Lmft medicare reimbursements
Reimbursement for Training
2024.05.20 06:31 Current_Flow8045 Reimbursement for Training
I know Long term facilities are obligated to reimburse due to their association with Medicare and Medicaid. I was curious if anyone had experience of hospitals offering a similar reimbursement?
submitted by Current_Flow8045 to cna [link] [comments]
2024.05.18 12:18 dvnschmchr Self-Employed Tax Credit (SETC) — $50,000+ in Tax Credits for Entrepreneurs Self-Employed Individuals
Self-Employed Tax Credit (SETC) — Over $50,000 in Tax Credits for Entrepreneurs and Self-Employed Individuals
The COVID-19 pandemic brought unprecedented challenges, especially for entrepreneurs and self-employed individuals.Enter the Families First Coronavirus Response Act (FFCRA) with its vital Sick Employees and Tax Credits (SETC) provisions.
This legislative act has been a lifeline for millions, and here's why you should be informed and act swiftly...
👉 Click here for more information on claiming your tax credit
Disclaimer: This article is for informational purposes only and does not constitute legal advice. The author is not liable for any errors or omissions, or for any actions taken based on this information. Consult a qualified legal professional for advice tailored to your circumstances. Please seek proper legal guidance.
In March 2020, the FFCRA was enacted to support businesses with paid sick leave and unemployment benefits due to COVID-19. Initially, it focused on employers with W-2 employees.
https://youtu.be/J0IMsehvlNw
By December 2020, the CARES Act expanded FFCRA to include self-employed individuals, freelancers, independent contractors, and gig workers, providing them with tax credits to offset lost income due to COVID-19.
The FFCRA offers paid sick leave, free COVID-19 testing, food assistance, and unemployment benefits. For self-employed individuals, it provides equivalent coverage through tax credits claimable on income tax returns, reimbursing them for COVID-19 related sick leave.
Self-Employed Tax Credit (SETC) FAQs
What Is The FFCRA?
The Families First Coronavirus Response Act (FFCRA), enacted in 2020, aimed to help small business owners provide sick leave for employees affected by COVID-19. Initially targeting small business employees, it was expanded in 2021 to include self-employed individuals facing business losses due to the pandemic.What is the Difference Between SETC and FFCRA?
The "Self-Employed Tax Credit" (SETC) refers to the tax credits for sick and family leave provided to self-employed individuals under the FFCRA. Essentially, SETC is for self-employed individuals, while FFCRA targets employees.What Dates Are Eligible For FFCRA/SETC Income Tax Credits?
Eligible dates for FFCRA/SETC income tax credits are from April 1, 2020, to March 31, 2021, and up to 10 days between April 1, 2021, and September 30, 2021.Breakdown of Eligible Days:
- Childcare-related time off: Up to 110 days
- 50 days between April 1, 2020, and March 31, 2021
- 60 days between April 1, 2021, and September 30, 2021
- Personal or family illness: Up to 20 days
- 10 days between April 1, 2020, and March 31, 2021
- 10 days between April 1, 2021, and September 30, 2021
Do I Still Qualify If I Did Not Pay Myself Sick Leave?
Yes, the FFCRA/SETC is designed to cover self-employed individuals, even if they did not pay themselves sick leave.Why Can't I Find Information About SETC on the IRS Website?
SETC is an informal term for the sick and family leave tax credits for self-employed individuals introduced under the FFCRA. Look for information under the FFCRA and its application to self-employed individuals.Do I Have to Be Self-Employed to File for the Tax Credit Refund?
Yes, the tax credit is specifically for self-employed individuals, including small business owners, freelancers, partners in partnerships subject to self-employment taxes, and 1099 contractors.Do I Need Positive Tax Earnings in 2020 to Qualify?
No, if you did not have positive earnings in 2020 due to COVID-19 but were self-employed, you can use your 2019 net income if it was positive.Do I Need Positive Tax Earnings in 2021 to Qualify?
No, if you did not have positive earnings in 2021 due to COVID-19 but were self-employed, you can use your 2020 net income if it was positive.How Much of a Tax Credit Can I Expect to Receive?
Several factors determine the refund amount, including:- Net income from Schedule C on your 2019, 2020, and 2021 tax returns.
- Days missed due to sickness or quarantine from COVID-19.
- Time spent caring for a loved one affected by COVID-19.
- Duration of school or daycare closures requiring care for a minor child.
Can I Qualify if I Already Filed My Taxes for 2020 & 2021?
Yes, you can still qualify. An amended tax return will need to be filed, requiring copies of your 2019, 2020, and 2021 tax returns and your driver's license.Do I Have to Fill Out Extensive Paperwork?
No, the process involves signing an agreement letter, completing a survey for information, and uploading copies of your tax returns and driver's license. The rest is handled for you.Can I Claim SETC Tax Credits If I Am Also a W2 Employee?
You may still be eligible for SETC tax credits if you earned self-employment income in addition to your W2 salary during 2020 and/or 2021. However, receiving paid leave benefits as an employee may affect the amount you can claim as a self-employed individual.Do I Qualify If I Already Received Sick & Family Leave Credit on Previous Returns?
You would only be eligible if you did not fully utilize the credit(s) on previous returns.Is the SETC Tax Credit Based on Gross or Net Self-Employed Income?
To qualify, you must have a positive net (after deductions) self-employed income for 2019, 2020, or 2021, and qualifying COVID days.How Long Before I Receive My Cash Refund?
Once the necessary paperwork is submitted, the process usually takes 12-16 weeks to complete and receive your cash refund from the IRS.Can Both Spouses Qualify for the SETC?
Yes, if both spouses are self-employed, each could qualify for up to the maximum amount of $32,220 under the right circumstances.Refund Statute of Limitations and SETC
The deadline to amend the 2020 tax return for SETC credits occurring between April 1, 2020, and Dec. 31, 2020, is April 15, 2024. For SETC credits between Jan. 1, 2021, and Sept. 30, 2021, the amendment deadline is April 18, 2025.Can I Qualify If I Received Unemployment Benefits in 2020 and/or 2021?
Yes, but you cannot claim days you received unemployment benefits as days unable to work due to COVID-19.Is a Complete Copy of My Return Needed to Amend?
Yes, a complete copy of the return is required to amend it for SETC credits.How Much Is the SETC Credit?
The SETC tax credit can be up to $32,220, based on your self-employed net earnings in 2020 and 2021.How Can I Claim the SETC Tax Credits?
Determine eligibility and amend your 2020 and/or 2021 tax returns, preferably using a Certified Public Accountant (CPA) or through Legacy Tax & Resolution Services.Why Would the IRS Refund My Taxes?
The federal government supports businesses affected by COVID-19. This is a limited-time opportunity, so filing for SETC credits promptly is crucial.What Is the Social Security Tax Deferral?
Employers can defer the 6.2% employer portion of Social Security tax for March 27, 2020, through December 31, 2020. Self-employed taxpayers can defer 50% of their self-employment tax for the same period. Deferred amounts must be repaid by December 31, 2022.Who Qualifies for the SETC Tax Credits?
Eligible individuals include self-employed persons, such as sole proprietors, 1099 contractors, freelancers, and partners in partnerships who filed Schedule SE with positive net income and paid self-employment tax for 2019, 2020, and/or 2021.Does SETC Apply to C or S Corp Income?
No, C or S Corporation income is not considered self-employed income. However, corporations may qualify for sick or family leave tax credits under FFCRA.Is Health Insurance Required for SETC Eligibility?
No, health insurance coverage does not affect eligibility for the SETC.Are Unpaid Medical Bills Eligible for the Tax Credit?
No, the SETC credit only considers average daily wages and missed days due to COVID-19-related issues.What Qualifies as a Reason for Claiming SETC?
Reasons include quarantine orders, self-quarantine advised by a healthcare provider, caring for someone under quarantine, experiencing COVID-19 symptoms, waiting for test results, getting vaccinated, experiencing vaccine side effects, and caring for a child due to school or daycare closure.How Long Before Receiving a Cash Refund?
Once paperwork is submitted, the process typically takes 12-16 weeks to complete and receive the cash refund from the IRS.Do Both Spouses Qualify for the Maximum SETC?
Yes, both can qualify for the maximum credit but cannot share qualifying COVID days.Is the SETC Tax Credit Taxable?
No, the SETC tax credit is not taxable.What
If I Have IRS Debt or a Treasury Offset?You need a $0 balance with the IRS to receive a refund. Outstanding debts must be paid off first.
Can I Claim SETC Tax Credits If I Am Also a W2 Employee?
Yes, but paid leave benefits as an employee may affect the SETC credit. If the employee status does not provide full coverage, additional credits based on self-employment income may be claimed.Can Weekends Be Claimed?
Yes, if self-employment work is typically done on weekends. If not, weekends cannot be claimed.What Is a Form 1040?
IRS Form 1040 is the standard individual income tax form used to report annual income and calculate tax liability.What Is a Form 1040X?
IRS Form 1040X is used to amend previously filed individual tax returns. Legacy Tax & Resolution Services will use Form 1040X to file for SETC tax credits.What Is a Schedule SE Form 1040?
Schedule SE is a tax form used by self-employed individuals to calculate the self-employment tax owed, covering Social Security and Medicare taxes for those who work for themselves.What Is a Schedule C?
Schedule C is used by sole proprietors, single-member LLCs, and other self-employed individuals to report business income and expenses. The net income from Schedule C is used to calculate self-employment income on Schedule SE.What Is a Form 7202?
IRS Form 7202 is used to claim the Families First Coronavirus Response Act (FFCRA) credits for self-employed individuals, detailing eligibility and tax credit calculations.What Is a Form 8821?
IRS Form 8821 authorizes the release of tax information to a third party, allowing Legacy Tax & Resolution Services to access necessary tax information to calculate SETC credits and amend returns.Are Processing Fees Required?
Legacy Tax & Resolution Services charges no upfront fee. After calculating the tax credit, the fee for filing tax returns is $395. An additional 20% of the refund amount is due after the refund is received.Does Filing for SETC Impact 2023 Income Taxes?
Filing for SETC credits does not impact the filing of 2023 income taxes. The team at Legacy Tax & Resolution Services will amend previously filed returns for 2020 and/or 2021.If Both Spouses Have Self-Employed Income, Can They Each Get the Credit?
Yes, both can receive the credit but cannot share qualifying COVID days.Is the SETC Tax Credit Taxable?
No, the SETC tax credit is not taxable.How Long Before Receiving a Cash Refund?
Once the necessary paperwork is submitted, it typically takes 12-16 weeks to receive the cash refund from the IRS.What If There Is IRS Debt or a Treasury Offset?
A $0 balance with the IRS is required to receive a refund. Any outstanding debts must be paid first.Can SETC Tax Credits Be Claimed If Also a W2 Employee?
Yes, but receiving paid leave benefits as an employee may affect the SETC credit. Additional credits may be claimed if employee benefits do not provide full coverage.Can Weekends Be Claimed?
Yes, if self-employment work is typically done on weekends. If not, weekends cannot be claimed.What Is the Definition of a Dependent?
A dependent is a qualifying child or relative of the taxpayer. A child must have lived with the taxpayer for over half the tax year, and the taxpayer must have provided more than half of the relative's total support. Gross income thresholds and other criteria apply.What Happens in Cases of Divorce After Filing 2020/2021 Taxes?
If the 2020 and/or 2021 tax returns were filed jointly, both taxpayer and spouse must sign the amended returns. If filed as Head of Household or Married Filing Separate, only the taxpayer's signature is required.Can Days Taken to Care for a Child Other Than Your Own Be Claimed?
No, only days taken to care for a dependent can be claimed.Can More Than One Parent or Guardian Claim FFCRA/SETC Credits?
Yes, but parents or guardians cannot claim the same dates twice.Is Online Schooling Considered "Closed" for the Credit?
Yes, if the physical location of the school or place of care is closed, it is considered "closed" for the purposes of the credit, even if the child is expected to complete assignments.What Does It Mean to Be Self-Employed?
A self-employed person is generally someone who carries on a trade or business as a sole proprietor, independent contractor, or a member of a partnership that conducts a trade or business. This includes part-time businesses and gig workers.Can SETC Tax Credits Be Claimed If Receiving Unemployment Benefits?
Yes, but days receiving unemployment benefits cannot be claimed as days unable to work due to COVID-19.Will Refunds Be Sent by Check or Direct Deposit?
Refunds for 2020 and 2021 will be sent directly by the IRS via check to the address provided on the amended return(s).Why Are Positive Net Earnings Required for SETC Income Tax Credit?
Positive net earnings are necessary to qualify for the credit as they indicate taxable income against which the credit can be applied. If positive earnings were not available in 2020 due to COVID-19, 2019 net income may be used.Can SETC Tax Credits Be Claimed If Also a W2 Employee?
Yes, but receiving paid leave benefits as an employee may affect the SETC credit. Additional credits may be claimed if employee benefits do not provide full coverage.Can Weekends Be Claimed?
Yes, if self-employment work is typically done on weekends. If not, weekends cannot be claimed.Can Days Taken to Care for a Child Other Than Your Own Be Claimed?
No, only days taken to care for a dependent can be claimed.Can More Than One Parent or Guardian Claim FFCRA/SETC Credits?
Yes, but parents or guardians cannot claim the same dates twice.Is Online Schooling Considered "Closed" for the Credit?
Yes, if the physical location of the school or place of care is closed, it is considered "closed" for the purposes of the credit, even if the child is expected to complete assignments.What Documentation Is Required?
A complete copy of the 2019, 2020, and 2021 tax returns, including Schedule C and a copy of the driver's license for identification, is required.What Is the Form 1040 SE?
Form 1040 SE is used to calculate self-employment taxes, including Social Security and Medicare taxes for individuals who work for themselves.What Is the Form 1040-X?
Form 1040-X is used to amend previously filed individual tax returns to claim the FFCRA/SETC credits.What Is a Schedule C?
Schedule C is used by self-employed individuals to report business income and expenses. The net income from Schedule C calculates self-employment income on Schedule SE.What Is the Form 7202?
Form 7202 is used to claim the FFCRA credits for self-employed individuals, detailing eligibility and tax credit calculations.What Is the Form 8821?
Form 8821 authorizes the release of tax information to a third party, allowing the calculation of SETC credits and the amendment of tax returns.What Are the Processing Fees?
Legacy Tax & Resolution Services charges no upfront fee. The fee for filing tax returns is $395, with an additional 20% of the refund amount due after the refund is received.Does Filing for SETC Impact 2023 Income Taxes?
Filing for SETC credits does not impact the filing of 2023 income taxes. Amendments are made to previously filed returns for 2020 and/or 2021.If Both Spouses Have Self-Employed Income, Can They Each Get the Credit?
Yes, both can receive the credit but cannot share qualifying COVID days.Is the SETC Tax Credit Taxable?
No, the SETC tax credit is not taxable.How Long Before Receiving a Cash Refund?
Once the necessary paperwork is submitted, it typically takes 12-16 weeks to receive the cash refund from the IRS.What If There Is IRS Debt or a Treasury Offset?
A $0 balance with the IRS is required to receive a refund. Any outstanding debts must be paid first.Can SETC Tax Credits Be Claimed If Also a W2 Employee?
Yes, but receiving paid leave benefits as an employee may affect the SETC credit. Additional credits may be claimed if employee benefits do not provide full coverage.Can Weekends Be Claimed?
Yes, if self-employment work is typically done on weekends. If not, weekends cannot be claimed.Can Days Taken to Care for a Child Other Than Your Own Be Claimed?
No, only days taken to care for a dependent can be claimed.Can More Than One Parent or Guardian Claim FFCRA/SETC Credits?
Yes, but parents or guardians cannot claim the same dates twice.Is Online Schooling Considered "Closed" for the Credit?
Yes, if the physical location of the school or place of care is closed, it is considered "closed" for the purposes of the credit, even if the child is expected to complete assignments.What Documentation Is Required?
A complete copy of the 2019, 2020, and 2021 tax returns, including Schedule C and a copy of the driver's license for identification, is required.👉 Click here for more information on claiming your tax credit
2024.05.17 18:06 VanillaSkittlez "It'll never work here", "it's just a cash grab" and 10 stupid arguments against congestion pricing - a guide
Inspired by trolls on posts about congestion pricing on this sub, I wanted to give a guide to folks who are misunderstood, confused, or otherwise apathetic to congestion pricing and give people a guide to push back against the most common arguments.
1) "It'll never work here" - Sure it will. It has worked in London, Stockholm, and Singapore to great success. The London metro area has about 15m people, not far off from the 19m in NYC. There is nothing that unique about NYC relative to other cities to suggest it won't work.
2) "It's just a cash grab." I love this one. Firstly, this implies that congestion pricing will not lower vehicle travel. Firstly, London, Singapore, Milan, and Stockholm all saw 20-30% reductions in traffic. Back to the first argument - what makes NYC so special that this wouldn't apply?
Unless you've taken the time to dive into their 909 page environmental report to see the kind of intensive modeling they've undertaken, then you're talking out of your ass. The review board estimates that 150k less cars will enter the Central Business District (CBD) every day, amounting to a projected 17% reduction in traffic below 60th street. Unless you have some solid methodological argument as to how the modeling overlooked some key aspect they missed in the decade of studying this, then kindly, you have no clue what you're talking about. It's also positioned to improve air quality, increase use of public transit by 1-2%, improve emergency response times, and a host of other benefits.
