HEALTH TRAIN EXPRESS
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State air board has urged a 500-foot buffer zone but now emphasizes design rather than distance.
By Tony Barboza and David Zahniser
Twelve years ago, California air quality officials delivered a warning to cities and counties: Avoid putting new homes in high-pollution zones within 500 feet of freeways.
That advice, which relied on years of research linking traffic pollution to asthma, heart attacks and other health problems, was aimed at keeping “children and other vulnerable populations out of harm’s way,” according to the state Air Resources Board’s 2005 handbook .
But earlier this year, the air board shifted its stance. It issued a newadvisory that emphasizes design rather than distance, recommending anti-pollution features such as air filters, sound walls and thick vegetation as “promising strategies” to reduce the health risks from freeways.
With those measures, communities can build “while simultaneously reducing exposure to traffic-related pollution,” the air board said.
In making that change, air regulators acknowledged a stark reality: Despite health risks, cities desperate for more housing at a time of soaring rents keep approving homes near traffic pollution. The Times reported earlier this year that residential development along freeways has surged in the decade since the air board issued its warning.
Business leaders and housing advocates have cheered the pivot by the air board, contending limits on home building near freeways will worsen an affordability crisis. The new advisory has also been embraced by state planning officials, who say urban development near transit is essential to fighting climate change by reducing reliance on cars.
But some worry that amid a push to build homes, the air-quality agency has muddied what had been a clear, if controversial, health warning.
Scott Fruin, professor of preventive medicine at USC, said the air board’s latest document presents best-case scenarios and overstates the extent to which air filters and other anti-pollution measures protect residents. By recommending those steps, he said, state regulators “may give the false impression that it is now OK to put schools and residences close to freeways.”
“The best current strategy to reduce near-freeway exposure is not to put schools and residences there in the first place,” said Fruin, who previously worked at the Air Resources Board. “Even with the best reduction measures available, air pollution in these locations will remain unhealthy.”
Air board officials said they prepared the advisory to give policymakers the latest, scientifically based options to reduce pollution exposure at a time when the state is encouraging home construction near transit lines that are often next to freeways and other high-traffic corridors.
Those projects are challenging in cities like Los Angeles, “where freeways and major thoroughfares abound,” air board spokesman Stanley Young said. “In responding to that reality, we felt it was important to give planners and developers information on how to mitigate the impacts,” he added.
Kurt Karperos, a deputy executive officer for the air board, said the April advisory does not change the agency’s 2005 recommendation to avoid siting homes within 500 feet of freeways. “That’s a very basic health position that the agency has taken and we still stand by.”
In recent years, Karperos said, some have suggested the agency replace its recommendation for a 500-foot buffer, since vehicles have become less polluting over the last decade. “We disagreed.”
Still, one official in Gov. Jerry Brown’s administration reached a different conclusion, saying the 2005 recommendation “was replaced” by this year’s advisory on air filters, sound walls and other anti-pollution strategies.
Ken Alex, who directs the governor’s Office of Planning and Research, pointed to the April advisory as he defended the state’s decision to finance affordable housing next to freeways. The air board’s position is “much more nuanced than ‘don’t build’ ” within 500 feet, said Alex, whose agency is responsible for long-range policies on how California grows and develops.
State air regulators say their 2005 guidelines have not, in fact, been replaced.
Air Resources Board officials said they decided to supplement them in light of new science on freeway pollution and the effectiveness of air filters and other measures. Regulators drafted a report — an appendix to be considered in addition to the 2005 guidelines — and presented it to the air board in January 2016.
At that meeting, air board chair Mary Nichols acknowledged that the push for dense urban development, which can reduce driving and overall emissions, also can “result in increased exposures for people who live or go to school and spend any time outdoors in areas near roadways.”
“Trying to optimize both of these strategies has proven to be somewhat controversial and an interesting challenge,” Nichols said at the meeting.
The final document, published in April, was an advisory. Air quality officials do not have the power to regulate land use. The document said research shows “the public health, climate, financial, and other benefits of compact, infill development along transportation corridors” and found alternatives to distance-based guidelines “that can protect public health while not dictating development patterns.”
