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Mon, 10 Oct 2022 12:01:00 -0500 en text/html https://www.morningstar.com/collections/520/etf-specialist
Killexams : Hospitals Have Been Slow to Bring On Addiction Specialists

In December, Marie, who lives in coastal Swampscott, Massachusetts, began having trouble breathing. Three days after Christmas, she woke up gasping for air and dialed 911.

“I was so scared,” Marie said later, her hand clutched to her chest.

Marie, 63, was admitted to Salem Hospital, north of Boston. The staff treated her chronic obstructive pulmonary disease, a lung condition. A doctor checked on Marie the next day, said her oxygen levels looked good, and told her she was ready for discharge.

We are not using Marie’s last name because she, like 1 in 9 hospitalized patients, has a history of addiction to drugs or alcohol. Disclosing a diagnosis like that can make it hard to find housing, a job, and even medical care in hospitals, where patients with an addiction might be shunned.

But talking to the doctor that morning, Marie felt she had to reveal her other medical problem.

“‘I got to tell you something,’” Marie recalled saying. “‘I’m a heroin addict. And I’m, like, starting to be in heavy withdrawal. I can’t — literally — move. Please don’t make me go.’”

At many hospitals in Massachusetts and across the country, Marie would likely have been discharged anyway, still in the pain of withdrawal, perhaps with a list of local detox programs that might provide help.

Discharging a patient without specialized addiction care can mean losing a crucial opportunity to intervene and treat someone at the hospital. Most hospitals don’t have specialists who know how to treat addiction, and other clinicians might not know what to do.

Hospitals typically employ all sorts of providers who specialize in the heart, lungs, and kidneys. But for patients with an addiction or a condition related to drug or alcohol use, few hospitals have a clinician — whether that be a physician, nurse, therapist, or social worker — who specializes in addiction medicine.

That absence is striking at a time when overdose deaths in the U.S. have reached record highs, and research shows patients face an increased risk of fatal overdose in the days or weeks after being discharged from a hospital.

“They’re left on their own to figure it out, which unfortunately usually means resuming [drug] use because that’s the only way to feel better,” said Liz Tadie, a nurse practitioner certified in addiction care.

In fall 2020, Tadie was hired to launch a new approach at Salem Hospital using $320,000 from a federal grant. Tadie put together what’s known as an “addiction consult service.” The team included Tadie, a patient case manager, and three recovery coaches, who drew on their experiences with addiction to advocate for patients and help them navigate treatment options.

After Marie asked her doctor to let her stay in the hospital, he called Tadie for a bedside consultation.

Tadie started by prescribing methadone, a medication to treat opioid addiction. Although many patients do well on that drug, it didn’t help Marie, so Tadie switched her to buprenorphine, with better results. After a few more days, Marie was discharged and continued taking buprenorphine.

Marie also continued seeing Tadie for outpatient treatment and turned to her for support and reassurance: “Like, that I wasn’t going to be left alone,” Marie said. “That I wasn’t going to have to call a dealer ever again, that I could delete the number. I want to get back to my life. I just feel grateful.”

Tadie helped spread the word among Salem’s clinical staff members about the expertise she offered and how it could help patients. Success stories like Marie’s helped make the case for addiction medicine — and helped unravel decades of misinformation, discrimination, and ignorance about patients with an addiction and their treatment options.

The small amount of training that doctors and nurses get is often unhelpful.

“A lot of the facts are outdated,” Tadie said. “And people are trained to use stigmatizing language, words like ‘addict’ and substance ‘abuse.’”

Tadie gently corrected doctors at Salem Hospital, who, for example, thought they weren’t allowed to start patients on methadone in the hospital.

“Sometimes I would recommend a dose and somebody would deliver pushback,” Tadie said. But “we got to know the hospital doctors, and they, over time, were like, ‘OK, we can trust you. We’ll follow your recommendations.’”

Other members of Tadie’s team have wrestled with finding their place in the hospital hierarchy.

