Home Care Agencies Often Wrongly Deny Medicare Help To The Chronically Ill
Colin Campbell, shown last month in his home near Los Angeles, was diagnosed with Lou Gehrig’s disease — ALS — eight years ago. He gets Medicare because of his disability, but was incorrectly told by several agencies that he couldn’t use it for home care. Instead, he pays $4,000 a month for those services.
Heidi de Marco/Kaiser Health News
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Heidi de Marco/Kaiser Health News
Colin Campbell needs help dressing, bathing and moving between his bed and his wheelchair. He has a feeding tube because his partially paralyzed tongue makes swallowing “almost impossible,” he says.
Campbell, 58, spends $4,000 a month on home health care services so he can continue to live in his home just outside Los Angeles. Eight years ago, he was diagnosed with amyotrophic lateral sclerosis, or Lou Gehrig’s disease, which relentlessly attacks the nerve cells in his brain and spinal cord and has no cure.
Because of his disability, he has Medicare coverage, but he can’t use it for home care — as the former computer systems manager has been told by 14 home health care providers.
That’s an incorrect but common belief. Medicare does cover home care services for patients who qualify but, according to advocates for seniors and the home care industry, incentives intended to combat fraud and reward high quality care are driving some home health agencies to avoid taking on long-term patients, such as Campbell, who have debilitating conditions that won’t get better. Rule changes that took effect this month could make the problem worse.
“We feel Medicare coverage laws are not being enforced and people are not getting the care that they need in order to stay in their homes,” says Kathleen Holt, an attorney and associate director of the Center for Medicare Advocacy, a nonprofit, nonpartisan law firm. The group is considering legal action against the government.
Because of his ALS, Colin Campbell needs to wear a brace, and he relies on help from a home health worker to get bathed and dressed every day.
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Heidi de Marco/Kaiser Health News
Federal law requires Medicare to pay indefinitely for home care — with no copayments or deductibles — if a doctor ordered it and patients can leave home only with great difficulty. They must need intermittent nursing, physical therapy or other skilled care that only a trained professional can provide. They do not need to show improvement.
Those who qualify can also receive an aide’s help with dressing, bathing and other daily activities. The combined services are limited to 35 hours a week.
Medicare affirmed this policy in 2013 when it settled a key lawsuit brought by the Center for Medicare Advocacy and Vermont Legal Aid. In that case, the government agreed that Medicare covers skilled nursing and therapy services — including those delivered at home — to maintain a patient’s abilities or to prevent or slow decline. It also agreed to inform providers, those who audit bills, and others that a patient’s improvement is not a condition for coverage.
Campbell is able to move around his house with the help of a walker.
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Campbell says some home health care agencies told him Medicare would pay only for rehabilitation, “with the idea of getting you better and then leaving,” he says. They told him that Medicare would not pay them if he didn’t improve, he says. Other agencies told him Medicare simply did not cover home health care.
Medicaid, the federal-state program for low-income adults and families, also covers home health care and other home services, but Campbell doesn’t qualify for Medicaid.
Securing Medicare coverage for home health services requires persistence, says John Gillespie, whose mother has gone through five home care agencies since she was diagnosed with ALS in 2014. He successfully appealed Medicare’s decision denying coverage, and afterward Medicare paid for his mother’s visiting nurse as well as speech and physical therapy.
“You have to have a good doctor and people who will help fight for you to get the right company,” says Gillespie, of Orlando, Fla. “Do not take no for an answer.”
Yet a Medicare official did not acknowledge any access problems. “A patient can continue to receive Medicare home health services as long as he/she remains eligible for the benefit,” says spokesman Johnathan Monroe.
A leading industry group contends that Medicare’s home health care policies are often misconstrued. “One of the myths in Medicare is that chronically ill individuals are not qualified for coverage,” says William Dombi, president of the National Association for Home Care and Hospice, which represents nearly half of the nation’s 12,000 home care providers.
Part of the problem is that some agencies fear they won’t be paid if they take on patients who need their services for a long time, Dombi says. Such cases can attract the attention of Medicare auditors who can deny payments if they believe the patient is not eligible, or they suspect billing fraud. Rather than risk not getting paid, some home health agencies “stay under the radar” by taking on fewer Medicare patients who need long-term care, Dombi says.
And those companies may have a good reason to be concerned. Medicare officials have found that about a third of the agency’s payments to home health firms in the fiscal year ending last September were improper.
Shortages of home health aides in some areas might also lead an overburdened agency to focus on those who need care for only a short time, Dombi says.
Another factor that may have a negative effect on chronically ill patients is Medicare’s Home Health Compare ratings website. It includes grades on patient improvement, such as whether a client got better at walking with an agency’s help. That effectively tells agencies who want top ratings “to go to patients who are susceptible to improvement,” Dombi says.
This year, some home care agencies will earn more than just ratings. Under a Medicare pilot program, home health firms in nine states will start receiving payment bonuses for providing good care and those who don’t will pay penalties. Some criteria used to measure performance depend on patient improvement, Holt says.
Another new rule, which took effect last Saturday, prohibits agencies from discontinuing services for Medicare and Medicaid patients without a doctor’s order. But that, too, could backfire.
“This is good,” Holt says. “But our concern is that some agencies might hesitate to take patients if they don’t think they can easily discharge them.”
This article was written with the support of a journalism fellowship from New America Media, the Gerontological Society of America and the Silver Century Foundation. Kaiser Health News (KHN) is a nonprofit news service. It’s an editorially independent program of the Kaiser Family Foundation, and not affiliated with Kaiser Permanente. You can find Susan Jaffe on Twitter @susanjaffe.
