Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.
— Rachel Patterson, Washington, D.C.
In Respect to Nurse Practitioners
My dispute with this story (“Bill of the Month: The Doctor Didn’t Show Up, but the Hospital ER Still Charged $1,012,” Jan. 24) is not about the actual billing or details of the injustice suffered by the patient. Instead, I am appalled at the gross misrepresentation of the nurse practitioner (NP) profession. In a few instances, the article referred to the NP as “nurse.” NPs are highly trained advanced practice providers. Educated at the master’s or doctoral level, NPs undergo extensive training and possess the scope of practice to assess, diagnose, treat, and prescribe medications for a vast array of conditions. They carry expertise in clinical judgment that is held to the highest clinical standards. They are widely recognized and respected for their breadth of knowledge and skills.
This article incorrectly refers to the NP as “nurse” and, more insultingly, repeatedly suggests that the value of the NP’s assessment is insufficient. Using the quote from Adam Fox (“if they are not provided treatment”) leads readers to believe that the patient was not assessed by a competent health care provider. This is factually untrue. This misperception and misinformation undermine the inherent value and understanding of the NP profession.
Nurse practitioners exist to serve patients, their families, their communities, and the health care system by providing thorough, high-level, and evidenced-based care. This article missed the opportunity to educate the public about the indisputable value of NPs in a complex health care landscape.
— Gautham Iyer, lead nurse practitioner in the Department of Advanced Lung Disease & Lung Transplantation, UCSF School of Nursing; San Rafael, California
— Dan Matevia, Cincinnati
I found this piece deceptive. First, the care was rendered not just by a registered nurse at triage (standard procedure) but by a nurse practitioner, who was the medical service provider. The patient’s father did not seem to understand that, however limited and insufficient that may have seemed at the time. In Missouri, that type of provider may act independently from a physician to provide medical care in limited situations. In some states, they may act fully independently, including prescribing medication and doing procedures.
Secondly, comparing the charges of care rendered in an ER, which is open 24/7/365, to what a mechanic or pharmacy charges for service is ludicrous and insulting. On any given day, the cost of providing nursing care alone throughout the hospital, let alone the ER, is upward of 70% of the daily operating expense. Who should pay for that, I wonder?
I have no argument that the cost of care in hospitals is too high, especially in the ER, but we have a very imperfect system. It results in shifting costs from those whose bills are unpaid (roughly half of all ER visits) to those who can pay, by whatever insurance they do or do not have. Not a perfect idea, but that is the way it will be until there is a “better” system.
— Dr. Robert D. Greene, Palm Springs, California
— Ritesh Patel, Montclair, New Jersey
Nursing Homes’ Balancing Act
Rules regarding nursing home visitation are determined by state and federal regulators — not the providers (“Families Complain as States Require Covid Testing for Nursing Home Visits,” Jan. 20).
Neither we nor our mission-driven members advocate an unqualified return to “lockdown,” when visits were not allowed.
In following current Centers for Medicare & Medicaid Services guidance, nursing home staff members face a delicate balancing act. They welcome visitors in to preclude possible resident social isolation while, at the same time, fight to keep the highly transmissible covid-19 omicron variant out.
Keeping nursing home residents (who due to age and underlying health conditions are among the most vulnerable to covid), as well as the staff who care for them, safe from covid is a public health issue that requires concerted community effort. Everyone has a role to play. We urge everyone to get tested, vaccinated, and boosted before visiting a loved one in a nursing home. And once there, follow proper infection control and hygiene. Lastly, if you are sick, stay home.
As one of our nursing home member CEOs told Judith Graham, “We want visitors. We want them to bring their life, their love, and their joy. We don’t want them to bring infection.”
— Katie Smith Sloan, president and CEO of LeadingAge, Washington, D.C.
— Kate Yandell, Philadelphia
Extra Shots for the Immunocompromised
I just wanted to say thank you for your article on fourth covid shots for the immunocompromised (“Pharmacies Are Turning Away Immunocompromised Patients Seeking 4th Covid Shot,” Jan. 25). I would have had a terrible experience with this myself if not for a pharmacist at Harris Teeter who was willing to move heaven and earth to make it happen. As the U.S. covid response and prevailing attitudes continue to make me feel increasingly isolated and marginalized, writing like yours helps me feel seen.
