Ongoing cuts to Medicare reimbursement rates are leaving New England private practices in critical condition.

Doctors said the outdated payment system is forcing them to close or consolidate, limiting patient access to lifesaving treatments.

Dr. Christopher Kwolek, chief medical officer of The Vascular Care Group, said outpatient facilities, which use high-cost equipment to treat heart disease, cancer and diabetes, are most at risk.

"We're trying to make care more cost-effective and more patient-centered and focused," Kwolek asserted. "And yet, with the current reimbursement mechanism, it's actually driving things in the opposite direction."

Kwolek pointed out Medicare does not cover the cost of care or physician pay for at least 300 office-based services. He argued without congressional action, patients will face longer wait times and increasingly higher prices.

The Office Based Facility Association, a coalition of health care specialists, is calling on lawmakers to reform what is known as the Medicare Physician Fee Schedule, which determines what services are covered for what price. It is asking for a new payment model for outpatient providers and changes to how high-cost supplies are covered.

Jason McKitrick, executive director of the association, said failure to act will have widespread implications.

"We'll see more center closures, more consolidation, more migration of physicians to higher-cost sites of service," McKitrick contended. "It will take what is already a crisis and make it that much worse."

McKitrick noted outpatient centers, especially in rural areas, are efficient, have higher patient satisfaction rates and take pressure off community hospitals, which often face staffing shortages. A bipartisan group of more than 200 House members is urging leadership to prevent another cut to the reimbursement rate planned for next year and to draft legislation to avoid further cuts in the future.

By Dawn Attride for Sentient.
Broadcast version by Shanteya Hudson for California News Service reporting for the Sentient-Public News Service Collaboration

Avian flu, also known as H5N1, continues to infect hundreds of cattle, and is making its way into humans. Since avian flu isn't as easily spread among people for now, the main concern is for those in contact with cows, such as the dairy workers who have reported infections. However, as of November 13, 2024, a teenager in British Columbia -- who seemingly had no contact with animals - is now in critical condition, making it Canada's first human case of bird flu.

Since 2022, the current strain of the virus in the United States has infected over 100 million birds and is remarkable in its "scope and scale" to move beyond its usual avian host, and into mammals at a concerning rate, experts say. Wastewater detection shows the virus present in California, Texas and Michigan, among other states. As of this writing, there have been 53 confirmed human cases in the United States. All, except one, were exposed to infected cattle or birds, according to the CDC. Unlike Canada's critical patient, all U.S. cases reported mild symptoms.

A Potential 'Win-Win' Solution

"No matter how you look at it, we're in a pretty unique and extraordinary position. We've never had an outbreak of an animal-borne virus this large in the last five to 10,000 years of human history since we first domesticated animals for food," Maurice Pitesky, an associate professor and expert in poultry disease modeling at the UC Davis School of Veterinary Medicine, tells Sentient.

One of the main reasons for that is how we farm, he says. A California-native, Pitesky has seen hundreds of dairy facilities in the Central Valley alone overlapping or overtaking natural wild bird habitats, such as wetlands. As a result, these wild birds, particularly waterfowl, start congregating near dairy and poultry farms, leading to more interactions with farmed animals, and increasing the risk of avian flu spread.

Pitesky's lab researches how we can shift waterfowl habitat away from livestock farms, for example by restoring wetlands.

"In many ways, that's kind of a win-win solution. It creates a natural habitat for waterfowl - which we've lost a lot of - and then also reduces and mitigates the potential for exposure to viruses," Pitesky says. (It's also good for mitigating climate change.)

Another concern is that avian flu spread to a pig in a backyard farm for the first time in the U.S. this October. Pigs can pick up multiple infections at the same time, which can create a perfect storm in terms of creating a virus that can be easily spread among humans - an example being the swine flu pandemic in 2009.

More needs to be done on the public health side, Pitesky tells Sentient, to avoid human-animal interaction. "An RNA virus [such as avian flu] can mutate really easily. The more that we keep tempting fate by having the virus interact with humans, the greater the potential for the virus to eventually get snake eyes - if you will - as far as how it can adapt to different hosts, including us."