Today in Movie Culture: Fan-Made 'Nightwing' Trailer, Spotlight on Daniel Day-Lewis and More
Here are a bunch of little bites to satisfy your hunger for movie culture:
Dream Movie of the Day:
What if Joseph Gordon-Levitt had starred in a Nightwing movie spun off from Christopher Nolan’s Dark Knight trilogy? This fan-made trailer by fan-made trailer by Stryder HD imagines the missed opportunity:
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Remade Scene of the Day:
There was one thing missing from the climactic battle scene in Star Wars: The Last Jedi, so here are some kids with an extended re-ceation (via Rian Johnson):
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Cosplay of the Day:
Speaking of The Last Jedi, here’s a funny but cheap and efficient and sufficient way to cosplay as one of Snoke’s Elite Praetorian Guards:
god i love cosplay pic.twitter.com/Rax3i71ixf
— Sequel Memes (@SequelMemes) January 16, 2018
Cover Song of the Day:
Watch a very clever fan perform the Star Wars “Cantina Song” on a Rubik’s Cube as he’s quickly solving it (via Geekologie):
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Truthful Marketing of the Day:
The latest Honest Trailer tackles the phenomenal critical and box office hit Stephen King adaptation It and reveals it to be very far from perfect:
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Vintage Image of the Day:
John Carpenter, who turns 70 today, sits back on the set of his 1986 cult classic Big Trouble in Little China:
Actor in the Spotlight:
In honor of the widening release of Phantom Thread, No Small Parts showcases the career of Daniel Day-Lewis:
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Movie Influences of the Day:
With I, Tonya and other biopics in theaters this time of year, here’s a look at movies based on true stories side by side with actual footage of the real-life subjects:
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Fan Theory of the Day:
More than 20 years later, we still don’t know what’s in the briefcase in Pulp Fiction, so here’s Metaflix with a look at the still most popular theory (via /Film):
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Classic Trailer of the Day:
Today is the 20th anniversary of the theatrical release of Half Baked. Watch the original trailer for the classic comedy below.
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and
Turning Soybeans Into Diesel Fuel Is Costing Us Billions
An engineer shows a sample of biodiesel at an industrial complex in General Lagos, Santa Fe province, Argentina. The United States recently imposed duties on Argentine biodiesel, blocking it from the U.S. market.
Eitan Abramovich/AFP/Getty Images
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Eitan Abramovich/AFP/Getty Images
This year, trucks and other heavy-duty motors in America will burn some 3 billion gallons of diesel fuel that was made from soybean oil. They’re doing it, though, not because it’s cheaper or better, but because they’re required to, by law.
The law is the Renewable Fuel Standard, or RFS. For some, especially Midwestern farmers, it’s the key to creating clean energy from American soil and sun. For others — like many economists — it’s a wasteful misuse of resources.
And the most wasteful part of the RFS, according to some, is biodiesel. It’s different from ethanol, a fuel that’s made from corn and mixed into gasoline, also as required by the RFS. In fact, gasoline companies probably would use ethanol even if there were no law requiring it, because ethanol is a useful fuel additive. That’s not true of biodiesel.
“This is an easy one, economically. Biodiesel is very expensive, relative to petroleum diesel,” says Scott Irwin, an economist at the University of Illinois, who follows biofuel markets closely. He calculates that the extra cost for biodiesel comes to about $1.80 per gallon right now, meaning that the biofuel law is costing Americans about $5.4 billion a year.
Irwin explains that use of biodiesel is driven by three different parts of the Renewable Fuel Standard. The law includes a quota for biodiesel use, but in addition to that, biodiesel also is used in order to meet the law’s demand for “advanced biofuels.” Finally, there’s an overall quota for biofuels of all sorts, and companies are using biodiesel to meet that quota as well because they’ve run into limits on their ability to blend ethanol into gasoline.
Defenders of biodiesel insist that it’s a much cleaner fuel than regular diesel, because it doesn’t come from the ground, but from soybean plants that capture carbon dioxide from the air as they grow. In fact, by the EPA’s calculations, replacing petroleum-based fuel with biodiesel will cut greenhouse emissions at least in half.
A growing number of environmentalists, however, say that this calculation is dead wrong. They say that if more soybeans are needed to make fuel in addition to food, it inevitably means that people somewhere on Earth will have to plow up grasslands or cut down forests in order to grow that additional supply — and clearing such land releases huge amounts of carbon dioxide into the atmosphere.
Two environmental groups — ActionAid USA and Mighty Earth — just released a report connecting America’s biodiesel demands directly to deforestation in Argentina.
Investigators from the two groups documented widespread clearing of Argentine forests in order to expand cultivation of soybeans. Simultaneously, Argentina expanded its exports of soybean-derived biodiesel to the United States. In 2016, in fact, Argentina shipped more than 400 million gallons of biodiesel to the U.S., equivalent to almost 15 percent of all the biodiesel that Americans consumed.
The story, however, is more complicated than it seems. For one thing, that boom in Argentine biodiesel exports is over, at least for now. Last summer, the the United States accused Argentina of subsidizing its biodiesel producers and “dumping” cheap biodiesel on the world market. In retaliation, the U.S. imposed hefty taxes on on all biodiesel from Argentina. Overnight, those imports ceased. Americans now will have to rely on biodiesel produced here in the U.S. — which also is more expensive. (In a way, Argentina was doing the U.S. a favor, helping it satisfy its biodiesel demands more cheaply.)
In addition, the most powerful factor driving demand for soybeans these days is China’s appetite for soy meal, to feed its pigs and chickens, rather than America’s need for soy oil to make fuel.
“The big story is China’s demand,” says Irwin of the University of Illinois. “If anything is related to tearing up pastures in Argentina to grow soybeans, it’s China and not biodiesel.”
In fact, China wants so much soy meal that it’s boosted global supplies of soy oil, because soybeans, when they’re crushed, yield both meal and oil. By satisfying China’s demand for meal, soy processors inevitably end up with plenty of oil to sell, too. (Interestingly, this is a reversal of the situation a century ago, when soybeans were mainly grown for their oil, and producers struggled to find uses for the meal.)