David Cave, one of Salem’s recovery coaches, is often the first person to speak to patients who come to the emergency room in withdrawal. He tries to help the doctors and nurses understand what the patients are going through and to help the patients navigate their care. “I’m probably punching above my weight every time I try to talk to a clinician or doctor,” Cave said. “They don’t see letters after my name. It can be kind of tough.”

Naming addiction as a specialty, and hiring people with specific training, is shifting the culture of Salem Hospital, said social worker Jean Monahan-Doherty. “There was finally some recognition across the entire institution that this was a complex medical disease that needed the attention of a specialist,” Monahan-Doherty said. “People are dying. This is a terminal illness unless it’s treated.”

A photo shows Liz Tadie and Jean Monahan-Doherty standing together inside of a hospital.
Liz Tadie (left) was the director of substance use disorder services at Salem Hospital, north of Boston. Jean Monahan-Doherty (right), a social worker at the hospital, says, “There was finally some recognition across the entire institution that this was a complex medical disease that needed the attention of a specialist.” Tadie is starting a job at another hospital, but Salem Hospital leaders say the program will continue.(Jesse Costa / WBUR)

This approach to treating addiction is winning over some Salem Hospital employees — but not all.

“Sometimes you hear an attitude of, ‘Why are you putting all this effort into this patient? They’re not going to get better.’ Well, how do we know?” Monahan Doherty said. “If a patient comes in with diabetes, we don’t say, ‘OK, they’ve been taught once and it didn’t work, so we’re not going to offer them support again.’”

Despite lingering reservations among some Salem clinicians, the demand for addiction services is high. Many days, Tadie and her team have been overwhelmed with referrals.

Four other Massachusetts hospitals added addiction specialists in the past three years using federal funding from the HEALing Communities Study. The project is paying for a wide range of strategies across several states to help determine the most effective ways to reduce drug overdose deaths. They include mobile treatment clinics; street outreach teams; distribution of naloxone, a medicine that can reverse an opioid overdose; rides to treatment sites; and multilingual public awareness campaigns.

It’s a new field, so finding staff members with the right certifications may be a challenge. Some hospital leaders say they’re worried about the costs of addiction treatment and fear they’ll lose money on the efforts. Some doctors report not wanting to initiate a medication treatment while patients are in the hospital because they don’t know where to refer patients after they’ve been discharged, whether that be to outpatient follow-up care or a residential program. To address follow-up care, Salem Hospital started what’s known as a “bridge clinic,” which offers outpatient care.

Dr. Honora Englander, a national leader in addiction specialty programs, said the federal government could support the creation of more addiction consult services by offering financial incentives — or penalties for hospitals that don’t embrace them.

At Salem Hospital, some staffers worry about the program’s future. Tadie is starting a new job at another hospital, and the federal grant ended June 30. But Salem Hospital leaders say they are committed to continuing the program and the service will continue.

This story is part of a partnership that includes WBURNPR and KHN.

Mon, 10 Oct 2022 21:18:00 -0500 en-US text/html https://khn.org/news/article/hospitals-have-been-slow-to-bring-on-addiction-specialists/
Killexams : Wealthspire Advisors Partners With Medicare Specialist Chapter

In the first week of October, independent RIA Wealthspire Advisors announced a partnership with Chapter, a non-government Medicare advisory practice, to “improve how we support [clients] with their healthcare planning needs,” said Kevin Smith, a senior vice president and advisor at Wealthspire who helped spearhead the partnership, in an email.

Chapter’s specialists will work to find healthcare savings and identify comprehensive benefits for Wealthspire’s clients. In addition, Chapter’s proprietary data platform will help Wealthspire clients navigate Medicare options and enroll in the best coverage for each individual, improving their health coverage over time.

Medicare, of course, is the federally mandated health insurance program for all Americans age 65 and older. (It is also open to some younger folks who have certain health conditions.) But there are several levels and coverage options.

Medicare Part A covers hospitalizations and, to an extent, home healthcare. Part B is essentially medical insurance for outpatient care and medical equipment. Both are part of “original Medicare,” guaranteed by the federal government and available for free. Part C, better known as a Medicare Advantage Plan, is offered by private companies approved by Medicare to provide extra coverage for dental, vision and hearing care. Part D, also run by approved private insurance carriers, covers prescription drugs. In addition, Medicare Supplement Insurance—sometimes called Medigap—refers to private insurance that fills the gaps left by other Medicare options. You cannot have both Medigap and a Medicare Advantage Plan at the same time.

