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There are not enough health workers in lasix street price California to meet the needs of the state’s increasingly diverse, growing, important source and aging population, and the situation is getting worse. In 2019, 39 percent of Californians identified as Latinx, but only 14 percent of medical school students and 6 percent of active patient care physicians in California were Latinx.Researchers from Mathematica, with support from the California Health Care Foundation, recently reviewed evidence from key health workforce policy interventions to determine their impact on access to health care, the diversity of the health workforce, and providers’ ability to deliver services in a language other than English (“language concordance”). The evidence review included academic literature and interviews of key experts in the lasix street price field. It focused on health professions that require an advanced degree, because it has been particularly challenging to improve access, diversity, and language concordance through these jobs.“There have been many public and private efforts in California to increase the number and diversity of health professionals, but they have not been sufficient to alleviate the crisis,” said Diane Rittenhouse, a senior fellow at Mathematica.

€œIn a year with a state budget surplus, this report reviews evidence and presents options for public investment to improve health care lasix street price access and health workforce diversity.” Mathematica’s researchers concluded that a blended approach is necessary to achieve better health care access and improve the diversity of the health workforce. For example, loan repayment in exchange for a commitment to serve in a medically underserved area of California is a quick way to improve access to primary care, behavioral health, and dentistry in those areas. Improving the diversity of the workforce, however, requires support for a diverse array of college lasix street price students to succeed in California’s health professional training programs. Ultimately, underserved rural and urban areas are more likely to retain health professionals who are from those areas, and interventions that seek to engage those professionals will likely have the greatest impact.

Read the report here lasix street price. For more information on the report or on health workforce challenges in California, please contact Todd Kohlhepp.Despite the important mission of adult education to provide adults with the competencies they need to succeed in the workforce and achieve economic self-sufficiency, policymakers and practitioners have limited evidence on effective strategies for improving adult learners’ outcomes. The Workforce Innovation and Opportunity Act (WIOA) Title II, the key federal investment helping adults acquire important skills and lasix street price credentials to succeed in the workplace, encourages adult education programs to use evidence-based strategies to improve services and participant success. A new review of existing research, authored by staff at Mathematica for the Institute of Education Sciences at the U.S.

Department of Education, identifies some promising strategies and a need for more rigorous studies to guide decision making around successful strategies for adult lasix street price learners. The available evidence provides limited support for the use of particular adult education strategies over others, although bridge classes and integrated education and training programs offer some promise. The authors also note opportunities lasix street price for the field to prioritize research investments to increase the evidence base. Namely, under WIOA, Title II requires adult education programs to collect data on skill gains, educational progress, employment, and earnings for program participants.

These data lasix street price offer opportunities to examine adult education strategies that might improve these learner outcomes. The emphasis in WIOA on longer term educational attainment and labor market outcomes also provides opportunities for research on strategies with an increased focus on improving adult learner transitions to postsecondary education or to better jobs and higher earnings, outcomes for which reliable data sources exist.“This systematic review provides some guidance for the field to make progress on its goals of helping adult learners obtain the competencies they need to be productive workers, family members, and citizens,” noted project director Alina Martinez. This research can help policymakers and local providers target their resources to help adult learners achieve higher earnings and career success.“Read the IES snapshot..

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Madison Cano knew she lasix price wanted to fluid medicine lasix breastfeed her son, Theo. But breastfeeding was painful for her. The skin on her breasts was chafed and blistered last July when she returned home from the hospital fluid medicine lasix. And Theo sometimes screamed during feedings.

Cano, 30, realized she needed help to get the short- and long-term health benefits of breastfeeding for moms and babies. New studies also have shown that hypertension medications-vaccinated fluid medicine lasix mothers pass protective antibodies on to their newborns. However, Cano lives in Montrose in western Colorado, 60 miles away from her lactation counselor, Ali Reynolds, in Grand Junction — and it was during the thick of the lasix. She messaged Reynolds on Facebook and took photos and recorded videos of herself breastfeeding so Reynolds could offer advice and encouragement from afar.

It worked fluid medicine lasix. She no longer had pain. Cano is still breastfeeding Theo, who just turned 1. €œI don’t think I would have understood what was happening and been able to work through fluid medicine lasix it without that resource,” said Cano.

Support for breastfeeding was upended last year, when it no longer seemed safe to take a baby class at the hospital or invite a nurse into one’s home. Hospitals, lactation counselors and support groups turned to virtual platforms like Zoom or phone calls. That made lactation support fluid medicine lasix accessible to struggling families during the lasix, said Danielle Harmon, executive director of the United States Lactation Consultant Association. Today, although lactation specialists have more options to safely meet in person with families after their hypertension medications vaccinations, many are choosing to continue virtual classes, keeping alive the online communities they created and relying on the technology that worked for many families.

Virtual options especially help those in remote areas or those with limited transportation access, breastfeeding experts say. Right before the lasix, for example, Sandrine Druon typically had one or two moms attend in-person meetings she held for La Leche League of Longmont at the First Evangelical Lutheran fluid medicine lasix Church or at a Ziggi’s Coffee shop. But because they could no longer meet in person, last June she launched two monthly virtual meetings. Now, an online meeting will typically include nine or 10 moms.

She started an online Spanish-speaking meeting in May and parents joined from their homes in several states fluid medicine lasix and even from other countries. She hopes eventually to have a mix of online and in-person meetings. The virtual switch hasn’t worked for everyone. Harmon said the logistics of video support remain difficult, along with privacy concerns on platforms fluid medicine lasix that could be hacked.

Other lactation experts noted Black and Hispanic mothers are sometimes still left behind. So lactation specialists are trying to learn from the lasix on what worked — and what didn’t — to reach all kinds of new parents. Before the fluid medicine lasix lasix, 84% of U.S. Mothers breastfed at least initially, according to 2019 data from the Centers for Disease Control and Prevention, while Colorado had a 93% rate.

Theo sometimes screamed when his mother, Madison Cano, tried to breastfeed him ― she often found it painful. Cano got help with breastfeeding online, when fluid medicine lasix her lactation counselor coached her via Facebook. (Abie Livesay for KHN) The lasix hasn’t seemed to change the picture, said Stacy Miller, Colorado’s breastfeeding coordinator for the Special Supplemental Nutrition Program for Women, Infants and Children, shorthanded as WIC. Citing state birth certificate data, Miller said preliminary breastfeeding rates among families discharged from Colorado hospitals remained similar in the first quarter of 2021 to rates from 2020 or 2019.

Throughout the lasix, lactation specialists fluid medicine lasix have tried to offer convenient options for parents. St. Joseph Hospital in Denver launched virtual breastfeeding support groups that still occur today, in addition to breastfeeding help during families’ hospital stays, said Katie Halverstadt, the hospital’s clinical nurse manager of lactation and family education. Last year fluid medicine lasix in North Carolina, experts adapted an in-person prenatal breastfeeding program to an interactive video platform in English and Spanish.

A separate effort on New York’s Long Island successfully converted in-person breastfeeding support to phone and video calls in 2020. To help support parents in Grand Junction, Colorado, Reynolds expanded her private practice, Valley Lactation, by offering virtual appointments while continuing to see some clients in their homes. That hybrid model continues today, although Reynolds said the demand for virtual or phone appointments has decreased lately as the country reopens fluid medicine lasix. Paying out-of-pocket for appointments is a hurdle her clients face, said Reynolds, but she encourages them to submit claims for telehealth or in-person visits to their health insurance companies for reimbursement.

Early in the lasix, telehealth rules were relaxed to encourage more telephone and virtual appointments — many of which have been covered by insurance. But insurance coverage for lactation support will likely continue to be an issue independent of whether lasix telehealth rules expire, USLCA’s fluid medicine lasix Harmon said. While the Affordable Care Act mandates that insurance companies cover lactation support and supplies, such as breast pumps, Harmon said reimbursement is often spotty. Mirroring Medicaid, insurance providers often cover services only from licensed providers, she said, but just four states — Georgia, New Mexico, Oregon and Rhode Island — license lactation consultants.

Experts such fluid medicine lasix as Jennifer Schindler-Ruwisch, an assistant professor at Fairfield University in Connecticut, found the lasix may have exacerbated breastfeeding barriers for those without access to online technology or translation services, among other things. She published one of the first studies in the U.S. To examine hypertension medications’s effect on lactation services by collecting experiences from lactation support providers in Connecticut, including many working in WIC programs. For income-eligible WIC fluid medicine lasix families, all breastfeeding classes, peer groups and one-on-one consultations are free.

Birdie Johnson, a doula who provides breastfeeding and other postpartum support to Black families as part of Sacred Seeds Black Doula Collective of Colorado, said virtual support groups during the lasix also did not meet her clients’ needs for connection and interaction. Social media built communities online, particularly by normalizing breastfeeding struggles among Black parents, she said, but obstacles remained. €œhypertension medications brought our community together and at the same time destroyed fluid medicine lasix it,” Johnson said. Black parents in the U.S.

Already had lower rates of breastfeeding than Asian or white parents, according to 2017 CDC data, and both Black and Hispanic parents have had lower rates of exclusively breastfeeding their babies at 6 months, which is what the American Academy of Pediatrics recommends. Socioeconomics and fluid medicine lasix lack of workplace support have been found to contribute to the gap. Research also has found Black mothers are more likely than white moms to be introduced to infant formula at hospitals. A scarcity of Black health care providers in lactation, women’s health and pediatrics is a continuing fluid medicine lasix concern, Johnson said.

In Colorado last year, the Colorado Breastfeeding Coalition, the Center for African American Health, Elephant Circle and Families Forward Resource Center held three training sessions for people of color to become lactation specialists, said Halverstadt, who chairs the coalition. Jefferson County, which encompasses much of Denver’s western suburbs, is now training at least a dozen Spanish-speaking community members for lactation certification. In addition to classes, the trainees fluid medicine lasix log clinical hours in breastfeeding support, sometimes during virtual meetings of a Spanish-speaking support group called Cuenta Conmigo Lactancia. €œYou are more confident and more at ease with someone who knows your language, your culture and who is part of the community,” said Brenda Rodriguez, a dietitian and certified lactation consultant for Jefferson County Public Health, which reaches roughly 400 breastfeeding families each month through its WIC programs.

Angelica Pereda, a maternal and child health registered nurse, is part of that training program. Pereda, who is Hispanic and bilingual, gave birth to son Ahmias in April 2020 and struggled with breastfeeding because he could not latch on to her breasts fluid medicine lasix. A lactation consultant could not come into her home during the lasix, and she was skeptical of virtual consultations because of privacy concerns. So she pumped her breast milk and bottle-fed it to her son.

Her experience gave her newfound empathy for families, and she wants to help other fluid medicine lasix Spanish-speaking parents find solutions — whether in person or virtually. €œThere is just not enough breastfeeding support in general, but especially when that support is in a different language,” said Pereda. Related Topics Contact Us Submit a Story TipMEMPHIS, Tenn. €” Just fluid medicine lasix a quick walk through the parking lot of Choices-Memphis Center for Reproductive Health in this legendary music mecca speaks volumes about access to abortion in the American South.

Parked alongside the polished SUVs and weathered sedans with Tennessee license plates are cars from Mississippi, Arkansas, Florida and, on many days, Alabama, Georgia and Texas. Choices is one of two abortion clinics in the Memphis metro area, with a population of 1.3 million. While that might seem a surprisingly limited number of options for women seeking a commonplace medical procedure, fluid medicine lasix it represents a wealth of access compared with Mississippi, which has one abortion clinic for the entire state of 3 million people. A tsunami of restrictive abortion regulations enacted by Republican-led legislatures and governors across the South have sent women who want or need an early end to a pregnancy fleeing in all directions, making long drives or plane trips across state lines to find safe, professional services.

For many women, that also requires taking time off work, arranging child care and finding transportation and lodging, sharply increasing the anxiety, expense and logistical complications of what is often a profoundly difficult moment in a woman’s life. €œEspecially for women coming from long distances, child care is the biggest thing,” said Sue fluid medicine lasix Burbano, a patient educator and financial assistance coordinator at Choices. €œThey’re coming all the way from Oxford, Mississippi, or Jackson. This is a three-day ordeal.

I can just see how exhausted they are.” Choices-Memphis Center for Reproductive Health is one of two abortion clinics in the Memphis metro area, with a population of 1.3 million fluid medicine lasix. (Warren Architecture) The long drives and wait times could soon spread to other states, as the U.S. Supreme Court prepares this fall to consider a Mississippi ban on nearly all abortions after 15 weeks of pregnancy, with no allowances for cases of rape or incest. Under a law enacted in 2018 by the Republican-led legislature, a woman could obtain a legal abortion only if the pregnancy threatens her life or would cause an “irreversible impairment of a major bodily function.” Mississippi’s ban was promptly challenged by abortion rights activists and put on hold as a series of lower courts have deemed it unconstitutional fluid medicine lasix under the Supreme Court’s landmark Roe v.

Wade decision. That 1973 ruling, in concert with subsequent federal case law, forbids states from banning abortions before “fetal viability,” the point at which a fetus can survive outside the womb, or about 24 weeks into pregnancy. Tennessee, Texas, Mississippi and several other states have since passed laws that would ban abortions after six fluid medicine lasix weeks. That legislation is also on hold pending legal review.

Groups opposed to abortion rights have cheered the court’s decision to hear the Mississippi case, believing the addition of Justice Amy Coney Barrett gives the court’s conservative bloc enough votes to overturn Roe, or at least vastly expand the authority of individual states to restrict abortion. But, for supporters of reproductive rights, anything but a firm rejection of the Mississippi ban raises the specter of an even larger fluid medicine lasix expanse of abortion service deserts. Abortion could quickly become illegal in 21 states — including nearly the entire South, the Dakotas and other stretches of the Midwest — should the court rescind the principle that a woman’s right to privacy protects pregnancy decisions. €œIf we end up with any kind of decision that goes back to being a states’ rights issue, the entire South is in a very bad way,” said Jennifer Pepper, executive director of Choices in Memphis.

The decades-long strategy by conservative white evangelical Christians to chip away at abortion access state by fluid medicine lasix state has flourished in the South, where hard-right Republicans hold a decisive advantage in state legislatures and nearly all executive chambers. Though details vary by state, the rules governing abortion providers tend to hit similar notes. Among them are requirements that women seeking abortions, even via an abortion pill, submit to invasive vaginal uasounds. Mandatory waiting periods of fluid medicine lasix 48 hours between the initial consultation with a provider and the abortion.

And complex rules for licensing physicians and technicians and disposing of fetal remains. Some states insist that abortion providers require women to listen to a fetal heartbeat. Other providers have been unable to obtain fluid medicine lasix admitting privileges at local hospitals. €œEverything is hard down here,” said Pepper.

The rules also have made some doctors reluctant to perform the procedure. While obstetricians and gynecologists in California, New York, Illinois fluid medicine lasix and elsewhere routinely perform abortions at their medical offices — the same practices where they care for women through pregnancy and delivery — their peers in many Southern states who perform more than a small number of abortions a year must register their practices as abortion clinics. None has done so. Texas offers an example of how targeted legislation can disrupt a patient’s search for medical care.

In 2012, 762 Texans went out of state for abortions, according to researchers at the University fluid medicine lasix of Texas-Austin. Two years later, after then-Gov. Rick Perry signed into law the nation’s most restrictive abortion bill, shuttering about half the state’s abortion facilities, 1,673 women left Texas to seek services. In 2016, 1,800 did so fluid medicine lasix.