White House Doctor Says Trump Is In 'Excellent' Physical, Cognitive Health
President Trump shakes hands with White House physician Ronny Jackson, following his annual physical at Walter Reed National Military Medical Center on Jan. 12.
Saul Loeb/AFP/Getty Images
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President Trump is in excellent health with “no indication” of “any cognitive issues” — but he could afford to lose a few pounds and start exercising over the coming year, according to the president’s physician.
Dr. Ronny Jackson, a Navy rear admiral who directs the White House medical unit, conducted Trump’s annual physical last Friday. He told reporters on Tuesday that the president’s cardiac health is strong and that there are no concerns about any memory or cognitive issues.
“I found no evidence that the president has any issues whatsoever with his thought process,” Jackson told reporters during Tuesday’s White House briefing.
The tabloid-style book Fire and Fury by journalist Michael Wolff, published this month, led to speculation about Trump’s mental fitness for office. Trump responded to the criticism by calling himself a “very stable genius.”
Jackson said on Tuesday that Trump asked him to perform the cognitive exam, which the doctor had not planned to do, having deemed it unnecessary. Jackson said Trump performed “exceedingly well” and is “very sharp.”
Jackson said the president enjoyed good health despite a subpar diet and no exercise routine.
“It’s called genetics,” Jackson said. “Some people just have great genes. I told the president if he had a healthier diet over the last 20 years he might live to be 200.”
Jackson also noted that Trump has abstained from alcohol and tobacco for his entire life, which contributed to his relatively good health.
Trump, 71, is 6 feet 3 inches tall and weighs 239 pounds, Jackson said, which is classified as overweight and is 1 pound away from being obese, according to the NIH’s body mass index calculator.
Jackson said he will work with Trump to exercise more over the coming year, to eat better and lose between 10 and 15 pounds.
Trump does take Crestor to lower his cholesterol, daily aspirin for heart health, Propecia for male pattern baldness, a skin cream for rosacea and a daily multivitamin. His blood tests and other vitals were all normal.
Jackson said that there is no reason Trump wouldn’t be able to complete his first term healthwise, in addition to a second term if re-elected.
During the presidential campaign, Trump’s longtime personal physician, Harold Bornstein, famously declared that Trump would be “the healthiest individual ever elected to the presidency.” Trump released his health history in 2016 on controversial TV host Dr. Mehmet Oz’s show.
Banana Drama Gets Much Attention At Australian Open
CoCo Vandeweghe was fined by a referee for refusing to take to the court before she had a chance to eat her banana. Denis Shapovalov could not seem to peel a banana right during a break in his match.
RACHEL MARTIN, HOST:
Good morning. I’m Rachel Martin. Now to the drama of this year’s Australian Open over bananas – there was CoCo Vandeweghe, who was fined by a referee for refusing to take to the court before she had a chance to eat her banana. The best, though, is Denis Shapovalov. For whatever reason, he could not seem to peel a banana right during a break in his match. A video shows him getting exasperated, even throwing one of the bananas on the ground. Finally, one more go at it – and, yes, he gets the banana open, complete with an arm pump of victory. It’s MORNING EDITION.
Copyright © 2018 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.
LinkedIn Co-Founder On What Resolutions Silicon Valley Should Make For 2018
Between sexual harassment scandals, fake ads and stronger calls for regulation, Big Tech had a rocky year in 2017. LinkedIn Co-founder and venture capitalist Reid Hoffman talks with NPR’s Kelly McEvers about resolutions Silicon Valley should make in 2018.
KELLY MCEVERS, HOST:
And in All Tech Considered this week, we are talking about what is ahead for the tech industry in 2018.
(SOUNDBITE OF ULRICH SCHNAUSS’ “NOTHING HAPPENS IN JUNE”)
MCEVERS: In some ways, 2017 was a great year for tech companies – big growth, big profits. In other ways, it was a pretty bad year. Facebook, Twitter and Google admitted that Russian operatives used their platforms to promote fake stories during the election. There were sexual harassment scandals and criticism of the fact that white men still basically run the place.
My guest is someone who knows many of the leaders of these companies, Reid Hoffman. He is a venture capitalist. He’s the co-founder of LinkedIn. And he’s got some thoughts about how Silicon Valley can do better in 2018. Welcome to the show.
REID HOFFMAN: It’s great to be here.
MCEVERS: Up until now, tech companies have not been super great at taking responsibility for their problems. Do you think that this is the year of reckoning for tech companies?
HOFFMAN: Well, I hope that it’s actually a year of growth. I think actually part of what the tech companies are learning is they started as challengers, these kind of, you know – think of it as young teenagers with good ideas…
MCEVERS: Yeah.
HOFFMAN: …Trying to prove themselves. And now they realize I think, no, actually, in fact, we’re the incumbents. We’re the providers of the infrastructure. We have influence in the national dialogue, and we need to upgrade our play. And I think you can see that as the changing messages from them throughout the year. The way I like to look at this is – I have a funny phrase. It’s Spider-Man ethics. With power comes responsibility. With great power comes great responsibility.
And I think there’s beginning to have that recognition of, we have this responsibility, and we know that we need to act now both in conversation with society and societies and also to make sure that, like, there’s a higher level of trust and reliability and information and in a kind of – a sense of safety and security in your participation in these online networks and communities.
MCEVERS: Last year you came out with a decency pledge, and it was aimed at stopping sexual harassment in the industry. And one of the things you talked about was how much power venture capitalists have over entrepreneurs, entrepreneurs who frankly need the money (laughter), right?
HOFFMAN: Yeah.
MCEVERS: What’s being done about that? Like, how – you’re not going to undo that system, the way things work in that industry. So how do you address the problem?