The other thing I'd like to point out to it being a cash grab is, "So what if it is?" The MTA is required to raise $1 billion per year from this plan, all of which is required to be used for public transit improvements. Let's say in this hypothetical there is 0 reduction in congestion, and the only thing that happens is that the MTA collects $1 billion a year to improve public transit based on monetizing what people are already doing. They're currently polluting the air, hitting pedestrians and cyclists (such that about 10 people die in the district every year), increasing noise pollution for residents, slowing emergency response times, impeding deliveries for local businesses, and a host of other issues. The least we could do is make them pay for these externalities that we all suffer from to rectify the inequity.
3) "But the MTA is corrupt. Where is all that money actually going?" Yeah, probably. But this is a strawman (and I'd encourage you to find a city or state agency that isn't rife with some form of corruption). Once again, we can flip my prior argument around: let's say that in a hypothetical, $0 of money goes to improving public transit or anything meaningful, but we get a 17% reduction in congestion - that is a win for all the reasons I listed above.
But of course, people also love to overlook the fact that it's not actually $1B, it's $1B that can help secure $15b in bond financing, which the MTA has already laid out a robust plan to show where all of that money is going to go - namely, substantial capital project improvements and long overdue maintenance. Not to mention, I don't hear these same people demanding to see where the money from the Brooklyn Battery Tunnel, or Triboro Bridge go to. How is this any different? In a time where fare evasion has increased dramatically post COVID, losing the MTA $700m a year - nearly half of all MTA bus riders on local buses skipped the fare in Q4 2023 - it is more important than ever to ensure we have sustainable income to support our crumbling infrastructure. And no, you absolute buffoon, you do not have a right to skip the fare because the service sucks, any more than you have the right to not pay for a sandwich you ate in its entirety because you decided after the fact you didn't like it.
4) "But the majority of car traffic in the CBD is Ubers and Lyfts, why should everyone else be punished?" Let's get a few things straight. In 2018, about 35% of all vehicles in the CBD were personal automobiles and motorcycles. That is compared to 52% that are for hire vehicles and taxis, so yes, there are more taxis/Ubers/Lyfts than personal vehicles, but personal vehicles make up a substantial portion.
Comparing people whose car is used for work vs. a vehicle that gets you to work is disingenuous. Firstly, people who drive to work overwhelmingly don't have to drive to work - they have other options. For the taxi drivers, that is their income. Secondly, let's talk about congestion.
The vast majority of personal automobiles in the CBD have 1 person inside of them. That person will drive in, presumably park on the street or in a garage, go about their day to work, and then drive home. 1 person utilized that vehicle over the course of an entire work day, and for about 90% of that work day, the car sat on the street or in a garage, taking up space and doing absolutely nothing. This is the pinnacle of inefficient transportation usage.
A taxi, meanwhile, never parks. It can pick up dozens and dozens of passengers every single day, making for a much more efficient use of space, fuel, and time. We should be encouraging efficient trips to reduce congestion and not encouraging one-person, personal automobile use to get to the best connected transit area on the continent. And we are - the price during the day for personal automobiles is $15, whereas riders will pay a surcharge of $1.25 in taxis and $2.50 in for-hire vehicles.
5) "Okay, but what about the people that need to drive to Manhattan?" Almost nobody "needs" to drive to Manhattan's CBD, but I'll humor it. First of all, nobody lives in a transit desert in NYC. All areas of NYC except Breezy Point live within a half mile of some kind of public transit service. Let's focus on those that don't: approximately 440k people. Of those 440k, about 34k (7.7%) commute to the CBD. And of those 34k, 5,200 people commute to the CBD by car. And I can hear you trolls seething now: "But living within a half mile of a transit stop doesn't mean the transit is good!!" And you know what can make it good? More investment in the service by raising capital money through tolls on people that can afford it.
6) "But how is that fair to the people in Long Island, upstate, or New Jersey?!" I want to make one thing very clear here: the needs of people that live in the city should ALWAYS come above those who simply commute in and leave at the end of the day. Commerce and jobs are of course important, but nothing is more important than the livelihood of residents that live in the area. And those residents suffer from all the externalities I mentioned before as a result of it, and this is attempting to restore equity. People who live in the suburbs choose to do so, and of course, that's their right to. But because you made the decision to live in a bigger house in a quieter neighborhood well outside of the city, does not mean you get to have your cake and eat it too. You can pay for the convenience and externalities you bring to the residents of the city as a function of your choosing not to live there. Also like... New Jersey is New Jersey. Their state dollars benefit their residents, not us. This is a New York program for New York residents that stands to benefit New York City residents.
Let's talk about New Jersey for a second. It is a complete myth that New Jersey residents need to drive to Manhattan. In the 21 legislative districts closest to Manhattan, just 1.6% of commuters commute to Manhattan by car. Of those 1.6%, the median income is approximately $108k. In other words, they can afford the $15 toll if they choose to not use the many public transit options available to them.
I might add that you are only charged the toll by entering the CBD - if you are someone in New Jersey trying to get to Long Island, provided you stay only on highways and don't enter local streets, you will not pay the congestion pricing charge.
7) "But what about disadvantaged New Yorkers? How are they supposed to afford this?" Thankfully, the subway fare is $2.90, and the Fair Fares program allows that to be cut in half if you qualify. But if you insist on driving into Manhattan as a low income resident, there is the Low-Income Discount Plan (LIPD) which results in a 50% discount on congestion pricing tolls after the first 10 trips in a calendar month, but requires your federal adjusted gross income in the prior year to be less than $50k.
For individuals with disabilities, you have the Individual Disability Exemption Plan (IDEP). To be eligible you must have a qualifying disability that prevents you from using public transit - which surprise surprise, is very, very few people.
Emergency vehicles, buses, and specialized government owned vehicles are also exempted.
8) "Okay, but what about my 130-year old grandmother who lost 3 legs and absolutely must drive to go to the hospital in the CBD?" In all seriousness, public transit exists, but some individuals are too ill or unable to take transit. Many of those individuals are also too ill or unable to drive.
For the few that remain, there are countless city services that can help them. Medicaid and Medicare enrollees cover low-income people and those with developmental disabilities, as well as veterans and some aged 60+ and offer free or discounted transportation to medical appointments. Access-A-Ride provides public transit for eligible customers with disabilities or health conditions that otherwise prevent them from using public buses or trains for some or all of their trip. If you have a Flexible Spending Account, Health Savings Account, or Health Reimbursement Arrangement, transportation costs to and from medical appointments are often reimbursable.
9) "And what about our public servants? They do such important work, why should they have to pay?" They don't! They can take transit and pay the measly fare of just $2.90.
The work they do is incredibly important, which is why we should be investing in our public transit system and improving its reliability to they can get to work easily, on time, and safely, which is exactly what congestion pricing is set to do. But if it's so important they get exempted, then why not exempt them on all bridges, highways, and other tolls? Or all parking fees? Why does the congestion pricing toll represent something so unique that must be exempted?
Fun fact while we're here: the majority of public servants already take transit to work. Census Tract 29 in Manhattan near Canal Street has the highest proportion of commuters getting there by car than any other Census Tract in the CBD. 6,832 workers, over 40% of commuters to that Census Tract, drive to work there, despite it being one of the richest areas for public transit in the entire city. Why is this you might ask? Well, because of all the law enforcement and government buildings: One Police Plaza, Manhattan Criminal Court, New York Supreme Court, New York County Supreme Court, City Hall, etc. In other words? The vast majority of people driving to work are police or other city officials abusing placards to have free parking on Park Row. And surely, you as someone that hates congestion pricing, are incredibly concerned with public corruption, right? (See point 3).
10) "But all this is going to do is push car traffic toward other, less advantaged communities." Firstly, I'm a believer that we should let experts do what they do best and while we should always apply skepticism, we should ultimately trust those who have dedicated their entire careers to study a particular domain area. And one of those domain areas that you and I don't know shit about is traffic modeling, and the MTA published a 900-page document detailing every little bit of considerations regarding traffic flow through robust models. I'm not going to pretend to understand every detail of how or why it works, but clearly, neither do you, and so I think we should let the experts handle this one.
So far, the anticipated effects on other neighborhoods and parts of the city are expected to be small, as people will take to other forms of commuting, like public transit, or driving at different hours than they usually do, etc. The toll credits on bridges and highways will reduce "toll shopping" which will ultimately mean many of those will not elongate their commute to look for cheaper options, and those that choose to drive will overwhelmingly end up just paying the toll.
Perhaps the area most anticipated to be affected is the Cross Bronx expressway, of which there are expected to be about 700 more trucks there than before. It might increase soot from truck traffic 5%, and overall soot by 1%. The MTA is trying to rectify this by spending $25m on an asthma treatment in the Bronx, as well as other initiatives like planting vegetation near roads and renovating parks and green spaces.
To be very clear these are real impacts to people that already suffer some of the worst consequences of congestion. We are trying to do the right thing for the most amount of people, and while Manhattan's CBD congestion pricing will carry a lot of benefits for everyone, and the overall effects on the Bronx are expected to be small, they are not negligible, and require their own attention to figure out. Ultimately, this all comes down to the very thing that we are trying to advocate for - less car reliance, less pollution, less lives lost due to unnecessary driving and unhealthy transit habits. This is step 1 in trying to address these long-term, very serious inequities and is the tip of the iceberg in turning all of NYC into a more livable city for all residents.
TL;DR: Congestion pricing good, trolls bad.
Any thoughts or other arguments you want to see me address? Comment your requests! And thank you if you've read this far - I clearly have too much time on my hands.
submitted by VanillaSkittlez to MicromobilityNYC [link] [comments]
1) "It'll never work here" - Sure it will. It has worked in London, Stockholm, and Singapore to great success. The London metro area has about 15m people, not far off from the 19m in NYC. There is nothing that unique about NYC relative to other cities to suggest it won't work.
2) "It's just a cash grab." I love this one. Firstly, this implies that congestion pricing will not lower vehicle travel. Firstly, London, Singapore, Milan, and Stockholm all saw 20-30% reductions in traffic. Back to the first argument - what makes NYC so special that this wouldn't apply?
Unless you've taken the time to dive into their 909 page environmental report to see the kind of intensive modeling they've undertaken, then you're talking out of your ass. The review board estimates that 150k less cars will enter the Central Business District (CBD) every day, amounting to a projected 17% reduction in traffic below 60th street. Unless you have some solid methodological argument as to how the modeling overlooked some key aspect they missed in the decade of studying this, then kindly, you have no clue what you're talking about. It's also positioned to improve air quality, increase use of public transit by 1-2%, improve emergency response times, and a host of other benefits.
The other thing I'd like to point out to it being a cash grab is, "So what if it is?" The MTA is required to raise $1 billion per year from this plan, all of which is required to be used for public transit improvements. Let's say in this hypothetical there is 0 reduction in congestion, and the only thing that happens is that the MTA collects $1 billion a year to improve public transit based on monetizing what people are already doing. They're currently polluting the air, hitting pedestrians and cyclists (such that about 10 people die in the district every year), increasing noise pollution for residents, slowing emergency response times, impeding deliveries for local businesses, and a host of other issues. The least we could do is make them pay for these externalities that we all suffer from to rectify the inequity.
3) "But the MTA is corrupt. Where is all that money actually going?" Yeah, probably. But this is a strawman (and I'd encourage you to find a city or state agency that isn't rife with some form of corruption). Once again, we can flip my prior argument around: let's say that in a hypothetical, $0 of money goes to improving public transit or anything meaningful, but we get a 17% reduction in congestion - that is a win for all the reasons I listed above.
But of course, people also love to overlook the fact that it's not actually $1B, it's $1B that can help secure $15b in bond financing, which the MTA has already laid out a robust plan to show where all of that money is going to go - namely, substantial capital project improvements and long overdue maintenance. Not to mention, I don't hear these same people demanding to see where the money from the Brooklyn Battery Tunnel, or Triboro Bridge go to. How is this any different? In a time where fare evasion has increased dramatically post COVID, losing the MTA $700m a year - nearly half of all MTA bus riders on local buses skipped the fare in Q4 2023 - it is more important than ever to ensure we have sustainable income to support our crumbling infrastructure. And no, you absolute buffoon, you do not have a right to skip the fare because the service sucks, any more than you have the right to not pay for a sandwich you ate in its entirety because you decided after the fact you didn't like it.
4) "But the majority of car traffic in the CBD is Ubers and Lyfts, why should everyone else be punished?" Let's get a few things straight. In 2018, about 35% of all vehicles in the CBD were personal automobiles and motorcycles. That is compared to 52% that are for hire vehicles and taxis, so yes, there are more taxis/Ubers/Lyfts than personal vehicles, but personal vehicles make up a substantial portion.
Comparing people whose car is used for work vs. a vehicle that gets you to work is disingenuous. Firstly, people who drive to work overwhelmingly don't have to drive to work - they have other options. For the taxi drivers, that is their income. Secondly, let's talk about congestion.
The vast majority of personal automobiles in the CBD have 1 person inside of them. That person will drive in, presumably park on the street or in a garage, go about their day to work, and then drive home. 1 person utilized that vehicle over the course of an entire work day, and for about 90% of that work day, the car sat on the street or in a garage, taking up space and doing absolutely nothing. This is the pinnacle of inefficient transportation usage.
A taxi, meanwhile, never parks. It can pick up dozens and dozens of passengers every single day, making for a much more efficient use of space, fuel, and time. We should be encouraging efficient trips to reduce congestion and not encouraging one-person, personal automobile use to get to the best connected transit area on the continent. And we are - the price during the day for personal automobiles is $15, whereas riders will pay a surcharge of $1.25 in taxis and $2.50 in for-hire vehicles.
5) "Okay, but what about the people that need to drive to Manhattan?" Almost nobody "needs" to drive to Manhattan's CBD, but I'll humor it. First of all, nobody lives in a transit desert in NYC. All areas of NYC except Breezy Point live within a half mile of some kind of public transit service. Let's focus on those that don't: approximately 440k people. Of those 440k, about 34k (7.7%) commute to the CBD. And of those 34k, 5,200 people commute to the CBD by car. And I can hear you trolls seething now: "But living within a half mile of a transit stop doesn't mean the transit is good!!" And you know what can make it good? More investment in the service by raising capital money through tolls on people that can afford it.
6) "But how is that fair to the people in Long Island, upstate, or New Jersey?!" I want to make one thing very clear here: the needs of people that live in the city should ALWAYS come above those who simply commute in and leave at the end of the day. Commerce and jobs are of course important, but nothing is more important than the livelihood of residents that live in the area. And those residents suffer from all the externalities I mentioned before as a result of it, and this is attempting to restore equity. People who live in the suburbs choose to do so, and of course, that's their right to. But because you made the decision to live in a bigger house in a quieter neighborhood well outside of the city, does not mean you get to have your cake and eat it too. You can pay for the convenience and externalities you bring to the residents of the city as a function of your choosing not to live there. Also like... New Jersey is New Jersey. Their state dollars benefit their residents, not us. This is a New York program for New York residents that stands to benefit New York City residents.
Let's talk about New Jersey for a second. It is a complete myth that New Jersey residents need to drive to Manhattan. In the 21 legislative districts closest to Manhattan, just 1.6% of commuters commute to Manhattan by car. Of those 1.6%, the median income is approximately $108k. In other words, they can afford the $15 toll if they choose to not use the many public transit options available to them.
I might add that you are only charged the toll by entering the CBD - if you are someone in New Jersey trying to get to Long Island, provided you stay only on highways and don't enter local streets, you will not pay the congestion pricing charge.
7) "But what about disadvantaged New Yorkers? How are they supposed to afford this?" Thankfully, the subway fare is $2.90, and the Fair Fares program allows that to be cut in half if you qualify. But if you insist on driving into Manhattan as a low income resident, there is the Low-Income Discount Plan (LIPD) which results in a 50% discount on congestion pricing tolls after the first 10 trips in a calendar month, but requires your federal adjusted gross income in the prior year to be less than $50k.
For individuals with disabilities, you have the Individual Disability Exemption Plan (IDEP). To be eligible you must have a qualifying disability that prevents you from using public transit - which surprise surprise, is very, very few people.
Emergency vehicles, buses, and specialized government owned vehicles are also exempted.
8) "Okay, but what about my 130-year old grandmother who lost 3 legs and absolutely must drive to go to the hospital in the CBD?" In all seriousness, public transit exists, but some individuals are too ill or unable to take transit. Many of those individuals are also too ill or unable to drive.
For the few that remain, there are countless city services that can help them. Medicaid and Medicare enrollees cover low-income people and those with developmental disabilities, as well as veterans and some aged 60+ and offer free or discounted transportation to medical appointments. Access-A-Ride provides public transit for eligible customers with disabilities or health conditions that otherwise prevent them from using public buses or trains for some or all of their trip. If you have a Flexible Spending Account, Health Savings Account, or Health Reimbursement Arrangement, transportation costs to and from medical appointments are often reimbursable.
9) "And what about our public servants? They do such important work, why should they have to pay?" They don't! They can take transit and pay the measly fare of just $2.90.
