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justinspoliticalcorner · 14 days

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Jessica Glenza at The Guardian:

A bill introduced by the US senator Bernie Sanders would dramatically expand access to oral healthcare by adding dental benefits to Medicare and enhance them in Medicaid, public health insurance programs that together cover 115 million older and lower-income Americans.

Despite Americans’ reputation for the flashy “Hollywood smile”, millions struggle to access basic dental care. One in five US seniors have lost all their natural teeth, almost half of adults have some kind of gum disease and painful cavities are one of the most common reasons children miss school. “Any objective look at the reality facing the American people recognizes there is a crisis in dental care in America,” Sanders told the Guardian in an exclusive interview. “Imagine that in the richest country in the world.” Nearly 69 million adults and almost 7 million children lack dental insurance. For those who have insurance, costs are often opaque and high. Multi-thousand-dollar bills are so common that the nation’s largest professional organization for dentists, the American Dental Association (ADA), signed an exclusive partnership with a medical credit card company. In 2019, more than 2 million Americans went to the emergency room for tooth pain, a 62% increase since 2014, and a crisis of affordability pushed an estimated 490,000 Americans to travel to other countries such as Mexico for lower-cost dental care.

“The issue of dental care is something we have been working on for years,” said Sanders. “It is an issue I think tens of millions of Americans are deeply concerned about, but it really hasn’t quite gotten the media attention it deserves.” Sanders said he had seen how poor dental health can affect every aspect of a person’s life – he described constituents who cover their mouths when they laugh or have been turned down for jobs because of missing teeth. Sanders said he recognized the importance of the issue by attending town halls in his home state of Vermont, “and learning how hard it is to get dental care, how expensive it is and [how] dental insurance [is] totally inadequate”. “Having bad teeth or poor teeth is a badge of poverty,” said Sanders. “It becomes a personal issue, a psychological issue, an economic issue as well.”

Sanders’ bill expands dental coverage by adding comprehensive benefits to Medicare; incentivizing states to improve dental benefits through Medicaid; and providing dental benefits to veterans through the Veterans Administration. Additionally, the bill would attempt to tackle some states’ dentist shortage by creating student loan forgiveness programs for dentists who practice in underserved areas, and increasing funding to non-traditional places to see dentists, including at community health centers and schools. Expanding dental coverage is exceedingly popular – recent polls show 92% of voters support the proposal, including an overwhelming majority of Republicans. Sanders said his proposal was good policy and “very good politics”.

Senator Bernie Sanders (I-VT) has proposed a bill called the Comprehensive Dental Reform Act that would dramatically increase coverage for dental care for Medicaid and Medicare patients.

#Bernie Sanders #Dental Care #Health Care #Comprehensive Dental Reform Act #118th Congress #US Senate #Dentist Shortage #Medicare #Medicaid

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autisticadvocacy · 1 year

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ASAN is dismayed by the debt ceiling deal recently signed into law. While Medicaid remains protected, ensuring access to Home- and Community-Based Services (HCBS) and healthcare for many members of our community, the deal does harm to other safety net programs.

The debt ceiling negotiations were a manufactured crisis. Congress and the administration were not trying to agree on how the government will spend money in the future. Instead, the negotiations were about whether the US will keep its promises to pay for goods and services it already bought. If Congress had not raised the debt ceiling in time, the government would not pay all of its bills on time and the consequences of this would have been devastating. There would have been a recession in the US and possibly in other countries. Marginalized people— including disabled people— would have been hit especially hard by job losses. Benefits payments to individuals and federal wages might have stopped. Delayed Medicare and Medicaid payments could have caused chaos in the health care system and interrupted the HCBS many of us need to live in our communities. These consequences would have especially affected marginalized communities.

Congress should have raised the debt ceiling without trying to change federal spending, as it regularly did prior to 2011. It was irresponsible for some members of Congress to put Americans at risk of interrupted benefits and health care access, and people around the world in danger of job loss and poverty, just to try to cut benefits programs. Congress should decide what the country will spend in budget negotiations, not put millions of people at risk of hardship by arguing about whether to pay for what the country has already bought.