HOFFMAN: Well, so the decency pledge is meant to be a – kind of a first step to just have a whole bunch of people say, look; I will not do business with people who are, you know, sexual predators, harassers, abusing their position of power in any capacity. And then everyone can make the public statement to that and that part of that public statement is then not only am I articulating a voice, but I can also be held accountable by the people who know me and see what’s going on.
I think the thing that we need to move from is – you know, last year’s decency pledge was very much of the, look; here’s a baseline that we can all do to step forward as individuals. To react to this, I think we now need to move from that reactive game to a proactive game.
MCEVERS: I just want to be really specific. Like, is that a step that’s led to any change, you know, that you can point to, any examples?
HOFFMAN: Well, I think one of the things that was really awesome is a large number of the powerful VCs in the Valley all publicly signed up to it.
MCEVERS: Yeah.
HOFFMAN: They all said, hey, I’m taking this, too. So I do think – I’ve heard from women entrepreneur friends of mine, women investor friends of mine that the atmosphere has become much more conducive to being able to speak up. And I do think that people are paying attention to – is, like, not only do we protect the victims, but we also try to fix the system. And we try to say, we have a zero tolerance around, you know, sexual harassment, sexual predators trying to abuse these power relationships. And so I think at least it’s moved the culture in the right direction. And I’ve heard good signs and conversation. I don’t have a dashboard that I could share.
MCEVERS: Recently some Apple investors urged the company to address concerns that its technology was hurting children. You know, there’s been a lot of fear out there – right? – that tech is addictive and it’s harmful or, at the very least, it’s replacing, you know, human interactions. Do you think one day we will think of tech companies the way we think of big tobacco – you know, this idea of, like, selling a dangerous product without consequences, without remorse at least?
HOFFMAN: Look; so technology always has some rough edges and downsides as well as upsides. But overall, you know, I’m glad we have it. I’m glad we’re more globally connected. I’m glad we have – even though it’s an information overload, (laughter) I’m glad we have a lot of information and can do searches and find information on things.
And you know, I tend to think that a lot of this tends to be older generations. Like, we feel, like, addicted and overwhelmed, but then the younger generations learn and adapt. So I tend to think that people are adaptive. And we can improve the technology to be net massively positive. So I think the chance that future technology is looked at as Big Tobacco is almost zero.
MCEVERS: But it puts the onus on the people who are using it – right? – to sort of adapt. And it puts a lot of, like, faith in you guys to do good. And I think that’s the hard sell right now, right?
HOFFMAN: Well, so that’s a little bit of the reason why was saying I think the broad move is towards more transparency. And either the industry will adopt ways of being transparent, which I hope and I’m pushing for. Or the government will say, well, OK, since you’re not actually being sufficiently disclosive to make sure that we don’t feel like we’re being manipulated and so forth, then we’re going to establish some rules. And the rules may limit your ability to innovate and create great new things for the world and for us, but c’est la vie.
MCEVERS: Yeah.
HOFFMAN: But I have faith that part of what I’m seeing happening, as I mentioned in the beginning, in 2017 is that the technologists and the technology companies are going, hey, no, we have responsibilities here. Let’s try to figure them out.
MCEVERS: Do you think it’s time in 2018 for, you know, more regulation?
HOFFMAN: Well, my big worry is that the most common pattern in regulation is to lock the past in slow motion against the future.
MCEVERS: Right.
HOFFMAN: And, A, I think the future’s very good for us – you know, what we can invent in precision medicine and what we can invent in anything from new communications technologies to autonomous vehicles and so forth. The second point of it is – is actually, you know, nations and groups are in competition. So if we say, well, we’re going to slow down our tech development, (laughter) you know, I don’t think other countries – China, et cetera – I don’t think they will be.
Now, that being said, if you said, OK, you know, we got to do some regulation – must do – what would it be? It would be like, well, try to demand some more transparency on the variables that most matter to you, like how much, you know, for example, election hacking is actually going on on your platform, (laughter) right?
MCEVERS: Right, yeah.
HOFFMAN: And what are you doing about it?
MCEVERS: Yeah.
HOFFMAN: And you need to be transparent about that. It’s not that we say, no election hacking. It’s – we say, you’ve got to give us good reports about what’s going on and how you’re making progress and what you’re doing about it. And I think that would be the kind of thing that I think – I hope tech companies will do more voluntarily. And I also think that if you – if I were to start doing anything because I’m so concerned about technology being part of the solution as opposed to part of the problem – that we don’t slow down our path to the solution.
MCEVERS: Reid Hoffman is a partner at the Silicon Valley venture capital firm Greylock. He also hosts the Masters of Scale podcast. Thanks for being with us.
HOFFMAN: Awesome to be here.
(SOUNDBITE OF CUT CHEMIST SONG, “THE GARDEN”)
Copyright © 2018 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.
For Once, The Minnesota Vikings Could Be A Team Of Destiny
The NFL team that could never catch a playoff break finally got one. In their NFC Divisional Round matchup, the Minnesota Vikings pulled off a miracle win against the New Orleans Saints. NPR’s Kelly McEvers speaks with Ben Goessling, who covers the team for the Star Tribune.
KELLY MCEVERS, HOST:
There’s sad, and then there’s the playoff history of the Minnesota Vikings. Despite having some of the greatest teams in NFL history, the Vikings have never won a title. In fact, they were the first team to lose four Super Bowls. You’ve heard of the Hail Mary pass, right? Well, you can think the Vikings for that. The phrase Hail Mary pass was first used in 1975 after the Dallas Cowboys’ last-second miracle touchdown pass beat the Vikings. So last night, with the Vikings trailing the New Orleans Saints going down to the final play, most fans thought it was going to be yet another awful moment until it wasn’t.
(SOUNDBITE OF ARCHIVED RECORDING)
PAUL ALLEN: Case on a deep throw, steps up in the pocket. He’ll fire to the right side, caught by Diggs.