“Navigating healthcare on your own can be difficult,” said Smith. “It’s critical to ensure that clients find or remain on the best Medicare coverage to meet their needs so they can maximize their health benefits and minimize their healthcare costs during retirement.”

In a press release, Chapter CEO and co-founder Cobi Blumenfeld-Gantz explained, “Many Americans overpay for healthcare in retirement. Without expert guidance and advanced technology, it’s nearly impossible to properly plan for these expenses because the Medicare system is so unnecessarily confusing.”

The new partnership will help Wealthspire clients more easily identify the right Medicare coverage for their specific needs. It will also offer the firm’s clients ongoing education about ever-changing healthcare options and annual policy reviews to ensure they are making up-to-date, informed choices about their health coverage year after year.

“Guiding our clients through all parts of their financial journey is our number one priority,” said Mike LaMena, CEO of Wealthspire, in the press release. “The majority of Americans underestimate the true costs of healthcare in retirement, which is why it is critical that financial advisors emphasize the importance of Medicare planning as part of the financial planning process.”

Smith noted that Wealthspire and Chapter “share the same values of providing objective, client-centric advice.” The partnership “furthers our mission of being fiduciaries who offer world-class resources for personalized advice to our clients, and [it] meaningfully improves how we support them with their healthcare planning needs.”

The move is also part of a larger plan to expand Wealthspire’s footprint nationwide. Wealthspire currently has offices spread across 10 states throughout the Northeast, mid-Atlantic, Midwest and West Coast. By including Chapter’s resources, Wealthspire can offer a “consistent solution” anywhere in the country. “Our goal,” said Smith, “is for clients to have a similar Wealthspire experience regardless of geography.”

Wed, 05 Oct 2022 00:15:00 -0500 Ben Mattlin text/html https://www.fa-mag.com/news/wealthspire-advisors-partners-with-medicare-specialist-chapter-69994.html
Killexams : What Plan Sponsors Should Expect From a Retirement Plan Adviser

Many plan sponsors are evaluating their relationships with plan advisers as they look for more guidance on managing their benefits, according to retirement industry veterans who spoke during a recent edition of the 2022 Plan Progress webinar series.

The Great Resignation has only complicated matters, said Jim Scheinberg, founder and managing partner at North Pier Fiduciary Management, as firms are seeing both high turnover and a reduction of staff across the board. While most human resources and finance teams used to comprise four to five team members, now there may be fewer people with the same volume of work spread among them, he said.

“We’re also seeing that reflected on the service provider side, with recordkeepers or administrators, where their service teams are being stretched a lot thinner,” Scheinberg said. “You’re seeing that reflected in response times, hold times, getting resolution to various items that may be normal in the course of governing your plan, or maybe one-off items.”

As a result, many with such heightened responsibilities are looking for more help with understanding how they should proceed as they review certain tasks, Scheinberg said. As plan sponsors look to their adviser for help, many are beginning to see the difference, and it can become an issue when the adviser fails to deliver for their client.

Many plan sponsors are struggling to locate experienced talent and are seeking out advice from their adviser more often than ever, because they lack the in-house expertise in reviewing plan documents or plan audits, said Robert Massa, managing director at Qualified Plan Advisors. In his view, advisers must be able to understand more than just retirement—they also have to understand where and how retirement fits into the whole benefits scheme.

Scheinberg noted that, as plan sponsors look to reevaluate their relationships with their retirement plan adviser, they may simply be validating the original reason for working with an adviser, or they could be looking for a change. Mergers and acquisitions may also prompt reevaluation, as there has recently been a “tremendous” amount of consolidation in the adviser space and sponsors may want to vet the service structure or culture of the new organization, he said.