Similarly, in March 2020, as the hypertension lasix took hold, Gov. Greg Abbott issued an order prohibiting all abortions unless the woman’s life was in danger, deeming the procedure “not medically necessary.” The month before the order, about 150 Texans went out of state to seek abortion services. In March and April, with the order in effect, nearly 950 women sought care fluid medicine lasix outside Texas. There can also be an unsettling stigma in some parts of the South.

Vikki Brown, 33, who works in education in New Orleans, said she initially tried to end her pregnancy in Louisiana, calling her gynecologist for advice, and was told by a receptionist that she was “disgusted” by the request. She sought out the lone abortion clinic operating in New fluid medicine lasix Orleans but found it besieged with both protesters and patients. €œI knew but didn’t understand how difficult it was to get care,” said Brown, who moved to Louisiana in 2010 from New York City. €œThe clinic fluid medicine lasix was absolutely full.

People were sitting on the floor. It was swamped.” It took her six hours to get an uasound, which cost $150, she said. A friend fluid medicine lasix in Washington, D.C., counseled Brown that “it didn’t have to be like that” and the pair researched clinics in the nation’s capital. She flew to Washington, where she was able to get an abortion the same day and for less than it would have cost her in New Orleans, even including airfare.

€œNo protesters, no waiting period,” she said. €œIt was a wildly different fluid medicine lasix experience.” Atlanta, a Southern transportation hub, has also become a key piece in the frayed quilt of abortion care in the region. Kwajelyn Jackson, executive director of Feminist Women’s Health Center in Atlanta, said the clinic regularly sees patients from other states, including Alabama, Tennessee, Kentucky and the Carolinas. These visits often involve long drives or flights, but rarely overnight stays because the state-mandated 24-hour waiting period can begin with a phone consultation rather than an in-person visit.

Georgia has many of the same laws other states employ to make clinical operations more burdensome — requirements to cremate fetal remains, for instance, and that abortion providers adhere to the onerous building standards set for outpatient surgical centers — but its urban clinics so far have weathered fluid medicine lasix the strategies. Jackson said staffers at her clinic are aware of its role as a refuge. €œWe’ve had patients who were able to get a ride from Alabama, but they weren’t able to get a ride home,” she said. €œWe had to help them find a ride fluid medicine lasix home.

It is so much simpler to go 3 or 4 miles from your home and sleep in your bed at night. That is a luxury that so many of our patients can’t enjoy.” Many women embarking on a search for a safe abortion are also confronting serious expenses. State Medicaid programs in the South do not pay for abortions, and many private insurers refuse to cover fluid medicine lasix the procedure. In addition, the longer a woman’s abortion is delayed, the more expensive the procedure becomes.

Becca Turchanik, a 32-year-old account manager for a robotics company in Nashville, Tennessee, drove four hours to Atlanta for her abortion in 2019. €œWe got fluid medicine lasix an appointment in Georgia because that was the only place that had appointments,” she said. Turchanik said her employer’s health insurance would not cover abortion, and the cost of gas, food, medications and the procedure itself totaled $1,100. Her solution?.

Take on debt fluid medicine lasix. €œI took out a Speedy Cash loan,” she said. Turchanik had a contraceptive implant when she learned she was six weeks pregnant. She said she was in an unhealthy relationship with a man she discovered to be fluid medicine lasix dishonest, and she decided to end her pregnancy.

€œI wish I had a child, but I’m glad it wasn’t his child,” she said. €œI have accomplished so much since my abortion. I’m going to make my life better.” But the emotions of fluid medicine lasix the ordeal have stayed with her. She’s angry that she had to call around from state to state in a panic, and that she was unable to have her abortion close to home, with friends to comfort her.

Others turn to nonprofit groups for financial and logistical support for bus and plane tickets, hotels, child care and medical bills, including the National Abortion Federation, which operates a hotline to help women find providers. Last year, the fluid medicine lasix federation received 100,000 calls from women seeking information, said its president, the Very Rev. Katherine Hancock Ragsdale. Access Reproductive Care-Southeast, an abortion fund based in Atlanta, has trained over 130 volunteers who pick women up at bus stations, host them at their homes and provide child care.

A study published this year in the International Journal of Environmental Research and Public Health fluid medicine lasix examined 10,000 cases of women seeking assistance from ARC-Southeast. 81% were Black, 77% were uninsured or publicly insured, 77% had at least one child, and 58% identified as Christian. €œIt’s amazing to see the scope of the people we work with,” said Oriaku Njoku, ARC-Southeast’s co-founder. €œThe post-Roe reality that y’all are afraid of is the lived reality for folks today in the South.” A Texas law targets precisely this kind of help, allowing such organizations or individuals to be sued by anyone fluid medicine lasix in the state for helping a woman get an abortion.

It could go into effect Sept. 1, though abortion rights advocates are suing to stop the new law. Despite the controversy surrounding abortion, Choices makes no effort to hide its mission fluid medicine lasix. The modern lime-green building announces itself to its Memphis neighborhood, and the waiting room is artfully decorated, offering services beyond abortion, including delivery of babies and midwifery.

Like other clinics in the South, Choices has to abide by state laws that many abortion supporters find onerous and intrusive, including performing transvaginal uasounds and showing the women seeking abortions images from those uasounds. Nonetheless, the clinic is booked full most days with patients from almost all of the eight states that touch Tennessee, fluid medicine lasix a slender handsaw-shaped state that stretches across much of the Deep South. And Katy Deaton, a nurse at the facility, said few women change their minds. €œThey’ve put a lot of thought into this hard decision already,” she said.

€œI don’t think it changes the fact that they’re getting an abortion fluid medicine lasix. But it definitely makes their life harder.” Sarah Varney. svarney@kff.org, @SarahVarney4 Related Topics Contact Us Submit a Story TipNot so long ago, laws governing abortion in Massachusetts and Rhode Island were far more restrictive than those in the Deep South, as state legislators throughout New England regularly banned the procedure, no matter the circumstances, during the 1960s and ’70s. Nowadays, however, the American South represents a hub of anti-abortion fervor, home to a series of laws and regulations fluid medicine lasix that have eroded Roe v.

Wade, as liberal states in the Northeast and elsewhere have enacted laws to codify that landmark 1973 Supreme Court decision. How that regional reversal came to pass touches on demographic and ideological shifts, as well as a political environment in which few governors or state legislators anywhere claim to be moderates on the issue. More than fluid medicine lasix anything, the switch can be traced to religion, and how Christian faiths have in some cases become as polarized on the issue of abortion as the views of elected officials who rely on votes of the religious faithful. Q.

Why was famously liberal New England fluid medicine lasix so opposed to abortion?. Two words. The pope. Daniel Williams, author of “God’s fluid medicine lasix Own Party.

The Making of the Christian Right” and “Defenders of the Unborn. The Pro-Life Movement Before Roe v. Wade,” said that in the early 1970s the strongest opposition to abortion came not from fluid medicine lasix Southern evangelicals but from states with strong Catholic ties in the Northeast. Even as states like Connecticut and Maine were passing bans, states that were home to large populations of more conservative religious denominations allowed women to safely end pregnancies in cases of rape, incest, fetal deformities and when a woman’s life was at risk.

North Carolina was one of the first states to allow for limited legal access to abortion in 1967. Georgia followed in 1968, and South Carolina and Arkansas fluid medicine lasix in 1970. In Texas, a poll taken in 1970 by the Baptist Standard, the periodical of the Baptist convention, found that 90% of its readers — largely pastors and deacons — believed Texas’ abortion laws were too harsh. Religious scholars say white evangelical Protestants did not support unfettered abortion rights, but without a strong theology about when human life begins, less restrictive abortion laws were not a moral threat.

Evangelicals viewed abortion as fluid medicine lasix a Catholic cause. €œThe general view among Southern evangelicals in the 1960s and early 1970s was that abortion was ethically problematic,” said Williams, who serves as a professor of history at the University of West Georgia. €œBut there was no firm biblical support for the Catholic claim that human life began at conception.” Q. So, why did the South — and Southern evangelicals fluid medicine lasix — change their minds?.

One could say it started offshore. In March 1970, Hawaii became the first state to decriminalize abortion, though the law applied only to state residents. Later that year, New York, then led by a Republican governor, Nelson Rockefeller, and a Republican-dominated legislature, went further, allowing women from any state fluid medicine lasix to receive abortion care. In 1972, some 200,000 women had legal abortions in New York, and 3 of 5 were from out of state.

That alarmed many Southerners, who feared that the procedure was being used — and abused — by unmarried women. €œMany of the Baptists in Texas might fluid medicine lasix have thought if a married woman experienced problems with a pregnancy” she should have the option of a safe, legal abortion, said Williams. €œThey were not envisioning there would be 200,000. This was clearly not a limited procedure in a small number of instances.” Q.

Was it just abortion that fluid medicine lasix worried evangelicals?. Aversion to women’s rights was not limited to reproductive issues. Disaffected by the sexual revolution and the feminist movement, Christian conservative leaders campaigned against the Equal Rights Amendment. They also battled to protect the tax-exempt status of racially segregated private schools and pushed to ban gay teachers from public schools and restore classroom prayer fluid medicine lasix.

As opposition to abortion among Catholic voters and lawmakers eased, white evangelicals and fundamentalists grew more strident on the issue. By the late 1970s, white evangelicals had fully embraced the position that legal abortion was an assault on moral values. As biblicists, committed to the text of the Bible, evangelical leaders found new meaning in certain verses they believed gave credence fluid medicine lasix to prenatal life. €œThe connection these conservative evangelicals saw was that when Americans drifted away from God in public life, a change in gender roles came in,” said Williams.

€œChristianity was being replaced by secular, humanistic, sexual ethics, and Roe v. Wade became the symbol for fluid medicine lasix all of that.” Q. What role did politics play in the shift?. A major one.

While Catholics are fairly dispersed around the country, white evangelicals are heavily concentrated in Southern states, where true believers often also hold elected office, and thus the power to make laws, said Andrew Lewis, associate professor of political science at the fluid medicine lasix University of Cincinnati. Mary Ziegler, a professor at Florida State University College of Law and author of “Abortion and the Law in America. Roe v. Wade to the Present,” describes fluid medicine lasix a trifecta that reinforced abortion opposition in the South.

€œThere are a lot of white evangelicals, a lot of Republicans and a lot of gerrymandered swing states,” she said. The acceleration of state-level abortion restrictions arose from grassroots conservative activists and socially conservative state legislators, not from national Republican Party strategists. €œOnce the fluid medicine lasix Republican Party took over the South, it did so largely through the efforts of the Christian Coalition” of America, said Williams. And that connection between white evangelicals and the GOP intensified as the decades passed.

By 2009, white evangelicals made up 35% of the Republican Party. Q. Where does it all stand now?. Nearly 50 years after the U.S.

Supreme Court legalized abortion, the South is the most fervently anti-abortion region in the country. And year after year, Southern legislatures have outdone one another, passing ever more restrictive measures on abortion care and criminal punishment to those who provide it. For instance, a 99-year prison sentence for doctors who perform abortions in Alabama. A ban on nearly all abortions after 15 weeks of pregnancy in Mississippi and six weeks in Texas.

Rape crisis counselors are subject to lawsuits from private citizens if a woman chooses to end her pregnancy. Few of these laws have taken effect. Most have been struck down or frozen by the courts and, until last month, the Supreme Court declined to consider many of them. But state legislators, often acting without guidance from national anti-abortion organizations, have continued to introduce anti-abortion bills at a fevered pace.

And with the Supreme Court’s rightward shift, many in the movement sense their moment has arrived. The Democratic Party in the South “generally doesn’t fight” abortion restrictions, Williams said. The party, which counts on the support of Black and Hispanic voters, tends to focus on other priorities, he said. €œThere is much greater interest in talking about health care and jobs.” And while many voters, even conservative ones, have shifted to the left on issues like gay rights, Williams said, younger evangelicals are more likely than their parents to oppose abortion.

€œThe Republican Party has a lot of staying power in Georgia and Alabama and across much of the South for the foreseeable future,” Williams said. Sarah Varney. svarney@kff.org, @SarahVarney4 Related Topics Contact Us Submit a Story TipTennova Healthcare-Lebanon doesn’t exist anymore as a hospital. But it still sued Hope Cantwell.

A knock came on the door of Cantwell’s Nashville, Tennessee, apartment early this year. She said she hadn’t been vaccinated against hypertension medications yet and wasn’t answering the door to strangers. So she didn’t. But then several more attempts came over the course of a week.

Eventually she masked up and opened. A legal assistant served her a lawsuit. She was summoned to appear in court. €œI couldn’t believe someone — someone?.

a corporation?. a company?. — was doing this during a lasix,” Cantwell said. It started with a hospital visit in May 2019.

Cantwell was admitted for a short stay at Tennova Healthcare-Lebanon, owned at the time by Community Health Systems, a publicly traded company headquartered in Franklin, Tennessee. Her insurance covered most of the stay, but it still left her with $2,700 to pay. Nearly a year later, she was in a financial position to start chipping away at the bill. She went online to pay but couldn’t find the hospital or its payment portal.

Cantwell did a little Googling and noticed Vanderbilt University Medical Center bought the 245-bed facility around the time of her stay. It’s called Vanderbilt Wilson County Hospital now. Then the lasix hit. She was furloughed from work for three months.

And soon after, a letter arrived. A law firm representing the former hospital owner demanded payment and threatened to take her to court. She wasn’t sure what to do, since she couldn’t come up with all the cash. She was in a holding pattern until the knock on the door from the legal assistant.

lasix Push A WPLN News investigation found Tennova Healthcare-Lebanon sued more than 1,000 patients, including Cantwell, over the past two years across multiple counties after striking a deal to be sold. And hundreds of those suits were filed during the lasix, at a time when many companies have backed away from taking patients to court over unpaid medical debt. The state of New York banned the practice. Community Health Systems is on the tail end of a corporate downsizing that shrank the company from more than 200 hospitals to 84.

The sell-off helped stabilize the company after it took on massive debt during a period of rapid growth that briefly gave Community Health Systems more hospitals than any other chain in the country. But now many of those institutions are like zombie hospitals — little more than a legal entity still taking patients to court even after being sold to new owners that don’t sue over medical bills. When her summons arrived, panic set in for Cantwell. €œMy mind went immediately to the stimulus payments,” she said.

€œâ€˜At least I have a way to take care of this now.'” When her final lasix stimulus money dropped into her bank account, Cantwell said, she sent it straight to the company that had sued her, even though she almost felt like the victim of a scam. She wondered if she really owed all the money or if she qualified for financial assistance since she lost income during the lasix. But lawsuits are a rich man’s game. She couldn’t justify trying to find an attorney or fighting a big for-profit company that would pursue her for $2,700.

€œI don’t have the resources and emotional and mental capacity to handle anything more than just kind of rolling over and handing over whatever amount of money they would be happy with,” she said. Community Health Systems’ Debt Problem Court records indicate Community Health Systems stepped up filing lawsuits against patients in 2015 at the same time its stock price plummeted over concerns about its outsize corporate debt. Aside from a hospital fire sale, Community Health Systems also aggressively went after patients. And the company didn’t let the lasix slow that plan, even though it received more than $700 million from the federal government in hypertension medications relief money.

