Letters to the Editor is a periodic characteristic. We welcome all comments and will publish a variety. We edit for size and readability and require full names.

On ‘Doctor Assistant’: Watch Your Language

I believe this story neglected a number of essential items of knowledge (“A Title Fight Pits Physician Assistants Against Doctors,” Dec. 3). The time period “doctor affiliate” is already utilized in Eire and the UK, and Yale’s P.A. program has used the time period for a while. A latest replace to the U.S. Division of Training’s Classification of Tutorial Applications modified the title of CIP Code 51.0912 from Doctor Assistant to Doctor Affiliate/Assistant. The slash signifies equal program titles. Whereas the titles weren’t up to date, residency and fellowship packages for P.A.s in Collection 60 embrace “doctor affiliate” as an illustrative instance.

— Allan Joseph Medwick, Clinton Township, Michigan

— Charles Taylor, Muncie, Indiana

It’s disturbing that the story didn’t spend a lot time discussing the distinction in coaching and schooling. After all, we’re grateful for our midlevel suppliers, however there’s a huge distinction in the kind of coaching obtained and the extent of duty that doctor assistants and nurse practitioners are lobbying for in lots of states. It’s harmful. The article made it seem to be this boils down to cash, and it doesn’t. It’s about schooling and coaching and the security of our sufferers. The P.A. on the finish of the story made a remark about altering tires on a automotive and not needing a jet engineer, however actually it’s about realizing the distinction between a automotive and a jet.

— Dr. Sharita Trimuel, Columbus, Georgia

If doctor assistants need to develop into medical doctors, why don’t they 5X their coaching and full medical faculty, residency and maybe fellowship.

There are not any shortcuts in changing into a physician. https://t.co/MlxgxqsGav

— AJ Kavanaugh (@AjKavanaugh) December 7, 2021

— AJ Kavanaugh, Fishers, Indiana

The well being of the affected person. That is and ought to stay the purpose of all well being care suppliers. Superior observe suppliers (APPs) resembling doctor assistants and nurse practitioners assist physicians fill this function. Most sufferers who see an APP really feel that APPs add worth to their care, assist them to see a supplier sooner and are trusted to care for his or her well being. I perceive the apprehension of physicians towards the title change from “doctor assistant” to “doctor affiliate” and advocate that each well being care supplier ought to observe inside their scope of observe. The truth is that well being care is a group sport. As a pupil incomes twin grasp’s levels in public well being and doctor assistant research, I’m passionate and enthusiastic about this. Environment friendly and efficient collaboration between nurse practitioners, doctor assistants, nurses, social employees, pharmacists, dietitians, public well being employees and many others is critical to look after the inhabitants of sufferers that we see.

I additionally perceive the need for the title change. Once I inform folks or sufferers that I’m a doctor assistant pupil, hardly ever multiple or two will perceive what my function shall be except they routinely see a P.A. Most consider a P.A. to be a private assistant, scheduler or scribe to the doctor in my expertise. I consider {that a} title change to doctor affiliate will foster belief from sufferers that the P.A. is an extension of the doctor. All these concerned in well being care ought to stay aware of their scope of observe, however the title of P.A.s ought to mirror the belief positioned in them by the physicians they work with and the sufferers they see.

There appears to be a disconnect between physicians and doctor assistants on an organizational stage. Plainly collaboration and communication on titles and roles ought to mirror the quantity of collaboration between physicians and advanced-practice suppliers in caring for sufferers day by day. It is vital to keep in mind that we’re all on the identical group and ought to talk as such.

Interprofessional collaboration is the way forward for medication. I’m proud to be a part of a program that locations such a excessive worth on this and usually permits us to develop these expertise with college students from different packages. No one function can fill each want of the affected person. Open communication, collaboration, innovation and belief will assist us work collectively as a well being care neighborhood to meet the wants of the underinsured, underserved and these already dealing with an uphill well being battle due to their determinants of well being. We’re all on this battle collectively. The battle for the well being of the affected person.

— Gabby Henshue, Madison, Wisconsin

Guarding the Medicare Model

I wrote an op-ed article about this not too long ago (“Readers and Tweeters Find Disadvantages in Medicare Advantage,” Nov. 12) arguing that it’s fraudulent to allow personal medical insurance to use the title “Medicare” for any of its profit-making plans. Medicare is held in such excessive regard that non-public corporations really feel the necessity to steal its model, but when we proceed to allow them to achieve this, we might witness the tip of Medicare.