“Where we see the most of our search work is when the committee chair itself or a very senior staff person has a very heavy hand on the management of the plan,” Scheinberg said. “When that role has changed, the new person comes in and gets settled for the first six months or so, and then they want to start looking around and making sure that, ultimately, they like the team they’re with—or possibly want to consider something new.”

As plan sponsors evaluate their relationships, they should be prepared to ask “culturally uncomfortable” questions that are generally acceptable in the financial services industry, said David Morehead, vice president at OneDigital. Questions like “how much are you getting paid?” or “what is your compensation for this plan?” are straightforward, important questions to ask, because fiduciaries should be aware of an adviser’s or service provider’s pricing model, he said.

When vetting to fill an adviser role, plan sponsors should expect advisers to be able to answer their questions about most general retirement issues on the spot, Massa said.

“I think this is part of the interview process. Am I dealing with a competent professional or am I dealing with someone who doesn’t deal with this every day?” Massa said. “I would take some time to try to come up with a few of those questions. Some may affect your company, some may not … but it tells you a lot about their knowledge of ERISA [Employee Retirement Income Security Act], their knowledge of the IRS tax code and whether they are a professional in retirement or just an investment professional.”

It’s also important for advisers to explain exactly what they are going to do when it comes to how they handle things such as managed account investments, or how exactly they plan to deliver participants advice, Massa said.

“You want to make sure that they’re going to spend time with that employee, they’re going to actually educate them and they’re not just going to hand them off to a computer program … to me, that’s not advice,” Massa said. “You really need to ask a lot of questions about that adviser to ultimately get them to disclose whether they’re in this for you or for them—because they’re supposed to work for you. That’s their job.”

Mon, 26 Sep 2022 09:04:00 -0500 en text/html https://www.planadviser.com/plan-sponsors-expect-retirement-plan-adviser/
Killexams : Why Even Big Tech Companies Keep Getting Hacked—and What They Plan to Do About It

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Killexams : Documents reveal nonprofit’s plan to downplay abortion in the midterms

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In a Facebook ad targeting voters in four states that could decide control of Congress next month, a young woman announces to her grandmother that the Supreme Court’s decision eliminating constitutional protections for abortion is “such a big deal.”

“And you know what’s a bigger deal?” her grandmother replies gently. “Unsafe communities, soaring prices and schools that don’t care about their kids or their parents.”

The young woman furrows her brow. “But you fought so hard for abortion rights,” she says.

“And we’ll both keep fighting,” her grandmother assures her. “But we must send a message on other issues hurting other people every day. And that’s what’s on my mind now.”

The ad, which seeks to marry the pro-abortion rights position with Republican talking points on other topics, is part of a broader effort by a conservative nonprofit, Independent Women’s Voice, to blunt the impact of June’s Dobbs v. Jackson Women’s Health Organization decision on next month’s midterms.

A fundraising proposal and other internal memos prepared by Independent Women’s Voice were obtained by the watchdog group Documented and shared with The Washington Post. They illustrate the fear among conservatives that new restrictions on abortion could hurt the GOP’s chances of retaking control of Congress. They also reflect the quest among conservative groups to develop strategies to neutralize the issue for abortion rights supporters who otherwise lean Republican.

“As we predicted last May, the left has used the Dobbs decision to manufacture through misinformation a War on Women 2.0-playbook, updated from 2012, to drive women away from common-sense conservative positions and no one is effectively countering it,” argues the September proposal, titled “A WINNING STRATEGY.”

Independent Women’s Voice is led by Heather Higgins, an heiress to the Vicks VapoRub fortune, who once touted her group as a tool in the “Republican conservative arsenal” because: “Being branded as neutral but actually having the people who know, know that you’re actually conservative puts us in a unique position.”

Higgins declined to be interviewed for this article but issued a written statement saying, in part, “Our starting premise is that intelligent public policy requires honest and accurate discussion about underlying facts.” She said her group has “no electioneering plans to advocate for or against any candidate.”

A separate fall proposal for donors promises the group will “execute targeted campaigns … to drive moderate or slightly left-leaning audiences toward conservative policies and ideas.” The aim, the proposal states, is to “WIN.”