A spokesperson for HCA Healthcare, the largest for-profit hospital chain in the country, said its hospitals do not sue patients over unpaid medical debt — during the lasix or otherwise. The Nashville-based corporation returned all its hypertension medications relief funds. An investigation by CNN found Community Health Systems sued at least 19,000 patients during the lasix, though the number is likely an undercount given the lawsuits filed on behalf of its former hospitals. Like Tennova Healthcare-Lebanon, two other Community Health Systems hospitals in Tennessee also continued taking patients to court after selling to Vanderbilt more recently.

Community Health Systems held on to its debt in the deals with Vanderbilt and continues to pursue patients who owe it money. Vanderbilt University Medical Center spokesperson John Howser said Vanderbilt does not sue patients to collect on medical debt. €œCommunity Health Systems and its subsidiary Tennova Healthcare is a private company that is not owned or operated by Vanderbilt University Medical Center,” Howser wrote in a statement. €œAs such, VUMC is not involved in these lawsuits.” Vanderbilt University Medical Center does help run a Community Health Systems-owned hospital in Clarksville, Tennessee, that continues to sue patients, but Howser noted Community Health Systems has the controlling interest.

€œThe thing is, these aren’t rich people who don’t want to pay their bills,” said Christi Walsh, a nurse practitioner who directs clinical research at Johns Hopkins University. Her team focuses on hospitals suing patients and pressures them to stop. €œI’ve been on the ground in the courthouses. These are people who don’t have the money to pay it.” In Wilson County, Tennessee, a husband and wife were both sued by Tennova Healthcare-Lebanon.

He works in a distribution center that shut down for months during the lasix. She cared for their foster kids and delivered meals with DoorDash, telling WPLN News they were too busy to make their court date. The problem is, not showing up to face a debt in court can allow a company to take a cut of someone’s paycheck. It also wrecks a person’s financial credit, and the stress can lead to health problems.

€˜It Threatens the Public Trust’ Walsh’s team researched the most litigious hospitals in Texas from 2018 to 2020. The top five were all affiliated with Community Health Systems. And the most lawsuits were filed by South Texas Regional Medical Center, which was sold to HCA in 2017. But South Texas Regional Medical Center continued to sue patients.

Marty Makary, a surgeon at Johns Hopkins who wrote a book about health care billing called “The Price We Pay,” said most hospitals have changed tactics. Suing their patients doesn’t make them tons of money after attorney and court fees, and it hurts their brand. But he said Community Health Systems has not expressed such concern. €œCommunity Health Systems, in all of our research of hospital pricing and billing practices, stands out as an aggressive institution that uniformly, across the country, engages in very aggressive predatory billing — suing patients in court to garnish their wages,” he said.

Even if Community Health Systems is willing to take a hit to its reputation, Makary said, patients think of the health system as a whole. And they’ll think twice next time they need to go to the doctor. €œIt threatens the public trust in our community institutions. And medical institutions are supposed to be above those games,” he said.

In a statement to WPLN News, a Community Health Systems spokesperson said the company used its hypertension medications relief money to pay for lasix expenses and make up for lost revenue. In January, the company said it will take patients to court only if they make at least twice the federal poverty level — or about $53,000 annually for a family of four. €œWe continually evaluate modifications to our collection practices to support patients who struggle to pay their hospital bills,” spokesperson Rebecca Pitt said. The policy change is meant to be retroactive.

The company will withdraw litigation for anyone who qualifies, Pitt said. Patients who owe Community Health Systems and its former hospitals money are being made aware of the new policy in legal correspondence and can call 800-755-5152 to begin the process to drop a lawsuit, she said. This story is from a reporting partnership that includes WPLN, NPR and KHN. Blake Farmer, Nashville Public Radio.

bfarmer@wpln.org, @flakebarmer Related Topics Contact Us Submit a Story TipIt was a Sunday morning in late November when Bryan Keller hopped on a bike for a routine ride to pick up his groceries, cruising with ease in a relatively empty New York City. The surprises came fast and hard. A fall that sent his head into the pavement and left him bleeding profusely and in shock, a trip to an urgent care clinic for five stitches and then a $1,039.50 bill. Keller’s health insurance covered much of the cost of his visit to the CityMD clinic on Manhattan’s Lower East Side.

But it didn’t cover the physician who arrived to stitch his forehead ― an out-of-network plastic surgeon with a Park Avenue office. €œThe people at CityMD just said [this] sort of thing is covered as part of an emergency procedure,” said Keller, a regular cyclist who’s lived in New York City for three decades. Even in post-accident “delirium,” he said, he asked several times whether the stitches would be covered by his health insurance because it struck him as unusual that a plastic surgeon would do them. €œIt really irked me that, it’s this classic thing you hear in this country all the time,” Keller said.

€œWhen you do all the right things, ask all the right questions and you’re still hit with a large bill because of some weird technicality that there’s absolutely no way for you to understand when you’re in the moment.” Under a law Congress passed last year, many surprise medical bills will be banned starting in January. Patients with private insurance will be protected against unexpected charges for emergency out-of-network care, for treatment by out-of-network providers at in-network facilities and for transport in an air ambulance. But one gray area. Visits to urgent care clinics, which have proliferated in recent years as patients seek speed and convenience over waiting hours at an emergency room or weeks to get a regular doctor’s appointment.

There are roughly 10,500 urgent care centers in the U.S., according to the Urgent Care Association, which lobbies on their behalf. Urgent care clinics were not explicitly addressed in the No Surprises Act, but Keller’s experience underscores patients’ predicament ― insurers often try to steer patients to urgent care and away from costly emergency rooms, but individuals could still get hit with large bills in the process. The Biden administration has expressed an interest in prohibiting surprise bills in those clinics, which may treat serious conditions but not life-threatening injuries and illnesses. In July, several federal agencies issued interim regulations that largely would not protect patients from surprise urgent care bills.

Regulation varies significantly across states, and data is scarce on how common surprise bills are in those facilities. Before the surprise billing rules are finalized, the Department of Health and Human Services and three other federal agencies have asked for information on issues such as the frequency of such bills at urgent care facilities and how health insurers contract with the clinics. The current regulatory gap, if left untouched before the new law takes effect in January, is one that health care experts say could leave patients at risk. €œThere’s a real interesting question about whether it should apply to the extent that people perceive these as places to go for an emergency,” said Jack Hoadley, research professor emeritus for Georgetown University’s McCourt School of Public Policy.

CityMD, which was founded by doctors in 2010 and merged with the large medical practice Summit Medical Group in 2019, operates a massive chain of urgent care clinics in New York and New Jersey. Most of its physicians are emergency doctors. The combined enterprise created Summit Health, which is backed by private equity with investments from well-known firms Warburg Pincus ― which acquired CityMD in 2017 ― and Consonance Capital Partners. Matt Gove, chief marketing officer of Summit Health, confirmed that the plastic surgeon who treated Keller ― Dr.

Michael Wolfeld ― has an agreement with the company that allows him to see patients at certain CityMD clinics. Though he was unable to comment on the specifics of Keller’s situation, he said, CityMD’s “normal procedure” is to “make the patient aware that this is available to them and that they can then make the choice as to whether or not it’s important to them to be seen by a plastic surgeon.” “This is a patient choice,” Gove said. €œWe certainly don’t require that a patient be seen by Dr. Wolfeld or any other provider.” But Keller said it was never put to him as an option.

€œIt was framed to me as ‘This is how we do things,’” he said. €œIn order to have a preference I would have to know that there is an alternative.” Wolfeld did not respond to a request for comment. €œIt really irked me that, it’s this classic thing you hear in this country all the time,” Bryan Keller says of the $1,040 bill for five stitches he received after a bike accident last year. €œWhen you do all the right things, ask all the right questions and you’re still hit with a large bill because of some weird technicality that there’s absolutely no way for you to understand when you’re in the moment.”(José A.

Alvarado Jr. / for KHN) Last month the Biden administration proposed prohibiting surprise bills at urgent care centers licensed to perform emergency procedures, essentially treating them as free-standing emergency rooms. Some states, like Arizona, allow urgent care centers to provide emergency services, but they then are considered free-standing ERs, a spokesperson for the state Department of Health Services said. But urgent care centers aren’t licensed as health care facilities in most states, let alone encouraged to provide emergency services, according to health care advocates that have tracked the issue and have pushed for greater government oversight of the industry.

New York, where Keller lives, doesn’t consistently regulate urgent care providers, requiring licenses for some companies but not for CityMD clinics. Regardless of what’s prescribed in state regulations, what’s considered an “emergency” versus “urgent” can vary by patient. That potentially creates confusion about whether patients would be protected from certain kinds of out-of-network bills if they show up at an urgent care facility for an acute illness or injury. KHN also found that the urgent care clinic where Keller was treated describes several of its services as emergency care even though many are not meant to treat emergency conditions as envisioned in federal law.

For example, the clinic characterizes physical exams, flu shots and vaccinations as emergency medical services. Under federal law, an emergency medical condition is defined as one where the absence of immediate medical attention could seriously jeopardize a patient’s health. Summit Health spokesperson Gove said the use of the term “emergency” is meant to be “patient-facing and patient-centric, and not having to do with miscategorizing or misrepresenting the nature of the services we provide.” The provider is “just making it clear to people that when you have something you need done quickly, which you might call personally an emergency, we’re here to do that.” CityMD has never marketed itself as an emergency room designed to treat all emergency conditions, Gove said. Lou Ellen Horwitz, CEO of the Urgent Care Association, said urgent care clinics are akin to private doctor practices rather than an emergency room or hospital facility that would be subject to broad bans on surprising billing.

She said that, even as urgent care clinics grow more common, there’s “no data” to suggest consumer confusion about what they treat. The association would oppose any federal push to classify these clinics as something akin to independent emergency departments, Horwitz said. Indeed, she said, such a move “contradicts” their very purpose. To treat non-life-threatening injuries and illnesses.

€œThe standard practice of the industry as well is that we don’t hold ourselves out to be emergency departments,” she said. €œThe likelihood of this being misunderstood is very low.” Nationwide, under the Biden administration’s interim regulations, patients needing care for nonemergencies will not be protected if treated by an out-of-network provider at an in-network urgent care facility, according to health care experts. €œYou don’t have protections if it turns out the doctor or the physician assistant was out of network,” Hoadley said. A March report from Community Catalyst, a Boston-based health care advocacy organization focused on consumer issues, and the National Health Law Program, a civil rights advocacy group, found that fewer than 10 states issue facility licenses for urgent care clinics.

Those licenses give state officials greater leeway to set standards for care, staffing levels, inspections or price transparency, but could also make care more expensive by increasing providers’ expenses. Without being licensed as a health care facility ― something that exists for hospitals, ambulatory surgery centers and critical access hospitals ― urgent care clinics are generally treated as private physician practices subject to less regulation. €œThey’re really flying under the radar now in many cases,” said Lois Uttley, director of the Women’s Health Program at Community Catalyst. Horwitz, however, said the clinics should not be lumped in with those providers because their operations are fundamentally different.

Unlike hospitals and other practices that include facility fees in their charges to patients, “we don’t charge or receive payments as a facility,” she said. In the midst of an injury, however, making such distinctions can be difficult. Keller said his motivation in going to urgent care was to get his wounds treated quickly instead of waiting hours in an ER, amid a spike in hypertension medications cases that would presage the country’s deadly winter. He had also been to that particular CityMD clinic for a hypertension medications test, so he knew it accepted his insurance.

Keller hadn’t been wearing a helmet the day of his accident, caused by trying to prevent a bag of groceries from falling off his bike. With a bleeding forehead and banged-up knees and wrists ― Keller brushed a parked car and went off the bike himself ― he was given a tetanus shot and had elevated blood pressure from the shock of the accident. Still, in that moment, he thought it was odd that a plastic surgeon was being called in to give him a handful of stitches, he said. €œIt sounds expensive and it sounds like something optional,” he said.

€œI said, ‘OK, is this going to be covered?. €™ And they said, ‘Oh, yeah, they should be covered. He does this, he comes here all the time.’” In New York, CityMD is not subject to facility licensure requirements because it’s considered a private physician practice, said Jeffrey Hammond, a spokesperson for the New York State Department of Health. As a result, rather than more sweeping regulations that would govern the practices of urgent care clinics, state health officials oversee individual practitioners and investigate complaints related to misconduct.

On its website for the location Keller visited, CityMD advertised many of the services it provides as “emergency medical services.” They include physical exams, vaccinations, pediatric care, lab tests, X-rays, and treatment for sore throats and ear s. €œJust stop by the CityMD walk-in clinic located on 138 Delancey St. Between Norfolk and Suffolk St, where quick, reliable, emergency care service is available 365 days a year,” the website reads. About six weeks after receiving his stitches, Keller said, he went to the same plastic surgeon to get them removed.

His health insurer, Aetna, has denied an appeal to fully cover the cost. €œIt’s so clear that getting stitches for a wound, for an open bleeding wound, is an emergency procedure to the normal world,” Keller said. As for his forehead, eight months later, Keller still has a visible scar. Eight months after a bike accident resulted in five stitches and a plastic surgeon’s $1,040 bill at an urgent care clinic, Bryan Keller still has a scar.(José A.

Alvarado Jr. / for KHN) Rachana Pradhan. rpradhan@kff.org, @rachanadixit Related Topics Contact Us Submit a Story Tip.

Madison Cano http://www.jamiegianna.com/2020/01/10/using-a-solutions-approach/ knew lasix street price she wanted to breastfeed her son, Theo. But breastfeeding was painful for her. The skin on her breasts was chafed and blistered lasix street price last July when she returned home from the hospital. And Theo sometimes screamed during feedings.

Cano, 30, realized she needed help to get the short- and long-term health benefits of breastfeeding for moms and babies. New studies also have shown that hypertension medications-vaccinated mothers pass protective antibodies on to lasix street price their newborns. However, Cano lives in Montrose in western Colorado, 60 miles away from her lactation counselor, Ali Reynolds, in Grand Junction — and it was during the thick of the lasix. She messaged Reynolds on Facebook and took photos and recorded videos of herself breastfeeding so Reynolds could offer advice and encouragement from afar.

It worked lasix street price. She no longer had pain. Cano is still breastfeeding Theo, who just turned 1. €œI don’t think I would have understood what was happening and been able to work through it lasix street price without that resource,” said Cano.

Support for breastfeeding was upended last year, when it no longer seemed safe to take a baby class at the hospital or invite a nurse into one’s home. Hospitals, lactation counselors and support groups turned to virtual platforms like Zoom or phone calls. That made lactation support accessible to struggling families during the lasix, said Danielle lasix street price Harmon, executive director of the United States Lactation Consultant Association. Today, although lactation specialists have more options to safely meet in person with families after their hypertension medications vaccinations, many are choosing to continue virtual classes, keeping alive the online communities they created and relying on the technology that worked for many families.

Virtual options especially help those in remote areas or those with limited transportation access, breastfeeding experts say. Right before the lasix, for example, Sandrine Druon typically had one or two moms attend in-person meetings she held for La Leche League of Longmont at the First Evangelical lasix street price Lutheran Church or at a Ziggi’s Coffee shop. But because they could no longer meet in person, last June she launched two monthly virtual meetings. Now, an online meeting will typically include nine or 10 moms.