— John Steen, South Burlington, Vermont

— David Howard, Decatur, Georgia

Gauging Medicare Benefit Prices: It’s Sophisticated

Please make the numbers a bit extra comprehensible for people who might have problem greedy the magnitude of the issue (“Researcher: Medicare Advantage Plans Costing Billions More Than They Should,” Nov. 11). The typical particular person might discover it simpler to perceive the gravity of the difficulty for those who informed them that their Medicare Benefit insurance coverage firm is receiving $1,000 a month per particular person or $12,000 a yr of their taxpayer {dollars} that might be higher spent on offering common or unique Medicare recipients dental, imaginative and prescient and listening to and different useful protection. Folks can not relate to billions stolen by massive companies, however they will relate to 1000’s of {dollars} being stolen from every of them.

— Cheri Zao, Coeur d’Alene, Idaho

That is an unimaginable pile of nonsense. Evaluating the safety supplied to seniors by MA plans to straight, government-issue Medicare is like evaluating a Kia to a Mercedes S-Class. Let me clarify why these comparisons are completely invalid. 1/5https://t.co/EdkRoEdrMW

— Michael Bertaut (@MikeBertaut) November 11, 2021

— Michael Bertaut, Galvez, Louisiana

It was disappointing to learn KHN’s one-sided reporting of Medicare Benefit prices and spending, which omitted key data that might have helped to inform seniors.

For instance, the article parrots beforehand debunked claims that “taxpayers pay way more for comparable sufferers who be part of [Medicare Advantage] … than for these in unique Medicare.”

The reality? A new actuarial analysis from Milliman discovered that complete authorities funds to unique Medicare are “barely greater” than Medicare Benefit for beneficiaries of an analogous well being standing.

The report goes on to clarify that “[Medicare Advantage’s] decrease price of protection regardless of offering extra advantages than FFS [original] Medicare lowers complete program prices … and will increase the worth for each healthcare greenback spent by the federal government and the beneficiary.”

This analysis was shared with the reporter prior to KHN’s publication of this text and was regrettably not included.

What’s extra, the article casts doubt on Medicare Benefit’s threat adjustment course of, the authorized mechanism by which Medicare Benefit receives fee for beneficiaries’ care.

KHN’s reporting argues that common threat scores in Medicare Benefit have risen in recent times, with out offering a proof as to why.

Once more, analysis from Milliman reveals that, from 2013 to 2019 alone, enrollment in Medicare Benefit amongst dual-eligible beneficiaries — who typically current extra complicated well being wants and greater charges of social threat elements — elevated by 125%, even because it dropped in fee-for-service Medicare.

Now, Medicare Benefit serves a better proportion of minority and low-income beneficiaries, in addition to a better proportion of beneficiaries with three or extra persistent situations. This context is useful in understanding threat scores in Medicare Benefit at this time.

Danger adjustment is essential to Medicare Benefit’s success in figuring out unmet wants, coordinating earlier interventions, and driving higher well being outcomes for the 27 million seniors and Individuals with disabilities who entrust this program with their care.

At a time after we want to improve understanding of threat adjustment and Medicare Benefit spending, this biased reporting sadly solely added to the misinformation that faces seniors.

— Mary Beth Donahue, president and CEO of Higher Medicare Alliance, Chevy Chase, Maryland

— U.S. Rep. Lloyd Doggett, Austin, Texas

With So Many ‘On the Take,’ Enrollment Assist for the Taking

If the Facilities for Medicare & Medicaid Companies is so involved, I don’t perceive why it doesn’t inform the insurance coverage corporations to cease the barrage of advertisements on TV which might be deceptive (“Medicare’s Open Enrollment Is Open Season for Scammers,” Nov. 11). It’s not even clear that insurance coverage salespeople are going to be on the cellphone traces or whether or not you want to have Medicaid to get a “deal.” And why, for heaven’s sake, don’t you inform the general public that they will get free sign-up assist from their native Space Company on Getting older workplace? As an elder regulation lawyer in Texas, I’m appalled at what I’m seeing occurring — a free-for-all for the insurance coverage corporations that ought to merely be open enrollment for seniors. Proper now, everyone seems to be thrown into the arms of a grasping insurance coverage firm that doesn’t appear to care in the event that they meet the general public’s wants or not. (I’ve talked to far too many seniors who grew to become homeless as a result of they got misinformation about getting Medicare and Medicaid.)

— Barbara Epstein, Austin, Texas

Appears like he’s saying the “free market” doesn’t actually work in healthcare > Becerra Says Shock Billing Guidelines Drive Medical doctors Who Overcharge to Settle for Truthful Costs https://t.co/T24yrhapow by way of @khnews

— Simon F. Haeder (@SimonFHaeder) November 23, 2021

— Simon F. Haeder, Centre County (“Pleased Valley”), Pennsylvania

Don’t Blame the Medical doctors

I not too long ago learn the article “Becerra Says Surprise Billing Rules Force Doctors Who Overcharge to Accept Fair Prices” (Nov. 22), written by Michael McAuliff. This text may be very deceptive to the general public with reference to who truly controls medical care prices for many sufferers. Most sufferers obtain their care in practices owned by massive hospital techniques. Hospital techniques cost sufferers “X” {dollars} for care. The insurance coverage firm units what they’ll reimburse the hospital system. The doctor, in most contexts, has nothing to do with the value of care. Please be aware: Most hospitals are run by non-physicians. Due to this fact, the value gouging isn’t on the shoulders of physicians however within the arms of insurance coverage corporations and hospital directors. Please place the blame the place it actually belongs.