UNIDENTIFIED SPORTSCASTER: (Screaming) Oh, my God, oh, my God, no way.
ALLEN: (Screaming) At the 30, 10 – touchdown.
UNIDENTIFIED SPORTSCASTER: (Screaming) What a miracle finish.
ALLEN: (Screaming) Are you kidding me? It’s a Minneapolis miracle.
UNIDENTIFIED SPORTSCASTER: (Screaming) No way.
MCEVERS: Could that Minneapolis miracle lead to the first Vikings Super Bowl title? To talk about that, we turn to Ben Goessling, who covers the Vikings for the Star Tribune. Hey, Ben.
BEN GOESSLING: Hi. How are you?
MCEVERS: Good. So you are a native Minnesotan. Can you explain how bad things have actually been over the years?
GOESSLING: I guess I always put it this way. It’s appropriate in some ways that Charles Schulz, the creator of “Peanuts,” is from Minnesota because obviously everybody knows the skit in “Peanuts” where Charlie Brown thinks he’s going to get to kick the football. And every time he gets his hopes up and then Lucy pulls the ball out, he ends up sitting on the ground, you know, sort of wondering what just happened. And that really epitomizes the Vikings’ experience in the playoffs. I mean, every time they get close, something happens. So I mean, really that’s what made yesterday so remarkable.
MCEVERS: What’s it like in Minnesota right now?
GOESSLING: People are on cloud 9 right now. To be in that stadium yesterday when they scored that touchdown, it was just kind of this mixture of shock and exultation in a lot of ways. And you see that kind of spilling forward into today. People are, you know, all over social media, raving about the game as people posted videos of where they were, you know, what they were doing when they when the game ended, you know, what their reaction to the play was. There were people out doing snow angels.
MCEVERS: (Laughter).
GOESSLING: And it was no small feat given the fact it was sub-zero temperatures for most of the day and we got a bunch of snow. So it’s the kind of win, as a couple of players said yesterday, you almost have to go forward now and make it to the Super Bowl and win it. You don’t want to waste something like that and what it meant for fans. And it’s quite a remarkable thing for people around here that are used to (laughter) suffering for a long time.
MCEVERS: We should say that the Super Bowl will be in Minneapolis this year.
GOESSLING: It will.
MCEVERS: So if the Vikings win next weekend, they’ll be the first host team to actually play in the Super Bowl. I mean, does it feel like with that plus last night, things are finally coming together? Or do you not want to say anything and jinx it?
GOESSLING: Well, I mean, players certainly have been asked that question. Does this feel like a team of destiny? And you know, the number of things they’ve had go wrong in the past – a lot of those could’ve happened this year. They lose their starting quarterback, Sam Bradford, after week one. Dalvin Cook, their first pick in the draft, the running back, goes down in week four. I mean, a lot of these injuries that you think, OK, this is going to be what derails them really haven’t.
So you know, it’s going to be very interesting to see what the Super Bowl is like because, you know, the NFL tries to do everything they can to make it as neutral an environment as possible. But the Vikings are going to have some built-in advantages if they’re in that game. It really would be a one-of-a-kind environment for a Super Bowl if they make it. And you know, at this point, you know, obviously we root for stories as much as anything, and it would be a fantastic story if they make it.
MCEVERS: Ben Goessling covers the Vikings for the Star Tribune. Thanks so much.
GOESSLING: Thank you – enjoyed it.
(SOUNDBITE OF JAMES MCLEOD’S “SKOL, VIKINGS”)
Copyright © 2018 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.
Box Office Report: Spielberg's 'The Post' Expansion Scoops Other New Releases at Box Office
Here’s your estimated 3-day box office returns (new releases bolded):
1. Jumanji: Welcome to the Jungle – $27.0 million ($283.1 million total)
2. The Post – $18.6 million ($23.0 million total)
3. The Commuter – $13.4 million ($13.4 million total)
4. Insidious: The Last Key – $12.1 million ($48.3 million total)
5. The Greatest Showman – $11.8 million ($94.5 million total)
6. Star Wars: The Last Jedi – $11.2 million ($591.5 million total)
7. Paddington 2 – $10.6 million ($10.6 million total)
8. Proud Mary – $10.0 million ($10.0 million total)
9. Pitch Perfect 3 – $5.6 million ($94.6 million total)
10. Darkest Hour – $4.5 million ($35.73 million total)
The Big Stories
Weekend two of 2018 is not much different than weekend one except (1) there are a lot more new movies to see and (2) there’s a holiday on Monday. People went to see the new movies but they were still clearly interested in catching up on the movies that were dominating at the end of 2017. Aside from that, though, at least one of the season’s major Oscar contenders finally expanded into wide release and had an opening that should be very encouraging with nominations just around the next weekend corner.
Publish or Perish
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Steven Spielberg’s The Post started filming last June and was put into limited release in late December. While he continues to work on Ready Player One, which he filmed before and will be released on March 30, Spielberg felt the story of a corrupt, lying President who tried to shut down press freedom may have had some significance in our time. What could have given him that idea? The historical prequel (of sorts) to All the President’s Men had made nearly $4.5 million in the 21 days leading up to this weekend, starting with just nine theaters and expanding to 36 last week. This weekend it moves into 2,819 and once again it couldn’t feel more timely.
Spielberg, without question, is one of our greatest living directors (and you can put him up against most of the passed-on ones as well.) Don’t take my word for it, though, as evidenced by his critical score at Rotten Tomatoes since just 2001:
Catch Me If You Can (96%), Minority Report (91%), Bridge of Spies (91%), Lincoln (90%), The Post (88%), Munich (77%), Indiana Jones and the Kingdom of the Crystal Skull (77%), War Horse (76%), The BFG (75%), The Adventures of Tintin (74%), War of the Worlds (74%), A.I.: Artificial Intelligence (73%), The Terminal (60%).