She started an online Spanish-speaking meeting in May lasix street price and parents joined from their homes in several states and even from other countries. She hopes eventually to have a mix of online and in-person meetings. The virtual switch hasn’t worked for everyone. Harmon said the logistics of video support remain difficult, along with privacy concerns lasix street price on platforms that could be hacked.

Other lactation experts noted Black and Hispanic mothers are sometimes still left behind. So lactation specialists are trying to learn from the lasix on what worked — and what didn’t — to reach all kinds of new parents. Before the lasix, 84% lasix street price of U.S. Mothers breastfed at least initially, according to 2019 data from the Centers for Disease Control and Prevention, while Colorado had a 93% rate.

Theo sometimes screamed when his mother, Madison Cano, tried to breastfeed him ― she often found it painful. Cano got help with breastfeeding lasix street price online, when her lactation counselor coached her via Facebook. (Abie Livesay for KHN) The lasix hasn’t seemed to change the picture, said Stacy Miller, Colorado’s breastfeeding coordinator for the Special Supplemental Nutrition Program for Women, Infants and Children, shorthanded as WIC. Citing state birth certificate data, Miller said preliminary breastfeeding rates among families discharged from Colorado hospitals remained similar in the first quarter of 2021 to rates from 2020 or 2019.

Throughout the lasix street price lasix, lactation specialists have tried to offer convenient options for parents. St. Joseph Hospital in Denver launched virtual breastfeeding support groups that still occur today, in addition to breastfeeding help during families’ hospital stays, said Katie Halverstadt, the hospital’s clinical nurse manager of lactation and family education. Last year in North Carolina, experts adapted an in-person prenatal lasix street price breastfeeding program to an interactive video platform in English and Spanish.

A separate effort on New York’s Long Island successfully converted in-person breastfeeding support to phone and video calls in 2020. To help support parents in Grand Junction, Colorado, Reynolds expanded her private practice, Valley Lactation, by offering virtual appointments while continuing to see some clients in their homes. That hybrid model continues today, although Reynolds said the demand for virtual or phone lasix street price appointments has decreased lately as the country reopens. Paying out-of-pocket for appointments is a hurdle her clients face, said Reynolds, but she encourages them to submit claims for telehealth or in-person visits to their health insurance companies for reimbursement.

Early in the lasix, telehealth rules were relaxed to encourage more telephone and virtual appointments — many of which have been covered by insurance. But insurance coverage lasix street price for lactation support will likely continue to be an issue independent of whether lasix telehealth rules expire, USLCA’s Harmon said. While the Affordable Care Act mandates that insurance companies cover lactation support and supplies, such as breast pumps, Harmon said reimbursement is often spotty. Mirroring Medicaid, insurance providers often cover services only from licensed providers, she said, but just four states — Georgia, New Mexico, Oregon and Rhode Island — license lactation consultants.

Experts such as Jennifer Schindler-Ruwisch, an assistant professor at Fairfield University in Connecticut, found the lasix may have exacerbated breastfeeding barriers for those without access to online technology or translation services, among lasix street price other things. She published one of the first studies in the U.S. To examine hypertension medications’s effect on lactation services by collecting experiences from lactation support providers in Connecticut, including many working in WIC programs. For income-eligible WIC families, all breastfeeding lasix street price classes, peer groups and one-on-one consultations are free.

Birdie Johnson, a doula who provides breastfeeding and other postpartum support to Black families as part of Sacred Seeds Black Doula Collective of Colorado, said virtual support groups during the lasix also did not meet her clients’ needs for connection and interaction. Social media built communities online, particularly by normalizing breastfeeding struggles among Black parents, she said, but obstacles remained. €œhypertension medications brought lasix street price our community together and at the same time destroyed it,” Johnson said. Black parents in the U.S.

Already had lower rates of breastfeeding than Asian or white parents, according to 2017 CDC data, and both Black and Hispanic parents have had lower rates of exclusively breastfeeding their babies at 6 months, which is what the American Academy of Pediatrics recommends. Socioeconomics and lack of workplace support have been found to contribute to lasix street price the gap. Research also has found Black mothers are more likely than white moms to be introduced to infant formula at hospitals. A scarcity lasix street price of Black health care providers in lactation, women’s health and pediatrics is a continuing concern, Johnson said.

In Colorado last year, the Colorado Breastfeeding Coalition, the Center for African American Health, Elephant Circle and Families Forward Resource Center held three training sessions for people of color to become lactation specialists, said Halverstadt, who chairs the coalition. Jefferson County, which encompasses much of Denver’s western suburbs, is now training at least a dozen Spanish-speaking community members for lactation certification. In addition to classes, the trainees log clinical hours in lasix street price breastfeeding support, sometimes during virtual meetings of a Spanish-speaking support group called Cuenta Conmigo Lactancia. €œYou are more confident and more at ease with someone who knows your language, your culture and who is part of the community,” said Brenda Rodriguez, a dietitian and certified lactation consultant for Jefferson County Public Health, which reaches roughly 400 breastfeeding families each month through its WIC programs.

Angelica Pereda, a maternal and child health registered nurse, is part of that training program. Pereda, who is Hispanic and bilingual, gave birth to son Ahmias in April 2020 and struggled with breastfeeding because he could not latch on to lasix street price her breasts. A lactation consultant could not come into her home during the lasix, and she was skeptical of virtual consultations because of privacy concerns. So she pumped her breast milk and bottle-fed it to her son.

Her experience gave her newfound empathy for families, and she wants to help lasix street price other Spanish-speaking parents find solutions — whether in person or virtually. €œThere is just not enough breastfeeding support in general, but especially when that support is in a different language,” said Pereda. Related Topics Contact Us Submit a Story TipMEMPHIS, Tenn. €” Just a quick walk through the parking lot of Choices-Memphis Center for Reproductive Health in this legendary music mecca speaks volumes about access to abortion lasix street price in the American South.

Parked alongside the polished SUVs and weathered sedans with Tennessee license plates are cars from Mississippi, Arkansas, Florida and, on many days, Alabama, Georgia and Texas. Choices is one of two abortion clinics in the Memphis metro area, with a population of 1.3 million. While that might seem a surprisingly limited number of options for women seeking a commonplace medical procedure, it represents a wealth of access compared with Mississippi, which has one abortion clinic for the entire state of 3 million people lasix street price. A tsunami of restrictive abortion regulations enacted by Republican-led legislatures and governors across the South have sent women who want or need an early end to a pregnancy fleeing in all directions, making long drives or plane trips across state lines to find safe, professional services.

For many women, that also requires taking time off work, arranging child care and finding transportation and lodging, sharply increasing the anxiety, expense and logistical complications of what is often a profoundly difficult moment in a woman’s life. €œEspecially for women coming from long distances, lasix street price child care is the biggest thing,” said Sue Burbano, a patient educator and financial assistance coordinator at Choices. €œThey’re coming all the way from Oxford, Mississippi, or Jackson. This is a three-day ordeal.

I can just see how exhausted they are.” Choices-Memphis Center for Reproductive Health is one of two abortion clinics in the Memphis metro area, with a population lasix street price of 1.3 million. (Warren Architecture) The long drives and wait times could soon spread to other states, as the U.S. Supreme Court prepares this fall to consider a Mississippi ban on nearly all abortions after 15 weeks of pregnancy, with no allowances for cases of rape or incest. Under a law enacted in 2018 by the Republican-led legislature, a woman could obtain a legal abortion only if the pregnancy threatens her life or would cause an “irreversible impairment of a major bodily function.” Mississippi’s ban was promptly challenged by abortion rights activists and put on hold as a series of lower courts have deemed it unconstitutional under the Supreme Court’s landmark Roe v lasix street price.

Wade decision. That 1973 ruling, in concert with subsequent federal case law, forbids states from banning abortions before “fetal viability,” the point at which a fetus can survive outside the womb, or about 24 weeks into pregnancy. Tennessee, Texas, Mississippi and several other states have since lasix street price passed laws that would ban abortions after six weeks. That legislation is also on hold pending legal review.

Groups opposed to abortion rights have cheered the court’s decision to hear the Mississippi case, believing the addition of Justice Amy Coney Barrett gives the court’s conservative bloc enough votes to overturn Roe, or at least vastly expand the authority of individual states to restrict abortion. But, for supporters of reproductive rights, anything but a firm rejection of the Mississippi ban raises the specter of an even larger expanse lasix street price of abortion service deserts. Abortion could quickly become illegal in 21 states — including nearly the entire South, the Dakotas and other stretches of the Midwest — should the court rescind the principle that a woman’s right to privacy protects pregnancy decisions. €œIf we end up with any kind of decision that goes back to being a states’ rights issue, the entire South is in a very bad way,” said Jennifer Pepper, executive director of Choices in Memphis.

The decades-long strategy by conservative white evangelical Christians to chip away at abortion access state by state has flourished in the South, where hard-right Republicans hold a decisive lasix street price advantage in state legislatures and nearly all executive chambers. Though details vary by state, the rules governing abortion providers tend to hit similar notes. Among them are requirements that women seeking abortions, even via an abortion pill, submit to invasive vaginal uasounds. Mandatory waiting lasix street price periods of 48 hours between the initial consultation with a provider and the abortion.

And complex rules for licensing physicians and technicians and disposing of fetal remains. Some states insist that abortion providers require women to listen to a fetal heartbeat. Other providers lasix street price have been unable to obtain admitting privileges at local hospitals. €œEverything is hard down here,” said Pepper.

The rules also have made some doctors reluctant to perform the procedure. While obstetricians lasix street price and gynecologists in California, New York, Illinois and elsewhere routinely perform abortions at their medical offices — the same practices where they care for women through pregnancy and delivery — their peers in many Southern states who perform more than a small number of abortions a year must register their practices as abortion clinics. None has done so. Texas offers an example of how targeted legislation can disrupt a patient’s search for medical care.

In 2012, 762 Texans went out of state for abortions, lasix street price according to researchers at the University of Texas-Austin. Two years later, after then-Gov. Rick Perry signed into law the nation’s most restrictive abortion bill, shuttering about half the state’s abortion facilities, 1,673 women left Texas to seek services. In 2016, 1,800 lasix street price did so.

Similarly, in March 2020, as the hypertension lasix took hold, Gov. Greg Abbott issued an order prohibiting all abortions unless the woman’s life was in danger, deeming the procedure “not medically necessary.” The month before the order, about 150 Texans went out of state to seek abortion services. In March and April, with the order in effect, nearly 950 women sought care outside lasix street price Texas. There can also be an unsettling stigma in some parts of the South.

Vikki Brown, 33, who works in education in New Orleans, said she initially tried to end her pregnancy in Louisiana, calling her gynecologist for advice, and was told by a receptionist that she was “disgusted” by the request. She sought lasix street price out the lone abortion clinic operating in New Orleans but found it besieged with both protesters and patients. €œI knew but didn’t understand how difficult it was to get care,” said Brown, who moved to Louisiana in 2010 from New York City. €œThe clinic was lasix street price absolutely full.

People were sitting on the floor. It was swamped.” It took her six hours to get an uasound, which cost $150, she said. A friend in Washington, D.C., counseled Brown that “it didn’t have lasix street price to be like that” and the pair researched clinics in the nation’s capital. She flew to Washington, where she was able to get an abortion the same day and for less than it would have cost her in New Orleans, even including airfare.

€œNo protesters, no waiting period,” she said. €œIt was a wildly different experience.” Atlanta, a Southern transportation lasix street price hub, has also become a key piece in the frayed quilt of abortion care in the region. Kwajelyn Jackson, executive director of Feminist Women’s Health Center in Atlanta, said the clinic regularly sees patients from other states, including Alabama, Tennessee, Kentucky and the Carolinas. These visits often involve long drives or flights, but rarely overnight stays because the state-mandated 24-hour waiting period can begin with a phone consultation rather than an in-person visit.

Georgia has many of the same laws lasix street price other states employ to make clinical operations more burdensome — requirements to cremate fetal remains, for instance, and that abortion providers adhere to the onerous building standards set for outpatient surgical centers — but its urban clinics so far have weathered the strategies. Jackson said staffers at her clinic are aware of its role as a refuge. €œWe’ve had patients who were able to get a ride from Alabama, but they weren’t able to get a ride home,” she said. €œWe had to lasix street price help them find a ride home.

It is so much simpler to go 3 or 4 miles from your home and sleep in your bed at night. That is a luxury that so many of our patients can’t enjoy.” Many women embarking on a search for a safe abortion are also confronting serious expenses. State Medicaid programs in the South do not lasix street price pay for abortions, and many private insurers refuse to cover the procedure. In addition, the longer a woman’s abortion is delayed, the more expensive the procedure becomes.

Becca Turchanik, a 32-year-old account manager for a robotics company in Nashville, Tennessee, drove four hours to Atlanta for her abortion in 2019. €œWe got an appointment in Georgia because that was the only place that had appointments,” she lasix street price said. Turchanik said her employer’s health insurance would not cover abortion, and the cost of gas, food, medications and the procedure itself totaled $1,100. Her solution?.

Take lasix street price on debt. €œI took out a Speedy Cash loan,” she said. Turchanik had a contraceptive implant when she learned she was six weeks pregnant. She said she was in an unhealthy relationship with a man she discovered to be lasix street price dishonest, and she decided to end her pregnancy.

€œI wish I had a child, but I’m glad it wasn’t his child,” she said. €œI have accomplished so much since my abortion. I’m going to make my life better.” But the emotions lasix street price of the ordeal have stayed with her. She’s angry that she had to call around from state to state in a panic, and that she was unable to have her abortion close to home, with friends to comfort her.

Others turn to nonprofit groups for financial and logistical support for bus and plane tickets, hotels, child care and medical bills, including the National Abortion Federation, which operates a hotline to help women find providers. Last year, the federation received 100,000 calls from women seeking information, said lasix street price its president, the Very Rev. Katherine Hancock Ragsdale. Access Reproductive Care-Southeast, an abortion fund based in Atlanta, has trained over 130 volunteers who pick women up at bus stations, host them at their homes and provide child care.

A study published this year in the International Journal of Environmental Research and lasix street price Public Health examined 10,000 cases of women seeking assistance from ARC-Southeast. 81% were Black, 77% were uninsured or publicly insured, 77% had at least one child, and 58% identified as Christian. €œIt’s amazing to see the scope of the people we work with,” said Oriaku Njoku, ARC-Southeast’s co-founder. €œThe post-Roe reality that y’all are afraid of is the lived reality for folks today in the South.” A Texas law targets precisely this kind of help, allowing such organizations or individuals to be sued by anyone in the state lasix street price for helping a woman get an abortion.

It could go into effect Sept. 1, though abortion rights advocates are suing to stop the new law. Despite the lasix street price controversy surrounding abortion, Choices makes no effort to hide its mission. The modern lime-green building announces itself to its Memphis neighborhood, and the waiting room is artfully decorated, offering services beyond abortion, including delivery of babies and midwifery.

Like other clinics in the South, Choices has to abide by state laws that many abortion supporters find onerous and intrusive, including performing transvaginal uasounds and showing the women seeking abortions images from those uasounds. Nonetheless, the clinic is booked full most days with patients from almost all of the eight states lasix street price that touch Tennessee, a slender handsaw-shaped state that stretches across much of the Deep South. And Katy Deaton, a nurse at the facility, said few women change their minds. €œThey’ve put a lot of thought into this hard decision already,” she said.

