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Business December 25, 2018

Legalizing Hemp Will Likely Shake Up The Market

The 2018 farm bill legalized industrial hemp, after decades of restrictions. Hemp looks like marijuana, it smells like marijuana, but it’s not marijuana. Hemp growers are now anticipating a boom.



ESTHER HONIG, BYLINE: The 2018 Farm Bill legalized industrial hemp after decades of restrictions. Hemp looks like marijuana and smells like marijuana. But it’s not marijuana. Esther Honig of Harvest Public Media reports that hemp growers are now anticipating a boom.

HONIG: Farmers can already grow hemp in more than half the country. States like Colorado where Kristen Kunau grows it with her husband. Come December, most of what’s left of her crop sits in her fridge. She pulls out a mason jar of thick dark syrup. Does that smell more hemp-like or?

KRISTEN KUNAU: Kind of. Kind of sweet.

HONIG: Yeah. But still a little – it smells like…

KUNAU: Cannabis.

HONIG: …Marijuana.

KUNAU: Yeah.

HONIG: I’m always…

KUNAU: It is cannabis.

HONIG: This is CBD or cannabidiol. An oil made from hemp flowers. Unlike marijuana, there’s hardly any THC. So it won’t get you high. It’s increasingly popular for its purported health benefits.

KUNAU: I gave it to my kids. I put it on my face, burns, cuts. We’ve had so many different people tell us how much it’s helped them.

HONIG: CBD is driving the hemp market, which was once a common crop in the U.S. until lumped together with marijuana and banned in 1937. Then in 2014, Republican Senate Majority Leader Mitch McConnell called for hemp to be grown again as part of state-run research programs. This year, he pushed to remove hemp as a controlled substance.

KUNAU: With the Farm Bill passing and everything, we’re going to be doing more full time.

HONIG: Like many of today’s hemp farmers, the Kunaus have a small operation, just one acre. They also work day jobs. But with the law change, they can finally access bank accounts and low interest federal loans even to be eligible for crop insurance. It all comes at a time when the market for hemp CBD is booming.

JAMIE SCHAU: It’s extremely versatile. It can be used for a whole host of different applications.

HONIG: That’s Jamie Schau with Brightfield Group, a market research company. She says CBD is used in everything from lotions to sports drinks, even dog treats.

SCHAU: It has treatments for everything from epilepsy to MS to arthritis to anxiety, depression, insomnia. The list goes on and on and on.

ESTHER BLESSING: We don’t know that. We don’t have the clinical trial evidence to support that.

HONIG: Esther Blessing teaches psychiatry at NYU and is studying the effects of CBD on people with PTSD and alcohol abuse. The FDA recently approved CBD in a drug that treats a form of epilepsy but that’s it. She says all the hype around CBD is getting ahead of the research.

BLESSING: But on the other hand, as a scientist, I really feel like it is one of the most promising medications that has come along in the last 50 years.

HONIG: Meanwhile, hemp growers like the Kunaus are bracing for change. The price for a pound of hemp flowers reached $75. But with legalization, that’s likely to drop.

KUNAU: I do know everybody’s going to be wanting to grow hemp and CBD. And this one acre is going to seem like nothing compared to people doing 10s and 30 or 50.

HONIG: As more hemp is planted in the country, she hopes falling prices don’t squeeze out small farmers. For NPR News, I’m Esther Honig.

ARI SHAPIRO, HOST:

That story comes to us from Harvest Public Media, a reporting collaboration focusing on agriculture and rural issues.

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.

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Health December 25, 2018

How Working On Christmas Became A Privilege For 2 Young Doctors

Illustration of a young doctor trapped in a snowglobe by Katherine Streeter for NPR.

Katherine Streeter for NPR

In what has become a holiday tradition for Shots, we’re encoring a piece by Dr. John Henning Schumann that first ran in 2013. He reminisced then about a difficult assignment during his medical residency that helped him understand what it meant to be a good doctor.

December is supposed to be the time of year filled with family gatherings and holiday good cheer. For medical residents, quite the opposite is true.

There are no school breaks during residency. Being a medical resident is a real job, and a stressful one at that. Residents work long shifts, even with caps that max out at 16 hours for the newbies and up to 28 hours for those beyond the first year.

For many of our trainees — especially those fresh out of medical school — this will be the first holiday season without time off.