The outcomes of the debt limit deal are mixed. We are glad that Medicaid was protected from funding cuts and new work reporting requirements. ASAN sends our thanks to everyone who contacted their legislators to protect Medicaid, and helped keep this vital program unchanged.

We are disgusted at the way the debt ceiling deal harms people who count on other lifesaving programs. The debt ceiling deal caps federal spending on many safety net programs for two years. This means that the programs’ budgets will not keep up with inflation. Because of inflation, these programs will need more money to fund the same amount of services, but the cap makes sure they will not get increased funding. This will work like a budget cut over time, hurting people who are part of these programs now or will need them in the future.

Congress also added more work reporting requirements to the Temporary Assistance to Needy Families (TANF) program and raised the age for work reporting requirements on the Supplemental Nutrition Assistance Program (SNAP). That means that people on SNAP will have to continue meeting work reporting requirements until age 55 from now on, rather than 49. Fewer people will be able to get these critical benefits. Those who can still get help through these programs will have to fill out more paperwork and go through complicated processes that are often inaccessible. While there are some exemptions for disabled people, this ignores the fact that many disabled people cannot get a diagnosis due to disparities in healthcare costs and access. This is especially true for multiply marginalized people, including people of color and trans people. People without a diagnosis will not be able to use these exemptions.

People will lose access to the benefits they need as a result of the funding caps and new work reporting requirements. Many of those people are disabled or otherwise marginalized. The decisions made during the debt ceiling negotiations will not meaningfully change the government’s debt. What they will do is cause mass suffering for some of the most marginalized people in our society. Parts of the debt ceiling deal, like cuts to funding for tax collection, will increase how much money the government has to borrow to meet its financial commitments. It is clear that the members of Congress who demanded changes to federal spending in exchange for raising the debt ceiling did not prioritize improving the federal government’s finances. Instead, their top priority was slashing assistance to the most vulnerable Americans.

ASAN remains committed to defending programs that serve as a lifeline for our communities, especially Medicaid. The fight for our community’s dignity and access to lifesaving essentials, like food, home- and community-based services, and access to healthcare does not end here — and we remain dedicated to seeing it through.

The Autistic Self Advocacy Network seeks to advance the principles of the disability rights movement with regard to autism. ASAN believes that the goal of autism advocacy should be a world in which autistic people enjoy equal access, rights, and opportunities. We work to empower autistic people across the world to take control of our own lives and the future of our common community, and seek to organize the autistic community to ensure our voices are heard in the national conversation about us. Nothing About Us, Without Us!

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newtonsheffield · 1 year

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Sorry please feel free to ignore this but NHS cards aren’t a thing! You go up to a and e and they ask your details and you pop up on their system with ur info from ur gp office!!!

Weird. Google said they were a thing. You should at least have an NHS number given from your GP right? Which is weird to me that it's managed by your GP to begin with honestly.

In Australia our health system is called Medicare and we have a card from the national government. Looks like this and it carries like 15 to 40 ID points/100 usually as well when applying for passports or Driver's licenses. Very important.

Nothing to do with our GP but it's per family. So like I used to be on my parent's Medicare card but then when I left home I applied for my own card and my medicare number changed but the files merged. It carries our vaccine data and any other health services we've accessed and it's essentially how the government is billed for our care.

So if you ran my medicare card number, you could see that in 2004 I received a meningococcal vaccine during a school vaccine program and in 2008 I was vaccinated against HPV also as part of the school vaccination program.

Yes! in Australia for some vaccinations a form gets sent home, a bunch of nurses show up at your school on a day and they vaccinate everyone in a certain age group whose parents have agreed to it like it's a school lunch (A system that we do not have in Australia. Everyone brings lunch from home pretty much.) it's the easiest way to catch kids because parents don't have to pay a consultation fee (Though Public GPs are completely bulk billed and there's no Co-pay just depends what your doctor is) and your parents don't have to remember to take you. Great for parents who work a lot or low SES kids that might not otherwise be able to access the service.

Anyway, this has taken a tangent but pretty much our medicare card is an identity document and yah. We all have one.

