of rebel group Allied Democratic Forces looted pharmacies during an attack. Source: Radio Moto

07 November 2022: In Djugu territory, Ituri province, the International Committee of the Red Cross restarted their activities in the area after having been suspended since 2001 following the killing of six Red Cross aid workers. Sources: Actualité and Radio Moto

09 November 2022: In Kabasha village, located on the road between Butembo and Beni cities,
North Kivu province, more than 200 heavily armed members of the rebel group Allied Democratic Forces (ADF) entered the village and looted the hospital centre of Kabasha before setting it on fire.
A male doctor found at the hospital centre was also kidnapped, while hospital patients were threatened. The perpetrators burnt down fourteen local shops including pharmacies. Sources:
Actualité I, Actualité II, La Prunelle, Radio Moto I, Radio Moto II, and Radio Okapi

Attacks on Health Care in the DRC

At least 25 health workers have been kidnapped in the DRC between 01 January and 20 October 2022. Download the dataset with details on the reported perpetrator and weapons used on HDX. The dataset does not yet include incidents reported in this News Brief. Registered HDX user? Follow us for the latest dataset updates.

Kenya

01 November 2022: Near Mandera town and county, along the Kenya-Ethiopia-Somalia border, al Shabaab militants hijacked a government ambulance that was on its way to the Elwak Referral Hospital, and abducted four men – the driver, two paramedics of the Lafey Health Centre, and a 40-year-old patient – taking them towards Somalia. The medics and the patient were released the next day, while the driver was set free on 03 November. Sources: AA, Al Jazeera, All Africa, Garowe,
Nation, Reuters, The Standard, The Star and Voice of America

Niger

05 November 2022: Between Arlit and Tchibarakaten departments, Agadez

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