€œI don’t think it lasix street price changes the fact that they’re getting an abortion. But it definitely makes their life harder.” Sarah Varney. svarney@kff.org, @SarahVarney4 Related Topics Contact Us Submit a Story TipNot so long ago, laws governing abortion in Massachusetts and Rhode Island were far more restrictive than those in the Deep South, as state legislators throughout New England regularly banned the procedure, no matter the circumstances, during the 1960s and ’70s. Nowadays, however, lasix street price the American South represents a hub of anti-abortion fervor, home to a series of laws and regulations that have eroded Roe v.

Wade, as liberal states in the Northeast and elsewhere have enacted laws to codify that landmark 1973 Supreme Court decision. How that regional reversal came to pass touches on demographic and ideological shifts, as well as a political environment in which few governors or state legislators anywhere claim to be moderates on the issue. More than anything, the switch can be traced to religion, and how Christian faiths have in some lasix street price cases become as polarized on the issue of abortion as the views of elected officials who rely on votes of the religious faithful. Q.

Why was lasix street price famously liberal New England so opposed to abortion?. Two words. The pope. Daniel Williams, author of “God’s Own Party lasix street price.

The Making of the Christian Right” and “Defenders of the Unborn. The Pro-Life Movement Before Roe v. Wade,” said that in the early 1970s the strongest opposition lasix street price to abortion came not from Southern evangelicals but from states with strong Catholic ties in the Northeast. Even as states like Connecticut and Maine were passing bans, states that were home to large populations of more conservative religious denominations allowed women to safely end pregnancies in cases of rape, incest, fetal deformities and when a woman’s life was at risk.

North Carolina was one of the first states to allow for limited legal access to abortion in 1967. Georgia followed lasix street price in 1968, and South Carolina and Arkansas in 1970. In Texas, a poll taken in 1970 by the Baptist Standard, the periodical of the Baptist convention, found that 90% of its readers — largely pastors and deacons — believed Texas’ abortion laws were too harsh. Religious scholars say white evangelical Protestants did not support unfettered abortion rights, but without a strong theology about when human life begins, less restrictive abortion laws were not a moral threat.

Evangelicals viewed abortion as a Catholic cause lasix street price. €œThe general view among Southern evangelicals in the 1960s and early 1970s was that abortion was ethically problematic,” said Williams, who serves as a professor of history at the University of West Georgia. €œBut there was no firm biblical support for the Catholic claim that human life began at conception.” Q. So, why lasix street price did the South — and Southern evangelicals — change their minds?.

One could say it started offshore. In March 1970, Hawaii became the first state to decriminalize abortion, though the law applied only to state residents. Later that year, New York, then led by a Republican governor, Nelson Rockefeller, and a Republican-dominated legislature, went further, allowing women from any state to receive abortion lasix street price care. In 1972, some 200,000 women had legal abortions in New York, and 3 of 5 were from out of state.

That alarmed many Southerners, who feared that the procedure was being used — and abused — by unmarried women. €œMany of the Baptists in Texas might have thought if a married woman experienced problems with a pregnancy” she should have the option of a safe, legal abortion, said lasix street price Williams. €œThey were not envisioning there would be 200,000. This was clearly not a limited procedure in a small number of instances.” Q.

Was it lasix street price just abortion that worried evangelicals?. Aversion to women’s rights was not limited to reproductive issues. Disaffected by the sexual revolution and the feminist movement, Christian conservative leaders campaigned against the Equal Rights Amendment. They also battled to protect the tax-exempt status of racially segregated private schools lasix street price and pushed to ban gay see here teachers from public schools and restore classroom prayer.

As opposition to abortion among Catholic voters and lawmakers eased, white evangelicals and fundamentalists grew more strident on the issue. By the late 1970s, white evangelicals had fully embraced the position that legal abortion was an assault on moral values. As biblicists, committed to the text of the Bible, evangelical lasix street price leaders found new meaning in certain verses they believed gave credence to prenatal life. €œThe connection these conservative evangelicals saw was that when Americans drifted away from God in public life, a change in gender roles came in,” said Williams.

€œChristianity was being replaced by secular, humanistic, sexual ethics, and Roe v. Wade became lasix street price the symbol for all of that.” Q. What role did politics play in the shift?. A major one.

While Catholics are fairly dispersed around the country, white evangelicals are heavily concentrated in Southern states, where true believers often also hold elected office, and lasix street price thus the power to make laws, said Andrew Lewis, associate professor of political science at the University of Cincinnati. Mary Ziegler, a professor at Florida State University College of Law and author of “Abortion and the Law in America. Roe v. Wade to the Present,” describes a trifecta that reinforced abortion opposition in lasix street price the South.

€œThere are a lot of white evangelicals, a lot of Republicans and a lot of gerrymandered swing states,” she said. The acceleration of state-level abortion restrictions arose from grassroots conservative activists and socially conservative state legislators, not from national Republican Party strategists. €œOnce the Republican Party took over the South, it did so largely lasix street price through the efforts of the Christian Coalition” of America, said Williams. And that connection between white evangelicals and the GOP intensified as the decades passed.

By 2009, white evangelicals made up 35% of the Republican Party. Q. Where does it all stand now?. Nearly 50 years after the U.S.

Supreme Court legalized abortion, the South is the most fervently anti-abortion region in the country. And year after year, Southern legislatures have outdone one another, passing ever more restrictive measures on abortion care and criminal punishment to those who provide it. For instance, a 99-year prison sentence for doctors who perform abortions in Alabama. A ban on nearly all abortions after 15 weeks of pregnancy in Mississippi and six weeks in Texas.

Rape crisis counselors are subject to lawsuits from private citizens if a woman chooses to end her pregnancy. Few of these laws have taken effect. Most have been struck down or frozen by the courts and, until last month, the Supreme Court declined to consider many of them. But state legislators, often acting without guidance from national anti-abortion organizations, have continued to introduce anti-abortion bills at a fevered pace.

And with the Supreme Court’s rightward shift, many in the movement sense their moment has arrived. The Democratic Party in the South “generally doesn’t fight” abortion restrictions, Williams said. The party, which counts on the support of Black and Hispanic voters, tends to focus on other priorities, he said. €œThere is much greater interest in talking about health care and jobs.” And while many voters, even conservative ones, have shifted to the left on issues like gay rights, Williams said, younger evangelicals are more likely than their parents to oppose abortion.

€œThe Republican Party has a lot of staying power in Georgia and Alabama and across much of the South for the foreseeable future,” Williams said. Sarah Varney. svarney@kff.org, @SarahVarney4 Related Topics Contact Us Submit a Story TipTennova Healthcare-Lebanon doesn’t exist anymore as a hospital. But it still sued Hope Cantwell.

A knock came on the door of Cantwell’s Nashville, Tennessee, apartment early this year. She said she hadn’t been vaccinated against hypertension medications yet and wasn’t answering the door to strangers. So she didn’t. But then several more attempts came over the course of a week.

Eventually she masked up and opened. A legal assistant served her a lawsuit. She was summoned to appear in court. €œI couldn’t believe someone — someone?.

a corporation?. a company?. — was doing this during a lasix,” Cantwell said. It started with a hospital visit in May 2019.

Cantwell was admitted for a short stay at Tennova Healthcare-Lebanon, owned at the time by Community Health Systems, a publicly traded company headquartered in Franklin, Tennessee. Her insurance covered most of the stay, but it still left her with $2,700 to pay. Nearly a year later, she was in a financial position to start chipping away at the bill. She went online to pay but couldn’t find the hospital or its payment portal.

Cantwell did a little Googling and noticed Vanderbilt University Medical Center bought the 245-bed facility around the time of her stay. It’s called Vanderbilt Wilson County Hospital now. Then the lasix hit. She was furloughed from work for three months.

And soon after, a letter arrived. A law firm representing the former hospital owner demanded payment and threatened to take her to court. She wasn’t sure what to do, since she couldn’t come up with all the cash. She was in a holding pattern until the knock on the door from the legal assistant.

lasix Push A WPLN News investigation found Tennova Healthcare-Lebanon sued more than 1,000 patients, including Cantwell, over the past two years across multiple counties after striking a deal to be sold. And hundreds of those suits were filed during the lasix, at a time when many companies have backed away from taking patients to court over unpaid medical debt. The state of New York banned the practice. Community Health Systems is on the tail end of a corporate downsizing that shrank the company from more than 200 hospitals to 84.

The sell-off helped stabilize the company after it took on massive debt during a period of rapid growth that briefly gave Community Health Systems more hospitals than any other chain in the country. But now many of those institutions are like zombie hospitals — little more than a legal entity still taking patients to court even after being sold to new owners that don’t sue over medical bills. When her summons arrived, panic set in for Cantwell. €œMy mind went immediately to the stimulus payments,” she said.

€œâ€˜At least I have a way to take care of this now.'” When her final lasix stimulus money dropped into her bank account, Cantwell said, she sent it straight to the company that had sued her, even though she almost felt like the victim of a scam. She wondered if she really owed all the money or if she qualified for financial assistance since she lost income during the lasix. But lawsuits are a rich man’s game. She couldn’t justify trying to find an attorney or fighting a big for-profit company that would pursue her for $2,700.

€œI don’t have the resources and emotional and mental capacity to handle anything more than just kind of rolling over and handing over whatever amount of money they would be happy with,” she said. Community Health Systems’ Debt Problem Court records indicate Community Health Systems stepped up filing lawsuits against patients in 2015 at the same time its stock price plummeted over concerns about its outsize corporate debt. Aside from a hospital fire sale, Community Health Systems also aggressively went after patients. And the company didn’t let the lasix slow that plan, even though it received more than $700 million from the federal government in hypertension medications relief money.

A spokesperson for HCA Healthcare, the largest for-profit hospital chain in the country, said its hospitals do not sue patients over unpaid medical debt — during the lasix or otherwise. The Nashville-based corporation returned all its hypertension medications relief funds. An investigation by CNN found Community Health Systems sued at least 19,000 patients during the lasix, though the number is likely an undercount given the lawsuits filed on behalf of its former hospitals. Like Tennova Healthcare-Lebanon, two other Community Health Systems hospitals in Tennessee also continued taking patients to court after selling to Vanderbilt more recently.

Community Health Systems held on to its debt in the deals with Vanderbilt and continues to pursue patients who owe it money. Vanderbilt University Medical Center spokesperson John Howser said Vanderbilt does not sue patients to collect on medical debt. €œCommunity Health Systems and its subsidiary Tennova Healthcare is a private company that is not owned or operated by Vanderbilt University Medical Center,” Howser wrote in a statement. €œAs such, VUMC is not involved in these lawsuits.” Vanderbilt University Medical Center does help run a Community Health Systems-owned hospital in Clarksville, Tennessee, that continues to sue patients, but Howser noted Community Health Systems has the controlling interest.

€œThe thing is, these aren’t rich people who don’t want to pay their bills,” said Christi Walsh, a nurse practitioner who directs clinical research at Johns Hopkins University. Her team focuses on hospitals suing patients and pressures them to stop. €œI’ve been on the ground in the courthouses. These are people who don’t have the money to pay it.” In Wilson County, Tennessee, a husband and wife were both sued by Tennova Healthcare-Lebanon.

He works in a distribution center that shut down for months during the lasix. She cared for their foster kids and delivered meals with DoorDash, telling WPLN News they were too busy to make their court date. The problem is, not showing up to face a debt in court can allow a company to take a cut of someone’s paycheck. It also wrecks a person’s financial credit, and the stress can lead to health problems.

€˜It Threatens the Public Trust’ Walsh’s team researched the most litigious hospitals in Texas from 2018 to 2020. The top five were all affiliated with Community Health Systems. And the most lawsuits were filed by South Texas Regional Medical Center, which was sold to HCA in 2017. But South Texas Regional Medical Center continued to sue patients.

Marty Makary, a surgeon at Johns Hopkins who wrote a book about health care billing called “The Price We Pay,” said most hospitals have changed tactics. Suing their patients doesn’t make them tons of money after attorney and court fees, and it hurts their brand. But he said Community Health Systems has not expressed such concern. €œCommunity Health Systems, in all of our research of hospital pricing and billing practices, stands out as an aggressive institution that uniformly, across the country, engages in very aggressive predatory billing — suing patients in court to garnish their wages,” he said.

Even if Community Health Systems is willing to take a hit to its reputation, Makary said, patients think of the health system as a whole. And they’ll think twice next time they need to go to the doctor. €œIt threatens the public trust in our community institutions. And medical institutions are supposed to be above those games,” he said.

In a statement to WPLN News, a Community Health Systems spokesperson said the company used its hypertension medications relief money to pay for lasix expenses and make up for lost revenue. In January, the company said it will take patients to court only if they make at least twice the federal poverty level — or about $53,000 annually for a family of four. €œWe continually evaluate modifications to our collection practices to support patients who struggle to pay their hospital bills,” spokesperson Rebecca Pitt said. The policy change is meant to be retroactive.

The company will withdraw litigation for anyone who qualifies, Pitt said. Patients who owe Community Health Systems and its former hospitals money are being made aware of the new policy in legal correspondence and can call 800-755-5152 to begin the process to drop a lawsuit, she said. This story is from a reporting partnership that includes WPLN, NPR and KHN. Blake Farmer, Nashville Public Radio.

bfarmer@wpln.org, @flakebarmer Related Topics Contact Us Submit a Story TipIt was a Sunday morning in late November when Bryan Keller hopped on a bike for a routine ride to pick up his groceries, cruising with ease in a relatively empty New York City. The surprises came fast and hard. A fall that sent his head into the pavement and left him bleeding profusely and in shock, a trip to an urgent care clinic for five stitches and then a $1,039.50 bill. Keller’s health insurance covered much of the cost of his visit to the CityMD clinic on Manhattan’s Lower East Side.

But it didn’t cover the physician who arrived to stitch his forehead ― an out-of-network plastic surgeon with a Park Avenue office. €œThe people at CityMD just said [this] sort of thing is covered as part of an emergency procedure,” said Keller, a regular cyclist who’s lived in New York City for three decades. Even in post-accident “delirium,” he said, he asked several times whether the stitches would be covered by his health insurance because it struck him as unusual that a plastic surgeon would do them. €œIt really irked me that, it’s this classic thing you hear in this country all the time,” Keller said.

€œWhen you do all the right things, ask all the right questions and you’re still hit with a large bill because of some weird technicality that there’s absolutely no way for you to understand when you’re in the moment.” Under a law Congress passed last year, many surprise medical bills will be banned starting in January. Patients with private insurance will be protected against unexpected charges for emergency out-of-network care, for treatment by out-of-network providers at in-network facilities and for transport in an air ambulance. But one gray area. Visits to urgent care clinics, which have proliferated in recent years as patients seek speed and convenience over waiting hours at an emergency room or weeks to get a regular doctor’s appointment.

There are roughly 10,500 urgent care centers in the U.S., according to the Urgent Care Association, which lobbies on their behalf. Urgent care clinics were not explicitly addressed in the No Surprises Act, but Keller’s experience underscores patients’ predicament ― insurers often try to steer patients to urgent care and away from costly emergency rooms, but individuals could still get hit with large bills in the process. The Biden administration has expressed an interest in prohibiting surprise bills in those clinics, which may treat serious conditions but not life-threatening injuries and illnesses. In July, several federal agencies issued interim regulations that largely would not protect patients from surprise urgent care bills.

