Physicians in North Carolina are warning that what they describe as Medicare's outdated payment system is putting patient care on the line, especially in rural communities.

For years, Dr. Sreejit Nair's practice, Sunrise Vascular, has provided specialized vascular treatments to patients who would otherwise need to travel hours for care. Now, because of ongoing Medicare cuts, Nair said he fears without immediate reform, his patients and many others in underserved areas could lose access to life-saving treatments.

"It's already too late for many practices," he said, "and there are a few of us that are still trying to hang on for dear life, trying to still provide these desperately needed services to areas of the country where there's no other option."

The problem stems from Medicare's Physician Fee Schedule, which has slashed payments to lower-cost private practices such as Dr. Nair's, while increasing them for higher-cost hospital-based services. The imbalance is pushing many private practices to the brink of closure, leaving patients with fewer options for affordable care.

The Office-Based Facility Association is advocating for reforms to pull high-cost supplies and equipment out of the fees currently covered, and create a new payment model for office-based providers.

Jason McKitrick, the association's executive director, said these changes would still reimburse for these supplies, and be the lifeline for these smaller medical practices.

"Over the last few decades, as the technology advances have allowed those services to move from the hospital to the office-based setting," he said, "the money hasn't gone with it."

He said Medicare's own data show what is reimbursed today doesn't cover the direct cost of care or doctor's salaries for at least 300 office-based services.

McKitrick stressed that without these reforms, the burden will also fall on patients, who'll have to seek more expensive care.

"When these centers shut down, they have to go to a higher-cost site of service - and in many states, the only other option is a hospital," he said, "and so, they're paying up to five times more for some services."

He said this affects patients who need all types of care, from physical therapy to oncology and even cardiac surgery. He suggested that prompt legislative action is critical.

Community Health Centers are stepping up to meet a critical need for dental care across Tennessee.

Dental visits at these clinics have increased by 19% and patient numbers have risen by nearly 16%, underscoring the importance of these services.

Libby Thurman, CEO of the Tennessee Primary Care Association, said the demand has grown, especially as more people have gained dental coverage through TennCare, the state's Medicaid program. Thurman explains TennCare did not cover dental services for adults until recently, although it did cover children.

"In 2023, the state expanded access to dental services under TennCare for adults," Thurman noted. "We have had some challenges keeping up with that demand, and that really stems from just making sure we have enough dentists to serve all of those patients."

In 2023, Community Health Centers in the state provided more than 79,000 dental visits to more than 35,000 patients. Across the state, 24 of the 30 health centers now offer dental health services.

Thurman stressed the importance of having access to dental care, since it is so closely tied to a person's overall health. She added the clinics integrate dental services into their broader mission of providing whole-person care.

"Dental care, aside from just oral health, actually has a lot of links to systemic health," Thurman explained. "It's linked to a lot of chronic disease management - so, if your oral health care is unmanaged, likely your chronic disease could be worsened."

Thurman emphasized Community Health Centers provide care to all, regardless of a person's insurance or income status. They also have a sliding-fee scale, so patients are often able to get dental care at a lower cost than they might find elsewhere.

Groups across the state are working to reduce overdose deaths among minority populations.

According to state data, overdose deaths are on the decline but among Black residents, there were around 68 deaths per 100,000 people last year; more than 51% greater than the overall rate of deaths.

Matt Johnson, board member of the nonprofit CARES Coalition in Franklin County, said the county is struggling with a lack of emergency shelter and medical services for undocumented individuals. The coalition's Community Connectors Project aims to go door-to-door in neighborhoods to help residents access the services they need.

"People who don't necessarily have a visa or a green card, or even health insurance," Johnson outlined. "We need them to be able to go and receive services; for kids to be able to see dentists, especially within our minority population has been a challenge."

The coalition is one of 10 organizations awarded $50,000 grants from the Foundation for a Healthy Kentucky's Funding for Recovery Equity and Expansion program, a partnership with the Cabinet for Health and Family Services' Kentucky Overdose Response Effort.

In Western Kentucky, the Four Rivers Foundation has expanded mental health and health care services in underserved schools.

Dr. Alex Wright, CEO of Wright Medical who works with the foundation, said gaps in access often result in students either not receiving or experiencing long delays in care. He noted so far, more than 3,000 students have been served in the classroom.

"In some of our districts, we estimated up to 50% of children were lacking any continuity of health care," Wright reported. "Many of these children haven't had a pediatrician or primary care provider, usually since they were an infant or a toddler."

Research points to increased stigma surrounding substance use disorder and mental health in communities of color. According to the Yale School of Medicine, treatment inequities persist. Nationwide in 2018, the majority of Black and Hispanic people diagnosed with the substance use disorder did not receive treatment.


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By Cat Sandoval for WISH-TV.
Broadcast version by Joe Ulery for Indiana News Service reporting for the WISH-TV-Free Press Indiana-Public News Service Collaboration

Respiratory syncytial virus (RSV) is on the rise in Indiana, according to the Centers for Disease Control and Prevention, and it's forcing some hospitals to implement visitor restrictions.

Dr. Christopher Doehring, of Franciscan Health in Indianapolis, spoke with News 8 about why this respiratory virus increases during winter months and what hospitals are doing to prevent its spread.

"Like most of the respiratory viruses, as the weather turns cooler and people spend more time inside and around each other, its a just a highly contagious respiratory virus," Doehring said. "Like all respiratory viruses, we tend to see an increase in cases this time of year."

Holiday get-togethers can help spread the virus.

"You start to see around Thanksgiving time, you start having families coming together," Doehring said. "They're spending times in doors and it's multiple generations together. It's a natural epidemiologic phenomenon."

According to medical experts, RSV causes infections in the lungs. In healthy adults and older children, symptoms are mild, similar to the common cold.

RSV can be prevented by using good hygiene, such as washing hands and avoiding touching one's face.

Doehring said babies, premature babies, and immunocompromised elderly adults can experience severe cough, shortness of breath, and pneumonia, or even death. Doehring recommends getting vaccinated.

"Once you have the symptoms or are under the weather, take the time to recover, heal, and minimize exposing others as best as you can," Doehring said.

At Franciscan Health Hospital, masks and hand sanitizers stations are readily available to prevent the spread. Those under the age of 18 because younger visitors are more likely to spread respiratory viruses. Other hospitals in Marion County are doing the same.

Doehring says he has seen an increase of RSV cases, which is typical this time of year, but it's not alarming.

"Certainly in our hospitals and around other hospitals in central Indiana, we're not at a point where we're overrun or overcrowded in our ICUs or emergency department," Doehring said.


Cat Sandoval wrote this article for WISH-TV.


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