The work they do is incredibly important, which is why we should be investing in our public transit system and improving its reliability to they can get to work easily, on time, and safely, which is exactly what congestion pricing is set to do. But if it's so important they get exempted, then why not exempt them on all bridges, highways, and other tolls? Or all parking fees? Why does the congestion pricing toll represent something so unique that must be exempted?
Fun fact while we're here: the majority of public servants already take transit to work. Census Tract 29 in Manhattan near Canal Street has the highest proportion of commuters getting there by car than any other Census Tract in the CBD. 6,832 workers, over 40% of commuters to that Census Tract, drive to work there, despite it being one of the richest areas for public transit in the entire city. Why is this you might ask? Well, because of all the law enforcement and government buildings: One Police Plaza, Manhattan Criminal Court, New York Supreme Court, New York County Supreme Court, City Hall, etc. In other words? The vast majority of people driving to work are police or other city officials abusing placards to have free parking on Park Row. And surely, you as someone that hates congestion pricing, are incredibly concerned with public corruption, right? (See point 3).
10) "But all this is going to do is push car traffic toward other, less advantaged communities." Firstly, I'm a believer that we should let experts do what they do best and while we should always apply skepticism, we should ultimately trust those who have dedicated their entire careers to study a particular domain area. And one of those domain areas that you and I don't know shit about is traffic modeling, and the MTA published a 900-page document detailing every little bit of considerations regarding traffic flow through robust models. I'm not going to pretend to understand every detail of how or why it works, but clearly, neither do you, and so I think we should let the experts handle this one.
So far, the anticipated effects on other neighborhoods and parts of the city are expected to be small, as people will take to other forms of commuting, like public transit, or driving at different hours than they usually do, etc. The toll credits on bridges and highways will reduce "toll shopping" which will ultimately mean many of those will not elongate their commute to look for cheaper options, and those that choose to drive will overwhelmingly end up just paying the toll.
Perhaps the area most anticipated to be affected is the Cross Bronx expressway, of which there are expected to be about 700 more trucks there than before. It might increase soot from truck traffic 5%, and overall soot by 1%. The MTA is trying to rectify this by spending $25m on an asthma treatment in the Bronx, as well as other initiatives like planting vegetation near roads and renovating parks and green spaces.
To be very clear these are real impacts to people that already suffer some of the worst consequences of congestion. We are trying to do the right thing for the most amount of people, and while Manhattan's CBD congestion pricing will carry a lot of benefits for everyone, and the overall effects on the Bronx are expected to be small, they are not negligible, and require their own attention to figure out. Ultimately, this all comes down to the very thing that we are trying to advocate for - less car reliance, less pollution, less lives lost due to unnecessary driving and unhealthy transit habits. This is step 1 in trying to address these long-term, very serious inequities and is the tip of the iceberg in turning all of NYC into a more livable city for all residents.
TL;DR: Congestion pricing good, trolls bad.
Any thoughts or other arguments you want to see me address? Comment your requests! And thank you if you've read this far - I clearly have too much time on my hands.
2024.05.17 13:53 Complex_Biscotti_813 Can I get tested in Peru?
I'm in Lima, Peru. I finished my course and I submitted my sample for testing in Labcorp right before I left the US, planning to view my results when abroad. Infuriatingly, I learned that my doctor's office mishandled my sample so Labcorp was not able to test. Labcorp told me that the urgent care put it in an incorrect container without the preservative.
Is there a Labcorp, Quest or any lab with reliable PCR test for this here in Lima, Peru? What would the cost be of out-of-pocket? Would my insurance (medicare) likely reimburse? I would need to go through doctor presumably like in the US? This would be a challenging as I'm not fluent in Spanish.
Or should I interrupt my trip and fly back to the US for this? I need to decide now.
submitted by Complex_Biscotti_813 to Ureaplasma [link] [comments]
Is there a Labcorp, Quest or any lab with reliable PCR test for this here in Lima, Peru? What would the cost be of out-of-pocket? Would my insurance (medicare) likely reimburse? I would need to go through doctor presumably like in the US? This would be a challenging as I'm not fluent in Spanish.
Or should I interrupt my trip and fly back to the US for this? I need to decide now.
2024.05.17 00:04 Cardinal_r3d FEDS: CAPE COD HOSPITAL TO PAY $24.3 MILLION TO RESOLVE ALLEGATIONS THAT IT FAILED TO COMPLY WITH MEDICARE CARDIAC PROCEDURE RULES
FEDS: CAPE COD HOSPITAL TO PAY $24.3 MILLION TO RESOLVE ALLEGATIONS THAT IT FAILED TO COMPLY WITH MEDICARE CARDIAC PROCEDURE RULES
BOSTON – [DOJ MEDIA STATEMENT] - Cape Cod Hospital has agreed to pay $24.3 million to resolve allegations that it knowingly submitted claims to Medicare for transcatheter aortic valve replacement (TAVR) procedures that failed to comply with Medicare rules specifying the way in which hospitals were required to evaluate patient suitability for the procedures.
Beginning in 2015, Cape Cod Hospital began offering TAVR procedures for patients suffering from aortic stenosis, a serious heart condition that restricts blood flow from the heart to the rest of the body. A TAVR procedure involves replacing a patient’s damaged heart valve with an artificial one. Medicare rules at the time required that, prior to performing a TAVR procedure, hospitals engage specified clinical personnel to conduct an independent examination of prospective patients to evaluate their suitability for TAVR; document the rationale for their clinical judgment; and make the rationale available to the medical team performing the TAVR procedure.
The settlement resolves allegations that from November 2015 through December 2022, Cape Cod Hospital knowingly submitted hundreds of claims to Medicare for TAVR procedures that did not comply with the applicable Medicare requirements. In some instances, not enough physicians examined a patient’s suitability for the procedure, while in other instances the physicians failed to document and share their clinical judgment with the medical team responsible for the TAVR procedure.
“Medicare permitted coverage for this newly developed cardiac procedure only under certain conditions, to ensure patient safety. Cape Cod Hospital ignored those rules and received millions of dollars from Medicare to which it was not entitled. This conduct persisted for years despite internal warnings,” said Acting United States Attorney Joshua S. Levy for the District of Massachusetts. “This investigation and settlement ensure that patient safety is prioritized over a hospital’s bottom line.”
“Hospitals that participate in the Medicare program must abide by applicable coverage and reimbursement rules,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “The department will hold healthcare providers accountable when they knowingly fail to comply with Medicare reimbursement requirements.”
“Health care providers are expected to follow Medicare rules and bill properly,” said Roberto Coviello, Special Agent in Charge with the U.S. Department of Health and Human Services, Office of Inspector General. “We are committed to pursuing allegations of False Claims Act violations as we work to protect the integrity of the taxpayer-funded Medicare program, and we encourage the public to come forward with information about such conduct.”
In connection with the settlement, Cape Cod Hospital has entered into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), which provides for an annual review of its paid Medicare claims by an Independent Review Organization.
Cape Cod Hospital received credit under the Department’s guidelines for taking disclosure, cooperation, and remediation into account in False Claims Act cases. Among other actions, Cape Cod Hospital voluntarily produced materials, identified the relevant medical records, admitted that it failed to adhere to the applicable Medicare requirements and implemented appropriate remedial measures.
The claims resolved by the resolution announced today include claims that were brought under the qui tam or whistleblower provisions of the False Claims Act. Under the Act, a private party can file an action on behalf of the United States and receive a portion of any recovery. As part of today’s resolution, the whistleblower will receive approximately $4.36 million.
The investigation and resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to HHS at 800-HHS-TIPS (800-447-8477).
Acting U.S. Attorney Levy; Principal Deputy AAG Boynton; and HHS-OIG SAC Coviello made the announcement today. Assistant U.S. Attorney Andrew A. Caffrey, III of the Affirmative Civil Enforcement Unit handled the matter along with Trial Attorney Kimya Saied of the Department of Justice’s Fraud Section.
submitted by Cardinal_r3d to CapeCod [link] [comments]
BOSTON – [DOJ MEDIA STATEMENT] - Cape Cod Hospital has agreed to pay $24.3 million to resolve allegations that it knowingly submitted claims to Medicare for transcatheter aortic valve replacement (TAVR) procedures that failed to comply with Medicare rules specifying the way in which hospitals were required to evaluate patient suitability for the procedures.
Beginning in 2015, Cape Cod Hospital began offering TAVR procedures for patients suffering from aortic stenosis, a serious heart condition that restricts blood flow from the heart to the rest of the body. A TAVR procedure involves replacing a patient’s damaged heart valve with an artificial one. Medicare rules at the time required that, prior to performing a TAVR procedure, hospitals engage specified clinical personnel to conduct an independent examination of prospective patients to evaluate their suitability for TAVR; document the rationale for their clinical judgment; and make the rationale available to the medical team performing the TAVR procedure.
The settlement resolves allegations that from November 2015 through December 2022, Cape Cod Hospital knowingly submitted hundreds of claims to Medicare for TAVR procedures that did not comply with the applicable Medicare requirements. In some instances, not enough physicians examined a patient’s suitability for the procedure, while in other instances the physicians failed to document and share their clinical judgment with the medical team responsible for the TAVR procedure.
“Medicare permitted coverage for this newly developed cardiac procedure only under certain conditions, to ensure patient safety. Cape Cod Hospital ignored those rules and received millions of dollars from Medicare to which it was not entitled. This conduct persisted for years despite internal warnings,” said Acting United States Attorney Joshua S. Levy for the District of Massachusetts. “This investigation and settlement ensure that patient safety is prioritized over a hospital’s bottom line.”
“Hospitals that participate in the Medicare program must abide by applicable coverage and reimbursement rules,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “The department will hold healthcare providers accountable when they knowingly fail to comply with Medicare reimbursement requirements.”
“Health care providers are expected to follow Medicare rules and bill properly,” said Roberto Coviello, Special Agent in Charge with the U.S. Department of Health and Human Services, Office of Inspector General. “We are committed to pursuing allegations of False Claims Act violations as we work to protect the integrity of the taxpayer-funded Medicare program, and we encourage the public to come forward with information about such conduct.”
In connection with the settlement, Cape Cod Hospital has entered into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), which provides for an annual review of its paid Medicare claims by an Independent Review Organization.
Cape Cod Hospital received credit under the Department’s guidelines for taking disclosure, cooperation, and remediation into account in False Claims Act cases. Among other actions, Cape Cod Hospital voluntarily produced materials, identified the relevant medical records, admitted that it failed to adhere to the applicable Medicare requirements and implemented appropriate remedial measures.
The claims resolved by the resolution announced today include claims that were brought under the qui tam or whistleblower provisions of the False Claims Act. Under the Act, a private party can file an action on behalf of the United States and receive a portion of any recovery. As part of today’s resolution, the whistleblower will receive approximately $4.36 million.
The investigation and resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to HHS at 800-HHS-TIPS (800-447-8477).
Acting U.S. Attorney Levy; Principal Deputy AAG Boynton; and HHS-OIG SAC Coviello made the announcement today. Assistant U.S. Attorney Andrew A. Caffrey, III of the Affirmative Civil Enforcement Unit handled the matter along with Trial Attorney Kimya Saied of the Department of Justice’s Fraud Section.
2024.05.16 16:12 Superchief440 Very Encouraging B of A 2024 Health Care Conference Presentation
Bank of America Health Care Conference 2024 Presentation
Exact Sciences' Mission is to help eradicate cancer by preventing it, detecting it earlier and guiding treatment. In the early innings of how genomics will transform cancer prevention, diagnosis and treatment
Exact Sciences' Cologuard and Oncotype DX are two of the top brands ever in cancer diagnostics. They are helping to build a platform company through which other innovative cancer diagnostics will help patients.
Guided to 15% growth (CAGR) through 2027. Projecting over 20% adjusted ebitda margins by 2027.
Near-term growth drivers - Cologuard and Oncotype DX globally. Future drivers - pipeline.
Reiterated 2024 Revenue and EBITDA guide.
60 million Americans not up to date with colon cancer screening - huge unscreened population
Q4 2023 - highest dollar growth in screening in history. Sequential decrease in Cologuard screening revenue due to normal Q1 seasonal weakness. Despite sequential screening revenue decline, screening revenue still increased 7% YOY, and management confident in achieving 2nd Quarter and 2nd Half Guide revenue guides.
Cologuard will have steady predictable growth based upon # of sales calls to primary care physicians and increasing Health System Orders.
New Cologuard business opportunity starting last year - screening in Medicare Advantage population and gap closure programs in large health systems.
CEO Kevin Conroy: "We are confident in our ability to meet our 2nd quarter and 2nd half sales guidance."
Q1 2024 was in-line with expectations. Q1 of 2023 was an anomaly.
Sales and Marketing Spend - Spent about $800 million in sales and marketing in 2023 (sales force a relatively small component of this, sales force being brought back to levels of 2022) - High ROI from investment in additional sales people.
Last 5 quarters added 50,000 new primary care providers - docs, pa’s and nurses
As docs order more, amount of orders increases. As sales calls increase in frequency, pcp’s order more.
Calling on a doc once per quarter will result on average in six orders. Calling on a doc six times per quarter will result on average in 24 order. Sales reps provide pcp's tools, education, motivation to increase colon cancer screening numbers.
Priorities for CFO - Maintain Growth Engine not only of CG and Oncotype, but also new product pipeline - Flywheel of innovation needs to keep spinning. Will expand over 300 basis points of leverage in 2024. Increasing leverage in G&A going forward. Clear and credible pathway to adjusted ebitda margins of 20% in 2027
CFO Aaron Bloomer: Exact Sciences will show FCF growth and positive FCF delivery for each of the next three quarters in 2024.
17% CG growth embedded in 15% CAGR through 2027. (Compound Annual Growth Rate)
Impressive CAGR over the past few years. Seeing increasing opportunities to enhance the use of Cologuard as a frontline screening tool.
Over a billion dollars invested in EXACT NEXUS - Electronic Ordering, Result Delivery, Prior Authorization, Reimbursement embedded into physician's EPIC electronic record. Huge amount of customer satisfaction - makes using Cologuard easy.
Long arduous process of including Cologuard into the Quality Measures (2-3 years from being included in USPSTF guidelines), which can help health systems and plans increase their star rating in order to get quality bonuses, which is a key to their success.
130,000 new cases/year, 50,000 deaths/year from Colon Cancer, with 60 million people in U.S. not current with CRC screening guidelines.
Colonoscopy capacity in US is 12,000,000. Half screening, half diagnostic. Cologuard is helping health system and GI’s getting more people screened.
Re-screening now mid 20's as a % of revenue - aiming for 50%
Because of Covid, for two years in a row, only 1.2 million people have been eligible for re-screens. This year 1.6 million eligible for re-screen, and that number will increase annually. Also, 20 million new prospective customers in the 45-49 age group - want them to be happy customers for next 30 years. The 45-49 age group rescreens are starting to kick off this year (USPSTF guideline to include that age group updated in 2021).
Cologuard Plus - 10 Years of R&D and Clinical Trials - Improved False Positive Rate, Cancer Detection, Advanced Adenoma Detection. Improvement on all levels, and Cologuard 3.0 already in development.
Looking for a modest price increase for Cologuard Plus rolling in over a couple years period of time. Because false positives are lower - 30% fewer false positives - more people will stay in Cologuard Testing Family
Cologuard Plus also benefits from 5-7% Lower COGs = margin expansion.
20th Anniversary for Oncotype in US. 1 billion cumulative investment in Oncotype infrastructure. Quality of Science and Clinical Evidence behind it is unmatched. Company is deeply rooted in being patient and customer-centric.
Question to Brian Baranick, General Manager of Precision Oncology - How are you gonna catch up in MRD?
With respect to MRD, have never seen such a fast developing market - real clinical unmet need - enthusiasm among patients and physicians - excited to be apart of this market. Exact Sciences will catch up in MRD due to the following:
1) World class commercial capabilities - precision oncology reps are experienced, know physicians/territories, how to sell and how to get access to leverage these relationships to launch CRC MRD next year.
2) Exact Sciences' Nexus Platform - IT infrastructure to help providers save time obtaining prior use authorizations. This billion dollar company investment will allow providers to obtain prior use authorizations and order MRD tests more quickly and easily.
3) Better Performing Product - Partnering with West German Study Group and NSABP (National Surgical Adjuvant Breast and Bower Project) To build out evidence around MRD tests - Goal is for Exact Sciences' MRD tests to have best in Class Evidence. Exact Sciences' MRD tests measure more mutations in blood than some of the first mover companies in space, and will have best in class evidence. Investors will hear more about performance of MRD assays and evidence in the back half of this year.
Blood-based screening assets - crowded marketplace - Use case for Cologuard Blood will be limited.
Great idea in concept - Bert Vogelstein is a pre-eminent researcher in the field and wrote a 2005 paper on the subject of CRC screening blood test. He concluded that detecting circulating tumor dna from precancerous lesions/polyps is impossible - you can’t find what’s not there. According to Kevin Conroy, if you’re not finding pre-cancer, you don’t have a true screening test.