Among the suggestions in the report: Lower speed limits to 55 mph or less and install roundabouts to reduce vehicle emissions. Design city streets with parks, bike lanes, wider sidewalks and buildings with “varying shapes and heights” to disperse traffic pollutants.
The Air Resources Board’s influence has grown considerably over the last decade as its core mission — protecting people from pollution — has expanded to include efforts to slash greenhouse gas emissions. That shift has sparked criticism from some environmentalists, who contend that the board has made tackling health threats from local pollution secondary to the global fight against climate change.
The new focus on anti-pollution design puts the air board in closer alignment with the city of Los Angeles, which has adopted stronger filtration requirements but has not imposed limits on how close homes can be built to freeways. That emphasis also drew praise from housing advocates and developers, who viewed the 2005 guidelines skeptically.
Freeway sound barriers
Stuart Waldman, president of the Valley Industry and Commerce Association, said the air board’s latest advisory “just shows that the original policy was unrealistic to begin with.”
Alan Greenlee, executive director of the Southern California Assn. of Non-Profit Housing, said he is happy the state “seems to have moved in the direction of allowing building where previously they weren’t interested.” With filters and other anti-pollution measures, developers “can house people affordably and healthfully in areas where the government says there are air quality issues.”
Some environmentalists view things differently.
Multi-function walls: Solar, sound and pollution barrier
When the air board’s handbook came out in 2005, “we thought that was a real step forward,” said Bill Magavern, policy director for the Coalition for Clean Air.
Environmental groups have largely favored the state’s push to concentrate new homes near transit, citing the climate benefits. But without limits on home building near freeway pollution, those policies will have unintended health consequences, Magavern said.
“New housing should be well planned so that it’s not putting residents’ health at risk,” Magavern said. “The goal is to have the homes near transit, not near freeways.”
In Southern California, officials with the South Coast Air Quality Management District say they continue to send letters to developers suggesting they increase the distance between new homes and traffic. In the Bay Area, air quality regulators last year published interactive traffic pollution maps and planning guidelines that recommend some of the same design measures as the state.
The Bay Area Air Quality Management District advised communities to put new homes as far from freeway pollution “as is feasible.” The words “as is feasible” were added “at the heavy insistence” of developers and affordable housing advocates, said Jackie Winkel, a principal environmental planner with the agency.
Kristin Baker Spohn is no mere mortal when it comes to hospital administration. If you are feeling inadequate or incompetent.,,,don't. The best experts are humbled by the gordion know which is now hospital charges. You see it is the outcome of fee for service charges, mixed with capitation, and contractual arrangements by disparate health insurers. The computer systems simply cannot keep up with the myriad changes of the Affordable Care Act, Medicare' annual changes in reimbursement, new ICD 10 codes,
This exec has spent her whole career in health care, and even she couldn't get her hospital bill fixed
This is her story about what happened when she noticed a duplicate billing for a procedure she had during her pregnancy...
"I've spent my entire career in health care.
It's impossible to work in this industry and not lament how challenging our system can be for patients. But I didn't truly appreciate its complexity until I was the one navigating it on my own.
Several years ago, I was diagnosed with gestational diabetes and classified as a "high risk" pregnancy. Following my doctor's orders, I had an additional ultrasound to check on the growth of my baby. A little over a week later, I went into labor and delivered my happy and healthy son.
We settled in with our new life at home and in a few weeks the onslaught of hospital bills and explanations of benefits (EOBs) from my health insurance administrator arrived. As the diligent chief financial officer and resident health care expert of our family, I jumped in, determined to reconcile the insurance reimbursement with the hospital bills.
In the haze of new motherhood, my recollection may be fuzzy, but it went something like this:
In one hospital bill, I noticed that there was a duplicate charge for my additional ultrasound.
Most people would groan -- or worse, not even notice the duplicate charge -- but for me, it was game time. I felt like an athlete who had trained for this moment for years. My finance background and attention to detail enabled me to reconcile and find errors in complex financial statements and models. My work at Castlight prepared me to understand all of the different healthcare systems, billing and reimbursement codes. And my weird love of negotiation energized me as I approached the starting line.
