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This is the time to be slow
Lie low to the wall
Until the bitter weather passes

Try, as best you can, not to let
The wire brush of doubt
Scrape from your heart
All sense of yourself
And your hesitant light.

If you remain generous,
Time will come good;
And you will find your feet

Again on fresh pastures of promise,
Where the air will be kind
And blushed with beginning.

John O’Donohue

To Bless the Space Between Us: A Book of Blessings

  “You can be 100 percent confident in your vivid memory and still be 100 percent wrong.” from "Remember": "The Science of Memory and the Art of Forgetting." -  Lisa Genova's book exploring the intricacies of how we remember, why we forget, and what we can do to protect our memories, Click to read the New Yorker's article by David Kortova,

"Repetition makes a fact seem more true, regardless of whether it is or not. It is a law of propaganda often attributed to the Nazi Joseph Goebbels.  Understanding this effect can help you avoid falling for propaganda, says psychologist Tom Stafford".....
...."The key finding is that people tend to rate items they've seen before as more likely to be true, regardless of whether they are true or not, and seemingly for the sole reason that they are more familiar".... Click to read Tom Stafford's article published by the BBC on October 26, 2016

Kyunghee Lee’s right hand hurts all the time.

She spent decades running a family dry cleaning store outside Cleveland after emigrating from South Korea 40 years ago. She still freelances as a seamstress, although work has slowed amid the covid-19 pandemic.

While Lee likes to treat her arthritis with home remedies, each year the pain in the knuckles of her right middle finger and ring finger increases until they hurt too much to touch. So about once a year she goes to see a rheumatologist, who administers a pain-relieving injection of a steroid in the joints of those fingers.

Her cost for each round of injections has been roughly $30 the past few years. And everything is easier, and less painful for a bit, after each steroid treatment.

So, in late summer she masked up and went in for her usual shots. She noticed her doctor’s office had moved up a floor in the medical building, but everything else seemed just the same as before — same injections, same doctor.

Then the bill came.

The Patient: Kyunghee Lee, a 72-year-old retiree with UnitedHealthcare AARP Medicare Advantage Walgreens insurance who lives in Mentor, Ohio

Medical Service: Steroid injections into arthritic finger joints

Service Provider: University Hospitals Mentor Health Center, part of the University Hospitals health system in northeastern Ohio

Total bill: $1,394, including a $1,262 facility fee listed as “operating room services.” The balance included a clinic charge and a pharmacy charge. Lee’s portion of the bill was $354.68.

What Gives: Lee owed more than 10 times what she had paid for the same procedure done before by the same physician, Dr. Elisabeth Roter.

Lee said it was the “same talking, same injection — same time.”

Lee and her family were outraged by the sudden price hike, considering she had gotten the same shots for the far lower price multiple times in the years before. Her daughter, Esther, said this was a substantial bill for her mother on her Social Security-supplemented income.

“This is a senior citizen for whom English is not her first language. She doesn’t have the resources to fight this,” Esther Lee said.

What had changed was how the hospital system classified the appointment for billing. Between 2019 and 2020, the hospital system “moved our infusion clinic from an office-based practice to a hospital-based setting,” University Hospitals spokesperson George Stamatis said in an emailed statement.

That was a change in definition for billing. The injection was given in the same medical office building, which is not a hospital. Lee did not need or get an infusion, which requires the insertion of an IV and some time spent allowing the medicine to flow into a vein.

Nonetheless, that change allowed the hospital system to bill what’s called a “facility fee,” laid out on Lee’s bill as “operating room services.” The increasingly controversial charge — basically a room rental fee — comes without warning, as hospitals are not required to inform patients of it ahead of time.

Hospitals say they charge the fee to cover their overhead for providing 24/7 care, when needed. Stamatis also noted the cost of additional regulatory requirements and services “that help drive quality improvement and assurance, but do increase costs.”

But facility fees are one reason hospital prices are rising faster than physician prices, according to a 2019 research article in Health Affairs.

“Facility fees are designed by hospitals in particular to grab more revenue from the weakest party in health care: namely, the individual patient,” said Alan Sager, a professor of health policy and management at the Boston University School of Public Health.

Lee’s insurance had changed to a Medicare Advantage plan in 2020. The overall cost for the appointment was nearly three times what it was in 2017 — before insurance even got involved.

The National Academy for State Health Policy has drafted model legislation for states to clamp down on the practice, which appears to have worsened, Executive Director Trish Riley said, as more private practices have been bought by hospitals and facility fees are tacked onto their charges.

“It’s the same physician office it was,” she said. “Operating in exactly the same way, doing exactly the same services — but the hospital chooses to attach a facility fee to it.”

New York, Oregon and Massachusetts are pursuing legislation to curtail this practice, she said. Connecticut has a facility fee transparency law on the books, and Ohio, where Lee lives, is considering legislation that would prohibit facility fees for telehealth services.

But Riley noted it’s difficult to fight powerful hospital lobbyists in a pandemic political climate, where hospitals are considered heroic.

The Centers for Medicare & Medicaid Services has attempted to curtail facility fees by introducing a site-neutral payment policy. The American Hospital Association sued over the move and plans to take the case to the Supreme Court.

Resolution: Lee’s daughter, Esther Lee, was furious with the hospital over the fee. Her mom, who is fiercely independent, finally brought her the bill after trying for weeks to get the billing office to change it.