The real power of colon cancer screening is finding and removing pre-cancerous polyps which may result in Stage 1 disease - that is the goal. As a result, it is highly unlikely that blood tests to screen for CRC will end up in the USPSTF guidelines and quality measures b/c they are unable to detect precancer. CRC screening blood test will end up being more of a niche market. Commercial payers will not be too excited to pay for something which is not in the quality measures. Probably won’t find out if blood CRC screening will be in the quality measures until 2028-29 (After likely USPSTF in 2027). Howver, fee for service medicare advantage has agreed to pay for blood based crc. USPSTF meets every 5-8 years on CRC screening (August, 2014 - May, 2021). Predict next Meeting in 2027. This cycle think 6 years until USPSTF and then quality measures 2-3 years later
Management expects two or three blood tests to be approved by the FDA, including Cologuard Blood. Don't believe blood tests will ultimately be a big overhand for investors as Cologuard will still grow market share even with other FDA approved CRC blood tests as it is the most effective CRC screening test. GI societies recently weighed in - not recommending blood tests for frontline CRC screening. The growth of Cologuard over the coming years will be what excites investors, not CRC blood test.
Question to CFO Aaron Bloomer: What is most underappreciated or misunderstood about the company?
CFO is excited about pipeline. The company has spent many years developing these pipeline products, a number or which are slated to launch over the next few years. Don’t think investors appreciate the impact these pipeline products will have on patients, on revenue and the Company's growth profile, as well as on margins.
Excited about mid-teens growth in Cologuard and along with MRD and other new products coming online in the next few years which will provide both the Company with both leverage and diversification.
submitted by Superchief440 to exactsciences [link] [comments]
Exact Sciences' Mission is to help eradicate cancer by preventing it, detecting it earlier and guiding treatment. In the early innings of how genomics will transform cancer prevention, diagnosis and treatment
Exact Sciences' Cologuard and Oncotype DX are two of the top brands ever in cancer diagnostics. They are helping to build a platform company through which other innovative cancer diagnostics will help patients.
Guided to 15% growth (CAGR) through 2027. Projecting over 20% adjusted ebitda margins by 2027.
Near-term growth drivers - Cologuard and Oncotype DX globally. Future drivers - pipeline.
Reiterated 2024 Revenue and EBITDA guide.
60 million Americans not up to date with colon cancer screening - huge unscreened population
Q4 2023 - highest dollar growth in screening in history. Sequential decrease in Cologuard screening revenue due to normal Q1 seasonal weakness. Despite sequential screening revenue decline, screening revenue still increased 7% YOY, and management confident in achieving 2nd Quarter and 2nd Half Guide revenue guides.
Cologuard will have steady predictable growth based upon # of sales calls to primary care physicians and increasing Health System Orders.
New Cologuard business opportunity starting last year - screening in Medicare Advantage population and gap closure programs in large health systems.
CEO Kevin Conroy: "We are confident in our ability to meet our 2nd quarter and 2nd half sales guidance."
Q1 2024 was in-line with expectations. Q1 of 2023 was an anomaly.
Sales and Marketing Spend - Spent about $800 million in sales and marketing in 2023 (sales force a relatively small component of this, sales force being brought back to levels of 2022) - High ROI from investment in additional sales people.
Last 5 quarters added 50,000 new primary care providers - docs, pa’s and nurses
As docs order more, amount of orders increases. As sales calls increase in frequency, pcp’s order more.
Calling on a doc once per quarter will result on average in six orders. Calling on a doc six times per quarter will result on average in 24 order. Sales reps provide pcp's tools, education, motivation to increase colon cancer screening numbers.
Priorities for CFO - Maintain Growth Engine not only of CG and Oncotype, but also new product pipeline - Flywheel of innovation needs to keep spinning. Will expand over 300 basis points of leverage in 2024. Increasing leverage in G&A going forward. Clear and credible pathway to adjusted ebitda margins of 20% in 2027
CFO Aaron Bloomer: Exact Sciences will show FCF growth and positive FCF delivery for each of the next three quarters in 2024.
17% CG growth embedded in 15% CAGR through 2027. (Compound Annual Growth Rate)
Impressive CAGR over the past few years. Seeing increasing opportunities to enhance the use of Cologuard as a frontline screening tool.
Over a billion dollars invested in EXACT NEXUS - Electronic Ordering, Result Delivery, Prior Authorization, Reimbursement embedded into physician's EPIC electronic record. Huge amount of customer satisfaction - makes using Cologuard easy.
Long arduous process of including Cologuard into the Quality Measures (2-3 years from being included in USPSTF guidelines), which can help health systems and plans increase their star rating in order to get quality bonuses, which is a key to their success.
130,000 new cases/year, 50,000 deaths/year from Colon Cancer, with 60 million people in U.S. not current with CRC screening guidelines.
Colonoscopy capacity in US is 12,000,000. Half screening, half diagnostic. Cologuard is helping health system and GI’s getting more people screened.
Re-screening now mid 20's as a % of revenue - aiming for 50%
Because of Covid, for two years in a row, only 1.2 million people have been eligible for re-screens. This year 1.6 million eligible for re-screen, and that number will increase annually. Also, 20 million new prospective customers in the 45-49 age group - want them to be happy customers for next 30 years. The 45-49 age group rescreens are starting to kick off this year (USPSTF guideline to include that age group updated in 2021).
Cologuard Plus - 10 Years of R&D and Clinical Trials - Improved False Positive Rate, Cancer Detection, Advanced Adenoma Detection. Improvement on all levels, and Cologuard 3.0 already in development.
Looking for a modest price increase for Cologuard Plus rolling in over a couple years period of time. Because false positives are lower - 30% fewer false positives - more people will stay in Cologuard Testing Family
Cologuard Plus also benefits from 5-7% Lower COGs = margin expansion.
20th Anniversary for Oncotype in US. 1 billion cumulative investment in Oncotype infrastructure. Quality of Science and Clinical Evidence behind it is unmatched. Company is deeply rooted in being patient and customer-centric.
Question to Brian Baranick, General Manager of Precision Oncology - How are you gonna catch up in MRD?
With respect to MRD, have never seen such a fast developing market - real clinical unmet need - enthusiasm among patients and physicians - excited to be apart of this market. Exact Sciences will catch up in MRD due to the following:
1) World class commercial capabilities - precision oncology reps are experienced, know physicians/territories, how to sell and how to get access to leverage these relationships to launch CRC MRD next year.
2) Exact Sciences' Nexus Platform - IT infrastructure to help providers save time obtaining prior use authorizations. This billion dollar company investment will allow providers to obtain prior use authorizations and order MRD tests more quickly and easily.
3) Better Performing Product - Partnering with West German Study Group and NSABP (National Surgical Adjuvant Breast and Bower Project) To build out evidence around MRD tests - Goal is for Exact Sciences' MRD tests to have best in Class Evidence. Exact Sciences' MRD tests measure more mutations in blood than some of the first mover companies in space, and will have best in class evidence. Investors will hear more about performance of MRD assays and evidence in the back half of this year.
Blood-based screening assets - crowded marketplace - Use case for Cologuard Blood will be limited.
Great idea in concept - Bert Vogelstein is a pre-eminent researcher in the field and wrote a 2005 paper on the subject of CRC screening blood test. He concluded that detecting circulating tumor dna from precancerous lesions/polyps is impossible - you can’t find what’s not there. According to Kevin Conroy, if you’re not finding pre-cancer, you don’t have a true screening test.
The real power of colon cancer screening is finding and removing pre-cancerous polyps which may result in Stage 1 disease - that is the goal. As a result, it is highly unlikely that blood tests to screen for CRC will end up in the USPSTF guidelines and quality measures b/c they are unable to detect precancer. CRC screening blood test will end up being more of a niche market. Commercial payers will not be too excited to pay for something which is not in the quality measures. Probably won’t find out if blood CRC screening will be in the quality measures until 2028-29 (After likely USPSTF in 2027). Howver, fee for service medicare advantage has agreed to pay for blood based crc. USPSTF meets every 5-8 years on CRC screening (August, 2014 - May, 2021). Predict next Meeting in 2027. This cycle think 6 years until USPSTF and then quality measures 2-3 years later
Management expects two or three blood tests to be approved by the FDA, including Cologuard Blood. Don't believe blood tests will ultimately be a big overhand for investors as Cologuard will still grow market share even with other FDA approved CRC blood tests as it is the most effective CRC screening test. GI societies recently weighed in - not recommending blood tests for frontline CRC screening. The growth of Cologuard over the coming years will be what excites investors, not CRC blood test.
Question to CFO Aaron Bloomer: What is most underappreciated or misunderstood about the company?
CFO is excited about pipeline. The company has spent many years developing these pipeline products, a number or which are slated to launch over the next few years. Don’t think investors appreciate the impact these pipeline products will have on patients, on revenue and the Company's growth profile, as well as on margins.
Excited about mid-teens growth in Cologuard and along with MRD and other new products coming online in the next few years which will provide both the Company with both leverage and diversification.
2024.05.15 23:19 Repulsive_Land_1374 Medical vs. Dental Insurance Coverage for Oral Surgery Due to Trauma
*If there is a better thread to post this under, please let me know :).
My mom had a fall few weeks ago, which resulted in her losing a couple of her front teeth and some fractures to her mandible and teeth. After she was discharged from the hospital, we went to her PCP, who referred her to an oral surgeon within her health plan network. My mom has Medicare (including a Medicare Advantage Plan) and Medicaid. We proceeded with the consultation since we had an authorization from the health insurance, but the oral surgery office had let us know that the oral surgeon is not in the dental plan network and therefore will be an out-of-network provider. The recommended oral surgery would include teeth extraction (D7210), bone grafting (D7953) and general anesthesia (D9222) for three teeth and will cost approximately 7k.
I was originally under the impression that because the oral surgery is needed due to trauma/injury/fall and not for cosmetic/teeth health reasons, the procedures will be billed to medical insurance, but after calling a different oral surgery office to ask, they told me that different offices bill differently, but it seems both offices would bill to dental insurance instead of medical insurance. The dental coverage under my mom's Medicare Advantage Plan has a quarterly allowance of a few hundred dollars, so we would still be responsible for at least 6k for the surgery. My mom's dental coverage through Medicaid is still processing so I'm unable to confirm if it will provide some coverage at the moment.
So I guess my questions are:
submitted by Repulsive_Land_1374 to medicare [link] [comments]
My mom had a fall few weeks ago, which resulted in her losing a couple of her front teeth and some fractures to her mandible and teeth. After she was discharged from the hospital, we went to her PCP, who referred her to an oral surgeon within her health plan network. My mom has Medicare (including a Medicare Advantage Plan) and Medicaid. We proceeded with the consultation since we had an authorization from the health insurance, but the oral surgery office had let us know that the oral surgeon is not in the dental plan network and therefore will be an out-of-network provider. The recommended oral surgery would include teeth extraction (D7210), bone grafting (D7953) and general anesthesia (D9222) for three teeth and will cost approximately 7k.
I was originally under the impression that because the oral surgery is needed due to trauma/injury/fall and not for cosmetic/teeth health reasons, the procedures will be billed to medical insurance, but after calling a different oral surgery office to ask, they told me that different offices bill differently, but it seems both offices would bill to dental insurance instead of medical insurance. The dental coverage under my mom's Medicare Advantage Plan has a quarterly allowance of a few hundred dollars, so we would still be responsible for at least 6k for the surgery. My mom's dental coverage through Medicaid is still processing so I'm unable to confirm if it will provide some coverage at the moment.
So I guess my questions are:
- Does Original Medicare (Parts A & B) provide coverage for oral surgeries due to trauma/injury? If so, does it matter whether the surgeon bills to dental or medical? Assuming the surgeon bills to dental and only gets the allowance from the Medicare Advantage Plan (Part C) or we pay upfront and get reimbursed the allowance amount, can I submit a claim of the remaining amount to Medicare to see if they're able to reimburse?
- My mom's dental insurance for Medicaid and Medicare Advantage Plan are with the same company (and therefore have the same in-network dentists/providers). Does anyone know what the Medicaid coverage is like for the procedures (with codes) above? If Medicaid can at least cover the teeth extractions or whatnot, that will help alleviate some of the out-of-pocket costs.
2024.05.15 19:29 quarantinepreggo Dumpster fire of a business in MD - where to file complaints?
This is a complicated mess, and I’m going to try to be as clear as I can, and provide as much detail as possible without doxing myself or anyone else involved in the situation. My questions are about a therapy practice in Maryland.
submitted by quarantinepreggo to AskALawyer [link] [comments]
- all therapists who work at this place, are classified as 1099 contractors.
- the therapists are required to use the company’s branding; their biller; their supervisors; their letterhead & documentation; etc. The therapists are required to pay the practice owner for all of these things.
- the therapists are required to pay for their own psychology today profile, but report on that site that they work for this particular practice. The practice website advertises all of the therapists as employees & required that they all utilize a specific photographer for headshots, and each therapist was required to pay for it.
- the therapists are required to use a specific EHR, at the highest/most expensive tier of that platform, and must pay for it themselves. They are required to give the biller and the practice owner access to the accounts.
- any therapist who is not clinically/independently licensed, are required to attend supervision with a supervisor picked by the practice owner. The therapist is required to pay for this supervision. Weekly individual and group supervision are put on their schedules, regardless of their own ability to meet during those scheduled times, and they are required to pay for every session, even if they don’t attend.
- for each session that is held, the therapists bill under the practice’s group PNI 2. The whole reimbursement rate is supposed to go to the therapist who held the session, but they are charged $15 per session for some of the fees listed above (biller, use of branding, etc). This means that they are paying self-employment taxes on that whole amount, but then they are paying a significant amount back to the practice so it’s not true income.
- therapist’s payments from insurances (which get first paid to the practice/business, and is then supposed to come to them), are being withheld if the business owner feels that the therapist owes her money for all of the fees listed above.
- other therapists have been sent letters from the practice owner and/or her admin, indicating that they will send invoices to collections if not paid by the therapists
- there have been increases/changes in fees, changes in practice policies, etc., which have been sent to therapists via newsletter. They are told that these changes are effective immediately. No therapists are given a new contract to sign when these changes are introduced.
- where can the therapists seek help?
- is this a DoL issue? I haven’t been able to find good info on the state DoL website on where/how to file complaints about misclassified employment outside of landscaping & seasonal workers
- should any of this be reported to insurance panels? Would the therapists put themselves at risk if they blew the whistle on filing claims under the group NPI 2 while they were classified as contractors? (Some mental health licensure in the state has regulations about provisionally licensed therapists working for themselves & some insurance panels won’t accept provisionally licensed therapists to take their coverage unless that therapist is part of a group practice)
- some provisionally licensed therapists were accepting Medicare; should this be reported to Medicare? Again, will this bring risk to the therapists?
- many of these therapists feel extremely stuck, as they are worried about retaliation and/or they can’t afford to leave or think they owe the practice owner a lot of money. How can they get access to good, competent legal advise for a very limited fee? Legal aid has indicated that this is out of their scope.
- how can these therapists successfully get paid & does anyone have tips on how to address the “collections” threats and withholding of payments?
2024.05.15 06:29 ginandtonicftw Please help me make sure our family is making the right decision
TLDR: mom is retiring and dad is insured through her, it would cost an additional $390/mo to keep him on this insurance. The difference in cost would pay for Part B, Medigap N/F-HD, and Part D. Is Original Medicare plus D and Medigap superior to most insurances? He has underlying conditions and just started Part B through the special enrollment period due to his insurance ending.
Hello all! I’ve been lurking in this group and learned a good deal. I’ll start with some background and appreciate any guidance. Thank you
My parent’s insurance is through my mom’s employer and she is retiring. My mom will be able to keep her insurance and my dad is able to as well. My understanding is that their plan requires them to sign up for Part B and will reimburse the premium through her pension. The cost to continue insurance through this plan is about $120/mom for my mom and about $510/mo for the both of them. She is able to convert her sick/personal time to help cover some of these costs.
When calculating the difference, the thought is that it essentially costs $390 ($215 if they reimburse Medicare Part B premium) to insure my dad through this plan. The plan is through UHC and there is a large network nearby them. They pay about $20-25 copays to see a specialist and maybe $20-25 for labs. He goes to see his various doctors about total of 12 times per year plus labs quarterly.
I have read that Original Medicare may be better than MA and I am not sure how their current plan compares to MA. My dad has underlying conditions (heart disease, diabetes) and could get on a Medicare Supplement through the special enrollment period (he just got Part B effective May 2024) since the group employer insurance is ending. He would likely not qualify or the premiums would be super high if done outside this time.
I was thinking that Plan N is roughly the same cost when he visits his doctors but his network opens up. It is also cheaper as Plan N is roughly half the cost of the $215 difference if he were to stay on my mom’s plan. I understand that the supplement premium is reassessed every year and will climb. I think my mom’s plan has been relatively stable. He would also need to sign up for Part D and his total costs (premium plus drugs) ranges from $50-140/mo based on his current medications.
Does this logic make sense? Am I missing anything?
Wild card: also considering F-HD as the cost is currently ~$40/mo. It seems like his copay would be just a little over the flat copays of N. He would be subject to at most $2800 out of pocket. He does not have an HSA but I could help with mine when/if needed. If this doesn’t work out after a few years, could he switch to N without a medical exam?