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spooniestrong · 1 year

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C19 National & Public Health Emergencies will end in May, despite—

💔 3 in 5 Adults in the U.S. are at High-risk of severe C19

💔 250,000 deaths in 2022

💔 ~15,000 deaths in Jan 2023 alone

💔 >23 million with #LongCOVID

💔 Healthcare capacity crisis

The removal of the emergencies will greatly impact #elderly, #spoonies, #immunocompromised, #longhaulers who need safe & affordable access to health care & preventative tools.

Based on the @cnn article:

🔺Hospitals will lose the 20% increase in Medicare’s payment rate for treating C19 patients.

🔺The #UNINSURED will lose testing, treatments & 💉C19 shots & boosters.

⚠️C19💉will cost between $82 and $130 per dose

(~3-4X Fed. gov’t has paid, acc. @kaiserhealthnews)

🔺#PRIVATEINSURANCE subscribers could face charges for lab tests, despite ordered by a provider.

🔹C19💉 will be covered for in-network providers for insured people.

🔹Private insurance will pay for the costs of monoclonal antibodies treatment when the Federal supply runs out.

🔺#MEDICARE beneficiaries will face out-of-pocket costs for at-home testing & all treatment.

🔺State #MEDICAID enrollees may face out-of-pocket costs for treatments.

🔹With Medicare & Medicaid, C19💉 & prescribed tests will be covered.

🔺Medicare Advantage plans enrollees will be billed for out-of-network medical facilities.

🔺Starting April 1, states will start kicking people off Medicaid. (~15 million people could be dropped from Medicaid, acc. @HHS.gov )

🔹Americans disenrolled from Medicaid could qualify for other coverage.

🔺Food stamp recipients will lose the supplement of > $95 a month, as of March. (Several states have already stopped providing it.)

🔹Telehealth for Medicare enrollees will continue through 2024. Beneficiaries can use smartphones & receive a wider array of services via telehealth.

🔹FDA will continue to issue emergency use authorizations for shots, tests and treatments.

🔹#Paxlovid and other oral antiviral drugs made available under emergency use authorization will remain covered by Medicare.

These Benefits Will Disappear when Biden Ends the Covid National and Public Health Emergencies in May | @cnnpolitics

https://cnn.it/3YbrB2P

#spooniestrong #spoonie #covid 19 #the war on the disabled #protect the immunocompromised

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cleoselene · 3 months

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Residential rates will remain relatively flat during the first quarter of 2024. Rates are scheduled to decrease in April when a temporary surcharge to pay for past hurricane restorations will end.

fucking christ, this is why my electric bill has been absurd for the last year+ I guess. I know inflation has been a bitch everywhere but it's been especially awful in post-Hurricane Ian Florida. Insurance, HOA fees, utilities, all jumped because of that storm

like my electric bill is already one of my biggest most inflated awful expenses. Living in south Florida and having Multiple Sclerosis, for my own health I don't have an option, I have to keep my AC running 365 days a year. Heat absolutely wrecks me. Medicare helps pay for utilities, THANK GOD, because I spend fully four times more on electricity in Florida than I did in Oregon

I am moving in a few years and even though the places I'm looking at have higher home prices, I have to remind myself that there are so many more expenses that come with living in Florida that will be cheaper somewhere else. Electricity is a big one.

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sanguinifex · 8 months

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Why you should McFucking Vote Democrat, because Biden is a bureaucratic genius

Ok so like. Bureaucracy is where the fiddly bits of how laws actually work happens. It’s anonymous, unthanked, very hard-working people in cubicles and terrible polo shirts who have to use the worst software ever invented. They’re the ones making and using the spreadsheets for “do you qualify for XYZ or not.”

Biden knows the House Republicans won’t let him pass any new laws worth jack, so his solution is to fine-tune the bureaucracy and its application of existing laws. It’s freaking genius. While a Republican president could technically reverse these reforms, in practice they mostly won’t, because it’s boring procedural spreadsheet stuff and not big flashy new laws banning things. The Republicans aren’t even going to notice half the things he’s fixing.