How it went down
Step 1: Pull all the documentation together. It is immediately clear that the information in the bills and EOBs isn't sufficient. I need an itemized bill from the hospital and a detailed EOB from my insurance administrator in order to make sense of all of the charges. Because I am on a high-deductible plan like millions of Americans, I also need the benefits coverage detail and my accumulators (how much of my health insurance deductible I had spent at the time of the ultrasound) in order to calculate my co-insurance responsibility.
Step 2: Log into my insurance provider's web portal to look up ultrasound coverage and attempt to determine my remaining deductible at the time of the ultrasound. I find the coverage information under "imaging benefits" and read that ultrasounds are "covered as a preventive service," but it's unclear what constitutes a preventive ultrasound vs. a non-preventive ultrasound, and which category mine falls into. I will need more detail from the hospital to figure this out.
Step 3: Call the hospital to get an itemized billing for the date of service which included the ultrasound. I request the CPT code for the service and am told that it is in a different department and I'll need to call back after 9am the next day.
Kristin Baker Spohn
[At this moment, my son starts crying. Break to change his diaper.]
Step 3b: Call the other hospital department line and ask for the CPT code (the guy on the line is shocked I know what a CPT code is and is confused why I'm asking for it).
[Next, I break to put my son down for a nap.]
Step 4: Call the insurance administrator for benefits coverage information related to ultrasounds. I'm informed that my benefits detail is specific to my employer's coverage and I should call my company's benefits team to ask for it.
Step 5: Call my company's HR team. They say, actually, since we are a fully-insured employer, the benefits should be available through my insurance administrator. Of course.
[Break again to take a quick work call.]
Step 6: Call the insurance administrator back and ask for the detailed summary of benefits. The support representative says I can go on the web portal, download, print and fill out and a request form and the document will be snail-mailed to me. Snail mail!
Step 7: Put my son in a stroller and walk to Fedex/Kinko's to print out the form and mail it in.
[Wait several weeks, it doesn't arrive. Baby gains two pounds!]
Step 8: Call the hospital back to request that they not send my bill to collections as there is an ongoing discussion with the billing department and insurance administrator over benefits coverage. I am assured by the support representative that this is noted in my file.
Everyone having fun yet?
Good, because we're going to rinse and repeat...for several weeks.
Why I gave up
After bouncing between three web portals and at least five call centers (across hospital departments and insurance administrator customer service lines), and spending more than 18 hours on the phone asking for CPT codes, diagnosis codes, and benefits information, and requesting extensions on my bill so that I could continue to pursue the reconciliation, I received….a collections notice.
I had been confident I could take care of this situation on my own, but after weeks of roadblocks and hold music, I felt defeated. I paid the bill. I couldn't risk the negative impact an unpaid bill could have on my credit score as my young family considered buying our first home.
Despite the fact that I had a (self-designated) advanced degree in healthcare technology, benefits and billing, I failed to successfully navigate the system.
I was recovering from childbirth, caring for a newborn, working on my company's upcoming IPO, and struggling to reconcile my hospital bills from a set of common services in a pregnancy.
My experience, while personally disheartening, added new fuel to my my passion for driving innovation and change in healthcare. If can't figure this out, what hope is there for the rest of us?
How health care could be
Contrary to some of the recent rhetoric from lawmakers, high-deductibles and health savings accounts (HSAs) won't magically create empowered healthcare consumers or a functional healthcare marketplace.
Stakeholders across the healthcare ecosystem system need to innovate, remove friction points and thoughtfully design products and processes that enable the experiences we would want for our own families. I've worked to help build two such innovative companies. And I'm joining Social Capital to broaden that reach.
I'm looking to work with health care entrepreneurs that understand the world as it is today, but also see how it could be. A world where everyone gets the experience they deserve, whether they're experts in the healthcare system, or the next new parents struggling to understand a bill.
Perhaps one of the most vulnerable groups are those with addiction disorders. This story is about inadequate safeguards as to whom is allowed to operate these 'sober homes' and the poor if not existent record keeping.