Regulation varies significantly across states, and data is scarce on how common surprise bills are in those facilities. Before the surprise billing rules are finalized, the Department of Health and Human Services and three other federal agencies have asked for information on issues such as the frequency of such bills at urgent care facilities and how health insurers contract with the clinics. The current regulatory gap, if left untouched before the new law takes effect in January, is one that health care experts say could leave patients at risk. €œThere’s a real interesting question about whether it should apply to the extent that people perceive these as places to go for an emergency,” said Jack Hoadley, research professor emeritus for Georgetown University’s McCourt School of Public Policy.

CityMD, which was founded by doctors in 2010 and merged with the large medical practice Summit Medical Group in 2019, operates a massive chain of urgent care clinics in New York and New Jersey. Most of its physicians are emergency doctors. The combined enterprise created Summit Health, which is backed by private equity with investments from well-known firms Warburg Pincus ― which acquired CityMD in 2017 ― and Consonance Capital Partners. Matt Gove, chief marketing officer of Summit Health, confirmed that the plastic surgeon who treated Keller ― Dr.

Michael Wolfeld ― has an agreement with the company that allows him to see patients at certain CityMD clinics. Though he was unable to comment on the specifics of Keller’s situation, he said, CityMD’s “normal procedure” is to “make the patient aware that this is available to them and that they can then make the choice as to whether or not it’s important to them to be seen by a plastic surgeon.” “This is a patient choice,” Gove said. €œWe certainly don’t require that a patient be seen by Dr. Wolfeld or any other provider.” But Keller said it was never put to him as an option.

€œIt was framed to me as ‘This is how we do things,’” he said. €œIn order to have a preference I would have to know that there is an alternative.” Wolfeld did not respond to a request for comment. €œIt really irked me that, it’s this classic thing you hear in this country all the time,” Bryan Keller says of the $1,040 bill for five stitches he received after a bike accident last year. €œWhen you do all the right things, ask all the right questions and you’re still hit with a large bill because of some weird technicality that there’s absolutely no way for you to understand when you’re in the moment.”(José A.

Alvarado Jr. / for KHN) Last month the Biden administration proposed prohibiting surprise bills at urgent care centers licensed to perform emergency procedures, essentially treating them as free-standing emergency rooms. Some states, like Arizona, allow urgent care centers to provide emergency services, but they then are considered free-standing ERs, a spokesperson for the state Department of Health Services said. But urgent care centers aren’t licensed as health care facilities in most states, let alone encouraged to provide emergency services, according to health care advocates that have tracked the issue and have pushed for greater government oversight of the industry.

New York, where Keller lives, doesn’t consistently regulate urgent care providers, requiring licenses for some companies but not for CityMD clinics. Regardless of what’s prescribed in state regulations, what’s considered an “emergency” versus “urgent” can vary by patient. That potentially creates confusion about whether patients would be protected from certain kinds of out-of-network bills if they show up at an urgent care facility for an acute illness or injury. KHN also found that the urgent care clinic where Keller was treated describes several of its services as emergency care even though many are not meant to treat emergency conditions as envisioned in federal law.

For example, the clinic characterizes physical exams, flu shots and vaccinations as emergency medical services. Under federal law, an emergency medical condition is defined as one where the absence of immediate medical attention could seriously jeopardize a patient’s health. Summit Health spokesperson Gove said the use of the term “emergency” is meant to be “patient-facing and patient-centric, and not having to do with miscategorizing or misrepresenting the nature of the services we provide.” The provider is “just making it clear to people that when you have something you need done quickly, which you might call personally an emergency, we’re here to do that.” CityMD has never marketed itself as an emergency room designed to treat all emergency conditions, Gove said. Lou Ellen Horwitz, CEO of the Urgent Care Association, said urgent care clinics are akin to private doctor practices rather than an emergency room or hospital facility that would be subject to broad bans on surprising billing.

She said that, even as urgent care clinics grow more common, there’s “no data” to suggest consumer confusion about what they treat. The association would oppose any federal push to classify these clinics as something akin to independent emergency departments, Horwitz said. Indeed, she said, such a move “contradicts” their very purpose. To treat non-life-threatening injuries and illnesses.

€œThe standard practice of the industry as well is that we don’t hold ourselves out to be emergency departments,” she said. €œThe likelihood of this being misunderstood is very low.” Nationwide, under the Biden administration’s interim regulations, patients needing care for nonemergencies will not be protected if treated by an out-of-network provider at an in-network urgent care facility, according to health care experts. €œYou don’t have protections if it turns out the doctor or the physician assistant was out of network,” Hoadley said. A March report from Community Catalyst, a Boston-based health care advocacy organization focused on consumer issues, and the National Health Law Program, a civil rights advocacy group, found that fewer than 10 states issue facility licenses for urgent care clinics.

Those licenses give state officials greater leeway to set standards for care, staffing levels, inspections or price transparency, but could also make care more expensive by increasing providers’ expenses. Without being licensed as a health care facility ― something that exists for hospitals, ambulatory surgery centers and critical access hospitals ― urgent care clinics are generally treated as private physician practices subject to less regulation. €œThey’re really flying under the radar now in many cases,” said Lois Uttley, director of the Women’s Health Program at Community Catalyst. Horwitz, however, said the clinics should not be lumped in with those providers because their operations are fundamentally different.

Unlike hospitals and other practices that include facility fees in their charges to patients, “we don’t charge or receive payments as a facility,” she said. In the midst of an injury, however, making such distinctions can be difficult. Keller said his motivation in going to urgent care was to get his wounds treated quickly instead of waiting hours in an ER, amid a spike in hypertension medications cases that would presage the country’s deadly winter. He had also been to that particular CityMD clinic for a hypertension medications test, so he knew it accepted his insurance.

Keller hadn’t been wearing a helmet the day of his accident, caused by trying to prevent a bag of groceries from falling off his bike. With a bleeding forehead and banged-up knees and wrists ― Keller brushed a parked car and went off the bike himself ― he was given a tetanus shot and had elevated blood pressure from the shock of the accident. Still, in that moment, he thought it was odd that a plastic surgeon was being called in to give him a handful of stitches, he said. €œIt sounds expensive and it sounds like something optional,” he said.

€œI said, ‘OK, is this going to be covered?. €™ And they said, ‘Oh, yeah, they should be covered. He does this, he comes here all the time.’” In New York, CityMD is not subject to facility licensure requirements because it’s considered a private physician practice, said Jeffrey Hammond, a spokesperson for the New York State Department of Health. As a result, rather than more sweeping regulations that would govern the practices of urgent care clinics, state health officials oversee individual practitioners and investigate complaints related to misconduct.

On its website for the location Keller visited, CityMD advertised many of the services it provides as “emergency medical services.” They include physical exams, vaccinations, pediatric care, lab tests, X-rays, and treatment for sore throats and ear s. €œJust stop by the CityMD walk-in clinic located on 138 Delancey St. Between Norfolk and Suffolk St, where quick, reliable, emergency care service is available 365 days a year,” the website reads. About six weeks after receiving his stitches, Keller said, he went to the same plastic surgeon to get them removed.

His health insurer, Aetna, has denied an appeal to fully cover the cost. €œIt’s so clear that getting stitches for a wound, for an open bleeding wound, is an emergency procedure to the normal world,” Keller said. As for his forehead, eight months later, Keller still has a visible scar. Eight months after a bike accident resulted in five stitches and a plastic surgeon’s $1,040 bill at an urgent care clinic, Bryan Keller still has a scar.(José A.

Alvarado Jr. / for KHN) Rachana Pradhan. rpradhan@kff.org, @rachanadixit Related Topics Contact Us Submit a Story Tip.

What should I tell my health care provider before I take Lasix?

They need to know if you have any of these conditions:

  • abnormal blood electrolytes
  • diarrhea or vomiting
  • gout
  • heart disease
  • kidney disease, small amounts of urine, or difficulty passing urine
  • liver disease
  • an unusual or allergic reaction to furosemide, sulfa drugs, other medicines, foods, dyes, or preservatives
  • pregnant or trying to get pregnant
  • breast-feeding

Can lasix cause high blood sugar

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This is but just a few of the apps currently available in the speech-to-text field. Many new apps are added all the time in both the Android Play marketplace and Apple App Store. The InnoCaption+ is free for registeredusers who self-certify they have hearingloss.

Apps for both Android and Apple iOS InnoCaption+ Android, 4 starsiOS, 4.6 stars InnoCaption+ is a free captioning service for the deaf and hard of hearing funded by the FCC (Federal Communications Commision). It provides real-time captioning on your mobile device. The app was developed in conjunction with live stenographers to provide fast, easy, accurate captioning.

Users must register and self-certify you have a hearing loss to use this service. Ava iOS, 4.3 starsAndroid, 3.6 stars 5 hours free per month, payment plans available for more usage This app turns your smartphone’s microphone into a captioning service that captures speech and turns it into a text conversation displayed on your screen. A good wifi connection is required.

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The app allows you to save conversations to share or review at a later date. Ava is also available on desktop for both Macs and PCs. CaptionMate iOS, 4.5 starsAndroid, 4.1 stars CaptionMate is a free app that instantly transcribes both sides of a phone call, and can be used on a smartphone, landline, tablet or computer.

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Conversations are saved and can be re-read later. RogerVoice iOS, 4.7 starsAndroid, 3.5 stars Pricing plans start at $5.99 and up. Rogervoice can live subtitle calls in over 150 languages.

After making a call, speech is displayed instantly as text on the screen. You can reply with speech or text. It can also caption incoming calls.

Caption apps for Apple iOS only ClearCaptions Mobile, 4.6 stars This Apple app offers real-time captioning on your mobile phone with ClearCaptions Mobile. ClearCaptions is an FCC-certified service made possible through a federally-funded program for qualified individuals with hearing loss. They offer a free account with a personal ClearCaptions voice phone number for captioned calls.

Captioned phone conversations can be saved for later review. Apps for Android only Live Transcribe &. Sound Notification, 3.8 stars This app is made by Google, who partnered with hearing loss experts at Gallaudet University on the development.

The app provides free, real-time transcriptions of conversations and also sends notifications based on surrounding sounds at home, such as a fire alarm or doorbell ringing. It is available in 80 languages and comes with several other features. Hamilton CapTel, 1.7 stars This mobile application is free and designed for those who have trouble hearing on the telephone and want to listen to phone conversations while reading word-for-word captions of what’s being said.

In addition to creating a Hamilton CapTel account, CapTel users must have a voice and data plan, and a Bluetooth or wired headset that works with hearing aids or cochlear implants. Other apps for hearing loss We've rounded up apps in several hearing categories to help you make the most of your smartphone or tablet. These apps can be very helpful in specific situations, but they are not a replacement for good hearing healthcare or properly fit hearing aids.

If you suspect you have hearing loss and need to find a hearing healthcare practitioner in your community, please visit our directory of consumer-reviewed hearing clinics..

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For example, converting phone calls or other conversations into text. Disclaimer. This is but just a few of the apps currently available in the speech-to-text field. Many new apps are added all the time in both the Android Play marketplace and Apple App Store.

The InnoCaption+ is free for registeredusers who self-certify they have hearingloss. Apps for both Android and Apple iOS InnoCaption+ Android, 4 starsiOS, 4.6 stars InnoCaption+ is a free captioning service for the deaf and hard of hearing funded by the FCC (Federal Communications Commision). It provides real-time captioning on your mobile device. The app was developed in conjunction with live stenographers to provide fast, easy, accurate captioning.

Users must register and self-certify you have a hearing loss to use this service. Ava iOS, 4.3 starsAndroid, 3.6 stars 5 hours free per month, payment plans available for more usage This app turns your smartphone’s microphone into a captioning service that captures speech and turns it into a text conversation displayed on your screen. A good wifi connection is required. The app also works with Bluetooth devices.

Users can share a QR code with other individuals to add them to the conversation. Ava also has a text-to-speech feature that can be accessed by using the keyboard. The app allows you to save conversations to share or review at a later date. Ava is also available on desktop for both Macs and PCs.

CaptionMate iOS, 4.5 starsAndroid, 4.1 stars CaptionMate is a free app that instantly transcribes both sides of a phone call, and can be used on a smartphone, landline, tablet or computer. This real-time captioning service is free to anyone with find out hearing loss, and is paid for by a fund administered by the FCC. Just as with InnoCaption, users must register and self-certify you have a hearing loss to use this service. The app can caption over 100 languages, and works in real-time.

Conversations are saved and can be re-read later. RogerVoice iOS, 4.7 starsAndroid, 3.5 stars Pricing plans start at $5.99 and up. Rogervoice can live subtitle calls in over 150 languages. After making a call, speech is displayed instantly as text on the screen.

You can reply with speech or text. It can also caption incoming calls. Caption apps for Apple iOS only ClearCaptions Mobile, 4.6 stars This Apple app offers real-time captioning on your mobile phone with ClearCaptions Mobile. ClearCaptions is an FCC-certified service made possible through a federally-funded program for qualified individuals with hearing loss.

They offer a free account with a personal ClearCaptions voice phone number for captioned calls. Captioned phone conversations can be saved for later review. Apps for Android only Live Transcribe &. Sound Notification, 3.8 stars This app is made by Google, who partnered with hearing loss experts at Gallaudet University on the development.

The app provides free, real-time transcriptions of conversations and also sends notifications based on surrounding sounds at home, such as a fire alarm or doorbell ringing. It is available in 80 languages and comes with several other features. Hamilton CapTel, 1.7 stars This mobile application is free and designed for those who have trouble hearing on the telephone and want to listen to phone conversations while reading word-for-word captions of what’s being said. In addition to creating a Hamilton CapTel account, CapTel users must have a voice and data plan, and a Bluetooth or wired headset that works with hearing aids or cochlear implants.

Other apps for hearing loss We've rounded up apps in several hearing categories to help you make the most of your smartphone or tablet. These apps can be very helpful in specific situations, but they are not a replacement for good hearing healthcare or properly fit hearing aids. If you suspect you have hearing loss and need to find a hearing healthcare practitioner in your community, please visit our directory of consumer-reviewed hearing clinics..

Para que sirve lasix

Lyft on Tuesday announced that it would partner with healthcare organizations such as Anthem, Epic, Centene, One Medical, Modern para que sirve lasix Health and other companies to facilitate Cheap lasix online rides to vaccination sites. According to the company, the rides will be facilitated through multiple channels. Lyft Healthcare, which partners with systems and health plans to transport patients to and from medical appointments, and LyftUp, which allows corporate partners to donate ride credits."With the highly anticipated treatment now rolling out across the country, we are pleased to be joining Lyft and other leading partners to ensure our nation’s most vulnerable consumers para que sirve lasix will have the opportunity to receive the treatment,” said Gail K.

Boudreaux, president and CEO at Anthem, in a statement. HIMSS20 Digital Learn on-demand, earn credit, find products and solutions para que sirve lasix. Get Started >>.

WHY IT MATTERSQuestions have continued to loom around treatment rollout logistics, as frontline healthcare workers begin to be inoculated against the novel hypertension.In anticipation of future phases, some companies are beginning to formulate plans for how best to get the treatment into the arms of the broader public. According to Lyft, the primary goal of this campaign will be to provide 60 para que sirve lasix million rides to and from vaccination sites for those who may face transportation or logistical hurdles. The company notes that Lyft's transportation network can provide access to care for those in communities disproportionately affected by hypertension medications, including members of vulnerable populations who will be prioritized for early treatment distribution.