— Julie Roy, Durham, North Carolina
— Tania Daniels, Los Angeles
A Heavy Lift: Leaving No Medicaid Patient Behind
Thank you so much for providing the story about how unreliable and ridiculous Medicaid transportation is (“Left Behind: Medicaid Patients Say Rides to Doctors Don’t Always Come,” Jan. 12). As a Medicaid patient, I’ve been left waiting hours, stranded at one point for four hours following an appointment. For me, it’s highly unsafe, as it is for any patient. The provider also stayed with me, as their office was closing for the day, and incurred their own additional expenses. But I’ve had other experiences of being loaded into cars with multiple other patients. It is not only an invasion of privacy but highly problematic for people like myself with multiple rare conditions. On top of that, when it comes to someone who is going to therapy or other appointments of personal natures with things like PTSD, it becomes a trigger having others there who shouldn’t be. It’s not OK under any circumstances and even when you request it not be they don’t abide. I’ve had vendors stop working with me because I require riding alone.
The best experience I have had is using Lyft. It doesn’t require advance notice. It doesn’t require anything but me and my phone. But it’s expensive. Medicaid riders need the flexibility to use Lyft on their phone through the Lyft app. Not through third-party services, because it doesn’t fix the issue when the third party is involved. They need to be able to be reimbursed for the ride or even not have to pay upfront, but given the ability to use a state benefit card as the form of payment on the app.
The ride companies who take the calls and schedule for Medicaid with the individual vendors often send wrong information to the ride providers, too, even after a patient enters it correctly. I’ve confirmed this with drivers in the past; I’d print a screenshot before I hit submit on the form. It was all accurate on my end. But the ride vendor found the ride scheduling company was a major problem. I also worked as an outpatient access specialist and saw it from the other side of the counter. It’s really bad. Patients waiting for four, five, or more hours after appointments for their ride home. Some crying in pain, some dealing with missing other treatments. And if you’ve got limited energy from diseases, it’s even worse. It’s dangerous.
— Ian Scheil, Rochester, New York
— Dr. Beth S. Linas, Washington, D.C.
The Shadow Pandemic: Our Nation’s Pediatric Behavioral Health Crisis
As we near two years of being locked inside a worldwide pandemic, we approach the first anniversary of pretending impassive gestures like flipping a calendar from one year to the next will cure what ails us.
This time last year, we were ready to put 2020 behind us and looked forward to the promise of 2021. For children’s hospitals, 2021 has been more frustrating than its predecessor as the pandemic has accelerated a youth mental health crisis years in the making — one we cannot effectively manage without help.
On July 13, we sounded the alarm. We demonstrated that the demand for services far exceeds supply, explained how children’s hospitals are not designed to care for kids with mental health needs at scale, and illuminated the impact of the crisis on kids we are caring for and the dedicated health care professionals caring for them.
On Oct. 19, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children’s Hospital Association declared a national emergency in youth mental health, echoing our concerns and urging policymakers to take action. They pointed to a 45% increase in self-injury and suicide cases among 5- to 17-year-olds at children’s hospitals during the first six months of 2021, as well as more than 140,000 U.S. children having experienced the death of a primary or secondary caregiver during the pandemic, with children of color disproportionately impacted.
On Dec. 6, a new poll highlighted the pandemic’s outsize impact on anxiety and stress among children and adolescents. On Dec. 7, the U.S. Surgeon General issued an advisory on the youth mental health crisis, calling for “a swift and coordinated response to this crisis.”
We hope that will be the case — at both federal and state levels of government. Because in the meantime, children’s hospitals continue to see an overwhelming demand for mental health care. An unprecedented number of patients are seeking outpatient care for concerns such as anxiety, depression, disruptive behaviors, academic problems, and eating disorders. The resources needed to provide this care are grossly insufficient (“Watch: No Extra Resources for Children Orphaned by Covid,” Dec. 1).
While there is no easy fix to this crisis, we as health care providers are interested in joining policymakers and other key stakeholders to develop the best, most comprehensive policy package we can. Our children and families deserve no less from us.
— Trish Lollo, president of St. Louis Children’s Hospital; Steven Burghart, president of SSM Health Cardinal Glennon Children’s Hospital; Paul Kempinski, president of Children’s Mercy Kansas City; and Dr. Joseph Kahn, president of Mercy Kids