The Orange County Register (California) TonySaavedra and Scott Schwebe investigated the Califonia system of recovery and sober homes. The allegations, if true are disturbing. Philip Ganong, his wife and their 34-year-old son built a fast-growing, multimillion-dollar empire on urine.
They collected it from drug addicts at their chain of Southern California sober living homes. They created labs to test it. And they charged insurance companies to analyze it.
But the success story was a scam, according to prosecutors, who have accused the Ganongs of fraud. They say the family used a network of doctors and others to bilk insurers out of as much as $22 million for tests that were unnecessary or never performed.
The Ganongs have pleaded not guilty and are awaiting trial.
But the allegations raised in the Ganong case highlight what a growing number of critics say are chronic shortcomings in the oversight of California’s multi-billion-dollar drug rehabilitation industry.
Among the complaints:
Drug counselors and others can run sober living homes and some types of treatment centers without passing any kind of criminal background check. Even people convicted of drug crimes are allowed, under current state law, to get a license to own and/or operate drug and alcohol rehab centers.
Addicts and families considering rehab have no easy way to check the records of treatment centers, recovery homes or their owners or staff.
The state lags behind others in adopting reforms to crack down on treatment center operators who exploit vulnerable addicts and focus more on profits than on effective care.
California is “the wild, wild west right now,” said Kansas Cafferty, a commissioner with the National Certification Commission for Addiction Professionals.
In a state with about 1,800 licensed recovery centers and an unknown number of unlicensed sober living homes and testing labs, Cafferty is among many who believe California needs to get better at rehab regulation.
“There (are) a lot of places committing crimes that authorities are trying to enforce, but they can’t keep up with it.”
The state agency has only a broad guidance system, with few enforceable actions.
It’s not a new problem, and California legislators have fought about it for years. Still, they’ve made only halting progress in beefing up licensing standards and rehab monitoring. That’s partly because of industry lobbying, and because of fears that tighter rules will raise treatment costs or limit the number of rehab beds just when the nation’s opioid crisis is cranking up demand.
This year, State Sen. Pat Bates, R-Laguna Niguel, introduced a bill to reform the system, but it stalled in committee. Today, she describes the state’s oversight of rehab operators, sober living homes and counselors as “troubling.”
operator’s) background,” Bates said. “There’s a culture about giving these people a second chance.”
Still, she insists that background checks and tougher licensing requirements for counselors, employees and rehab operators are vital. “It’s something we need to pursue.”
Putting a face on it. Alex Schmick dies of an overdose while living in a recovery facility. The family sued the facility and the physician who wrote the order for the medication.
California lags other states
Smick is not the first to raise the issue of transparency. A state Senate report in 2012 found a host of oversight problems in the recovery industry, including poor monitoring of rehab centers and inadequate information sharing related to treatment center operators.
Other state officials have pointed to financial abuses in the industry that authorities say bleed millions from public and private pockets. Part of the concern is tied to so-called “junkie hunters,” people who recruit addicts from around the country and bring them to rehab centers in California in return for kickbacks.
One area of the rehab industry – sober living homes – has virtually no oversight.
The homes, where addicts often live for a few months after leaving formal rehab, aren’t required to submit any records of their operations. This is true, in part, because operators aren’t claiming to provide medical treatment and the people living in them, recovering addicts, are protected under the Americans with Disabilities Act.
Policy analysts at the Centers for Disease Control and Prevention in Atlanta were told of the list of forbidden terms at a meeting Thursday with senior CDC officials who oversee the budget, according to an analyst who took part in the 90-minute briefing. The forbidden terms are “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based.”
In some instances, the analysts were given alternative phrases. Instead of “science-based” or “evidence-based,” the suggested phrase is “CDC bases its recommendations on science in consideration with community standards and wishes,” the person said. In other cases, no replacement words were immediately offered.
However it is no more offensive that our official government is banning certain words from HHS publications. This seems very similar to the past ban on network television of the seven 'famous' do not say words, in the words of George Carlin which first appeared in "Class Clown" his famous album, published in 1972.
These expletives can truly be assigned to our medical system.