It is, I reiterate, absolutely genius. Biden’s DHHS has requested that cannabis be downscheduled to the level of prescription cough syrup, he’s stopped disability discrimination in organ transplant decisions and custody decisions, he’s reinstated VA benefits for people were discharged from the military for being queer (which means so much less medical bills for them, and access to prescription drugs including HIV meds), he’s the first president to join a picket line, his FTC appointee is suing Amazon for being a monopoly, union-busting is now punishable by being forced to recognize the union, as VP he was heavily involved in the Affordable Care Act, better known as Obamacare…and that’s just what I can remember off the top of my head while completely exhausted. For those worried about his age, he’s obviously still smart as a tack based on his bureaucratic strategies, and if something were to happen to him, Harris is similarly competent and similarly well-versed in bureaucracy, and she’d make similar policy decisions if in office.

Like, Biden is implementing very similar reforms to what I’ve always wanted, and in pretty much the exact same ways I’d do them. It’s to where I’d vote for him in a primary now. It’s all very well to say “Medicare for All,” but then how do you implement it? And I think Biden is the kind of person who’d have a real answer to that, and more importantly, know exactly who to call on to work out the bits that aren’t his area of expertise, such as “how many computers, servers, and new hires would CMS need to accommodate a quadrupling of beneficiaries?” Or to write the changes to tax code (such as eliminating the income cap on Medicare taxes) to fund said influx.

Compare and contrast Trump’s absolute debacle of his pet border wall. Or his muslim ban. Or covid. Like, the only good thing that came out of his presidency was the increase of the standard deduction for personal income tax, and then that later inadvertently screwed over people working from home during the pandemic because they couldn’t deduct the new home office supplies like desks and office chairs that they had to buy.

Also compare and contrast how quickly 2021-2023 have passed by, compared to how 2017-2020 seemed to drag on forever. I know that, even with Russia’s invasion of Ukraine threatening to turn into WW3, I’ve had distinctly less fear of nuclear escalation during Biden’s presidency than during the Orange Turd’s.

Finally, consider what Biden will be able to do once he doesn’t have to worry about getting elected again. Yes, healthcare reform. Employers currently pay the largest share of health insurance costs for people under 65, and those costs have been going up, largely due to insurers’ and for-profit providers’ price-gouging. Said employers are increasingly upset about these costs, to the point that they would likely be willing to opt for single-payer if the state or federal taxes to support it were, say, 80 or 90% of what they’re currently paying in insurance premiums—which would probably be the case, that or less, since CMS would negotiate lower costs, probably no more than 200% of regular Medicare rates. I can tell you for sure that Aetna is paying hospitals 5 times that, and that extra cost is reflected in premiums and (for self-funded plans) in claims, which employers have to pay.

Will the combined lobbying forces of industry giants like Walmart, Amazon, Boeing, Sitel, AT&T, etc. outweigh the opposing lobbying forces of UHC/ OptumRx, Aetna, Blue Cross, CVS, Walgreens, the legion third party administrators, and for-profit medical groups?

Well, we won’t find out unless you vote Democrat next November! Because Biden is a genuinely progressive and competent president and I’d like to keep him, and no one with a single sane braincell wants the other guy. The other guy will probably get us into WW3 and turn it nuclear. Please register to vote, and then actually vote.

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quantumqnnest · 3 months

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QuantumNest LLC Konwn as Top RCM services company in california, offering unparalleled expertise in Revenue Cycle Management Services. With cutting-edge technology and a dedicated team, we optimize revenue streams for healthcare organizations, ensuring financial stability and growth.

#Top RCM services company in california #home health billing medicare in california #home health billing medicare in californa

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hislop3 · 7 months

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Compliance Update: Fraud and Abuse

A complex area for providers, especially with respect to their compliance programs, are the concepts of fraud and abuse. Central to current requirements for compliance programs, all post-acute providers are REQUIRED to have compliance programs that, Include policies and procedures to define, test for, and mitigate any issues pertaining to fraud and abuse. In this case, abuse is not patient abuse…

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#Audits #Billing #Cigna #CMS #Compliance #Department of Justice #False Claims Act #Fraud and Abuse #Home Health #Hospice #Management #Medicaid #Medicare #Money #Nursing Homes #Policy #Post-Acute #Reimbursement #Supreme Court

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dontmeantobepoliticalbut · 2 years

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Congressional Republicans have laid out their mega MAGA trickle-down economic plan clearly. Their economic plan will raise costs and make inflation worse. Their five part plan includes:

1. $3 TRILLION IN TAX CUTS SKEWED TO THE WEALTHY – WHICH WOULD ADD TO THE DEFICIT AND MAKE INFLATION WORSE

“GOP wants to push to extend Trump tax cuts… Republican lawmakers gear up to push 2017 tax law after midterm elections, despite potential impact on inflation.” — Washington Post (10/17/22)

Congressional Republicans are calling for extending expiring provisions of the Trump tax cuts and repealing Inflation Reduction Act (IRA) provisions that require large, profitable corporations to pay taxes and stop wealthy people and corporations from cheating on their taxes. These tax policies would add about $3 trillion to deficits over 10 years, Congressional Budget Office and Joint Committee on Taxation estimates have shown. By adding to near-term deficits, the tax cuts would increase inflation and work against efforts to bring inflation down in 2023.

And, these tax cuts would disproportionately benefit the wealthy. Under the Congressional Republican plan, the top 0.1% of Americans (with incomes over $4 million per year) would get tax cuts averaging over $110,000 per year, Tax Policy Center estimates show. That’s an annual tax cut that exceeds the typical American household’s total annual income.

2. RAISING PRESCRIPTION DRUG COSTS FOR MILLIONS OF SENIORS

“House GOP eyes repeal of Dems’ drug pricing law … Some key House Republicans are calling for the repeal of Democrats’ newly-passed drug pricing measure.” — Axios (9/23/22)

“Because those drug provisions are so dangerous… I would imagine [repealing the Inflation Reduction Act’s prescription drug policies] will be a top priority for Republicans in the new session.” — Rep. Kevin Brady (Ranking Member, Ways and Means Committee)

Repealing the IRA prescription drug provisions would increase prescription drug prices by eliminating the requirement that drug companies pay rebates to Medicare when they raise prices faster than inflation, as they did for 1,200 drugs from 2021-2022. It would expose millions of Medicare beneficiaries to the risk of higher costs by eliminating the IRA’s $2,000 cap on drug costs at the pharmacy, and immediately increase Medicare beneficiaries’ costs for insulin.

3. INCREASING HEALTH INSURANCE PREMIUMS

The IRA provisions making Affordable Care Act (ACA) premiums more affordable “bribe people into Obamacare,” give help to “people making over 400% of the poverty line, a group that was never intended to get subsidies under the original ACA,” “hide the true cost of health insurance,” and make “working taxpayers pay for Obamacare subsidies.” — Ways and Means Committee Minority press releases: 8/8, 8/10

Repealing the IRA improvements to ACA premium tax credits would raise health insurance premiums by an average of about $800 for 13 million people starting next year, with about 3 million people becoming uninsured. And if Congressional Republicans repeal the IRA provision that lets middle-class people get ACA premium tax credits, a 60-year old making $60,000 would pay over $10,000 for marketplace coverage in most states, versus half that today.

4. INCREASING ENERGY BILLS IN 2023 AND BEYOND

“GOP leaders have discussed using the debt limit and government shutdown fights to press for cuts to clean energy spending — which many experts view as necessary to slow climate change — approved as part of the Inflation Reduction Act, Biden’s signature economic legislation.” — Washington Post, 10/25

The Congressional GOP plan will eliminate tax credits that will save Americans thousands of dollars starting next year if they buy an electric vehicle, weatherize their homes, install a super-efficient heating and cooling system like a heat pump, install rooftop solar, or make other investments that will also directly cut their energy bills. Independent experts expect these clean energy provisions will cut households’ electricity bills by hundreds of dollars per year.

5. INCREASING STUDENT LOAN PAYMENTS

“[Student debt relief is] too significant to allow the Secretary to act without Congressional approval… This student loan debt scheme is not a legal or responsible policy…” — Rep. Virginia Foxx (Ranking Member, Education and Labor Committee) and 22 House Republicans, 9/7/22

Republican officials are suing to block the Biden administration’s student debt relief plan. If they succeed, that would mean higher debt payments for the over 40 million Americans who could benefit from up to $20,000 in student debt relief. The vast majority of that relief (nearly 90% of all relief dollars) will go to those earning less than $75,000.