It’s well-known among residency program directors like me that interns, trainees in their first year, enter the doldrums as daylight wanes and they have to come to and leave the hospital in cold darkness.

At holiday time, interns are approaching the midpoint of their year. That’s long enough to feel committed to their chosen path but not nearly far enough along to see the finish line’s banners. Doubts amplify.

Combine the low emotional ebb with the knowledge that more of our patients die at this time of year, and interns feel understandably vulnerable. Many wonder at this point if they’ve made the right professional choice. In extreme cases, they wonder if they’ll survive.

I remember lamenting my first December having to work straight through. A wise mentor helped me reframe my self-pity. “It’s a privilege to work on Christmas,” he told me. “Our patients count on us. You may not want to be in the hospital, but think of what they’re going through.” He smiled, as if he were welcoming me to a special club, one that I wasn’t wholeheartedly ready to join. “Your mere presence helps reduce each patient’s sense of loss.”

I was rotating in intensive care, where the outlook for patients can be quite grim on any day, regardless of the season.

A 30-something patient I’ll call Will was brought in after paramedics found him unconscious on the street.

He was in a coma. We didn’t know the cause but set to work trying to give him every opportunity to arise from the slumber of his critical illness.

I was on the rotation with two other interns. We took turns spending nights in the hospital — each of us taking every third night on call. The first night, my buddy Paul spent the night at Will’s bedside trying to figure out a way to replenish his body with fluid, given the massive output that was draining into his urine bag.

Will had suffered a brain injury. One effect was diabetes insipidus, a condition that meant his kidneys couldn’t hold on to his body’s water. The result can be rapid dehydration and death.

Paul’s work saved him. Paul squeezed a few bags of IV fluid into Will to rehydrate him and administered a drug called desmopressin that restored his water balance.

I was certain I wouldn’t have known what to do.

It soon became clear that Will wouldn’t recover from his brain injury. His brain had simply been without oxygen too long before Will got medical attention.

When it was my turn on call, the instructions were simple: Keep Will alive until his relatives could come and say goodbye in person. Will’s grieving mother had expressed the wish, and we felt honor-bound to make it happen. We saw ourselves in Will, and his mother could easily have been our own.

Two days later, when everybody had said their goodbyes, we somberly withdrew the ventilator keeping Will alive. He died soon thereafter.

Years later, reflecting on my first holidays in the hospital, I realized that my mentor’s wisdom had been crucial. That December, Paul and I had started the long process of becoming professionals.

John Henning Schumann is a writer and doctor in Tulsa, Okla. He serves as president of the University of Oklahoma, Tulsa. He also hosts Public Radio Tulsa’s Medical Matters and is on Twitter: @GlassHospital

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Business December 24, 2018

Dow Suffers Record-Breaking Christmas Eve Losses

The exterior of the New York Stock Exchange photographed last week. On Monday, the Dow Jones Industrial Average had its worst Christmas Eve performance since 1918.

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Patrick Sison/AP

The stock market was only open for half a day Monday, and that was more than enough time for the Dow Jones Industrial Average to drop 2.9 percent to 21,792.20. That was its worst Christmas Eve performance since 1918.

Other U.S. indexes fell too. The Nasdaq lost 2.2 percent to 6,192.92. The Standard & Poor’s 500 index fell 2.7 percent to 2,351.10.

U.S. stocks are on track for their worst year since 2008, which was during the Great Recession, and their worst December since 1931, which was during the Great Depression.

The markets have been dealing with concerns of a slowing global economy, the trade dispute with China and last week’s interest rate increase — the fourth by the Federal Reserve this year.

Over the weekend, reports surfaced that President Trump was asking advisers if he could legally fire Fed Chairman Jerome Powell. Trump nominated Powell last year to take over the Fed, but since interest rates began rising, Trump has upped his rhetoric against Powell.

Efforts by Treasury Secretary Steve Mnuchin on Sunday to reassure investors backfired. He tweeted that he had spoken with the heads of the nation’s six largest banks and was assured that they had sufficient lending capacity.

Today I convened individual calls with the CEOs of the nation’s six largest banks. See attached statement. pic.twitter.com/YzuSamMyeT

— Steven Mnuchin (@stevenmnuchin1) December 23, 2018

“We’ve gone through situations before where it’s absolutely normal for the secretary of Treasury to reach out to the private sector,” Quincy Krosby, a chief market strategist at Prudential Financial, told The Wall Street Journal.