Not a rotten tomato in the batch overall with an 80.1% average. Mathematically, four out of five critics think the man makes good movies, and we’re not even listing Jaws, Close Encounters, Raiders of the Lost Ark, E.T. and Jurassic Park (to name just a few.) The box office numbers these days can’t entirely compare to those films, which have alternated between fantasy and drama. The Post‘s $18.6 million weekend is firmly between Bridge of Spies‘ $15.3 million start and The Terminal‘s $19 million (which occurred in June of 2003.)
When Lincoln went wide in just its second week in mid-November 2012, it made $21 million that weekend and played into April to the tune of $182.2 million. The Post didn’t have the advantage of the full holiday season to boost its total and its opening might not be quite in the same league for Tom Hanks as Sully ($35 million) and Captain Phillips ($25.7 million). But we should expect the word-of-mouth to be strong and the numbers to not trail off too far once the film gets nominations for Best Picture and Actress (and possibly Director and Actor, though slightly less certain) and head somewhere in the vicinity of $100 million or more.
Tales of the Top Ten
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It was certainly a packed week at the box office. The best of the newest of newbies turned out to be The Commuter, Liam Neeson’s fourth collaboration with Jaume Collet-Serra. It opened to slightly better than their last film together, Run All Night ($13.4 vs. $11 million.) Comparatively, it’s critical and audience scores are closest to Jack Ryan: Shadow Recruit from 2014, which could give The Commuter about $40 million when it finishes its domestic run. It will need to pick up a bit more international steam to satisfy its $30 million budget.
Paddington 2, meanwhile, is hoping to follow a similar path to the original. It’s already behind with a $10.6 million weekend despite a perfect 100%. It made $25.4 million over the four-day MLK weekend in 2015. Warner Bros. was already behind with this being a late pickup from the remaining catalog of the Weinstein Co. Regardless if it matches even just the original’s multiple (which would put it at about $43 million domestically), it’s already made over $125 million internationally. (The original made $183 million overseas.) Meanwhile, Screen Gems’ Proud Mary did not screen for critics (it currently has a 28% with those who caught up with it) and it mustered up a $10 million three-day weekend. The ceiling is not very high for the $14 million budgeted film and with limited international prospects this should be Sony’s first loser of the year.
Not that they care much given the incredible success of Jumanji: Welcome to the Jungle. By next weekend it will be over $300 million and passing Skyfall on Sony’s all-time domestic grossing chart. (The James Bond film is still Sony’s all-time worldwide grosser.) It is even still ahead of the pace of Spider-Man: Homecoming which could put this third on the studio’s all-time list behind just Spider-Man and Spider-Man 2. The film is over $666 million worldwide which ranks 11th all-time for Sony. Star Wars: The Last Jedi, meanwhile, is still Jumanji times two with $600 million domestic expected by this Friday and $1.26 billion worldwide to date. It will be passing Frozen soon to become ninth all-time on the global chart. Fox and Universal also have films hitting the $100 million milestone in the next four to eight days with The Greatest Showman and Pitch Perfect 3. The former will still need roughly another $75 million to recoup its extravagant $84 million budget. Finally, in a lesser milestone, Insidious: The Last Key will be passing the $50 million mark this week despite a 59% drop.
If you want to listen to Erik Childress’ Holiday Box Office Prediction Show, you can download the podcast.
Erik Childress can be heard each week evaluating box office on WGN Radio with Nick Digilio as well as on Business First AM with Angela Miles and his Movie Madness Podcast.
[Box office figures via Box Office Mojo.]
For Now, Sequencing Cancer Tumors Holds More Promise Than Proof
Ben and Tara Stern relax at home in Essex, Md. Ben was diagnosed with glioblastoma in 2016. After conventional treatment failed to stop the tumor, Ben tried an experimental drug.
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People diagnosed with cancer understandably reach for the very best that medical science has to offer. That motivation is increasingly driving people to ask to have the DNA of their tumors sequenced. And while that’s useful for some malignancies, the hype of precision medicine for cancer is getting far ahead of the facts.
It’s easy to understand why that’s the case. When you hear stories about the use of DNA sequencing to create individualized cancer treatment, chances are they are uplifting stories. Like that of Ben Stern.
In the spring of 2016, Stern was diagnosed with a deadly brain cancer, glioblastoma. His doctors at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins promptly treated him with surgery, then over the months, chemotherapy and radiation. He even got on a clinical trial to see if a leading edge drug called a checkpoint inhibitor would work.
Ben Stern found out abruptly that wasn’t doing the trick either, when he was struck with a seizure. “My whole right side clenched up and [my wife] Tara had called 911 in the middle of it.”
The tumor had grown back, so surgeons went in again to remove what they could. Tara said the next month’s appointment showed the surgery hadn’t worked, either.
“The tumor had already grown back and it was already bigger than the original size tumor that we had found the previous May,” Tara Stern says. This staggering regrowth took only five weeks.
The Sterns hang up images of Ben’s brain tumor, shown on the right (white) in each image, and also five weeks after treatment.
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Stern’s doctor got a sample of the tumor and sent a genetic analysis of it to what Hopkins calls its “molecular tumor board.” It’s a small group of doctors who meet Mondays to review these genetic tests. They found an overactive gene in his tumor that’s only rarely associated with brain cancer. But that mutation in other cancers sometimes responds to a particular drug. So Ben went on it as part of his ongoing treatment.
“He started his next round of chemotherapy that Monday but he didn’t seem to get weaker,” Tara says, “He was getting stronger almost every day. It was almost miraculous.”
Ben says the drug even reversed his deteriorating mental state brought on by the brain tumor. At the next monthly appointment, following a brain scan, Ben and Tara got more good news.
“The tumor was immeasurable on that next MRI,” Tara says. “It wasn’t there, to put it bluntly.”