Physicians hate the shortage of value transparency in our well being care system. We don’t like the truth that we are able to’t say to a affected person, “This go to will price you ‘X’ variety of {dollars}.” Why can’t we do this? As a result of we aren’t conscious of the contract offers the hospital system has with a selected insurance coverage firm. So physicians typically have little thought about the price of a selected process, lab or workplace go to.

There appears to be an unfair assault on physicians when physicians are victims of for-profit “nonprofit” well being care techniques, enterprise capital companies and insurance coverage corporations. Most physicians actually don’t have any say within the value or how care is delivered except the doctor is practising in a non-public observe. Nearly all of physicians observe in non-private observe settings, which implies they don’t have any management over the costs sufferers are charged for care obtained.

If this assault towards physicians continues, medication will discover itself with fewer folks going into it due to the abuse in coaching as well as to physicians getting blamed for issues they don’t have any management over. The misrepresentation and propaganda should cease. Please get to the foundation explanation for an issue fairly than in search of a simple scapegoat (doctor). If not, I’m afraid for future generations, as a result of our greatest and brightest will refuse to enter the medical area, and I wouldn’t blame them.

— Dr. Dezmond Sumter, Columbia, South Carolina

— Joe Garbanzos, San Diego

Don’t Tie Physicians’ Arms on Off-Label Prescribing

This text quantities to an assault on off-label prescribing of the FDA-approved medication ivermectin and hydroxychloroquine (“Hospitals Refused to Give Patients Ivermectin. Lockdowns and Political Pressure Followed,” Dec. 2). The article obscures plain info of hospital observe. Physicians ought to have the precise to prescribe any drug that’s believed to be useful to their sufferers, topic to settlement with the medical employees director and pharmacy and therapeutics committee. To restrict their authority to use FDA-approved medication to accepted indications solely would deprive their sufferers of receiving many helpful off-patent medicines. Such previous medication don’t have any sponsor prepared to make investments hundreds of thousands of {dollars} in getting new indications accepted by the Meals and Drug Administration.

As to what the article phrases “harassment” of physicians, might I say that threats towards physicians and care employees are by no means acceptable. However contemplate how you’ll really feel for those who had been watching a member of the family within the intensive care unit “circle the drain” whereas medication which have cheap proof of utility are withheld. Training physicians are usually not held to the identical requirements of information evaluation as teachers and FDA employees as a result of sufferers’ lives are at stake proper now. I’ve seen reviews of using ivermectin and hydroxychloroquine being discouraged by bureaucratic claptrap whereas sufferers die, and I’m fed up. As a pharmacist with 40 years of expertise, I’ve motive to take a much less rosy view of the FDA than medical residents and the writer of this text.

— Brent Cornell, Boise, Idaho

Thoughts boggling. Are you able to think about being a medical skilled on this state of affairs? | Hospitals Refused to Give Sufferers Ivermectin. Lockdowns and Political Strain Adopted. https://t.co/dMmkD4Py2w by way of @khnews

— Kristi Arellano (@Kristi_Arellano) December 2, 2021

— Kristi Arellano, Denver

Navigators Received’t Steer You Fallacious

I used to be disenchanted that podcaster Dan Weissmann, throughout his visitor look to talk about purchasing for medical insurance on the “What the Well being?” podcast, failed to point out free, correct and unbiased help by the federally supported navigator system (“KHN’s ‘What the Health?’: Boosting Confusion,” Nov. 18). As a volunteer navigator, we help shoppers with medical insurance literacy, utility help, coverage choice to greatest serve their pursuits, referral to acceptable businesses if mandatory and post-enrollment points. Since by regulation we are able to don’t have any vested curiosity during which coverage they select, we are able to present completely unbiased data. For Medicare open enrollment, this system is named SHIIP (Seniors’ Well being Insurance coverage Info Program). With the Inexpensive Care Act, for which I present session, it’s the Navigator program, which could be accessed for all states by clicking the button “discover native assist” on the primary web page of the healthcare.gov web site. Offering this data to your readers will assist us promote our attain and mission. Thanks.