A third document, called “campaign strategy,” says Independent Women’s Voice is “the only group on the right” that’s focused on “non-base demographics” and is “perfectly positioned in the upcoming midterm elections … to move these groups towards conservative policies, and as a corollary, conservative candidates.”

The group is registered as a 501(c)4 charitable organization, a designation that allows it to engage in political campaign activity so long as that activity isn’t its primary purpose. In exchange, it is exempt from disclosing its donors and paying federal income taxes.

Among the groups that have reported funding Independent Women’s Voice or its sister 501(c)3 organization, Independent Women’s Forum, are the Charles Koch Foundation; top conservative donor-advised funds, including DonorsTrust and Donors Capital Fund; and several groups, such as the Judicial Crisis Network, that are associated with Leonard Leo, the former longtime head of the Federalist Society who advised former president Donald Trump on judicial nominations and oversees a vast network of conservative advocacy organizations.

The “WINNING STRATEGY” memo states that Independent Women’s Voice is uniquely positioned to address Dobbs “precisely because we don’t take a position on abortion — we just simply point out the facts.”

According to the memo, the court’s decision “has little impact on changing the status quo.”

More than a dozen states have banned or mostly banned the procedure since the decision. Changes continue to ripple. Just last month, the Republican-dominated legislature in West Virginia approved a near-total abortion ban.

Higgins, in her statement, acknowledged, “Obviously, Dobbs changed abortion law, but not nearly as dramatically and drastically as some of the hype encourages women to believe.” She said her group’s aim was countering a “toxic deluge of misinformation.”

At the center of the group’s work is the ad featuring the young woman and her grandmother, called “It’s Not 1973 Anymore,” a reference to the year the Supreme Court’s decision in Roe v. Wade found a constitutional right to abortion.

The ad started running last week and, in two days, drew as many as 70,000 views by women in Arizona, Georgia, Nevada and Pennsylvania, according to the Facebook ad archive, suggesting the project pitched to donors last month is in an early stage of execution. Higgins said Independent Women’s Voice would be delivering additional messaging via digital platforms as well as streaming TV services and text message.

The Facebook ad appears aimed at the “25 to 30 percent of Republican-leaning women who support exceptions, who maybe even support abortion rights in the first trimester, and who in any other year would vote Republican because of inflation, gas prices and crime,” said Christine Matthews, a Republican pollster at Bellwether Research and Consulting, which had no role in making the ad.

“The polling is showing that in some places, these women have reservations about voting for a Republican whose position is absolutely no exceptions for abortion,” Matthews said. “The ad is trying to deliver those women permission to vote based on other issues, to not prioritize the abortion issue.”

“In that sense, it’s probably a smart ad,” she said.

Independent Women’s Voice says it is especially focused on convincing two critical voting blocs — “Hispanics and independent women” — not to be persuaded by the abortion issue. It touts its ability, through “custom modeling,” to home in on a “new universe of civically engaged people who are weak conservative to weak liberal on the ideological spectrum” and serve these people messaging about transgender issues and “cancel culture” — issues that the group says push people toward a “conservative agenda.”

Higgins also chairs the group’s sister 501(c)3 nonprofit, the Independent Women’s Forum, which was founded by a conservative activist following the feminist outcry against the Supreme Court nomination of Clarence Thomas in 1992.

“We were concerned that those who would speak for American women were neither telling the truth about Clarence Thomas nor making sense with respect to issues of crucial importance to American women,” the activist, Rosalie Silberman, said in 1998.

That instinct — that messaging from left-leaning women’s groups may not resonate with many women — animates the nonprofit’s “WINNING STRATEGY” memo and the broader fall proposal for donors. “We will educate pro-women, independent constituents in seven to nine key states using issues that for these audiences are top tier but largely ignored by other issue organizations,” the proposal states.

A slide deck labeled a “Strategy Summary For Winning in 2022” identifies a handful of “Angel of Death Proposals” that the group claims harm women. These include paid leave and child care, benefits that enjoy broad public approval, according to surveys.