Appreciate any insights! Thanks for reading
submitted by ginandtonicftw to medicare [link] [comments]
Hello all! I’ve been lurking in this group and learned a good deal. I’ll start with some background and appreciate any guidance. Thank you
My parent’s insurance is through my mom’s employer and she is retiring. My mom will be able to keep her insurance and my dad is able to as well. My understanding is that their plan requires them to sign up for Part B and will reimburse the premium through her pension. The cost to continue insurance through this plan is about $120/mom for my mom and about $510/mo for the both of them. She is able to convert her sick/personal time to help cover some of these costs.
When calculating the difference, the thought is that it essentially costs $390 ($215 if they reimburse Medicare Part B premium) to insure my dad through this plan. The plan is through UHC and there is a large network nearby them. They pay about $20-25 copays to see a specialist and maybe $20-25 for labs. He goes to see his various doctors about total of 12 times per year plus labs quarterly.
I have read that Original Medicare may be better than MA and I am not sure how their current plan compares to MA. My dad has underlying conditions (heart disease, diabetes) and could get on a Medicare Supplement through the special enrollment period (he just got Part B effective May 2024) since the group employer insurance is ending. He would likely not qualify or the premiums would be super high if done outside this time.
I was thinking that Plan N is roughly the same cost when he visits his doctors but his network opens up. It is also cheaper as Plan N is roughly half the cost of the $215 difference if he were to stay on my mom’s plan. I understand that the supplement premium is reassessed every year and will climb. I think my mom’s plan has been relatively stable. He would also need to sign up for Part D and his total costs (premium plus drugs) ranges from $50-140/mo based on his current medications.
Does this logic make sense? Am I missing anything?
Wild card: also considering F-HD as the cost is currently ~$40/mo. It seems like his copay would be just a little over the flat copays of N. He would be subject to at most $2800 out of pocket. He does not have an HSA but I could help with mine when/if needed. If this doesn’t work out after a few years, could he switch to N without a medical exam?
Appreciate any insights! Thanks for reading
2024.05.14 04:45 iwant2banemt How hard has it been for your agencies to get reimbursements from Medicare and Medicaid?
After seeing how little is reimbursed, and hearing about how often it's complained about - how hard is it for your agencies to collect money from CMS? Do they pay monthly through a portal like Direct Deposit, or a check every 90 days, etc?
submitted by iwant2banemt to ems [link] [comments]
2024.05.13 23:09 midwest_monster Can bills be reimbursed after coverage disruption?
Hi folks!
I’m a social worker and I have a client who is a trans woman in her late 70’s. Her Medicare coverage was allegedly recently disrupted due to an issue with her name change. She was recently receiving medical treatment that is covered under Medicare. She is in the middle of appealing Medicare to get her coverage back (I’m not involved in this at all), but in the meantime, she’s concerned that she needs to stop all medical treatment while she isn’t covered by insurance.
If coverage is disrupted due to an issue with name change, would Medicare reimburse medical bills accrued during the disruption?
Thank you!
submitted by midwest_monster to medicare [link] [comments]
I’m a social worker and I have a client who is a trans woman in her late 70’s. Her Medicare coverage was allegedly recently disrupted due to an issue with her name change. She was recently receiving medical treatment that is covered under Medicare. She is in the middle of appealing Medicare to get her coverage back (I’m not involved in this at all), but in the meantime, she’s concerned that she needs to stop all medical treatment while she isn’t covered by insurance.
If coverage is disrupted due to an issue with name change, would Medicare reimburse medical bills accrued during the disruption?
Thank you!
2024.05.13 22:48 Wooden-Gur-4912 Medicare reimbursement
Has anyone seen this before? A bit concerning, what’s your thoughts?
https://www.aapa.org/news-central/2019/06/medicares-incident-to-billing-hinders-the-recognition-and-assessment-of-pa-value/
submitted by Wooden-Gur-4912 to physicianassistant [link] [comments]
https://www.aapa.org/news-central/2019/06/medicares-incident-to-billing-hinders-the-recognition-and-assessment-of-pa-value/
2024.05.13 04:01 SeaCucumber5555 Getting licensed in other states for Telehealth: who pays the most?
Title :) considering getting licensed in other states, which states reimburse the most? I would also take Medicaid Medicare in addition to your typical panels
submitted by SeaCucumber5555 to therapists [link] [comments]
2024.05.13 02:44 Rainyfriedtofu Vertical consolidation of healthcare: the goods, the bads, and the might not work out. bahaha!
Hello Fellow Apes,
This is the only time that I have to write so I'm going to make anymore post regarding vertical consolidation since UNH is being sue like a catholic priest over its current monopoly of healthcare.
https://news.bloomberglaw.com/health-law-and-business/unitedhealth-faces-justice-department-antitrust-probe-wsj-says
With that said, let's get this show on the road. Vertical consolidation, often referred to as vertical integration, is a strategy used by companies to gain control over their entire supply chain. This approach involves a company expanding its business operations into different stages of production or distribution that are normally operated by separate businesses. We're going to use UNH as an example here, but on the surface, UNH is pitching their vertical integration in a positive light.
UnitedHealth Group, through its Optum division, is actively engaging in vertical consolidation within the healthcare sector. This strategy involves integrating various healthcare services under one corporate umbrella, which has been a significant trend in the industry. Optum encompasses a wide range of health services, including pharmacy benefits management, healthcare providers, clinics, and data analytics platforms. By consolidating these services, UnitedHealth aims to create a more integrated healthcare delivery system that can provide more coordinated and efficient care. We'll go more into this later.
This type of vertical integration allows UnitedHealth to manage both the provision of healthcare services and the insurance coverage aspects, leading to "potentially" lower healthcare costs and improved health outcomes. However, this consolidation also raises concerns about market competition, as it could limit choices for consumers and control more of the healthcare process within a single company's ecosystem.
This consolidation trend is not unique to UnitedHealth. It reflects a broader movement within the healthcare industry where large entities are increasingly integrating providers such as hospitals and physician groups to create comprehensive healthcare networks. This trend is expected to continue and possibly accelerate, influencing how healthcare services are delivered and accessed in the United States.
Health insurance companies have increasingly engaged in vertical consolidation as a strategy to streamline operations, reduce costs, and expand their market influence. There are several ways in which these companies are using vertical consolidation to funnel consumers into their health services business segments:
Vertical consolidation can also provide insurers with extensive data on consumer behavior, health outcomes, and cost efficiency. This information can be used to optimize their own services and pricing models further, strengthening their market position and making it harder for others to compete on the same level of efficiency or personalization. Large, vertically integrated companies often have greater resources to influence healthcare policy and regulations. This can lead to a regulatory environment that favors large, integrated entities over smaller competitors or new entrants. While crowding power can lead to increased efficiency and potentially lower costs for consumers, it also raises significant concerns about competition, consumer choice, and the overall health of the market. Regulators often scrutinize such consolidations closely to ensure they don't harm consumer interests, and this is why UnitedHealth is being sued by DOJ.
For Medicare Advantage (MA) plans, which are private plans offering Medicare-covered benefits, vertical consolidation can play a significant role in managing financial risks and costs, particularly in the face of changing policies from the Centers for Medicare and Medicaid Services (CMS). One of the primary ways vertical consolidation helps is through more direct control over costs. For Medicare Advantage plans, controlling healthcare costs is crucial since they receive a fixed payment per enrollee from CMS. By owning providers, MA plans can directly influence the cost of care, reducing overall expenses and potentially offsetting losses due to policy changes that might reduce reimbursement rates or impose new cost-sharing requirements. Vertical integration allows MA plans to streamline care delivery. For example, they can implement more effective care coordination and management practices across their owned networks, which can lead to better health outcomes and reduced hospitalizations—a significant cost factor. This efficiency can help balance out negative impacts from policy changes by keeping patients healthier and reducing expensive medical interventions. Owning a broader swath of the healthcare delivery system gives MA plans access to comprehensive data across the care continuum. This data can be used to identify cost-saving opportunities, manage chronic conditions more effectively, and tailor preventive measures. Such data-driven strategies can help MA plans stay financially viable even when CMS policies become less favorable. However, with the recent earnings, we are seeing many companies failing on their cost modeling.
The twist behind all of this is the whole process might not be all rainbow and butterflies. In a somewhat new findings in the JAMA health forum, vertical consolidation might actually drive higher utilization and spending. In the words of Moocao, "Integration of health systems allows PCP to refer to higher-level specialists if they can't solve something. Before integration, they have to think really hard before referral"
https://www.fiercehealthcare.com/providers/newly-integrated-pcps-steer-patients-toward-systems-higher-utilization-spending-study
Despite previous studies, vertical integration isn't beneficial for healthcare access or coordination. This is why the Biden administration and other lawmakers are scrutinizing mergers that lead to greater vertical integration and provider consolidation. This scrutiny includes proposed updates by the Federal Trade Commission and the Department of Justice to antitrust guidelines, specifically considering the impacts of vertical integration. There is ongoing debate, with some stakeholders arguing that consolidation can help providers survive economically challenging times, while others believe these mergers cause significant market harm without benefiting patients.
Anyway, I hope this helps explain to you why you are seeing so much consolidation, but the cost saving isn't showing up, and why these giant healthcare companies are being sued.
submitted by Rainyfriedtofu to Healthcare_Anon [link] [comments]
This is the only time that I have to write so I'm going to make anymore post regarding vertical consolidation since UNH is being sue like a catholic priest over its current monopoly of healthcare.
https://news.bloomberglaw.com/health-law-and-business/unitedhealth-faces-justice-department-antitrust-probe-wsj-says
With that said, let's get this show on the road. Vertical consolidation, often referred to as vertical integration, is a strategy used by companies to gain control over their entire supply chain. This approach involves a company expanding its business operations into different stages of production or distribution that are normally operated by separate businesses. We're going to use UNH as an example here, but on the surface, UNH is pitching their vertical integration in a positive light.
UnitedHealth Group, through its Optum division, is actively engaging in vertical consolidation within the healthcare sector. This strategy involves integrating various healthcare services under one corporate umbrella, which has been a significant trend in the industry. Optum encompasses a wide range of health services, including pharmacy benefits management, healthcare providers, clinics, and data analytics platforms. By consolidating these services, UnitedHealth aims to create a more integrated healthcare delivery system that can provide more coordinated and efficient care. We'll go more into this later.
This type of vertical integration allows UnitedHealth to manage both the provision of healthcare services and the insurance coverage aspects, leading to "potentially" lower healthcare costs and improved health outcomes. However, this consolidation also raises concerns about market competition, as it could limit choices for consumers and control more of the healthcare process within a single company's ecosystem.
This consolidation trend is not unique to UnitedHealth. It reflects a broader movement within the healthcare industry where large entities are increasingly integrating providers such as hospitals and physician groups to create comprehensive healthcare networks. This trend is expected to continue and possibly accelerate, influencing how healthcare services are delivered and accessed in the United States.
Health insurance companies have increasingly engaged in vertical consolidation as a strategy to streamline operations, reduce costs, and expand their market influence. There are several ways in which these companies are using vertical consolidation to funnel consumers into their health services business segments:
- Many insurers are buying or partnering with hospitals, specialist clinics, and primary care practices. By owning these providers, insurers can direct their policyholders to use these in-network services, which are often cheaper for the insurance company due to controlled pricing and streamlined services.
- Insurers are acquiring or creating their own Pharmacy Benefits Managers (PBMs). These entities manage prescription drug benefits on behalf of health plans. By controlling the PBMs, insurers can influence prescriptions and direct consumers to specific pharmacies or mail-order drug services, often owned by the insurer itself.
- Some insurers are integrating vertically by acquiring companies that provide specialty medical services, such as dialysis centers, mental health services, and rehabilitation facilities. This allows them to keep these often expensive and frequently used services within their network, potentially lowering costs and increasing the use of these services among their insured population.
- Insurance companies are also developing or acquiring digital health platforms that offer telemedicine services, health apps, and other digital health tools. These platforms often direct users to preferred providers or services that are part of the insurer’s network, promoting an integrated approach to healthcare that keeps all aspects of patient care within one system.
- Through vertical consolidation, insurers are pushing more into value-based care agreements where providers are paid based on patient outcomes rather than services rendered. By owning healthcare providers, insurers can better implement these programs, which aim to reduce unnecessary services and focus on preventive care.
Vertical consolidation can also provide insurers with extensive data on consumer behavior, health outcomes, and cost efficiency. This information can be used to optimize their own services and pricing models further, strengthening their market position and making it harder for others to compete on the same level of efficiency or personalization. Large, vertically integrated companies often have greater resources to influence healthcare policy and regulations. This can lead to a regulatory environment that favors large, integrated entities over smaller competitors or new entrants. While crowding power can lead to increased efficiency and potentially lower costs for consumers, it also raises significant concerns about competition, consumer choice, and the overall health of the market. Regulators often scrutinize such consolidations closely to ensure they don't harm consumer interests, and this is why UnitedHealth is being sued by DOJ.
For Medicare Advantage (MA) plans, which are private plans offering Medicare-covered benefits, vertical consolidation can play a significant role in managing financial risks and costs, particularly in the face of changing policies from the Centers for Medicare and Medicaid Services (CMS). One of the primary ways vertical consolidation helps is through more direct control over costs. For Medicare Advantage plans, controlling healthcare costs is crucial since they receive a fixed payment per enrollee from CMS. By owning providers, MA plans can directly influence the cost of care, reducing overall expenses and potentially offsetting losses due to policy changes that might reduce reimbursement rates or impose new cost-sharing requirements. Vertical integration allows MA plans to streamline care delivery. For example, they can implement more effective care coordination and management practices across their owned networks, which can lead to better health outcomes and reduced hospitalizations—a significant cost factor. This efficiency can help balance out negative impacts from policy changes by keeping patients healthier and reducing expensive medical interventions. Owning a broader swath of the healthcare delivery system gives MA plans access to comprehensive data across the care continuum. This data can be used to identify cost-saving opportunities, manage chronic conditions more effectively, and tailor preventive measures. Such data-driven strategies can help MA plans stay financially viable even when CMS policies become less favorable. However, with the recent earnings, we are seeing many companies failing on their cost modeling.
The twist behind all of this is the whole process might not be all rainbow and butterflies. In a somewhat new findings in the JAMA health forum, vertical consolidation might actually drive higher utilization and spending. In the words of Moocao, "Integration of health systems allows PCP to refer to higher-level specialists if they can't solve something. Before integration, they have to think really hard before referral"
https://www.fiercehealthcare.com/providers/newly-integrated-pcps-steer-patients-toward-systems-higher-utilization-spending-study
Despite previous studies, vertical integration isn't beneficial for healthcare access or coordination. This is why the Biden administration and other lawmakers are scrutinizing mergers that lead to greater vertical integration and provider consolidation. This scrutiny includes proposed updates by the Federal Trade Commission and the Department of Justice to antitrust guidelines, specifically considering the impacts of vertical integration. There is ongoing debate, with some stakeholders arguing that consolidation can help providers survive economically challenging times, while others believe these mergers cause significant market harm without benefiting patients.
Anyway, I hope this helps explain to you why you are seeing so much consolidation, but the cost saving isn't showing up, and why these giant healthcare companies are being sued.
2024.05.11 02:21 DeeHoH Therapist- Medicare- Reimbursement
Hi. I am trying to understand Medicare and paying my out-of-network therapist.
So the provider doesn’t accept assignment and did not opt-out.
The charge is $107.16 and the limiting charge is $117.08. How much should I expect to be reimbursed?
Thank you!
submitted by DeeHoH to medicare [link] [comments]
So the provider doesn’t accept assignment and did not opt-out.
The charge is $107.16 and the limiting charge is $117.08. How much should I expect to be reimbursed?
Thank you!
2024.05.10 21:08 Stella827 Florida - Medicaid Reimbursement After Inheritance
Hi All,
My apologies if this is not worded well: I am aware that Medicaid can take certain assets after a person passes away to reimburse for past medical payments. From what I can see this happens after the Medicaid recipient dies, not while they are alive.
Can anyone tell me if they ever go after assets while the recipient is still alive if they come into a large amount of money? I know that it would normally make the recipient ineligible to continue Medicaid, but in this scenario the person is now old enough to be on Medicare so they are no longer using Medicaid.
Essentially - If they receive money from an inheritance will Medicaid be able to take it while they are still living? Or do they only have rights after the person with Medicaid debt passes away?
submitted by Stella827 to legaladvice [link] [comments]
My apologies if this is not worded well: I am aware that Medicaid can take certain assets after a person passes away to reimburse for past medical payments. From what I can see this happens after the Medicaid recipient dies, not while they are alive.
Can anyone tell me if they ever go after assets while the recipient is still alive if they come into a large amount of money? I know that it would normally make the recipient ineligible to continue Medicaid, but in this scenario the person is now old enough to be on Medicare so they are no longer using Medicaid.
Essentially - If they receive money from an inheritance will Medicaid be able to take it while they are still living? Or do they only have rights after the person with Medicaid debt passes away?
2024.05.10 18:06 Beautifier021 Who can order an MRI related to injury?
Dad has a worker's comp case that covers all medical related to an injury to his lumbar spine. Because he moved, we're waiting for a new list of approved physicians to choose between.