BONUS: CONGRESSIONAL REPUBLICANS ARE THREATENING THE GLOBAL ECONOMY TO CUT SOCIAL SECURITY OR MEDICARE

Sen. Rick Scott has called for putting Medicare and Social Security on the chopping block every five years. Sen. Ron Johnson has gone even further and said Medicare and Social Security should be put up for a vote every single year.

Congressional Republicans keep declaring they will hold the American economy hostage by putting the full faith and credit of the United States at risk in order to cut Medicare and Social Security. Rep. Kevin McCarthy endorsed the idea, and Rep. Nancy Mace said Sunday “I support this strategy.”

And the Republican Study Committee, which represents a majority of House Republicans, has proposed a specific plan to cut Medicare and Social Security benefits, including through privatization and raising the eligibility age.

Congressional Republicans will deny seniors’ benefits they have already paid into.

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tangledhearts1 · 1 year

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Decisions by CVS and Optum Panicked Thousands of Their Sickest Patients

Arthur Allen

NEW YORK — The fear started when a few patients saw their nurses and dietitians posting job searches on LinkedIn.

Word spread to Facebook groups, and patients started calling Coram CVS, a major U.S. supplier of the compounded IV nutrients on which they rely for survival. To their dismay, CVS Health confirmed the rumors on June 1: It was closing 36 of the 71 branches of its Coram home infusion business and laying off about 2,000 nurses, dietitians, pharmacists, and other employees.

Many of the patients left in the lurch have life-threatening digestive disorders that render them unable to eat or drink. They depend on parenteral nutrition, or PN — in which amino acids, sugars, fats, vitamins, and electrolytes are pumped, in most cases, through a specialized catheter directly into a large vein near the heart.

The day after CVS’ move, another big supplier, Optum Rx, announced its own consolidation. Suddenly, thousands would be without their highly complex, shortage-plagued, essential drugs and nutrients.

“With this kind of disruption, patients can’t get through on the phones. They panic,” said Cynthia Reddick, a senior nutritionist who was let go in the CVS restructuring.

“It was very difficult. Many emails, many phone calls, acting as a liaison between my doctor and the company,” said Elizabeth Fisher Smith, a 32-year-old public health instructor in New York City, whose Coram branch closed. A rare medical disorder has forced her to rely on PN for survival since 2017. “In the end, I got my supplies, but it added to my mental burden. And I’m someone who has worked in health care nearly my entire adult life.”

CVS had abandoned most of its less lucrative market in home parenteral nutrition, or HPN, and “acute care” drugs like IV antibiotics. Instead, it would focus on high-dollar, specialty intravenous medications like Remicade, which is used for arthritis and other autoimmune conditions.

Home and outpatient infusions are a growing business in the United States, as new drugs for chronic illness enable patients, health care providers, and insurers to bypass in-person treatment. Even the wellness industry is cashing in, with spa storefronts and home hydration services.

But while reimbursement for expensive new drugs has drawn the interest of big corporations and private equity, the industry is strained by a lack of nurses and pharmacists. And the less profitable parts of the business — as well as the vulnerable patients they serve — are at serious risk.

This includes the 30,000-plus Americans who rely for survival on parenteral nutrition, which has 72 ingredients. Among those patients are premature infants and post-surgery patients with digestive problems, and people with short or damaged bowels, often the result of genetic defects.

While some specialty infusion drugs are billed through pharmacy benefit managers that typically pay suppliers in a few weeks, medical plans that cover HPN, IV antibiotics, and some other infusion drugs can take 90 days to pay, said Dan Manchise, president of Mann Medical Consultants, a home care consulting company.

In the 2010s, CVS bought Coram, and Optum bought up smaller home infusion companies, both with the hope that consolidation and scale would offer more negotiating power with insurers and manufacturers, leading to a more stable market. But the level of patient care required was too high for them to make money, industry officials said.

“With the margins seen in the industry,” Manchise said, “if you’ve taken on expensive patients and you don’t get paid, you’re dead.”

In September, CVS announced its purchase of Signify Health, a high-tech company that sends out home health workers to evaluate billing rates for “high-priority” Medicare Advantage patients, according to an analyst’s report. In other words, as CVS shed one group of patients whose care yields low margins, it was spending $8 billion to seek more profitable ones.