When it comes to the abortion issue, too, polling suggests that Independent Women’s Voice may face an uphill battle. A recent Post-ABC News poll found that 64 percent of voters disapproved of the Supreme Court’s move to strike down Roe v. Wade. The percentage of newly registered voters who were women climbed in several key states following the Dobbs decision, data show.

But some polling also shows the issue may be receding in the minds of voters, providing an opening for messaging about the salience of other topics. A Gallup poll in September found that 6 percent of Americans rated abortion or the judicial system as the most important problem in the country, down from 10 percent in August and 14 percent in July.

Caroline Kitchener contributed to this report.

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Sat, 15 Oct 2022 02:39:00 -0500 Isaac Stanley-Becker en text/html https://www.washingtonpost.com/politics/2022/10/13/abortion-midterms-independent-womens-voice/
Killexams : Judge tosses lawsuit challenging Biden's student loan forgiveness plan for 'racial motive'

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Sat, 08 Oct 2022 18:39:00 -0500 en-US text/html https://www.usatoday.com/story/news/2022/10/07/lawsuit-biden-student-debt-relief-plan-race-tossed-wisconsin/8206846001/
Killexams : Hospitals have specialists on call for lots of diseases — but not addiction. Why not?

David Cave, a recovery coach who is part of an addiction specialty team at Salem Hospital, north of Boston, stands outside the emergency department. Jesse Costa/WBUR hide caption

toggle caption
Jesse Costa/WBUR

David Cave, a recovery coach who is part of an addiction specialty team at Salem Hospital, north of Boston, stands outside the emergency department.

Jesse Costa/WBUR

Marie lives in the coastal town of Swampscott, in Massachusetts. Last December, she began having more and more trouble breathing. One morning, three days after Christmas, she woke up gasping for air. A voice in her head said, "You're going to die." Marie dialed 911.

"I was so scared," Marie said later. Describing that day, the 63-year-old's voice filled with tension, and her hand clutched at her chest.

Marie was admitted to Salem Hospital, north of Boston. The staff treated her COPD, a chronic lung condition that includes emphysema and chronic bronchitis.

KHN logo

This story was produced in partnership with Kaiser Health News.

After her worst symptoms subsided, a doctor came the next day to check on her. He told Marie her oxygen levels looked good and that she was stable and ready to be discharged.

NPR is not using Marie's last name because she, like 1 in 9 hospitalized patients, has a history of addiction to drugs or alcohol. Disclosing a diagnosis like that can make it hard to find housing, a job and even medical care in hospitals where patients with an addiction may be shunned.

But talking to the doctor that morning, Marie felt she didn't have a choice. She had to tell him about her other medical problem.

"He said I could be released," Marie recalled. "And I said, 'I got to tell you something. I'm a heroin addict. And I'm, like, starting to be in heavy withdrawal. I can't literally move, please don't make me go.'"

Without care, discharged patients risk overdose

At many hospitals in Massachusetts and across the country, Marie would likely have been discharged anyway, while still in the pain of withdrawal. Perhaps she would leave with a list of local detox programs where she might — or might not — find help.

But a crucial opportunity to intervene and treat at the hospital would have been lost — partly because most hospitals don't have specialists available who know how to treat addiction, and other clinicians don't know what to do.

Hospitals typically employ all sorts of specialists who focus on critical organs like hearts, lungs and kidneys — or who treat systemic or chronic diseases of the immune system or the brain. There are specialists for children, for mental illness, for childbirth and hospice.

But if your illness is an addiction or a condition related to drug or alcohol use, there are few hospitals where patients can see a clinician — whether that be an M.D., nurse, therapist or social worker — who specializes in addiction medicine.

Their absence among hospital personnel is particularly striking at a time when overdose deaths in the U.S. have reached record highs, and research shows patients face an increased risk of fatal overdose in the days or weeks after they are discharged from a hospital.

"They're left on their own to figure it out, which unfortunately usually means resuming [drug] use because that's the only way to feel better," says Liz Tadie, a nurse practitioner certified in addiction care.

In the fall of 2020, Tadie launched a new approach at Salem Hospital, using $320,000 from a federal grant that the hospital had worked for several years to secure. Tadie put together what's known as an "addiction consult service."