“This is wrong,” Esther Lee said. “Even if it was a lot of money for services properly rendered, then of course she would pay it. But that’s not the case here.”

When Lee called her doctor’s office to complain, they told her to talk to the billing department of the hospital. So Lee, with Esther’s help, repeatedly called the billing department and filed a complaint with Medicare.

“I don’t want to lose my credit,” Kyunghee Lee said. “I always paid on time.”

But after receiving a “final notice” in February, and then being threatened with being sent to collections, the Lee family gave up the fight. Esther Lee paid the bill for her mother. But she’s worried her mom will delay getting the shots now, putting up with the pain longer, as she knows they are more expensive.

The Takeaway: When planning an outpatient procedure like an injection or biopsy, call ahead to ask if it will happen in a place that’s considered a “hospital setting” — even if you think you understand the office’s billing practices. Ask outright if there will be a facility fee — and how much — even if there’s not been one before. If it’s an elective procedure, you can search for a cheaper provider.

One easy place to scout for more affordable care is the office of a doctor whose practice has not been bought by a hospital. It is the hospital, not your longtime doctor, that is adding the fee, said Marni Jameson Carey, executive director of the Association of Independent Doctors.

“This is one of the terrible fallouts of consolidation,” Carey said.

Sources:

Stephanie O’Neill contributed to the audio version of this story.

Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

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

“My life … runs back through time and space to the very beginnings of the world and to its utmost limits. In my being I sum up the earthly inheritance and the state of the world at this moment.” ...Continue Reading

Wayne W. Dyer (1940 - 2015) was an American motivational speaker as well as a self-help and spiritual author. He wrote dozens of books. His first book, "Your Erroneous Zones, sold over 100 million copies and is considered one of the best selling books of all times.

Photo by Phil Konstantin

Billions of people in the world are living in poverty. Adjusted for the purchasing power in each country, 85% of the world population live on less than $30 per day. 
In an earlier post I said that ‘if we want global poverty to decline substantially then the economies that are home to the poorest billions of people need to grow.’ In this post I want to make this statement more concrete. I will look at the depth of global poverty today to get a quantitative sense of just how much the global income distribution would need to change to reduce global poverty substantially. Continue reading

Working from home is a dream come true for some people and a nightmare for others. It all depends on your perspective. In the wake of the coronavirus pandemic, some people who started working remotely were happy about the changes. For one thing, working from home saved them time and money that would have been spent on commuting to work every day. 

However, the most important advantage of working from home is that it will keep you safe from getting infected by the novel coronavirus. Right now, this is the only reason that counts. Thankfully, software developers have the privilege of working from home. This has propelled some of them to consider relocation from Silicon Valley to more affordable cities in Texas. 

Tech Talent Flee From Silicon Valley 

Do you know that there are more than 225,300 high tech workers in Silicon Valley, San Francisco? To put this into perspective, there are 387,000 high tech jobs in the entire country. So, if there are 225,300 high-tech jobs in Silicon Valley, then you can understand why it is the best hub for web developers around the world. Unfortunately, the city is at risk of losing its position as the number one destination for tech talent. This is primarily because of two things: talent relocation and company relocation. 

Without the companies and the hundreds of thousands of tech workers in Silicon Valley, the city is going to lose its title as the foremost destination for tech gurus in the United States. This makes it one of the most technologically innovative places in the world but it also makes it one of the most expensive. House rent in the Valley is unrealistically high and it's only going to keep increasing. Tech jobs pay more money than many other jobs in Silicon Valley. However, tech workers aren't satisfied with spending all the money they have on daily expenses. 

A small one-bedroom apartment in Silicon Valley costs over $2,000 monthly. By the time you factor in food and other expenses, you might spend over $5,000 just to survive in Silicon Valley every month. This isn't something the average worker can afford. Some of the tech workers who can afford this expensive lifestyle don't think the Valley is worth all the hype. Since they can now work from home, many of these workers have decided to leave the expensive city for more affordable places.

Why should any average worker pay $5,000 monthly to survive when they spend $2,000 for the same standard of living in another city? The primary reason why many of these tech workers remained in Silicon Valley for this long is because of their jobs. Now that they no longer have to go to the office, they want out of the city. Some of them have already indicated an interest in moving to Texas while many others have moved out already. 

Coronavirus is Changing Tech Salaries 

As tech talent and companies flee Silicon Valley, they inspire even more people to leave the overpriced city. However, tech companies that are remaining in Silicon Valley aren't ready to let their talent relocate, remote work, or not. Facebook and other companies have given their workers ultimatums. They have the choice to remain in Silicon Valley and keep their fat salaries or relocate and face cuts. The salary cuts depend on the company but Facebook is threatening to remove up to 10% of the salary of remote workers. Some other companies claim that they will cut between 8% to 20% depending on where their workers choose to go after leaving the Valley. The cheaper the cost of living in the new place, the higher the salary cut.

Bottom Line 

Covid-19 is changing tech salaries in the United States and every other part of the globe. Many similar things have been happening in tech companies around the world, but the most pronounced rate of relocation is in Silicon Valley. Tech companies like Oracle and Hewlett Packard have also left the Valley for Texas. Even Elon Musk has moved from his Silicon Valley home to the Lone Star State. If companies keep leaving the Valley, it will no longer be the most popular tech hub in the world.

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