(Lyft did not immediately respond to requests for comment about what accessibility measures are in para que sirve lasix place for riders with disabilities.) In addition to directly funding rides, Lyft says its corporate partners will leverage their customers and member networks to promote individual contributions to the campaign, and that community partners will route credits to those in need. "We estimate that 15 million Americans will face transportation issues trying to get to vaccination sites. That’s where Lyft can make a difference," said Megan Callahan, VP of Lyft Healthcare, in para que sirve lasix a statement.

THE LARGER TREND Callahan told Healthcare IT News earlier this month that she anticipated treatment rollout and distributions will have lasting impacts. She also said that Lyft is "talking to policymakers about getting them priority access to the treatment."Rideshare companies have made a number of entrees into the digital health landscape in recent months, with Lyft rival Uber launching a prescription delivery service in August, and Lyft and Uber integrating with Epic and Cerner, respectively. ON THE RECORD para que sirve lasix “Access to reliable transportation represents a major barrier to care for millions of Americans across the country," said Callahan.

The hypertension medications lasix has exacerbated this problem, creating a huge challenge in making sure vulnerable populations have access to the treatment – especially for seniors living alone, low income workers, and parents with young children." Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.A KLAS report released this week took a deep dive into how healthcare organizations perceive their electronic health record vendors' role in helping them to achieve meaningful interoperability.While all vendors have room to improve, the report found that Epic stands out as the leader, with almost all customers saying they have access to outside data."Both Epic and non-Epic customers feel the vendor’s commitment to outside sharing has grown," wrote KLAS researchers.WHY IT MATTERSKLAS defines "deep interoperability" as providers' ability to have consistent access to outside data.

Easily locate patient records. View outside data inside their EHR workflows. And experience positive, frequent impacts on patient care.Using that criteria, KLAS found that nearly two-thirds of Epic customers were able to achieve deep interoperability, followed by Cerner with 28% of customers, NextGen Healthcare at 19%, Allscripts Sunrise at 18%, and eClinicalWorks at 14%.Report authors noted that Cerner has quadrupled its customers who report deep interoperability since 2017, with progress coming from "significant improvements" to how fluidly records are presented in the clinical view and increased use of CommonWell."When it comes to making initial connections to outside EMRs or national networks, customers have started to see more proactivity from Cerner.

In the past, organizations didn’t see much progress without investing significant internal effort."Meanwhile, Greenway Health, Meditech and Allscripts customers' interoperability progress has stagnated, says the report.Although Meditech's migration to Expanse has been largely positive, KLAS said, "customers are left to drive interoperability on their own and, right now, are mainly focused on getting the new platform up and running and learning how to leverage product workflows."Greenway Health's progress, it continued, has been hindered by frequent leadership turnover and the prioritization of other areas besides interoperability.For Allscripts customers, "getting initial access to electronic records is a challenge but possible with enough internal effort," according to the report.THE LARGER TRENDEpic's record-sharing numbers on its Care Everywhere platform showed a big jump this year, according to data the EHR giant released earlier this month.Epic representatives said the increase mirrored the desire for mobility and increasing demand for healthcare services amidst the hypertension medications lasix."With hypertension medications, we got to see some of the value of that [interoperability] work at Epic," said Dave Fuhrmann, senior vice president of interoperability at the company.Meanwhile, Cerner revealed new interoperability tools in October, with CEO Brent Shafer saying hypertension medications has "inspired a burst of innovation."ON THE RECORD"Past KLAS reports have shown that most vendors achieve a high degree of deep interoperability when it comes to customers exchanging data with organizations using the same EMR," wrote report authors."This year, Epic and athenahealth customers continued to report a high degree of satisfaction. Cerner, NextGen Healthcare, and Meditech customers are starting to see more progress. Cerner customers would like the vendor to be more proactive.

Allscripts, eClinicalWorks, and Greenway Health customers feel their vendor still has a ways to go," they said. Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail.

Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.When it came to revenue cycle management, St. Joseph’s Health, one of New Jersey’s largest safety net health systems, used to be very fragmented between ambulatory and acute care settings.THE PROBLEMEntering charges was done by hand, rather than through an automated process, with physicians having no visibility into the process. As a result, the care provided and the billing charges entered did not always match properly.Fragmented tools and outdated processes left St.

Joseph’s with challenges it needed to overcome to provide patients with the healthcare experience they desired. The health system also needed a connected system to help make it easier for its physicians to do their jobs and provide excellent care.PROPOSAL“Cerner’s revenue cycle solutions offered a solution for us to better connect our systems and automate previously manual work,” said Dr. Beth J.

Kushner, chief medical information officer at St. Joseph’s Health. €œWe needed to be able to connect our whole system and create a clinically driven revenue cycle that is closely tied to care and documentation.”Cerner also offered the opportunity for St.

Joseph’s to more closely align with its physicians, the ones whose work and documentation are the primary source of revenue cycle input, she added. Cerner would help educate physicians on the importance of complete, accurate and detailed charting. In doing so, St.

Joseph’s wanted to show physicians how their work directly affects revenue, she said.MARKETPLACEThere are many vendors on the market with revenue cycle management technology solutions. Some of these vendors include Cerner, Conifer Health Solutions, Flywire, Guidehouse, nThrive, Patientco, RevSpring and VisitPay.MEETING THE CHALLENGEAfter St. Joseph’s transitioned to Cerner revenue cycle management, it was able to automate many of its previously manual processes and connect fragmented systems.

It also was able to carry out computerized charge entry, creating quick-order pages for the most common charge codes that were customized for each specialty.“We then conducted targeted education for the different specialties, showing examples of how to enter the most common procedures,” Kushner explained. €œWith the systems now connected, we were able to run reports to show the charges now match the procedures. This helped us ensure we were providing the most accurate information for our revenue cycle team.”Shortly after St.

Joseph’s migrated to the new revenue cycle management technology, it developed a cross-functional revenue cycle collaborative team that included physician leaders, as well as leaders from IT and billing.“We recognized the need to closely align with physicians in order to be successful, working with Cerner to educate them on each step of the revenue cycle process to understand how components of medical documentation contribute to billing,” Kushner noted.RESULTSUsing Cerner clinical and revenue cycle management solutions to help improve charge capture, correct fragmented processes and educate providers, St. Joseph’s increased charges by $39.6 million, or 19.7%, from 2018 to 2019.“A big contributing factor to this success was the creation of auto-text templates for common procedures, all pre-verified by coders to meet billing requirements,” Kushner said. €œAdditional auto-text entries helped verify the work was correct, a requirement for proper billing.”The revenue cycle management technology also has eligibility-checking functionality built in, helping staff determine if insurance will cover a patient’s care before scheduling an appointment.

In addition to streamlining scheduling, this improves the healthcare experience by helping staff speak with patients beforehand to let them know their copay and other potential charges, she added.ADVICE FOR OTHERS“Before implementing a new revenue cycle, organizations should do a thorough analysis of the current holes in their system in order to focus on areas with increased need,” Kushner advised. €œOrganizations also need to establish key performance metrics early on and review them regularly.“New solutions and systems only are successful with collaboration across the entire organization. Leaders need to facilitate a collaborative approach between physicians and revenue cycle teams to achieve great results.

When physicians are empowered with proper education and understand how their work impacts revenue, the organization will be more closely aligned.”Twitter. @SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.There's no question that the hypertension medications crisis ignited unprecedented patient interest in telehealth.

But along with the skyrocketing appointment rates and glowing reports about patient and provider satisfaction came concerns about security, accessibility and longevity.Many of those questions are still unanswered as we turn the corner into 2021. But to gain a sense of the landscape going forward, here's a refresher of Healthcare IT News' top 10 telehealth stories from 2020. Telemedicine during hypertension medications.

Benefits, limitations, burdens, adaptation. As the lasix began to spread across the country in March, no one was sure exactly what virtual care would, or could, look like. Industry leaders offered an early glimpse into the ways they were using telemedicine in their own systems – and vendors noted how their technology could be used to bridge the gap between clinicians and patients.

A guide to telehealth vendors in the age of hypertension medications. Companies – many of which had been in the virtual care space for years – jumped at the chance to demonstrate their products' usefulness in these unprecedented times. Some even gave away their services for free.

This guide, routinely updated with additional vendors, offered a snapshot of the wide variety of telemedicine tools available. A guide to connected health device and remote patient monitoring vendors. As hospitals became stretched increasingly thin, many began to rely on remote patient monitoring to treat patients without having to come into direct contact with them.

Connected health devices run the gamut from wearable heart monitors to Bluetooth-enabled scales to Fitbits. They provide health measures of patients and transmit them back to providers – or in some cases are reported back to providers – to facilitate healthcare decisions from afar. As with the guide to telehealth vendors, this piece has been updated regularly as more options become available.

hypertension medications. Malaysia’s lasix approaches and its impact on telehealth. hypertension medications is a global lasix that has necessitated a global response, and our readers enjoyed getting a look at the ways countries around the world have used virtual care to respond to clinicians' and patients' needs.

Epic launches new telehealth service with Twilio. Appearing to read the writing on the wall about the virtual care boom, the electronic health record giant teamed up with Twilio in May, enabling healthcare professionals to launch video visits while updating clinical documentation and reviewing patients' histories in the workflow. Congress waives telehealth restrictions for hypertension screening.

Legislators included a provision in their March hypertension medications supplemental funding package waiving some restrictions for Medicare telehealth coverage. This would prove to be among many virtual care regulations relaxed in the face of hypertension medications – with the future of these regulations still an open question in December. Trump administration expands Medicare telehealth benefits for hypertension medications fight.

The Trump administration was generally supportive of telemedicine, with the president issuing several executive orders emphasizing the importance of expanding virtual care for rural patients. The U.S. Centers for Medicare and Medicaid Services announced in March that it would temporarily pay clinicians for telehealth services nationwide to help stem the spread of hypertension medications.

Telehealth set for 'tsunami of growth,' says Frost &. Sullivan. I know I said up top that we've seen an astronomical increase in telehealth use this year.

But researchers in May predicted it wouldn't stop in 2021. Frost &. Sullivan forecast a sevenfold growth in telehealth by 2025.

That's a whopping five-year compound annual growth rate of 38.2%. Telehealth helps one hospital reduce ER overflow hours from 1,700 to 148. Features Editor Bill Siwicki has written dozens of case studies taking a look at how health systems have used telemedicine to streamline their patient care.

Although many of these stories highlighted the change in telehealth practices post-lasix, some – like this one, published in December 2019 – demonstrate that telemedicine had been useful even before it was advisable to avoid unnecessary in-person contact. What do CIOs want to see from telehealth apps?. More than a dozen weigh in.

Months into the lasix, many healthcare leaders have gotten the chance to take a breath and evaluate what they'd like to see from virtual care technology in their own systems. Seamless workflow integration, better patient engagement, artificial intelligence utilization and "multidisciplinary group chat" – the sky's the limit when it comes to potential telemedicine innovations. Kat Jercich is senior editor of Healthcare IT News.Twitter.

@kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication..

Lyft on Tuesday announced that it would partner with healthcare organizations such as Anthem, Epic, Centene, One Medical, http://keimfarben.dplusc.de/cheap-lasix-online Modern Health and other lasix street price companies to facilitate rides to vaccination sites. According to the company, the rides will be facilitated through multiple channels. Lyft Healthcare, which partners with systems and health plans to transport patients to and from medical appointments, and LyftUp, which allows corporate partners to donate lasix street price ride credits."With the highly anticipated treatment now rolling out across the country, we are pleased to be joining Lyft and other leading partners to ensure our nation’s most vulnerable consumers will have the opportunity to receive the treatment,” said Gail K.

Boudreaux, president and CEO at Anthem, in a statement. HIMSS20 Digital lasix street price Learn on-demand, earn credit, find products and solutions. Get Started >>.

WHY IT MATTERSQuestions have continued to loom around treatment rollout logistics, as frontline healthcare workers begin to be inoculated against the novel hypertension.In anticipation of future phases, some companies are beginning to formulate plans for how best to get the treatment into the arms of the broader public. According to Lyft, the primary goal of this campaign will lasix street price be to provide 60 million rides to and from vaccination sites for those who may face transportation or logistical hurdles. The company notes that Lyft's transportation network can provide access to care for those in communities disproportionately affected by hypertension medications, including members of vulnerable populations who will be prioritized for early treatment distribution.

(Lyft did not immediately respond to requests for comment about what accessibility lasix street price measures are in place for riders with disabilities.) In addition to directly funding rides, Lyft says its corporate partners will leverage their customers and member networks to promote individual contributions to the campaign, and that community partners will route credits to those in need. "We estimate that 15 million Americans will face transportation issues trying to get to vaccination sites. That’s where Lyft can make a difference," said Megan Callahan, VP of Lyft lasix street price Healthcare, in a statement.

THE LARGER TREND Callahan told Healthcare IT News earlier this month that she anticipated treatment rollout and distributions will have lasting impacts. She also said that Lyft is "talking to policymakers about getting them priority access to the treatment."Rideshare companies have made a number of entrees into the digital health landscape in recent months, with Lyft rival Uber launching a prescription delivery service in August, and Lyft and Uber integrating with Epic and Cerner, respectively. ON THE RECORD “Access to reliable transportation represents a major barrier to care for millions of Americans across lasix street price the country," said Callahan.

The hypertension medications lasix has exacerbated this problem, creating a huge challenge in making sure vulnerable populations have access to the treatment – especially for seniors living alone, low income workers, and parents with young children." Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.A KLAS report released this week took a deep dive into how healthcare organizations perceive their electronic health record vendors' role in helping them to achieve meaningful interoperability.While all vendors have room to improve, the report found that Epic stands out as the leader, with almost all customers saying they have access to outside data."Both Epic and non-Epic customers feel the vendor’s commitment to outside sharing has grown," wrote KLAS researchers.WHY IT MATTERSKLAS defines "deep interoperability" as providers' ability to have consistent access to outside data.

Easily locate patient records. View outside data inside their EHR workflows. And experience positive, frequent impacts on patient care.Using that criteria, KLAS found that nearly two-thirds of Epic customers were able to achieve deep interoperability, followed by Cerner with 28% of customers, NextGen Healthcare at 19%, Allscripts Sunrise at 18%, and eClinicalWorks at 14%.Report authors noted that Cerner has quadrupled its customers who report deep interoperability since 2017, with progress coming from "significant improvements" to how fluidly records are presented in the clinical view and increased use of CommonWell."When it comes to making initial connections to outside EMRs or national networks, customers have started to see more proactivity from Cerner.