In the meantime, he's in intense pain and is drastically losing his mobility. A doctor (not pre-approved by insurance) ordered an MRI for his lumbar & thoracic spine (there's an unrelated issue now in the thoracic spine as well), and dad is concerned that Medicare will catch and NOT cover the lumbar spine MRI. Would we be able to get this reimbursed from workers comp for it, or would they deny it because it wasn't ordered by an approved physician? In other words... can we go ahead and get this done since he's in such bad shape, or do we have to wait for all the red tape to get worked out and for a pre-approved doctor to order the lumbar MRI before we can get that done?
submitted by Beautifier021 to WorkersComp [link] [comments]
In the meantime, he's in intense pain and is drastically losing his mobility. A doctor (not pre-approved by insurance) ordered an MRI for his lumbar & thoracic spine (there's an unrelated issue now in the thoracic spine as well), and dad is concerned that Medicare will catch and NOT cover the lumbar spine MRI. Would we be able to get this reimbursed from workers comp for it, or would they deny it because it wasn't ordered by an approved physician? In other words... can we go ahead and get this done since he's in such bad shape, or do we have to wait for all the red tape to get worked out and for a pre-approved doctor to order the lumbar MRI before we can get that done?
2024.05.10 06:24 Real_Significance419 Today/this past week is the final straw; I don't know how to continue being a therapist even just for long enough to figure something else out career-wise
I'm an LMFT in Utah, in solo private practice; 43F.
For some additional background, I became a therapist as a second career after nearly 2 decades in various toxic corporate environments where I was so miserable I was having s/i most workdays. Prior to becoming a therapist, my qualifications were a BS in Biology and a MS in English-Technical Writing. Most of my jobs were laboratory or writing/editing roles for life sciences or healthcare-adjacent companies. Nearly all of these jobs were repetitive, boring, empty, and meaningless with terrible work environments and endless co-worker drama that made me dread most workdays. I lived for the weekends but was so drained from all the BS at whatever job I was at that I typically just spent most of the weekend sleeping.
I was in therapy myself for most of that time, but there was only so much it could do to help when the circumstances were what they were. I had always had an interest in psychology and by my mid-30's had met several people who were therapists in private practice and said they were happy with their work.
After a series of events that showed me how unsustainable my life was at the time, I decided to go back to school to get my MA in Counseling Psychology. At that time, and for a number of the years that followed, becoming a therapist felt like a spiritual calling, similar to how someone who is religious might feel called to be a priest, monk/nun, etc.
I desperately wanted (and still do want) to do meaningful work that truly helps others and serves the greater good, but as the years have gone on, that doesn't seem possible without it being detrimental to my own well-being, no matter how many adjustments I've tried to make in order to create a way of being a therapist that actually works for me. What first felt like a spiritual calling now just seems like a bad investment in which I lost practically everyone and everything that once mattered to me, and it's so depressing to live with that every day.
Anyway, when I went back to school I had basically no support and had to work full time while going to school and doing my internship hours. Even with this, it wasn't enough to cover tuition and other expenses, so I took out student loans to get by. While I enjoyed seeing clients, the work environments at my internships were overall worse and even more unethical than any of the corporate jobs I'd worked at, and both clients and clinicians were treated like crap. The supervision that was provided at one internship actually didn't meet my school's requirements, so I had to pay out of my own pocket for supervision that did (more student loan debt to cover that), when I was making next to nothing. I finally found a different internship that provided appropriate supervision and paid a bit more, but it was still the same exploitive model of the practice owners collecting a lot of money from clients while not paying clinicians (especially interns) a living wage. The situation didn't improve once I graduated and started working on my hours for licensure. I found a different group practice to work at, but the supervision was inadequate (often canceled without notice, or just unhelpful) and I still was not paid a living wage so I still had to work another job just to cover basic survival expenses. I had no such thing as work-life balance during the 2.5 years of school + 2 years of pre-licensure. I was so busy that I didn't have time to reach out to friends the way I did before, and once I was no longer reaching out to people, no one reached out to me. If I did have time to do something social and reach out to someone the response was typically that they were too busy, that they might have time in 3 weeks, or I'd just get left on read and hear nothing back at all.
I kept telling myself that things would be better once I had my own private practice. The day the state approved my hours was the same day I submitted the paperwork for setting up my private practice with the IRS and the state. That was in June of 2022. Within 8 months of getting the practice set up and building that on the side, I was finally able to leave the soul-crushing, underpaid job at the group practice where I'd been working since graduation and focus entirely on my business. It was going well for a few months and then I got extremely sick with COVID in March of 2023. That turned into long-COVID followed by other complications, including autoimmune issues. So I was left with trying to scrape by on just my own income from self-employment while also trying to recover from multiple health issues. I tried seeking support from family and friends but it wasn't there. I was/am in a weekly process group for therapists, but once I got sick and was no longer able to participate in the same way I had been, there was 0 compassion for my situation no matter how thoroughly I explained what was going on, and at this point I'll probably leave the group. I truly feel like I have no one.
Fast forward to now, the medical issues are mostly under control and even with not being able to work as much as I needed to in 2023, my private practice brought in nearly 6 figures; however, once I factor in business expenses and the insane amount of taxes I have to pay (even as an S-Corp) my income from the private practice is low and hasn't provided enough to keep up with just basic survival expenses in what has become a very high cost of living area. 99% of my clients are using insurance or EAP and the amount their insurance/EAP reimburses isn't adequate to keep up with costs of living after I've paid taxes and business expenses. I've tried/explored multiple ways of lowering expenses, none of which have made an appreciable difference. I have to see more clients than I want to every week, including some who are not really a great match for what I offer, just so I can scrape enough money together to survive.
So overall, my quality of life/standard of living, work-life balance, and general life satisfaction have taken a huge hit since becoming a therapist. At the very least, being self-employed is still better than working for someone else, but it's exhausting. After getting extremely sick in 2023 and feeling like I had to face my own mortality in a way I hadn't had to before, I no longer have s/i, but there's very little about my current life that feels worth living. I go to therapy every week, I've tried multiple ways of seeking support/community (none of which have worked out), I'm very careful about everything related to my health now and I try to find every way possible to live a balanced life, but I'm just as miserable as I was at the time when I started this path; except now I have $160,000 in student loan debt that I didn't have back then, plus a bunch of credit card debt and medical bills.
So that's the load I've been carrying.
Something was bound to happen eventually that was the "final straw," so to speak, and it all hit this week.
It was one of those weird weeks where I had far fewer appointments than usual. Then on Sunday, two clients called/texted to cancel their appointments. I've stated outright in my practice policies, on my website, etc that I'm not available for texts/calls on weekends, but one client made clear in their texts that they were frustrated with my lack of response. I addressed this on Monday when I responded to their text and that seemed to sort the situation out. Then, I don't know if it's just this time of year or what, but by Wednesday, about 1/3 of the clients that were scheduled for this week had cancelled, including some clients who are usually really reliable about keeping their appointments. It was frustrating, but I decided to try and make the best of it and focus on rest and self-care, and was doing ok with that until today.
This morning, I was supposed to meet with an EAP client who cancelled 5 minutes before their appointment time. This is a new EAP, so I'm still figuring things out. I contacted the provider help line for the EAP to ask if I'd still be paid for the late cancel and was told no, because the client had not agreed to my posted cancellation policy, which appears to have been a frustrating glitch on the EAP end, so this was yet another loss of income.
Right after this, I got a text from another client who told me she was having "serious" s/i. This was concerning so I responded and she agreed to meet for a video appointment today to talk through what was going on. I had to move several things around that I had planned in order to make room in my day (that would otherwise have been focused on rest, self-care and a couple of errands) so I could make this appointment happen. The client then no-showed to the appointment that I went out of my way to set up for her, which was extremely concerning (not to mention frustrating). I tried texting her and calling her with no reply, which was even more worrisome. I then reached out to her emergency contact (her husband) to ask if she was safe. No response. A couple of hours later while I'm doing one of my errands that I had to push back, I finally hear from her. She's with her family on vacation in a national park and had no cell service (....ummm.... then why agree to an appointment at all if you are in a place where you're probably not going to have cell service???)
At that point, the last little thread of hope that I could somehow have a sustainable career as a therapist just broke. But I still had one last appointment for the day. This client is someone who may not be a great match for what I offer as a therapist. He's brought up the idea of seeing another therapist multiple times, which I have supported and even offered him referrals of other clinicians who might be a better fit, yet he always ends up coming back to schedule with me. After the exceptionally hard day/week I've had, I was struggling to stay attuned and present during his session, and after after the session he texted me to say he felt like I was "checked out," which he's within his rights to do.
But that was it for me. If this is what being a therapist is going to be like for me, even in private practice when I'm constantly making adjustments to somehow make it actually work for me, I need to find something else. At this point, I have no idea what that something else would be, or even how to keep working as a therapist until I can figure something else out. I'm qualified to do several things, but even with as little as my takehome pay from the private practice is, the other things I could do would pay far less and would be the same toxic, corporate BS that I hoped to leave behind by making this career change.
I've looked into other options that I might like, such as academic advising, but the jobs I've seen posted don't pay nearly enough to even cover basic survival costs of living. I have no interest in working in HR or a hospital environment, which I've seen suggested in other threads here about alternate careers for therapists. I've looked into teaching, but the adjunct professor positions I've seen posted pay next to nothing for what seems like a huge amount of work.
I feel hopeless and heartbroken that I basically sacrificed everything to follow what seemed like a calling to help others, only to end up so much worse off than when I started.
What I really wanted to do was grow my private practice into a holistic healing center, with other therapists, a doctor, dietitian, massage therapist, and some complementary/alternative medicine practitioners on staff to provide clients with a full spectrum of healing services, because most of the clients I see would likely benefit from at least checking in with a doctor more regularly about their medications and health conditions. In that scenario, I'd see a few clients a week but mostly just focus on running the business. I also want to develop courses (for both clinicians and laypeople) on mental health, psychology, and general wellness practices, as well as write books, conduct workshops, and do public speaking engagements on those topics. All of those things would use my skillset in a way I'd be much happier with. But after a workday of seeing clients (even just 1-2 clients) I feel so drained and exhausted that I have no energy to put toward those goals.
I also have no idea how I'd manage to set up the holistic healing center without it falling into the same exploitive/abuse model I experienced at literally every group practice where I worked before starting my private practice.Anyway, I realize this is extremely long, many thanks to anyone who has read it and may have some kind words for me.
submitted by Real_Significance419 to therapists [link] [comments]
For some additional background, I became a therapist as a second career after nearly 2 decades in various toxic corporate environments where I was so miserable I was having s/i most workdays. Prior to becoming a therapist, my qualifications were a BS in Biology and a MS in English-Technical Writing. Most of my jobs were laboratory or writing/editing roles for life sciences or healthcare-adjacent companies. Nearly all of these jobs were repetitive, boring, empty, and meaningless with terrible work environments and endless co-worker drama that made me dread most workdays. I lived for the weekends but was so drained from all the BS at whatever job I was at that I typically just spent most of the weekend sleeping.
I was in therapy myself for most of that time, but there was only so much it could do to help when the circumstances were what they were. I had always had an interest in psychology and by my mid-30's had met several people who were therapists in private practice and said they were happy with their work.
After a series of events that showed me how unsustainable my life was at the time, I decided to go back to school to get my MA in Counseling Psychology. At that time, and for a number of the years that followed, becoming a therapist felt like a spiritual calling, similar to how someone who is religious might feel called to be a priest, monk/nun, etc.
I desperately wanted (and still do want) to do meaningful work that truly helps others and serves the greater good, but as the years have gone on, that doesn't seem possible without it being detrimental to my own well-being, no matter how many adjustments I've tried to make in order to create a way of being a therapist that actually works for me. What first felt like a spiritual calling now just seems like a bad investment in which I lost practically everyone and everything that once mattered to me, and it's so depressing to live with that every day.
Anyway, when I went back to school I had basically no support and had to work full time while going to school and doing my internship hours. Even with this, it wasn't enough to cover tuition and other expenses, so I took out student loans to get by. While I enjoyed seeing clients, the work environments at my internships were overall worse and even more unethical than any of the corporate jobs I'd worked at, and both clients and clinicians were treated like crap. The supervision that was provided at one internship actually didn't meet my school's requirements, so I had to pay out of my own pocket for supervision that did (more student loan debt to cover that), when I was making next to nothing. I finally found a different internship that provided appropriate supervision and paid a bit more, but it was still the same exploitive model of the practice owners collecting a lot of money from clients while not paying clinicians (especially interns) a living wage. The situation didn't improve once I graduated and started working on my hours for licensure. I found a different group practice to work at, but the supervision was inadequate (often canceled without notice, or just unhelpful) and I still was not paid a living wage so I still had to work another job just to cover basic survival expenses. I had no such thing as work-life balance during the 2.5 years of school + 2 years of pre-licensure. I was so busy that I didn't have time to reach out to friends the way I did before, and once I was no longer reaching out to people, no one reached out to me. If I did have time to do something social and reach out to someone the response was typically that they were too busy, that they might have time in 3 weeks, or I'd just get left on read and hear nothing back at all.
I kept telling myself that things would be better once I had my own private practice. The day the state approved my hours was the same day I submitted the paperwork for setting up my private practice with the IRS and the state. That was in June of 2022. Within 8 months of getting the practice set up and building that on the side, I was finally able to leave the soul-crushing, underpaid job at the group practice where I'd been working since graduation and focus entirely on my business. It was going well for a few months and then I got extremely sick with COVID in March of 2023. That turned into long-COVID followed by other complications, including autoimmune issues. So I was left with trying to scrape by on just my own income from self-employment while also trying to recover from multiple health issues. I tried seeking support from family and friends but it wasn't there. I was/am in a weekly process group for therapists, but once I got sick and was no longer able to participate in the same way I had been, there was 0 compassion for my situation no matter how thoroughly I explained what was going on, and at this point I'll probably leave the group. I truly feel like I have no one.
Fast forward to now, the medical issues are mostly under control and even with not being able to work as much as I needed to in 2023, my private practice brought in nearly 6 figures; however, once I factor in business expenses and the insane amount of taxes I have to pay (even as an S-Corp) my income from the private practice is low and hasn't provided enough to keep up with just basic survival expenses in what has become a very high cost of living area. 99% of my clients are using insurance or EAP and the amount their insurance/EAP reimburses isn't adequate to keep up with costs of living after I've paid taxes and business expenses. I've tried/explored multiple ways of lowering expenses, none of which have made an appreciable difference. I have to see more clients than I want to every week, including some who are not really a great match for what I offer, just so I can scrape enough money together to survive.
So overall, my quality of life/standard of living, work-life balance, and general life satisfaction have taken a huge hit since becoming a therapist. At the very least, being self-employed is still better than working for someone else, but it's exhausting. After getting extremely sick in 2023 and feeling like I had to face my own mortality in a way I hadn't had to before, I no longer have s/i, but there's very little about my current life that feels worth living. I go to therapy every week, I've tried multiple ways of seeking support/community (none of which have worked out), I'm very careful about everything related to my health now and I try to find every way possible to live a balanced life, but I'm just as miserable as I was at the time when I started this path; except now I have $160,000 in student loan debt that I didn't have back then, plus a bunch of credit card debt and medical bills.
So that's the load I've been carrying.
Something was bound to happen eventually that was the "final straw," so to speak, and it all hit this week.
It was one of those weird weeks where I had far fewer appointments than usual. Then on Sunday, two clients called/texted to cancel their appointments. I've stated outright in my practice policies, on my website, etc that I'm not available for texts/calls on weekends, but one client made clear in their texts that they were frustrated with my lack of response. I addressed this on Monday when I responded to their text and that seemed to sort the situation out. Then, I don't know if it's just this time of year or what, but by Wednesday, about 1/3 of the clients that were scheduled for this week had cancelled, including some clients who are usually really reliable about keeping their appointments. It was frustrating, but I decided to try and make the best of it and focus on rest and self-care, and was doing ok with that until today.
This morning, I was supposed to meet with an EAP client who cancelled 5 minutes before their appointment time. This is a new EAP, so I'm still figuring things out. I contacted the provider help line for the EAP to ask if I'd still be paid for the late cancel and was told no, because the client had not agreed to my posted cancellation policy, which appears to have been a frustrating glitch on the EAP end, so this was yet another loss of income.
Right after this, I got a text from another client who told me she was having "serious" s/i. This was concerning so I responded and she agreed to meet for a video appointment today to talk through what was going on. I had to move several things around that I had planned in order to make room in my day (that would otherwise have been focused on rest, self-care and a couple of errands) so I could make this appointment happen. The client then no-showed to the appointment that I went out of my way to set up for her, which was extremely concerning (not to mention frustrating). I tried texting her and calling her with no reply, which was even more worrisome. I then reached out to her emergency contact (her husband) to ask if she was safe. No response. A couple of hours later while I'm doing one of my errands that I had to push back, I finally hear from her. She's with her family on vacation in a national park and had no cell service (....ummm.... then why agree to an appointment at all if you are in a place where you're probably not going to have cell service???)
At that point, the last little thread of hope that I could somehow have a sustainable career as a therapist just broke. But I still had one last appointment for the day. This client is someone who may not be a great match for what I offer as a therapist. He's brought up the idea of seeing another therapist multiple times, which I have supported and even offered him referrals of other clinicians who might be a better fit, yet he always ends up coming back to schedule with me. After the exceptionally hard day/week I've had, I was struggling to stay attuned and present during his session, and after after the session he texted me to say he felt like I was "checked out," which he's within his rights to do.