A Resurgence of Raw Milk Could Help the Virus Spread

Marjorie Taylor Greene, a controversial far-right politician, recently promoted drinking raw milk on X, citing the Republican movement to "Make America Healthy Again." Robert F. Kennedy Jr., who President-elect Donald Trump has nominated to lead the Department of Health and Human Services, is also a proponent of raw milk. Raw milk can contain a host of other microbes that cause infection and should be avoided to prevent avian flu infection, seeing as a growing number of cattle herds now have the virus. The U.S. Department of Agriculture recently announced they will start testing bulk raw milk for the virus.

The CDC continues to say the current public health risk of avian flu is low, but that hasn't stopped health organizations from gearing up to be prepared. In Canada, several influenza vaccines are "authorized for use," as is a federal manufacturing agreement to scale up vaccine production if there is an avian flu pandemic. In early October, the U.S. invested $72 million in vaccines against avian flu "as part of national preparedness." With the upcoming change in national leadership, however, time will tell if preparing for avian flu remains a priority.

As the virus continues to spread, Pitesky recommends those with backyard chickens or other wild birds use caution when handling birds. For now, anyway, the CDC still advises consumers to avoid raw milk, practice good hygiene and avoid poultry and dairy farms, if possible.


Dawn Attride wrote this article for Sentient.


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Between 2013 and 2022, health care spending in Colorado surged by 139% to nearly $30 billion, according to a new analysis by the Center for Improving Value in Health Care.

Cari Frank, vice president of communications at the center, said in addition to rising private health insurance premiums paid by Coloradans and their employers, people are also paying more out-of-pocket.

"Out-of-pocket costs for the most recent year of data, in 2022, was roughly a little bit over $1000 out of pocket per person, per year, for people with commercial insurance," Frank reported. "That has risen over 45% since 2012."

Between 2013 and 2022, the amount of medicine prescribed to patients increased by 10% and drug costs rose by 151%. The number of outpatient visits ticked up by 25% and the cost of those visits rose by 51%.

Higher costs do not necessarily affect insurance company bottom lines. The Denver Post reported Cigna Healthcare's 2022 profits at $6.7 billion.

Frank noted out-of-pocket costs increased by 80% for older Coloradans with Medicare Advantage, plans claiming claim to limit health costs for people living on fixed incomes.

"Which is roughly $1700 per person, per year," Frank pointed out. "Again, huge for a senior population who may not have any income coming in the door besides Social Security."

The analysis of data from the Colorado All Payer Claims Database found the number of inpatient hospitalizations dropped by 19% since 2013 and costs only dropped by 11%.

Frank believes access to transparent, reliable data is essential for policymakers to improve the state's health care system.

"This data is helping people understand where can we implement policy changes that can bring down those prices," Frank emphasized. "Then this data can help track the progress that we're making when those legislative initiatives go into effect."

First responders in the east Texas city of Longview are getting help from a recently formed organization.

The GLOW program helps connect residents with services they need.

Amy Hooten, community health section chief for the City of Longview, said people sometimes call 911 for nonemergency issues.

"Like transportation, food insecurity, they have trouble getting their medication," Hooten outlined. "They don't really have family support. They're not able to connect with the resources that are available in the community, and so that's what we do."

She explained GLOW is made up of eight entities within Longview including the city, the county, United Way, both hospitals and mental-health services. It's funded through a grant from Episcopal Health Foundation.

The program was formed toward the end of the COVID-19 pandemic. Once residents sign up, a needs assessment is performed to determine what services they are lacking.

Hooten noted it is beneficial in addressing nonmedical drivers of health.

"As we're following them, we're able to see where the gaps in services are and where the gaps in connection are," Hooten observed. "Then we can help each other as medical agencies and as agencies within our community that are trying to help people with their needs."

She pointed out while 911 is designed to get people to emergency services, it also receives a range of calls from requests to tuck someone in at night to assistance with making a sandwich.

"Our highest utilizer at one point was 87 times in a year," Hooten recounted. "He sometimes was calling every day of the week, multiple times in a week, and with the GLOW program we were able to connect him to the right resources and give him some of the things he was needing, and he started calling once every three months."

She added connecting residents with the proper organizations frees up first responders for emergency calls.


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