CVS “pivots when necessary,” spokesperson Mike DeAngelis told KHN. “We decided to focus more resources on patients who receive infusion services for specialty medications” that “continue to see sustained growth.” Optum declined to discuss its move, but a spokesperson said the company was “steadfastly committed to serving the needs” of more than 2,000 HPN patients.

DeAngelis said CVS worked with its HPN patients to “seamlessly transition their care” to new companies.

However, several Coram patients interviewed about the transition indicated it was hardly smooth. Other HPN businesses were strained by the new demand for services, and frightening disruptions occurred.

Smith had to convince her new supplier that she still needed two IV pumps — one for HPN, the other for hydration. Without two, she’d rely partly on “gravity” infusion, in which the IV bag hangs from a pole that must move with the patient, making it impossible for her to keep her job.

“They just blatantly told her they weren’t giving her a pump because it was more expensive, she didn’t need it, and that’s why Coram went out of business,” Smith said.

Many patients who were hospitalized at the time of the switch — several inpatient stays a year are not unusual for HPN patients — had to remain in the hospital until they could find new suppliers. Such hospitalizations typically cost at least $3,000 a day.

“The biggest problem was getting people out of the hospital until other companies had ramped up,” said Dr. David Seres, a professor of medicine at the Institute of Human Nutrition at Columbia University Medical Center. Even over a few days, he said, “there was a lot of emotional hardship and fear over losing long-term relationships.”

To address HPN patients’ nutritional needs, a team of physicians, nurses, and dietitians must work with their supplier, Seres said. The companies conduct weekly bloodwork and adjust the contents of the HPN bags, all under sterile conditions because these patients are at risk of blood infections, which can be grave.

As for Coram, “it’s pretty obvious they had to trim down business that was not making money,” Reddick said, adding that it was noteworthy both Coram and Optum Rx “pivoted the same way to focus on higher-dollar, higher-reimbursement, high-margin populations.”

“I get it, from the business perspective,” Smith said. “At the same time, they left a lot of patients in a not great situation.”

***

Smith shares a postage-stamp Queens apartment with her husband, Matt; his enormous flight simulator (he’s an amateur pilot); cabinets and fridges full of medical supplies; and two large, friendly dogs, Caspian and Gretl. On a recent morning, she went about her routine: detaching the bag of milky IV fluid that had pumped all night through a central line implanted in her chest, flushing the line with saline, injecting medications into another saline bag, and then hooking it through a paperback-sized pump into her central line.

Smith has a connective tissue disorder called Ehlers-Danlos syndrome, which can cause many health problems. As a child, Smith had frequent issues such as a torn Achilles tendon and shoulder dislocations. In her 20s, while working as an EMT, she developed severe gut blockages and became progressively less able to digest food. In 2017, she went on HPN and takes nothing by mouth except for an occasional sip of liquid or bite of soft food, in hopes of preventing the total atrophy of her intestines. HPN enabled her to commute to George Washington University in Washington, D.C., where in 2020 she completed a master’s in public health.

On days when she teaches at LaGuardia Community College — she had 35 students this semester — Smith is up at 6 a.m. to tend to her medical care, leaves the house at 9:15 for class, comes home in the afternoon for a bag of IV hydration, then returns for a late afternoon or evening class. In the evening she gets more hydration, then hooks up the HPN bag for the night. On rare occasions she skips the HPN, “but then I regret it,” she said. The next day she’ll have headaches and feel dizzy, sometimes losing her train of thought in class.

Smith describes a “love-hate relationship” with HPN. She hates being dependent on it, the sour smell of the stuff when it spills, and the mountains of unrecyclable garbage from the 120 pounds of supplies couriered to her apartment weekly. She worries about blood clots and infections. She finds the smell of food disconcerting; Matt tries not to cook when she’s home. Other HPN patients speak of sudden cravings for pasta or Frosted Mini-Wheats.

Yet HPN “has given me my life back,” Smith said.

She is a zealous self-caretaker, but some dangers are beyond her control. IV feeding over time is associated with liver damage. The assemblage of HPN bags by compounding pharmacists is risky. If the ingredients aren’t mixed in the right order, they can crystallize and kill a patient, said Seres, Smith’s doctor.