“But what’s bad is this made the papers, and says the government is very worried,” Krosby told the paper, adding that with investors focused on so many issues, “it’s almost as if gravity is pulling this market toward a lower level before it bottoms out.”

Monday morning’s drop in U.S. financial markets began after Trump tweeted about the Fed.

The only problem our economy has is the Fed. They don’t have a feel for the Market, they don’t understand necessary Trade Wars or Strong Dollars or even Democrat Shutdowns over Borders. The Fed is like a powerful golfer who can’t score because he has no touch – he can’t putt!

— Donald J. Trump (@realDonaldTrump) December 24, 2018

“The only problem our economy has is the Fed,” the president said on Twitter. “They don’t have a feel for the Market, they don’t understand necessary Trade Wars or Strong Dollars or even Democrat Shutdowns over Borders. The Fed is like a powerful golfer who can’t score because he has no touch – he can’t putt!”

The Fed is an independent agency. While board members are nominated by the president, they make decisions separately of the White House.

Peter Conti-Brown, a financial historian at the Wharton School of the University of Pennsylvania, told The Associated Press: “We’ve never seen anything like this full-blown and full-frontal assault. This is a disaster for the Fed, a disaster for the president and a disaster for the economy.”

After Monday’s Wall Street losses, Asian markets followed. In early trading, Japan’s Nikkei 225 fell by 5.1 percent to 19,147.45 points. The Shanghai Composite Index lost 2.1 percent to 2,473.75. Benchmarks in Thailand and Taiwan also declined.

Markets in Hong Kong, Australia and South Korea were closed for Christmas.

After a pause in trading for the holiday, U.S. markets reopen Wednesday.

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Health December 24, 2018

As Partial Shutdown Continues, FDA Prepares To Furlough Employees

Many Food and Drug Administration activities will continue despite the partial federal shutdown.

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Andrew Harnik/AP

The partial government shutdown that started Saturday will affect quite a few activities of the Food and Drug Administration.

Although most of the agency’s employees weren’t working over the weekend and on Monday and Tuesday because of federal holidays, FDA will furlough some 40 percent of its staff starting Wednesday.

However, much of the agency’s workforce will continue through the shutdown, with more than 10,000 FDA employees — nearly 60 percent — reporting to work, according to numbers released by the agency Friday.

The majority of those people are doing work funded by user fees paid by pharmaceutical and medical device companies, according to an analysis by the Alliance for a Stronger FDA, an advocacy group representing patient and consumer advocates as well as trade associations.

Here is a quick breakdown of how the shutdown will affect the agency’s work.

Activities that will continue during the shutdown

The FDA will continue work that’s critical to public health and safety. It will be able to respond to emergencies, like the flu and foodborne illnesses. It will continue recalls of any foods, drugs and medical devices that pose a high risk to human health.

As FDA Commissioner Scott Gottlieb tweeted over the weekend, the agency will also continue to screen “food and drug imports” and inspect any facilities that might pose “an imminent threat to health and life.”

Some criminal and civil investigations where there is an immediate risk to public health will also continue through the shutdown, as will all of the agency’s work that is funded by user fees.

THREAD: During the lapse in federal funding, #FDA‘s ongoing work will fall into three key areas: emergency work to save lives and protect property, criminal and some civil enforcement work, and work funded by user fees. pic.twitter.com/fxCIGUZDtW

— Scott Gottlieb, M.D. (@SGottliebFDA) December 22, 2018

For example, the agency will continue to oversee the manufacturing and distribution of all tobacco products. “The tobacco program is 100 percent user-fee funded,” says Steven Grossman, deputy executive director at the Alliance for a Stronger FDA.

Similarly, much of the agency’s work with new products is funded by fees paid by industry, so the FDA will continue reviewing and approving drugs and medical devices where the fees have already been paid. It will also continue to review requests for clinical research and issue any necessary guidance.

Activities that will stop during the shutdown

Broadly speaking, all activities that are less likely to have an immediate impact on health and safety of consumers will come to a halt. For example, routine regulatory and compliance work for medical products, animal drugs and most foods will be paused, according to a contingency staffing plan put forward by the Department of Health and Human Services.

Routine inspections of facilities and all work related to cosmetics and nutrition will also be paused during this period.