But that was it for me. If this is what being a therapist is going to be like for me, even in private practice when I'm constantly making adjustments to somehow make it actually work for me, I need to find something else. At this point, I have no idea what that something else would be, or even how to keep working as a therapist until I can figure something else out. I'm qualified to do several things, but even with as little as my takehome pay from the private practice is, the other things I could do would pay far less and would be the same toxic, corporate BS that I hoped to leave behind by making this career change.
I've looked into other options that I might like, such as academic advising, but the jobs I've seen posted don't pay nearly enough to even cover basic survival costs of living. I have no interest in working in HR or a hospital environment, which I've seen suggested in other threads here about alternate careers for therapists. I've looked into teaching, but the adjunct professor positions I've seen posted pay next to nothing for what seems like a huge amount of work.
I feel hopeless and heartbroken that I basically sacrificed everything to follow what seemed like a calling to help others, only to end up so much worse off than when I started.
What I really wanted to do was grow my private practice into a holistic healing center, with other therapists, a doctor, dietitian, massage therapist, and some complementary/alternative medicine practitioners on staff to provide clients with a full spectrum of healing services, because most of the clients I see would likely benefit from at least checking in with a doctor more regularly about their medications and health conditions. In that scenario, I'd see a few clients a week but mostly just focus on running the business. I also want to develop courses (for both clinicians and laypeople) on mental health, psychology, and general wellness practices, as well as write books, conduct workshops, and do public speaking engagements on those topics. All of those things would use my skillset in a way I'd be much happier with. But after a workday of seeing clients (even just 1-2 clients) I feel so drained and exhausted that I have no energy to put toward those goals.
I also have no idea how I'd manage to set up the holistic healing center without it falling into the same exploitive/abuse model I experienced at literally every group practice where I worked before starting my private practice.Anyway, I realize this is extremely long, many thanks to anyone who has read it and may have some kind words for me.
2024.05.09 13:56 Tikkanen Report shows Indiana hospitals lost more than $700 million in income in 2023 - Hospitals hope to see increase in Medicaid and Medicare reimbursement rates
 | submitted by Tikkanen to Indiana [link] [comments] |
2024.05.09 12:35 ahead-market AVAH Q1 2024 Earnings: Modest Growth Amid Challenges
AVAH reported a revenue increase to $490.7 million in Q1 2024, up 5.2% year-over-year, with a net loss of $11.2 million, slightly worse than analyst expectations.
Segment Performance
Expectations: AVAH's reported revenue of $490.7 million slightly exceeded the average analyst estimate of $483.98 million for Q1 2024. However, the EPS of -$0.06 was below the average estimate of -$0.05. The company's revenue growth and raised full-year guidance are positive, but the net loss poses concerns.
submitted by ahead-market to ahead_market [link] [comments]
Key Metrics
| Revenue | $490.7M | 5.2% |
| Gross Profit | $145.9M | |
| Net Income | $-11.2M | |
| Earnings Per Share | $-0.06 | |
| Cash and Cash Equivalents | $42.6M |
- Private Duty Services (PDS) (revenue - $395.009M, growth - 5.9%) - Revenue increased by $22.1 million, driven by higher demand for home health services.
- Home Health & Hospice (HHH) (revenue - $54.613M, growth - -2.7%) - Revenue decreased by $1.5 million, primarily due to lower Medicare reimbursement rates.
- Medical Solutions (MS) (revenue - $41.031M, growth - 9.9%) - Revenue increased by $3.7 million, driven by growth in the company's respiratory therapy business.
- Increased Adjusted EBITDA by 22.5% to $34.9 million, driven by cost reductions and improved operating efficiency.
- Raised full-year 2024 revenue guidance to greater than $1,970 million and Adjusted EBITDA guidance to greater than $150 million.
- Revenue (full year): $greater than $1,970 millionM
Expectations: AVAH's reported revenue of $490.7 million slightly exceeded the average analyst estimate of $483.98 million for Q1 2024. However, the EPS of -$0.06 was below the average estimate of -$0.05. The company's revenue growth and raised full-year guidance are positive, but the net loss poses concerns.
2024.05.09 09:42 Beneficial-Leg4239 The role of the registered nurse BSN in expanding under value based care. The roles of the nurse and pharmacist (clinical nurse specialist and clinical pharmacist) look more alike everyday. References provided.
Clinical Nurse Specialist References: This looks like the acute care pharmacist role in ICU and ER.
You Tube Nursing Uncharted. The Role of a Clinical Nurse Specialist (CNS) Ep. 06 Highlight Nursing Uncharted
https://www.youtube.com/watch?v=L1_QwTuS3Hc
You Tube Nurse.org. How to Become a Clinical Nurse Specialist (CNS)How to Become a Clinical Nurse Specialist (CNS)
Nurse.org
https://www.youtube.com/watch?v=n8RXYQC0uIo
Nurse.org
How to Become a Clinical Nurse Specialist
https://nurse.org/resources/clinical-nurse-specialist/
“My day-to-day can transition from being in my office planning for a project. So I'm doing a lot of reading, researching, writing, things like that. Other days, I'm out on the unit helping the nurses, running to codes, running simulations, teaching classes, running meetings, etc. No one day is ever the same.”
In fact, according to the 2020 NACNS survey, CNSs said they spent 26.6 percent of their day providing direct patient care, 22.1 percent consulting with nurses and other staff, 26.5 percent teaching nurses and staff, and 19.7 percent leading evidence-based practice projects. The majority of their time is spent precepting students (32.5%).
Clinical nurse specialists will also perform the following activities according to the survey:
What Does a Clinical Nurse Specialist Do? A clinical nurse specialist's job varies depending on the type of facility they work at and their chosen specialty. However, their primary goal is always to improve outcomes. Therefore, they constantly ask questions like: How can I help the nurses at the bedside? How can I help these patients on the unit? What changes would improve processes throughout the hospital system?
Clinical Nurse Specialist Duties and Responsibilities According to CNS Andrea Paddock, CNS responsibilities may change daily: “My day-to-day can transition from being in my office planning for a project. So I'm doing a lot of reading, researching, writing, things like that. Other days, I'm out on the unit helping the nurses, running to codes, running simulations, teaching classes, running meetings, etc. No one day is ever the same.”
In fact, according to the 2020 NACNS survey, CNSs said they spent 26.6 percent of their day providing direct patient care, 22.1 percent consulting with nurses and other staff, 26.5 percent teaching nurses and staff, and 19.7 percent leading evidence-based practice projects. The majority of their time is spent precepting students (32.5%).
Clinical nurse specialists will also perform the following activities according to the survey: Assist with evidence-based practice projects Assist other nurses/staff with direct patient care (aka act as a resource) Assist with research Teach patients and families Conduct research as the primary investigator Teach in the community Provide transitional care In other words, CNSs wear several hats and are valued members of healthcare teams.
NP, CNS, and CNM Services:7 Medicare makes payment for NP, CNS, and CNM services based on the MPFS.
The MPFS is a fee schedule with an individual payment amount for as many as 8,000 different procedure
codes. Section 1833(a)(1)(O) of the Act requires NPs and CNSs to be paid 85% of what Medicare would pay a
physician for the same service or 85% of the MPFS payment amount. Until January 1, 2011, CNMs were paid
65% of the MPFS payment amount. Beginning January 1, 2011, Medicare allows CNMs to be paid 100% of
the MPFS amount. The final section of this paper will posit arguments for changing the statute so that all
APRNs are paid at 100% of the MPFS.
Reference ANA: Medicare Payment for Registered Nurse Services and Care Coordination
https://www.nursingworld.org/~498582/globalassets/practiceandpolicy/health-policy/final_carecoordination.pdf
All Nursing Schools:
https://preview.redd.it/jlk3in7crczc1.png?width=798&format=png&auto=webp&s=f6d55786d31c2eb16c766654faf8c9e0f0a83466
International Council of Nurses. Guidelines for Advance Practice Nursing 2020:
https://www.icn.ch/resources/publications-and-reports/guidelines-advanced-practice-nursing-2020
https://www.icn.ch/sites/default/files/2023-04/ICN_APN%20Report_EN.pdf
https://preview.redd.it/wh0da0a2sczc1.png?width=749&format=png&auto=webp&s=3244c41cae29378b5b16cea0c81450ed7b4014d7
https://preview.redd.it/hljay7v6sczc1.png?width=781&format=png&auto=webp&s=a31841593469f6cbb913a6ab27b064f020a555c1
https://preview.redd.it/4abhhsn9sczc1.png?width=768&format=png&auto=webp&s=cf2d63e1b9b50de0142b2997e1bb42dbf829b598
The role of the nurse is also expanding in Ambulatory care. This looks like the AMCare RPH References:
https://improvingprimarycare.org/sites/default/files/topics/RN-Intro1-RN%20Role%20Reimagined-CHCF-Aug2015.pdf
With growing demands on primary care and a shortage of primary care clinicians, safety-net clinics are asking, What is the role of the registered nurse (RN) in primary care?
This report describes how 11 community health centers and county health systems in California, as well as two health centers outside California, are using the following strategies to expand the RN role in primary care:
American Nurse:
https://macyfoundation.org/assets/reports/publications/macy_monograph_nurses_2016_webpdf.pdf
Registered nurses, the largest health profession in the nation with over 3.5 million
members, are ideally suited to provide the bulk of care for people with chronic
illnesses. In primary care, RNs may assume at least four responsibilities: 1) Engaging
patients with chronic conditions in behavior change and adjusting medications
according to practitioner-written protocols; 2) Leading teams to improve the care
and reduce the costs of high-need, high-cost patients; 3) Coordinating the care
of chronically ill patients between the primary care home and the surrounding
healthcare neighborhood; and 4) Promoting population health, including working
with communities to create healthier spaces for people to live, work, learn, and play.
Depending on their level of education and experience, the BMC Health Service Research Article observes, nurses can independently "provide a broad range of patient services, including preventative screening, health education and promotion, chronic disease management, acute episodic care, and a wide variety of therapeutic interventions."
The activation of nurses—under the guidance of MDs, physician assistants, and nurse practitioners—was a hallmark of 30 "high-performing, innovative primary care practices" highlighted in a 2017 study published by the Journal of Ambulatory Care Management. These organizations had "practice-wide standing orders" that directed nurses to "independently conduct preventative visits, manage minor acute illnesses, and provide significant chronic illness care and management" to the patient panels.
For example, a patient may need to see only the nurse and nurse assistant for one scheduled visit but on another visit needs to be examined by the physician and provided training by the nurse.
Additionally, the patient pathway from appointment preparation to next appointment rescheduling was streamlined to shorten wait time by starting intake procedures from the moment the patient enters the office. Further, the critical handoff between the physician and the nurse is expedited by the needs-based stratification of patients, each associated with evidenced-based care protocol. This expands the role of nurse, allowing them to assume greater responsibility for patient care.
To be successful in such value-based initiatives, healthcare organizations must ensure nurses are working at the top of their license. Progressive providers have increased patient access by conducting new nurse-only patient visits during which registered nurses document patient histories, order lab and other diagnostic tests, and determine patient acuity.
By implementing newly defined standardized procedures, clinics are increasing the registered nurse’s scope of clinical decision making including medication refills and anticoagulant and chronic care management. Nurses also are conducting physical examinations, providing triage, and subsequently presenting patient cases to practitioners—activities that significantly improve overall workflow and efficiency. Moreover, evidence shows nurse-led chronic, complex, and transitional care management results in decreased hospital days and emergency department (ED) admissions.
The Ohio State School of Nursing
https://preview.redd.it/uidu1bhktczc1.png?width=514&format=png&auto=webp&s=0c4b7aaf011e99de7c902915d66da15f7c2e7112
Implementing Nurse-Run Hypertension Clinics
https://www.careinnovations.org/resources/nurse-run-hypertension-care/
https://preview.redd.it/xpcdyccttczc1.png?width=798&format=png&auto=webp&s=67261d97068fd650e07c6e09f27a8ef876243782
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These tread seems to be international as all countries seem to move toward Value Based Care.
submitted by Beneficial-Leg4239 to pharmacy [link] [comments]
You Tube Nursing Uncharted. The Role of a Clinical Nurse Specialist (CNS) Ep. 06 Highlight Nursing Uncharted
https://www.youtube.com/watch?v=L1_QwTuS3Hc
You Tube Nurse.org. How to Become a Clinical Nurse Specialist (CNS)How to Become a Clinical Nurse Specialist (CNS)
Nurse.org
https://www.youtube.com/watch?v=n8RXYQC0uIo
Nurse.org
How to Become a Clinical Nurse Specialist
https://nurse.org/resources/clinical-nurse-specialist/
What Does a Clinical Nurse Specialist Do?
A clinical nurse specialist's job varies depending on the type of facility they work at and their chosen specialty. However, their primary goal is always to improve outcomes. Therefore, they constantly ask questions like:- How can I help the nurses at the bedside?
- How can I help these patients on the unit?
- What changes would improve processes throughout the hospital system?
Clinical Nurse Specialist Duties and Responsibilities
According to CNS Andrea Paddock, CNS responsibilities may change daily:“My day-to-day can transition from being in my office planning for a project. So I'm doing a lot of reading, researching, writing, things like that. Other days, I'm out on the unit helping the nurses, running to codes, running simulations, teaching classes, running meetings, etc. No one day is ever the same.”
In fact, according to the 2020 NACNS survey, CNSs said they spent 26.6 percent of their day providing direct patient care, 22.1 percent consulting with nurses and other staff, 26.5 percent teaching nurses and staff, and 19.7 percent leading evidence-based practice projects. The majority of their time is spent precepting students (32.5%).
Clinical nurse specialists will also perform the following activities according to the survey:
- Assist with evidence-based practice projects
- Assist other nurses/staff with direct patient care (aka act as a resource)
- Assist with research
- Teach patients and families
- Conduct research as the primary investigator
- Teach in the community
- Provide transitional care
What Does a Clinical Nurse Specialist Do? A clinical nurse specialist's job varies depending on the type of facility they work at and their chosen specialty. However, their primary goal is always to improve outcomes. Therefore, they constantly ask questions like: How can I help the nurses at the bedside? How can I help these patients on the unit? What changes would improve processes throughout the hospital system?
Clinical Nurse Specialist Duties and Responsibilities According to CNS Andrea Paddock, CNS responsibilities may change daily: “My day-to-day can transition from being in my office planning for a project. So I'm doing a lot of reading, researching, writing, things like that. Other days, I'm out on the unit helping the nurses, running to codes, running simulations, teaching classes, running meetings, etc. No one day is ever the same.”
In fact, according to the 2020 NACNS survey, CNSs said they spent 26.6 percent of their day providing direct patient care, 22.1 percent consulting with nurses and other staff, 26.5 percent teaching nurses and staff, and 19.7 percent leading evidence-based practice projects. The majority of their time is spent precepting students (32.5%).
Clinical nurse specialists will also perform the following activities according to the survey: Assist with evidence-based practice projects Assist other nurses/staff with direct patient care (aka act as a resource) Assist with research Teach patients and families Conduct research as the primary investigator Teach in the community Provide transitional care In other words, CNSs wear several hats and are valued members of healthcare teams.
CNS Certifications & Specialties
CNS certifications don't cover all specialty areas of nursing like other degrees. Currently, clinical nurse specialists can earn certifications in the following specialties:- Adult
- Pediatric
- Neonatal
- Geriatric
- Oncology
- Critical Care (Adult, Pediatric & Neonatal)
- Orthopedic
- Perioperative
- Psychiatric-Mental Health (Adult, Adolescent/Child) CNS Certifications & Specialties CNS certifications don't cover all specialty areas of nursing like other degrees. Currently, clinical nurse specialists can earn certifications in the following specialties: Adult Pediatric Neonatal Geriatric Oncology Critical Care (Adult, Pediatric & Neonatal) Orthopedic Perioperative Psychiatric-Mental Health (Adult, Adolescent/Child)
NP, CNS, and CNM Services:7 Medicare makes payment for NP, CNS, and CNM services based on the MPFS.
The MPFS is a fee schedule with an individual payment amount for as many as 8,000 different procedure
codes. Section 1833(a)(1)(O) of the Act requires NPs and CNSs to be paid 85% of what Medicare would pay a
physician for the same service or 85% of the MPFS payment amount. Until January 1, 2011, CNMs were paid
65% of the MPFS payment amount. Beginning January 1, 2011, Medicare allows CNMs to be paid 100% of
the MPFS amount. The final section of this paper will posit arguments for changing the statute so that all
APRNs are paid at 100% of the MPFS.