Ben’s eyes well up as he hears his wife telling the story. “I was basically as I am now, which is in tears.”
Eight months later, Ben was thinking ahead about his future, rather than wondering whether his life is ending.
Ben and Tara on their wedding day in 2015. The next year, Ben was diagnosed with a brain tumor.
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“We have to use this result with caution because we don’t know how long this effect might wear on, but for the time being this is a clinically very meaningful benefit,” says his doctor at Hopkins, medical oncologist Matthias Holdhoff.
And while it’s a good-news story for the field of precision medicine, it is also not the way most of these stories end.
“We’re getting better, but like many things in life, there’s hope and hype. And that’s also the reality with precision medicine right now,” says Ben Park, an oncology professor at the Sidney Kimmel Comprehensive Cancer Center at Hopkins. After noticing how much confusing genetic information was flooding doctors at Hopkins, he founded the molecular tumor board there.
“The reason I started this tumor board [in 2013]… was simply because there was a patient, a young woman who had metastatic breast cancer who had a mutation on one of these reports and decided to forego standard-of-care therapies, which have been proven to actually prolong life in this setting,” Park says. Instead, the woman enrolled in a clinical trial that didn’t really make sense for her particular type of cancer and “she almost died. She had really bad toxicity from the experimental drug.”
She was drawn, Park says, by the allure of precision medicine. Patients and doctors alike are clamoring for these tests. But interpreting the results isn’t easy because different companies offer these tests and interpret the DNA signatures differently, “and that can make a huge difference,” Park says.
“That’s where we’re having difficulty right now as a field,” he says, harmonizing test results that often disagree with each other.
Ben’s tumor recently grew back and he’s now undergoing further treatment.
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At Hopkins, the genomic tests usually don’t offer any suggestion for treatment. Only about one quarter of patients at Hopkins are steered toward particular drugs or toward ongoing clinical trials. Other top medical centers find they can identify potential treatments only about 10 percent of the time.
So far there’s only been one randomized study of this approach to precision cancer care — and it did not show a survival advantage for people who went through all this genetic testing.
“If you have this knowledge, it’s not enough,” Park says. “You have to prove that acting on that knowledge — some medical intervention — will actually afford benefit for patients. That’s the trickiest, toughest part about looking at all these types of genomic tests, to really prove that this is making a difference in the lives of our patients.”
Park has since passed on leadership of the molecular tumor board to his colleague, oncologist Josh Lauring. Lauring says there are a few cancers where DNA analysis does make a clear difference, say in melanoma and certain types of lung cancer.
Tara keeps detailed notes of Ben’s progress and also keeps track of his treatment schedule on a daily basis.
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“In other cancers, it’s really kind of an open question. At the same time, this testing is available commercially as well as at academic medical centers, and is being done. Patients want it, providers want it.”
So what’s happening, in effect, is a huge, unorganized experiment, involving real patients, treated differently in all sorts of settings. Lauring and colleagues at Hopkins are trying to keep track of all their patients: what treatment they got, how long it was successful, and how long the patients lived.
“We think it’s really important to capture that information as well, to try to learn from it,” Lauring says, “because in many cases it’s not going to be effective, but in some it is, and it’s important for us to figure that out.”
Therapies that target specific genetic patterns are appealing because medical scientists have some sense of the biology underlying their drugs — they aren’t just killing fast-growing cells, as conventional chemotherapy does.
“Unfortunately in many cases these responses, if they occur, are relatively brief.”
That unfortunately turned out to be the case for Ben Stern as well. Five months after his remarkable response, Ben started feeling weaker again. An MRI suggested the cancer might be on the move. So he went back to the hospital for another round of chemotherapy and radiation.
They’re hoping for the best.
Contact Richard Harris at rharris@npr.org.
The Call-In: The Nursing Industry
Depending on where you live, nurses can be in short supply. NPR’s Lulu Garcia-Navarro talks to Peter Buerhaus, a nursing professor at Montana State University, about the changing nursing industry.
LULU GARCIA-NAVARRO, HOST:
Now it’s time for the Call-In. Last week, we put nurses on call. Depending on where you live, nurses can be in short supply with potentially big consequences for patient care. What does it mean for the nursing industry, and how is the job changing? Well, we heard from a lot of you.
Here’s Ed Stern of Falls Church, Va., Gina DeMarco of Colorado Springs, Jennifer Steele of Milwaukee, and Christopher Todd of Big Pine Key, Fla.
ED STERN: I think nursing has changed. It’s evolved. It’s not just fluffing pillows and passing medications.
GINA DEMARCO: It’s physically demanding. It’s stressful. The hours are long. There’s days it’s rewarding, but I would say I second guess what I’m doing.
JENNIFER STEELE: This has been the most challenging and rewarding work. Nursing is not what I do; it is who I am.
CHRISTOPHER TODD: There’s always been a nursing shortage. And it’s only going to get worse because the average age of a nurse is getting up there.
GARCIA-NAVARRO: Twenty years ago, the nursing industry was in danger of a serious shortage, but that’s changed more recently.
PETER BUERHAUS: The good news is we have had a surge of people coming into nursing over the past 10 years such that we believe we’ll be able to avoid a large massive shortage of registered nurses that would cause access to care difficulties and delay care.
GARCIA-NAVARRO: Peter Buerhaus is a professor of nursing and a healthcare economist at Montana State University. He says around the country, though, there could be regional shortages in the near future.
BUERHAUS: I get a little bit worried around both coasts. New England, particularly, there’s a large number of nurses who are going to be retiring in the New England region but not as many new replacement nurses coming in. The West Coast could also be a troublespot. We just don’t see the growth there as we do in the middle part of the country. So I’m a little bit worried about future shortages developing there.
GARCIA-NAVARRO: I’d like to focus on nurse practitioners because we’re hearing a lot more about them. Explain what they are and why they’re becoming a more important part of the workforce.