— Dr. Robert Shapiro, Southport, North Carolina

— Harry Sit, Reno, Nevada

On the Hook for Stitches: A Staff’ Comp Loophole

I’m a Kaiser Permanente doctor who treats folks damage at work. The affected person in your story bought damage at work (“The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER,” Nov. 19). Why didn’t Tennessee employees’ compensation cowl his care? Why wasn’t this talked about as a problem? Many states have very restricted employees’ compensation protection. Maybe Tennessee is one such state. I observe in Washington state, which has a state-run employees’ comp system, however many people don’t know that their work accidents are coated, and they hesitate to search care due to concern of the price of going to an ER. 

— Dr. Janet E. Ploss, Seattle

[Editor’s note: Several readers wrote wondering the same thing. Workers’ compensation insurance wouldn’t cover the injury because Jason Dean was working for the company as an independent contractor — technically, a “1099” employee. This is a common employment situation that effectively bypasses workers’ compensation laws in some states, including Tennessee. The employee is treated as a subcontractor even though they function as an employee. The article has been updated to add this detail.]

Medical health insurance is the most important racket since medical billing codes. Medical billing codes are the most important racket since medical insurance. American well being care is a rip-off from each ends.

The ER Charged Him $6,500 for Six Stitches. https://t.co/skYcVnfBou

— TL Jordan (@dulcedemon) November 19, 2021

— Tara Jordan, Hazleton, Pennsylvania

Dental Hygienists: A Observe-Up

I would really like to tackle inaccuracies made by Illinois State Dental Society lobbyist Dave Marsh concerning why the ISDS killed laws to permit Illinois public well being dental hygienists to present preventive dental providers for sufferers in prisons, nursing properties and cellular dental vans with out an preliminary dental examination (“Hygienists Brace for Pitched Battles With Dentists in Fights Over Practice Laws,” Oct. 19). The ISDS mentioned it didn’t help the laws for “affected person security causes.”

1. There isn’t any information to point out hygienists initiating primary preventive providers — which they’re educated and licensed to carry out — hurt sufferers and not using a prior examination.

In his reference to hygienists offering preventive look after residents of nursing properties, Mr. Marsh mentioned, “I simply don’t really feel anyone with a two-year affiliate’s diploma is medically certified to right your well being. They’re skilled to clear tooth. They take a pointy little instrument and scrape your tooth. … That’s all they do.” He additionally cited a “shortage of analysis” on the advantages of dental hygienists having extra skilled freedom.

2. Had Mr. Marsh seemed, he would have discovered a plethora of information that helps fewer restrictions be positioned on hygienists to present providers they’re educated and licensed to carry out. In 1986, a California demonstration challenge allowed hygienists to open unbiased practices and present prophylaxis, fluoride, root planing and exams. Researchers in contrast the seven hygiene practices to six dentist-owned practices and discovered the hygienists supplied equal or higher care in most areas, together with an infection management. The hygienists stored extra correct medical data and additionally supplied extra providers to Medicaid sufferers than the dentists.

3. What Mr. Marsh didn’t say was that in 2015, when the Illinois legislature was contemplating laws to permit hygienists employed in public well being settings to present primary hygiene providers for Medicaid and low-income sufferers earlier than an examination by a dentist, the quid professional quo from ISDS for not killing the invoice was a provision to permit dental assistants to present “coronal scaling” for low-income sufferers up to age 12.

Though Mr. Marsh urged a scarcity of analysis on the advantages of hygienists having extra skilled freedom, information indicating affected person advantages from a superficial scaling above the gumline is nonexistent. Supragingival scaling is a part of a whole prophylaxis, it doesn’t change it, nor does it improve entry to look after underserved inhabitants teams, not like the now-defunct Illinois hygiene laws.

Dental Affiliation PACs use their deep pockets to leverage legislators on a regular basis, resembling Illinois Sen. Dave Syverson, who isn’t solely the primary cousin of the ISDS’ previous president, however, in an audio recording discovered by KHN on this problem, Syverson made it clear that when it comes to voting on dental points that profit Illinois’ underserved inhabitants, he’ll put his personal pursuits of attending ISDS freebie dinners and receptions forward of the general public each time.

4. For the roughly 60 million Individuals residing in dental deserts, this case is all too acquainted.

In July 2017, The Washington Put up reported on “the sudden political energy of dentists” and cited “a political pressure so unified, so relentless and so completely woven into American communities that its clout rivals that of the gun foyer.”

5. For years, dental hygienists have advocated to fill a essential want most licensed dentists are unwilling to tackle: offering primary preventive and therapeutic dental hygiene providers they’re licensed and educated to present for America’s underserved. It’s time for state political and skilled leaders to step up to the plate and make selections primarily based on what’s in one of the best curiosity of the general public they serve as an alternative of themselves.

— Suzanne Newkirk, Lakemont, Georgia