Reference ANA: Medicare Payment for Registered Nurse Services and Care Coordination
https://www.nursingworld.org/~498582/globalassets/practiceandpolicy/health-policy/final_carecoordination.pdf
CNS Independent Practice MapCNS Independent Practice Map
https://www.ncsbn.org/nursing-regulation/practice/aprn/aprn-consensus-implementation-status/cns-independent-practice-map.pageAll Nursing Schools:
What You’ll Do as a Clinical Nurse Specialist (CNS Job Description)
https://www.allnursingschools.com/clinical-nurse-specialist/job-description/https://preview.redd.it/jlk3in7crczc1.png?width=798&format=png&auto=webp&s=f6d55786d31c2eb16c766654faf8c9e0f0a83466
International Council of Nurses. Guidelines for Advance Practice Nursing 2020:
https://www.icn.ch/resources/publications-and-reports/guidelines-advanced-practice-nursing-2020
https://www.icn.ch/sites/default/files/2023-04/ICN_APN%20Report_EN.pdf
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The role of the nurse is also expanding in Ambulatory care. This looks like the AMCare RPH References:
RN Role Reimagined: How Empowering Registered Nurses Can Improve Primary Care
https://www.chcf.org/publication/rn-role-reimagined-how-empowering-registered-nurses-can-improve-primary-care/https://improvingprimarycare.org/sites/default/files/topics/RN-Intro1-RN%20Role%20Reimagined-CHCF-Aug2015.pdf
With growing demands on primary care and a shortage of primary care clinicians, safety-net clinics are asking, What is the role of the registered nurse (RN) in primary care?
This report describes how 11 community health centers and county health systems in California, as well as two health centers outside California, are using the following strategies to expand the RN role in primary care:
- Provide RNs with additional training in primary care skills, so they can make more clinical decisions
- Empower RNs to make more clinical decisions, using standardized procedures
- Reduce the triage burden on RNs to free up time for other responsibilities
- Include RNs on care teams, allowing them to focus on their team’s patients
- Implement RN-led new-patient visits to increase patient access to care
- Offer patients co-visits in which RNs conduct most of the visit, with providers joining in at the end
- Deploy RNs as “tactical nurses”
- Provide patients with RN-led chronic care management visits
- Employ RNs’ skills to care-manage patients with complex health care needs
- Train some RNs to take responsibility for specialized functions
- Schedule RNs to perform different roles on different days
- Preserve the traditional RN role and focus on training medical assistants (MAs) and licensed vocational nurses (LVNs) to take on new responsibilities
American Nurse:
Preparing RNs for emerging roles in primary care
https://www.myamericannurse.com/preparing-rns-for-emerging-roles-in-primary-care/Registered Nurses: Partners in Transforming Primary Care
https://macyfoundation.org/publications/registered-nurses-partners-in-transforming-primary-carehttps://macyfoundation.org/assets/reports/publications/macy_monograph_nurses_2016_webpdf.pdf
Registered nurses, the largest health profession in the nation with over 3.5 million
members, are ideally suited to provide the bulk of care for people with chronic
illnesses. In primary care, RNs may assume at least four responsibilities: 1) Engaging
patients with chronic conditions in behavior change and adjusting medications
according to practitioner-written protocols; 2) Leading teams to improve the care
and reduce the costs of high-need, high-cost patients; 3) Coordinating the care
of chronically ill patients between the primary care home and the surrounding
healthcare neighborhood; and 4) Promoting population health, including working
with communities to create healthier spaces for people to live, work, learn, and play.
The Vital Role of Nurses in Delivering Transformative Primary Care
https://www.chenmed.com/blog/vital-role-nurses-delivering-transformative-primary-careDepending on their level of education and experience, the BMC Health Service Research Article observes, nurses can independently "provide a broad range of patient services, including preventative screening, health education and promotion, chronic disease management, acute episodic care, and a wide variety of therapeutic interventions."
The activation of nurses—under the guidance of MDs, physician assistants, and nurse practitioners—was a hallmark of 30 "high-performing, innovative primary care practices" highlighted in a 2017 study published by the Journal of Ambulatory Care Management. These organizations had "practice-wide standing orders" that directed nurses to "independently conduct preventative visits, manage minor acute illnesses, and provide significant chronic illness care and management" to the patient panels.
Value-Based Care Elevates the Role of the Registered Nurse in Primary Care
https://www.hfma.org/payment-reimbursement-and-managed-care/value-based-payment/54348/For example, a patient may need to see only the nurse and nurse assistant for one scheduled visit but on another visit needs to be examined by the physician and provided training by the nurse.
Additionally, the patient pathway from appointment preparation to next appointment rescheduling was streamlined to shorten wait time by starting intake procedures from the moment the patient enters the office. Further, the critical handoff between the physician and the nurse is expedited by the needs-based stratification of patients, each associated with evidenced-based care protocol. This expands the role of nurse, allowing them to assume greater responsibility for patient care.
To be successful in such value-based initiatives, healthcare organizations must ensure nurses are working at the top of their license. Progressive providers have increased patient access by conducting new nurse-only patient visits during which registered nurses document patient histories, order lab and other diagnostic tests, and determine patient acuity.
By implementing newly defined standardized procedures, clinics are increasing the registered nurse’s scope of clinical decision making including medication refills and anticoagulant and chronic care management. Nurses also are conducting physical examinations, providing triage, and subsequently presenting patient cases to practitioners—activities that significantly improve overall workflow and efficiency. Moreover, evidence shows nurse-led chronic, complex, and transitional care management results in decreased hospital days and emergency department (ED) admissions.
The Ohio State School of Nursing
Redesigning nursing education to support patients in primary care
https://nursing.osu.edu/news/2020/12/16/redesigning-nursing-education-support-patients-primary-carehttps://preview.redd.it/uidu1bhktczc1.png?width=514&format=png&auto=webp&s=0c4b7aaf011e99de7c902915d66da15f7c2e7112
Implementing Nurse-Run Hypertension Clinics
https://www.careinnovations.org/resources/nurse-run-hypertension-care/
https://preview.redd.it/xpcdyccttczc1.png?width=798&format=png&auto=webp&s=67261d97068fd650e07c6e09f27a8ef876243782
https://preview.redd.it/zqwqlyywtczc1.png?width=855&format=png&auto=webp&s=5ea5fd3225bf154d658c8b3424fbc337d1d6e3d4
These tread seems to be international as all countries seem to move toward Value Based Care.
Tension as practice pharmacists ‘encroach’ on nurse duties
https://www.nursingtimes.net/news/primary-care/tension-as-practice-pharmacists-encroach-on-nurse-duties-12-03-2019/Hospital hires newly qualified pharmacists for wards amid nurse shortage
https://pharmaceutical-journal.com/article/news/hospital-hires-newly-qualified-pharmacists-for-wards-amid-nurse-shortage2024.05.08 14:59 Herban_Myth Florida Gov. Ron DeSantis receives 20 more bills. They could soon be law. Deadline is 5/22/24 (Credit: Anthony Talcott)
 | Published by Anthony Talcott submitted by Herban_Myth to florida [link] [comments] TALLAHASSEE, Fla. – Florida Gov. Ron DeSantis on Tuesday received 20 bills from the state Legislature covering a variety of issues, including building regulations, critical infrastructure crimes and rental security deposits. DeSantis has until Wednesday, May 22 to decide whether to sign the bills into law. The news bills include the following: HB 191 — Town of OrchidHouse Bill 191 refers to the town of Orchid in Indian River County.Under state law, local governments are required to hold public meetings within their jurisdictions — unless they have a population of 500 people or fewer. Orchid — with a population of 531 as of last year — doesn’t have any meeting facilities in its boundaries, so it’s been holding public meetings at a local privately owned golf club instead. As such, this bill would provide an exception under state statutes to allow Orchid to hold such meetings within five miles of its boundaries. If signed into law, the bill would take effect immediately. HB 267 — Building RegulationsHouse Bill 267 aims to amend the state’s building code.More specifically, the bill would implement set time limits for local governments to either approve or deny permit applications. In addition, the bill would make the following changes: Local governments must create auditing standards before auditing a private provider. Completing an internship program for residential building inspectors is a pathway for licensure as a residential building inspector. Sealed drawings will not be required for replacements of windows, doors, or garage doors in certain homes so long as they meet state standards. If signed into law, the bill would take effect on Jan. 1, 2025. HB 275 — “Critical Infrastructure” CrimesHouse Bill 275 aims to create new offenses under state law involving critical infrastructure.“Critical infrastructure” in the bill refers to linear assets that are designed to exclude unauthorized people, such as fences, no-trespassing signs, generators, energy plants, or TV stations. Under this bill, damaging, accessing or tampering with critical infrastructure could result in both criminal and civil penalties. If signed into law, the bill would take effect on July 1. HB 415 — Pregnancy and Parenting ResourcesHouse Bill 415 seeks to create a “comprehensive state website” with information about pregnancy and parenting resources.Under this bill, the Department of Health would be responsible for contracting a third party to create the website with details on both public and private resources. That website would have to include information on resources related to: Education materials on pregnancy and parenting Maternal health services Prenatal and postnatal services Educational and mentorship programs for fathers Social services Financial assistance Adoption services If signed into law, this bill would take effect on July 1. HB 509 — Collier Mosquito Control DistrictHouse Bill 509 aims to revise the boundaries of the Collier Mosquito Control District.The special district is responsible for cutting down on local mosquito populations, though this bill would expand its boundaries and allow it to service a broader area. If signed into law, the bill would take effect on Oct. 1. HB 691 — Town of Horseshoe BeachHouse Bill 691 aims to provide exceptions for the quota limitation of “quota licenses” for certain restaurants in the town of Horseshoe Beach.The bill is expected to increase revenues for local businesses in Horseshoe Beach, according to Legislative analysts. If signed into law, the bill would take effect immediately. HB 793 — Coral Springs Improvement DistrictHouse Bill 793 aims to address the Coral Springs Improvement District, which develops and operates water and sewer systems in Broward County.This bill would revise certain purchasing and contract requirements for the special district, such as requiring the district to public bid notices, increasing the threshold for competitive bidding, and clarifying that the district must accept the bid of the lowest responsible bidder (unless it’s in the district’s best interest to reject all bids). If signed into law, the bill would take effect immediately. HB 819 — Lehigh Acres Municipal Services Improvement DistrictHouse Bill 819 aims to address the Lehigh Acres Municipal Services Improvement District, which is responsible for public infrastructure in parts of Lee and Hendry counties.This bill would expand the boundaries of the special district, which is expected to increase revenues for the district. If signed into law, the bill would take effect on Oct. 1 HB 867 — North River Ranch Improvement Stewardship DistrictHouse Bill 867 aims to address the North River Ranch Improvement Stewardship District in Manatee County, which is responsible for overseeing community development.This bill would revise the boundaries of the special district, ultimately adding over 100 acres to it. The changes are estimated to raise an extra $500,000 for the district. If signed into law, the bill would take effect immediately. HB 1023 — St. Lucie CountyHouse Bill 1023 aims to amend health care policies for inmates at the St. Lucie County detention center.Under this bill, health care providers who provide medical services to these inmates may only be compensated for up to 110% of the Medicare reimbursement rate if the provider doesn’t have a contract with the county. In addition, such compensation would be limited to 125% of the Medicare reimbursement rate if the hospital reported a negative operating margin in the prior year. If signed into law, the bill would take effect immediately. HB 1025 — Municipal Service District of Ponte Vedra BeachHouse Bill 1025 aims to address the Municipal Service District of Ponte Vedra Beach in St. Johns County, which is responsible for providing certain community services.Under this bill, term limits for Trustees would receive a lifetime limit of 12 years. In addition, the bill would increase the threshold for capital projects that require voter approval. If signed into law, the bill would take effect on Oct. 1. HB 1133 — Vulnerable Road UsersHouse Bill 1133 aims to amend state statutes regarding traffic infractions involving “vulnerable road users.”Under state law, “vulnerable road users” are defined as one of the following: Pedestrian, including a person actually engaged in work upon a highway, or in work upon utility facilities along a highway, or engaged in the provision of emergency services within the right-of-way Person operating a bicycle, an electric bicycle, a motorcycle, a scooter, or a moped lawfully on the roadway; Person riding an animal; or Person lawfully operating on a public right-of-way, crosswalk, or shoulder of the roadway any: farm tractor or similar vehicle designed primarily for farm use; skateboard, roller skates, or in-line skates; horse-drawn carriage; electric personal assistive mobility device; or wheelchair. S. 316.027 (1)normal HB 1133 would set up specific penalties for anyone who commits a non-criminal traffic infraction that seriously injures or kills a vulnerable road user. Those penalties include fines, suspension of driver’s licenses, and the requirement to complete a driver improvement course. These are in addition to any other criminal charges that could arise from such incidents. If signed into law, the bill would take effect on July 1. HB 1305 — Security DepositsHouse Bill 1305 aims to amend the state’s Residential Landlord and Tenant Act following a recent case out of Palm Beach County.According to Seeking Rents, the case involved two tenants who sued their former apartment complex after it failed to return a $500 security deposit. Under state law, security deposits have to be held in a “Florida banking institution,” and the complex had kept the tenants’ deposits in an account with JP Morgan Chase — a national bank headquartered in New York. Legislative analysts said that the definition of “Florida banking institution” used by plaintiffs in that case have since been repealed, but because the Act doesn’t define that term, it opens up the possibility of similar lawsuits in the future, which could deter developers from investing in more rental housing that would drop prices. As a result, HB 1305 adds the following definition for “Florida banking institution” to the Act: A bank, credit union, trust company, savings bank, or savings or thrift association doing business under the authority of a charter issued by the United States, this state, or any other state which is authorized to transact business in this state and whose deposits or share accounts are insured by the Federal Deposit Insurance Corporation or the National Credit Union Share Insurance Fund House Bill 1305normal If signed into law, the bill would go into effect immediately. HB 1567 — Emergency Management DirectorsHouse Bill 1567 aims to create requirements to qualify for Emergency Management Directors in the state.Under the State Emergency Management Act, each county is required to have a director for its respective emergency management agency. These directors are appointed by local leaders, though there are no specific minimum qualifications to serve as one. As such, this bill seeks to establish minimum education, experience and training requirements to qualify for a director position. These standards include holding a bachelor’s degree, having at least four years of similar experience in another role, and completing 150 hours of emergency management training. If HB 1567 is approved, existing county emergency management directors will have until June 30, 2026 to meet the new criteria. If signed into law, the bill would go into effect on July 1. HB 5401 — New JudgeshipsHouse Bill 5401 aims to establish a few new judge positions in Florida.According to Legislative analysts, the state’s Supreme Court issued an order in November detailing the need for the new positions. As a result, this bill would set up the following: A circuit court judgeship in the First Judicial Circuit (Escambia, Okaloosa, Santa Rosa and Walton counties) A circuit court judgeship in the Twentieth Judicial Circuit (Charlotte, Collier, Glades, Hendry and Lee counties) A county court judgeship in Columbia County A county court judgeship in Santa Rosa County Two county court judgeships in Hillsborough County Three new county court judgeships in Orange County If signed into law, the bill would go into effect on July 1. SB 92 — Yacht and Ship Brokers’ ActSenate Bill 92 aims to revise state regulations of yacht and ship brokers/salespeople.Under this bill, such brokers wouldn’t be required to hold a license in Florida if they primarily operate as a broker in another state and buy a yacht from someone in Florida who is licensed. If signed into law, the bill would go into effect on Oct. 1. SB 328 — Affordable HousingSenate Bill 328 aims to amend parts of the Live Local Act.Some of those changes are as follows: Preempting local governments’ “floor area ratio” for certain developments Prohibiting qualifying developments within 1/4-mile of a military installation from using the Act’s administrative approval process Exempting certain airport-impacted areas from the Act’s provisions Modifying parking reduction requirements for qualifying developments located near certain transportation facilities Requiring local governments to publish policies on their websites about the procedures and expectations for approval of qualifying developments Clarifying that only the affordable units in a qualifying development must be rental units For ad valorem tax exemptions on newly constructed multifamily developments, the bill would require 10 units — rather than 70 — be set aside for income-limited households in the Florida Keys to qualify for the exemption. If signed into law, the bill would take effect immediately. SB 382 — Continuing Education RequirementsSenate Bill 382 aims to revise requirements for licensure by the Florida Department of Business and Professional Regulation.Under this bill, someone trying to renew their license with the DBPR and who has held their license for at least 10 years is exempted from being required to complete continuing education — so long as there is no disciplinary action imposed on the license. However, this rule would not apply to engineers, CPAs, brokers, broker associates, sales associates, real estate appraisers, architects or interior designers. If signed into law, the bill would take effect on July 1. SB 892 — Dental Insurance ClaimsSenate Bill 892 aims to revise parts of the Florida Insurance Code related to covered dental services.Under this bill, insurers would be prohibited from denying claim payments if a dental procedure was authorized by an insurer before taking place, with few exceptions. In addition, the bill seeks to make other changes, like requiring insurers to receive written consent from dentists prior to employing claim payments via credit cards, and prohibiting insurers from charging dentists a fee when paying a claim through an automatic clearinghouse. If signed into law, the bill would take effect on Jan. 1, 2025. SB 994 — Student Transportation SafetySenate Bill 994 aims to revise state statutes related to camera enforcement of traffic infractions where a driver passes a stopped school bus.More specifically, the bill would make the following changes: Manufacturers of school bus infraction detectors may receive a fixed amount of collected proceeds for services rendered regarding those detectors. Required signage on school buses with these detectors must be revised. Funds collected from related civil penalties are allocated to the respective school district to pay for the detector program and other student transportation safety enhancements. The collection of evidence from such a detector doesn’t constitute remote surveillance. The use of video and images on these detection systems are limited to their specific purpose. Certain traffic fines are remitted to the respective school district. If signed into law, the bill would take effect immediately. |