BUERHAUS: Nurse practitioners are nurses who have gone back to graduate school for advanced education. They choose a specialty. It could be primary care, or it could be caring for individuals in the emergency room or in acute-care settings. And what’s happening is that when we are looking at projections of physician shortages, we’re seeing that nurse practitioners can fill many of those medical roles that are opening up.
So NPs are growing very rapidly. They also are more likely to be working in rural areas of the country where we have some of the biggest shortages of primary care physicians. So there’s a lot of good reasons to be backing that sort of initiative in the nursing workforce. It’s helping out quite importantly.
GARCIA-NAVARRO: So you’ve mentioned this expanding world of opportunity for nurses. But might it also not be the case – and we heard this from some of our callers that they feel overworked, overstretched – that they’re being asked to do much more than they might have been previously? And that has been a burden.
BUERHAUS: Yeah. What we’ve seen, I think, over the past 10 years, is a significant push to improve quality and safety in our hospitals particularly. Oftentimes, though, this means that a nurse will come to work complying with so many regulations, so many check-off forms to note that they did a particular procedure in accordance with the qualifications that are important. Hospitals are under pressure to document that because this is how they’re going to get paid. So it it shifts down on to nurses, and it’s taking them away from the essence of establishing a relationship with a patient.
GARCIA-NAVARRO: And is there another issue, as well? We’re seeing, as you mentioned, younger nurses coming into the workforce, but they don’t have the institutional knowledge. They don’t have the experience, quite frankly. Is that a problem when you see senior-level nurses retiring?
BUERHAUS: It’s a great question, and it does concern me. It’s not that these nurses are not qualified or unprepared. But what concerns me about this, Lulu, is at the same time we have younger people coming in to replace the exiting baby-boom RNs, we’re going to have a surge of older people qualifying for Medicare. Many of them will be hospitalized. And they’re coming in to institutions with multiple chronic conditions – heart disease, stroke, cancer, diabetes. They’re complicated patients. A lot is going on. And they’re coming in just as the newer, less experienced nurses are coming in to take care of them.
GARCIA-NAVARRO: That was Peter Buerhaus, a nursing professor at Montana State University.
(SOUNDBITE OF MUSIC)
ASHLEE DOVER: Hey, Monica.
MONICA COFFEY: Hi, Ashlee.
DOVER: I am a nurse for about two years. So I’m a baby.
COFFEY: Well, congratulations.
DOVER: Thank you.
COFFEY: I’m Monica. And I’ve been a nurse for 41 years, which is probably older than you are (laughter).
GARCIA-NAVARRO: We brought two nurses together to share their experiences in nursing. Ashlee Dover is 24. Monica Coffey is 65. She remembers having a strong mentor when she got started decades ago.
COFFEY: I had a head nurse, Alice McGee (ph). Her office was on the floor. If things got busy, she came and helped pass meds. She gave lunches. And not only did she help me become a better nurse, she helped me to become a better human being. Now I think young nurses are not supported when they are starting out. They come into nursing with far less clinical background than I did as a new grad.
GARCIA-NAVARRO: Ashlee, does that sound right?
DOVER: Yes. That is absolutely correct. Most of the time, it’s just me, a bunch of other new nurses and maybe one or two senior nurses if I’m lucky enough that week to work with them. When you have 6 patients each – all of us – there’s really no time to really say, hey, how are you doing mentally, emotionally? What’s nursing like for you right now? It’s more of – do you need help passing meds, or cleaning up this patient? Can I help you like this?
GARCIA-NAVARRO: Ashlee, do you have any advice that you’d like to ask Monica?
DOVER: How did you mentally and emotionally make it through as a young nurse and, like, keep yourself emotionally, mentally put together for your patients and your family?
COFFEY: Well, I had other interests – an avid reader, hiker. But the thing about nursing is that, every day, I always felt like I was getting to do good work. I feel like the ethics of nursing sustain me. And even when it’s hard, even when it’s discouraging, I always feel like I’m getting to do the best I can do as a human being.
GARCIA-NAVARRO: Does that resonate, Ashlee?
DOVER: That completely resonates because I didn’t go into nursing to try to save lives or anything like that. I went to – I went into nursing to provide care, a shoulder, a listening ear to people in their times where they felt like nobody was listening or they didn’t know what was going on. And that’s my motivating factor is to be there for them. And sometimes it’s hard. You know, you’ve got six patients to take care of, and three of them require head-to-toe, like, complete care. And you just wonder, like, I don’t want to hurt them. I want to be there for them.
COFFEY: Yeah.
GARCIA-NAVARRO: So listening to this, it’s obviously really stressful and also very rewarding. And I just want you both to briefly talk to the patients right now. What do you want them to know?
COFFEY: You go first, Ashlee.
DOVER: OK. I am so privileged to be a part of your care. And I am so absolutely thankful that you let me into your life during these darkest moments. And I want you to know even if I’m late or if I haven’t checked on you in over an hour or two hours, I have not forgotten about you. Your care and everything about you means so much to me. And I promise to give you the best care possible.
COFFEY: That’s a beautiful sentiment and well stated. I would speak to the patients in this country and say, please, get informed about the issues surrounding health care. Think about improving and maintaining access to health care for all Americans.
GARCIA-NAVARRO: That was Ashlee Dover of Nashville, Tenn., and Monica Coffey of Ellsworth, Maine.
(SOUNDBITE OF MUSIC)
GARCIA-NAVARRO: And next week on the Call-In – it’s been a year since the women’s march movement brought huge numbers of demonstrators to the streets across the country. Did you participate last year or did you skip it? What have you done since then? Call in at 202-216-9217. Be sure to include your full name, where you’re from and your phone number. And we may use it on the air. That’s 202-216-9217.
(SOUNDBITE OF THE ANTLERS’ “INTRUDERS”)
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