He and other doctors would like to transition patients to food, but this isn’t always possible. Some eventually seek drastic treatments such as bowel lengthening or even transplants of the entire digestive tract.

“When they run out of options, they could die,” said Dr. Ryan Hurt, a Mayo Clinic physician and president of the American Society for Parenteral and Enteral Nutrition.

***

And then there are the shortages.

In 2017, Hurricane Maria crippled dozens of labs and factories making IV components in Puerto Rico; next came the covid-19 emergency, which shifted vital supplies to gravely ill hospital patients.

Prices for vital HPN ingredients can fluctuate unpredictably as companies making them come and go. For example, in recent years the cost of the sodium acetate used as an electrolyte in a bag of HPN ballooned from $2 to $25, then briefly to $300, said Michael Rigas, a co-founder of the home infusion pharmacy KabaFusion.

“There may be 50 different companies involved in producing everything in an HPN bag,” Rigas said. “They’re all doing their own thing — expanding, contracting, looking for ways to make money.” This leaves patients struggling to deal with various shortages from saline and IV bags to special tubing and vitamins.

“In the last five years I’ve seen more things out of stock or on shortage than the previous 35 years combined,” said Rigas.

The sudden retrenchment of CVS and Optum Rx made things worse. Another, infuriating source of worry: the steady rise of IV spas and concierge services, staffed by moonlighting or burned-out hospital nurses, offering IV vitamins and hydration to well-off people who enjoy the rush of infusions to relieve symptoms of a cold, morning sickness, a hangover, or just a case of the blahs.

In January, infusion professionals urged FDA Commissioner Robert Califf to examine spa and concierge services’ use of IV products as an “emerging contributing factor” to shortages.

The FDA, however, has little authority over IV spas. The Federal Trade Commission has cracked down on some spa operations — for unsubstantiated health claims rather than resource misuse.

Bracha Banayan’s concierge service, called IVDRIPS, started in 2017 in New York City and now employs 90 people, including 60 registered nurses, in four states, she said. They visit about 5,000 patrons each year, providing IV hydration and vitamins in sessions of an hour or two for up to $600 a visit. The goal is “to hydrate and be healthy” with a “boost that makes us feel better,” Banayan said.

Although experts don’t recommend IV hydration outside of medical settings, the market has exploded, Banayan said: “Every med spa is like, ‘We want to bring in IV services.’ Every single paramedic I know is opening an IV center.”

Matt Smith, Elizabeth’s husband, isn’t surprised. Educated as a lawyer, he is a paramedic who trains others at Columbia University Irving Medical Center. “You give someone a choice of go up to some rich person’s apartment and start an IV on them, or carry a 500-pound person living in squalor down from their apartment,” he said. “There’s one that’s going to be very hard on your body and one very easy on your body.”

The very existence of IV spa companies can feel like an insult.

“These people are using resources that are literally a matter of life or death to us,” Elizabeth Smith said.

Shortages in HPN supplies have caused serious health problems including organ failure, severe blisters, rashes, and brain damage.

For five months last year, Rylee Cornwell, 18 and living in Spokane, Washington, could rarely procure lipids for her HPN treatment. She grew dizzy or fainted when she tried to stand, so she mostly slept. Eventually she moved to Phoenix, where the Mayo Clinic has many Ehlers-Danlos patients and supplies are easier to access.

Mike Sherels was a University of Minnesota Gophers football coach when an allergic reaction caused him to lose most of his intestines. At times he’s had to rely on an ethanol solution that damages the ports on his central line, a potentially deadly problem “since you can only have so many central access sites put into your body during your life,” he said.

When Faith Johnson, a 22-year-old Las Vegas student, was unable to get IV multivitamins, she tried crushing vitamin pills and swallowing the powder, but couldn’t keep the substance down and became malnourished. She has been hospitalized five times this past year.

Dread stalks Matt Smith, who daily fears that Elizabeth will call to say she has a headache, which could mean a minor allergic or viral issue — or a bloodstream infection that will land her in the hospital.

Even more worrying, he said: “What happens if all these companies stop doing it? What is the alternative? I don’t know what the economics of HPN are. All I know is the stuff either comes or it doesn’t.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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