At Salem, that team included Tadie, a patient case manager, and three recovery coaches — who draw on their experience with addiction to advocate for patients and help them navigate their treatment options.

What an addiction consult service brings to the bedside

So on that day, when Marie said, "Please don't make me go," her doctor didn't tell Marie she had to leave. He called Tadie for a bedside consult.

Tadie started out the treatment by first prescribing methadone, a medication to treat opioid addiction. Although many patients do well on that drug, it didn't help Marie, so Tadie switched her to buprenorphine, with better results. After a few more days, Marie was eventually discharged and continued taking buprenorphine to manage her addiction to opioids.

But Marie continued seeing Tadie for treatment as an outpatient and was able to turn to her for support and reassurance:

"Like, that I wasn't going to be left alone," Marie said. "That I wasn't going to have to call a dealer ever again, that I could delete the number. I want to get back to my life. I just feel grateful."

Among Salem's clinical staff, Tadie helped spread the word about the expertise she can offer and how it can help patients. Success stories like Marie's helped her make the case for addiction medicine — which also meant unraveling decades of misinformation, discrimination and ignorance about patients with an addiction and their treatment options.

Part of the problem, according to Tadie, is that doctors, nurses and other clinicians get very little training in the physiology of addiction and withdrawal, the medications and treatment options, and the emerging science about what works for these patients. What little training that doctors and nurses do get is often unhelpful.

"A lot of the facts are outdated," Tadie says. "And people are training to use stigmatizing language — words like 'addict' and substance 'abuse.'"

Tadie gently corrected doctors at Salem Hospital, for example, who thought they weren't ever allowed to start patients on methadone in the hospital.

"Sometimes I would recommend a dose and somebody would deliver pushback," Tadie says. But "we got to know the hospital doctors and they, over time, were like, "OK, we can trust you. We'll follow your recommendations."

Over time, addiction specialists help change the culture

Other members of Tadie's team have also wrestled with finding their place in the hospital hierarchy. David Cave, one of the recovery coaches at Salem Hospital, is often the first person to speak to a patient who comes to the emergency room in withdrawal. He tries to help doctors and nurses understand what the person is going through and help navigate their care.

"I'm probably punching above my weight every time I try to talk to a clinician or doctor," says Cave. "They don't see letters after my name. It can be kind of tough."

But naming addiction as a specialty, and hiring people with training in this particular disease, is shifting the culture of Salem Hospital, according to Jean Monahan-Doherty, a social worker who has referred patients to Tadie.

"There was finally some recognition across the entire institution that this was a complex medical disease that needed the attention of a specialist," Monahan-Doherty says. "People are dying. This is a terminal illness unless it's treated."

Former director of substance use disorder services at Salem Hospital Liz Tadie (left) and social worker Jean Monahan-Doherty. Tadie is moving to a new job at another hospital, but Salem Hospital leaders say they are committed to continuing the program. Jesse Costa/WBUR hide caption

toggle caption
Jesse Costa/WBUR

Former director of substance use disorder services at Salem Hospital Liz Tadie (left) and social worker Jean Monahan-Doherty. Tadie is moving to a new job at another hospital, but Salem Hospital leaders say they are committed to continuing the program.

Jesse Costa/WBUR

This approach to treating addiction is winning over some Salem Hospital employees — but not all.

"Some of the medical staff continue to see it as a moral issue," Monahan-Doherty says. "Sometimes you hear an attitude of 'Why are you putting all this effort into this patient? They're not going to get better.' Well, how do we know? If a patient comes in with diabetes, we don't say, 'OK, they've been taught once and it didn't work. So we're not going to offer them support again.'"

Despite lingering reservations among some colleagues, the demand for their services is quite high. Many days, Tadie and her team have been overwhelmed with referrals.

With federal support, states experiment to stop overdose deaths

Four other Massachusetts hospitals also added addiction specialists in the past three years and experienced similar challenges and success. The additional staff were paid for by federal funding from the HEALing Communities study. This project is paying for a wide range of strategies across several states, to determine the most effective ways to reduce drug overdose deaths. They include mobile treatment clinics, street outreach teams, naloxone trainings and distribution, rides to treatment sites, and multilingual public awareness campaigns.