In the past, organizations didn’t see much progress without investing significant internal effort."Meanwhile, Greenway Health, Meditech and Allscripts customers' interoperability progress has stagnated, says the report.Although Meditech's migration to Expanse has been largely positive, KLAS said, "customers are left to drive interoperability on their own and, right now, are mainly focused on getting the new platform up and running and learning how to leverage product workflows."Greenway Health's progress, it continued, has been hindered by frequent leadership turnover and the prioritization of other areas besides interoperability.For Allscripts customers, "getting initial access to electronic records is a challenge but possible with enough internal effort," according to the report.THE LARGER TRENDEpic's record-sharing numbers on its Care Everywhere platform showed a big jump this year, according to data the EHR giant released earlier this month.Epic representatives said the increase mirrored the desire for mobility and increasing demand for healthcare services amidst the hypertension medications lasix."With hypertension medications, we got to see some of the value of that [interoperability] work at Epic," said Dave Fuhrmann, senior vice president of interoperability at the company.Meanwhile, Cerner revealed new interoperability tools in October, with CEO Brent Shafer saying hypertension medications has "inspired a burst of innovation."ON THE RECORD"Past KLAS reports have shown that most vendors achieve a high degree of deep interoperability when it comes to customers exchanging data with organizations using the same EMR," wrote report authors."This year, Epic and athenahealth customers continued to report a high degree of satisfaction. Cerner, NextGen Healthcare, and Meditech customers are starting to see more progress. Cerner customers would like the vendor to be more proactive.

Allscripts, eClinicalWorks, and Greenway Health customers feel their vendor still has a ways to go," they said. Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail.

Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.When it came to revenue cycle management, St. Joseph’s Health, one of New Jersey’s largest safety net health systems, used to be very fragmented between ambulatory and acute care settings.THE PROBLEMEntering charges was done by hand, rather than through an automated process, with physicians having no visibility into the process. As a result, the care provided and the billing charges entered did not always match properly.Fragmented tools and outdated processes left St.

Joseph’s with challenges it needed to overcome to provide patients with the healthcare experience they desired. The health system also needed a connected system to help make it easier for its physicians to do their jobs and provide excellent care.PROPOSAL“Cerner’s revenue cycle solutions offered a solution for us to better connect our systems and automate previously manual work,” said Dr. Beth J.

Kushner, chief medical information officer at St. Joseph’s Health. €œWe needed to be able to connect our whole system and create a clinically driven revenue cycle that is closely tied to care and documentation.”Cerner also offered the opportunity for St.

Joseph’s to more closely align with its physicians, the ones whose work and documentation are the primary source of revenue cycle input, she added. Cerner would help educate physicians on the importance of complete, accurate and detailed charting. In doing so, St.

Joseph’s wanted to show physicians how their work directly affects revenue, she said.MARKETPLACEThere are many vendors on the market with revenue cycle management technology solutions. Some of these vendors include Cerner, Conifer Health Solutions, Flywire, Guidehouse, nThrive, Patientco, RevSpring and VisitPay.MEETING THE CHALLENGEAfter St. Joseph’s transitioned to Cerner revenue cycle management, it was able to automate many of its previously manual processes and connect fragmented systems.

It also was able to carry out computerized charge entry, creating quick-order pages for the most common charge codes that were customized for each specialty.“We then conducted targeted education for the different specialties, showing examples of how to enter the most common procedures,” Kushner explained. €œWith the systems now connected, we were able to run reports to show the charges now match the procedures. This helped us ensure we were providing the most accurate information for our revenue cycle team.”Shortly after St.

Joseph’s migrated to the new revenue cycle management technology, it developed a cross-functional revenue cycle collaborative team that included physician leaders, as well as leaders from IT and billing.“We recognized the need to closely align with physicians in order to be successful, working with Cerner to educate them on each step of the revenue cycle process to understand how components of medical documentation contribute to billing,” Kushner noted.RESULTSUsing Cerner clinical and revenue cycle management solutions to help improve charge capture, correct fragmented processes and educate providers, St. Joseph’s increased charges by $39.6 million, or 19.7%, from 2018 to 2019.“A big contributing factor to this success was the creation of auto-text templates for common procedures, all pre-verified by coders to meet billing requirements,” Kushner said. €œAdditional auto-text entries helped verify the work was correct, a requirement for proper billing.”The revenue cycle management technology also has eligibility-checking functionality built in, helping staff determine if insurance will cover a patient’s care before scheduling an appointment.

In addition to streamlining scheduling, this improves the healthcare experience by helping staff speak with patients beforehand to let them know their copay and other potential charges, she added.ADVICE FOR OTHERS“Before implementing a new revenue cycle, organizations should do a thorough analysis of the current holes in their system in order to focus on areas with increased need,” Kushner advised. €œOrganizations also need to establish key performance metrics early on and review them regularly.“New solutions and systems only are successful with collaboration across the entire organization. Leaders need to facilitate a collaborative approach between physicians and revenue cycle teams to achieve great results.

When physicians are empowered with proper education and understand how their work impacts revenue, the organization will be more closely aligned.”Twitter. @SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.There's no question that the hypertension medications crisis ignited unprecedented patient interest in telehealth.

But along with the skyrocketing appointment rates and glowing reports about patient and provider satisfaction came concerns about security, accessibility and longevity.Many of those questions are still unanswered as we turn the corner into 2021. But to gain a sense of the landscape going forward, here's a refresher of Healthcare IT News' top 10 telehealth stories from 2020. Telemedicine during hypertension medications.

Benefits, limitations, burdens, adaptation. As the lasix began to spread across the country in March, no one was sure exactly what virtual care would, or could, look like. Industry leaders offered an early glimpse into the ways they were using telemedicine in their own systems – and vendors noted how their technology could be used to bridge the gap between clinicians and patients.

A guide to telehealth vendors in the age of hypertension medications. Companies – many of which had been in the virtual care space for years – jumped at the chance to demonstrate their products' usefulness in these unprecedented times. Some even gave away their services for free.

This guide, routinely updated with additional vendors, offered a snapshot of the wide variety of telemedicine tools available. A guide to connected health device and remote patient monitoring vendors. As hospitals became stretched increasingly thin, many began to rely on remote patient monitoring to treat patients without having to come into direct contact with them.

Connected health devices run the gamut from wearable heart monitors to Bluetooth-enabled scales to Fitbits. They provide health measures of patients and transmit them back to providers – or in some cases are reported back to providers – to facilitate healthcare decisions from afar. As with the guide to telehealth vendors, this piece has been updated regularly as more options become available.

hypertension medications. Malaysia’s lasix approaches and its impact on telehealth. hypertension medications is a global lasix that has necessitated a global response, and our readers enjoyed getting a look at the ways countries around the world have used virtual care to respond to clinicians' and patients' needs.

Epic launches new telehealth service with Twilio. Appearing to read the writing on the wall about the virtual care boom, the electronic health record giant teamed up with Twilio in May, enabling healthcare professionals to launch video visits while updating clinical documentation and reviewing patients' histories in the workflow. Congress waives telehealth restrictions for hypertension screening.

Legislators included a provision in their March hypertension medications supplemental funding package waiving some restrictions for Medicare telehealth coverage. This would prove to be among many virtual care regulations relaxed in the face of hypertension medications – with the future of these regulations still an open question in December. Trump administration expands Medicare telehealth benefits for hypertension medications fight.

The Trump administration was generally supportive of telemedicine, with the president issuing several executive orders emphasizing the importance of expanding virtual care for rural patients. The U.S. Centers for Medicare and Medicaid Services announced in March that it would temporarily pay clinicians for telehealth services nationwide to help stem the spread of hypertension medications.

Telehealth set for 'tsunami of growth,' says Frost &. Sullivan. I know I said up top that we've seen an astronomical increase in telehealth use this year.

But researchers in May predicted it wouldn't stop in 2021. Frost &. Sullivan forecast a sevenfold growth in telehealth by 2025.

That's a whopping five-year compound annual growth rate of 38.2%. Telehealth helps one hospital reduce ER overflow hours from 1,700 to 148. Features Editor Bill Siwicki has written dozens of case studies taking a look at how health systems have used telemedicine to streamline their patient care.

Although many of these stories highlighted the change in telehealth practices post-lasix, some – like this one, published in December 2019 – demonstrate that telemedicine had been useful even before it was advisable to avoid unnecessary in-person contact. What do CIOs want to see from telehealth apps?. More than a dozen weigh in.

Months into the lasix, many healthcare leaders have gotten the chance to take a breath and evaluate what they'd like to see from virtual care technology in their own systems. Seamless workflow integration, better patient engagement, artificial intelligence utilization and "multidisciplinary group chat" – the sky's the limit when it comes to potential telemedicine innovations. Kat Jercich is senior editor of Healthcare IT News.Twitter.

@kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication..

Lasix constipation

OPD, out lasix constipation patient department. QI, quality improvement. RAAC, rapid access arrhythmia clinic. RACP, rapid access chest pain clinic lasix constipation. RAHF, rapid access heart failure.

TLOC, transient loss of consciousness. TTE, transthoracic echocardiogram." data-icon-position data-hide-link-title="0">Figure 1 Potential interactions between primary and secondary lasix constipation care. AECG, ambulatory ECG. CP, chest pain. CTCA, CT coronary angiography lasix constipation.

EHR, electronic health records. EOL, end of life. EP, electrophysiology lasix constipation. GP, general practitioner. GPwSI, general practitioner with specialist interest.

GUCH, grown-up lasix constipation congenital heart disease. HF, heart failure. NT-pro BNP, N terminal pro B-type natriuretic peptide. OOH, out of hours lasix constipation. OPD, out patient department.

QI, quality improvement. RAAC, rapid access arrhythmia clinic lasix constipation. RACP, rapid access chest pain clinic. RAHF, rapid access heart failure. TLOC, transient lasix constipation loss of consciousness.

TTE, transthoracic echocardiogram.The association of low-income levels with adverse outcomes in patients with heart failure (HF) and the effects of universal health coverage on reducing those differences has not been well documented. In this issue of Heart, Hung and colleagues3 used nationwide data in Taiwan on 633 098 patients hospitalised for HF spanning the years from 1996 (just after implementation of a nationwide health insurance programme) to 2013. Overall, low-income patients, compared with high-income patients, had higher in-hospital mortality rates (5.07% vs 2.51%), higher HF readmission rates, and lower utilisation of guideline-directed medical lasix constipation therapy. However, the disparities in outcomes between low-income versus high-income patients appeared to dissipate over time (figure 2).Temporal trends of heart failure (HF) readmission (A) and all-cause mortality (B) by three income groups over time (1996–2013). A marked decrease in the incidence of HF readmission and all-cause mortality was observed over time for the low-income group (expressed as HR, reference.

High-income group) lasix constipation. A linear trend analysis was used for adjusted HR for low-income versus high-income HF group (as reference) across observation time (per year as ordinal category)." data-icon-position data-hide-link-title="0">Figure 2 Temporal trends of heart failure (HF) readmission (A) and all-cause mortality (B) by three income groups over time (1996–2013). A marked decrease in the incidence of HF readmission and all-cause mortality was observed over time for the low-income group (expressed as HR, reference. High-income group) lasix constipation. A linear trend analysis was used for adjusted HR for low-income versus high-income HF group (as reference) across observation time (per year as ordinal category).In an editorial, Zimerman and Rohde4 suggest three possible explanations for the worse outcomes in low-income patients with HF.

(1) poverty may be a marker of poor prognosis related to factors such as geographic barriers to access to healthcare, education levels, racial/ethnic biases, unemployment and stress levels. (2) poverty might cause lasix constipation adverse outcomes indirectly due to issues such as lack of expensive medications, inadequate nutrition and exercise. And (3) poverty might lead directly to poor health outcomes. The reasons for the improvement over time in income inequities in Taiwan are more difficult to explain. As the lasix constipation authors conclude.

€˜Healthcare professionals should understand how poverty is an indicator and a cause of poor healthcare and strive to explore alternatives to patients.’Another interesting article in this issue by Almorad and colleagues5 prospectively evaluated the accuracy of serum D-dimer levels for exclusion of left atrial (LA) thrombus in 142 patients with atrial fibrillation (AF) undergoing transoesophageal echocardiography (TOE) prior to planned cardioversions. Overall, D-dimer levels were lower in the 91% of patients with no LA thrombus compared with the 9% with an LA thrombus (729±611 vs 2376±1081 ng/L.

QI, quality lasix street price improvement. RAAC, rapid access arrhythmia clinic. RACP, rapid access chest pain clinic. RAHF, rapid access lasix street price heart failure.

TLOC, transient loss of consciousness. TTE, transthoracic echocardiogram." data-icon-position data-hide-link-title="0">Figure 1 Potential interactions between primary and secondary care. AECG, ambulatory lasix street price ECG. CP, chest pain.

CTCA, CT coronary angiography. EHR, electronic lasix street price health records. EOL, end of life. EP, electrophysiology.

GP, general lasix street price practitioner. GPwSI, general practitioner with specialist interest. GUCH, grown-up congenital heart disease. HF, heart lasix street price failure.

NT-pro BNP, N terminal pro B-type natriuretic peptide. OOH, out of hours. OPD, out patient department lasix street price. QI, quality improvement.

RAAC, rapid access arrhythmia clinic. RACP, rapid access lasix street price chest pain clinic. RAHF, rapid access heart failure. TLOC, transient loss of consciousness.

TTE, transthoracic echocardiogram.The lasix street price association of low-income levels with adverse outcomes in patients with heart failure (HF) and the effects of universal health coverage on reducing those differences has not been well documented. In this issue of Heart, Hung and colleagues3 used nationwide data in Taiwan on 633 098 patients hospitalised for HF spanning the years from 1996 (just after implementation of a nationwide health insurance programme) to 2013. Overall, low-income patients, compared with high-income patients, had higher in-hospital mortality rates (5.07% vs 2.51%), higher HF readmission rates, and lower utilisation of guideline-directed medical therapy. However, the disparities in outcomes between low-income versus high-income patients appeared to dissipate over time (figure 2).Temporal trends of heart failure (HF) readmission (A) lasix street price and all-cause mortality (B) by three income groups over time (1996–2013).

A marked decrease in the incidence of HF readmission and all-cause mortality was observed over time for the low-income group (expressed as HR, reference. High-income group). A linear trend analysis was used for adjusted HR for low-income versus high-income HF group (as reference) across observation time lasix street price (per year as ordinal category)." data-icon-position data-hide-link-title="0">Figure 2 Temporal trends of heart failure (HF) readmission (A) and all-cause mortality (B) by three income groups over time (1996–2013). A marked decrease in the incidence of HF readmission and all-cause mortality was observed over time for the low-income group (expressed as HR, reference.

High-income group). A linear lasix street price trend analysis was used for adjusted HR for low-income versus high-income HF group (as reference) across observation time (per year as ordinal category).In an editorial, Zimerman and Rohde4 suggest three possible explanations for the worse outcomes in low-income patients with HF. (1) poverty may be a marker of poor prognosis related to factors such as geographic barriers to access to healthcare, education levels, racial/ethnic biases, unemployment and stress levels. (2) poverty might cause adverse outcomes indirectly due to issues such as lack of expensive medications, inadequate nutrition and exercise.

And (3) lasix street price poverty might lead directly to poor health outcomes. The reasons for the improvement over time in income inequities in Taiwan are more difficult to explain. As the authors conclude. €˜Healthcare professionals should understand how poverty is an indicator and a cause of poor healthcare and strive to explore alternatives to patients.’Another interesting article in this issue by Almorad and colleagues5 prospectively evaluated the accuracy of serum D-dimer levels for exclusion of left atrial (LA) thrombus in 142 patients with atrial fibrillation (AF) undergoing transoesophageal echocardiography (TOE) prior to lasix street price planned cardioversions.

Overall, D-dimer levels were lower in the 91% of patients with no LA thrombus compared with the 9% with an LA thrombus (729±611 vs 2376±1081 ng/L. P<0.05).

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