"You really do provide better care for patients and you make the care environment one that people are more satisfied working in," says Dr. Jeffrey Samet, who leads the Massachusetts portion of this research effort. Samet practices primary care at Boston Medical Center and says adding addiction specialists in hospitals is a key piece of the solution.

Dr. Todd Kerensky, president of the Massachusetts Society of Addiction Medicine, has seen patients cry when they learn he specializes in addiction and wants to treat their disease, not shame them.

"It's gut-wrenching to know there are a lot of institutions that don't have this service," says Kerensky. It's not clear how many hospitals in Massachusetts have addiction experts on staff, but Kerensky says it's a "distinct minority."

There are many possible reasons. It's a new field, so finding qualified staff members with the right certifications may be a hurdle. Some hospital leaders say they're worried about the costs of addiction treatment and fear they'll lose money on the efforts. Some doctors report not wanting to initiate a treatment medication while the patient is still in the hospital, because they don't know where to refer patients after they've been discharged, whether that be outpatient follow-up care or a residential program. To address follow-up care, Salem Hospital started what's known as a "bridge clinic," where patients get help transitioning to outpatient care.

Despite these worries and reservations, hospitals that don't have an addiction specialty team need to start one, says Dr. Honora Englander, a national leader in addiction specialty programs.

"People with substance use disorder are coming to our hospitals now," said Englander, who directs an addiction care team at Oregon Health and Science University. "We can't wait. We have to do better, and this is the time."

Englander says the federal government could support the creation of more addiction consult services by offering financial incentives — or penalties for hospitals that don't embrace them. The Centers for Medicare & Medicaid Services, which has regulatory authority over most U.S. hospitals, could require that hospitals stock the medications used to treat an addiction and track outcomes for patients hospitalized with a substance use disorder, in the same way that CMS already does when it comes to readmissions for other health conditions.

At Salem Hospital, the program is still new, and some staff worry about its future. Liz Tadie is moving to a new job at another hospital, and the federal grant ended June 30. But Salem Hospital leaders say they are committed to continuing the program, and the service will continue.

Compared to the other four Massachusetts hospitals that launched addiction consult teams using the same federal grant, Salem Hospital has helped the most patients. Over a 15-month period, its team helped 448 patients begin medication to treat their opioid use disorder.

This story comes from NPR's health reporting partnership with WBUR and KHN (Kaiser Health News).

Fri, 30 Sep 2022 08:53:00 -0500 Martha Bebinger en text/html https://www.npr.org/sections/health-shots/2022/09/30/1124621377/addiction-treatment-specialists-salem-hospital
Killexams : Say Yes Cleveland support specialist funding in jeopardy in 2023

CLEVELAND, Ohio – A central pillar of Cuyahoga County’s Say Yes to Education program – which sends underprivileged students to college for free – is in jeopardy after an unexpected shortfall in funding.

Say Yes Cleveland, which was established in 2019, grants Cleveland Metropolitan School District graduates full scholarships to all public colleges, universities and Pell-eligible job-training programs in the state and more than 100 private institutions nationwide. Those scholarships are paid for by private sources in a separate fund and are not in danger.

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Tue, 11 Oct 2022 14:08:00 -0500 en text/html https://www.cleveland.com/news/2022/10/say-yes-cleveland-support-specialist-funding-in-jeopardy-in-2023.html
Killexams : Ask A Specialist – Shoulder Fractures

For those who suffer from a shoulder fracture, also known as a proximal humerus fracture, either due to a fall or other type of trauma, the road to recovery can be a slow and frustrating one. Learn more with Dr. Michael J. Chen, Orthopedic Surgeon & Fracture Specialist, at The Queen’s Medical Center-West Oahu in this segment of Ask a Specialist on Wake Up 2Day.

Mon, 19 Sep 2022 05:58:00 -0500 en-US text/html https://www.khon2.com/wake-up-2day/ask-a-specialist/ask-a-specialist-shoulder-fractures/
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