And the shutdown may affect some aspects of the drug review process as an estimated 30 percent of that work is funded by appropriations, according to the analysis by the Alliance for a Stronger FDA.

Should consumers be concerned about food and drug safety during the shutdown?

Probably not, at least not for now, says Grossman. “In the short term, consumers should not see much of an impact,” he says. That’s because “anything that could affect human health and safety [in the near term] will be staffed.”

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Sports December 24, 2018

New York Jets QB Sam Darnold Poses As A Mall Santa Claus

Last week in New Jersey, quarterback Sam Darnold went undercover as a mall Santa. Kids asked for toys and pets. One young fan asked for a Saquon Barkley jersey. Barkley plays for the New York Giants.



NOEL KING, HOST:

Good morning. I’m Noel King. New York Jets rookie quarterback Sam Darnold went undercover dressed in a red-and-white suit and a beard at a New Jersey mall last week. Kids asked him to bring them puppies and skateboards.

And then, eek, two young football fans asked him for Saquon Barkley jerseys. Barkley plays for the Giants. Darnold slumped a little and asked one kid kind of sadly, Saquon?

But when he revealed his true identity, a bunch of young Jets fans went nuts, and he seemed to cheer up.

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.

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Entertainment December 24, 2018

Trinidad And Tobago Remixes Caribbean Christmas Traditions

During the months leading up to Christmas, parang music can be heard just about everywhere in Trinidad.

John Otis/NPR


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The twin-island nation of Trinidad and Tobago is famous for calypso and soca, infectious music that takes center stage during the island’s annual Carnival. But during the Christmas season another type of music dominates.

At a sound check for a band that plays old-time instruments, musicians play cuatro, a small, four-stringed acoustic guitar. There are also mandolins, maracas and a box bass, Trinidad’s version of the washtub bass. These are some of the instruments that are used to make the religious folk music called parang.

During the months leading up to Christmas, parang can be heard just about everywhere in Trinidad. Most of the songs are about the birth of Christ. However, not everyone understands the lyrics. Parang was brought to Trinidad by migrant farm workers from nearby Venezuela. The songs are sung in Spanish even though the mother tongue on the island is English.

Some parang groups like Los Alumnos de San Juan pantomime to help audiences grasp the Spanish lyrics to songs. Alicia Jaggasar is the leader of Los Alumnos de San Juan and also heads the National Parang Association.

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“Parang music is our way at Christmastime to tell the story but in a different language and in a different musical style,” Jaggasar says. “So you wouldn’t hear it as the normal ‘Hark the herald angels sing, glory to the newborn king.’ You will hear: ‘Cantando gloria, gloria, gloria en el cielo. En un establo nació el Dios verdadero,‘” which translates to “Singing glory, glory, glory in heaven. The true God was born in a stable.”

Jaggasar’s group is booked until Christmas Eve. On that night, parang bands go house to house until the wee hours in an exuberant form of Christmas caroling. But they must adhere to some elaborate musical etiquette to gain entry.

Alicia Jaggasar is the leader of Los Alumnos de San Juan and also heads the National Parang Association.

John Otis/NPR


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John Otis/NPR

“You have to do a serenado from outside,” Jaggasar says. “And in that song, you have to actually say who you are, and what you’ve come to do. And it’s only when the host hears who you are, then the door is open. They don’t just open it just like that.”

But once inside, the party revs up.

“Christmas morning, I would hear the cuatros, the mandolins, as the groups went from house to house, ” Michele Reis, a Trinidad academic, says. “There is lots of rum flowing, there is food that comes. … And it’s just a really festive time, you know?”

To keep this tradition alive, high schools and colleges in Trinidad hold parang contests. Still, musicians are always tinkering with parang in an effort to reach a wider audience. One result is soca-parang, which is sung in English so more people will understand, and fused with the frenetic rhythms of soca.

Purists complain that the lyrics often glorify girls rather than the gospel. But Jaggasar endorses the hybrid. “Because we are land of calypso, soca and steel band, we like to mix things, that is just our culture,” Jaggasar says.

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Business December 23, 2018

Zoox Inc. Snags First California Permit To Transport Passengers In Self-Driving Cars

Bay Area-based Zoox Inc has received approval from California to transport passengers in its autonomous vehicles. It’s the first permit handed out by the state as part of a pilot program for self-driving cars.

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Self-driving cars, once a futuristic projection, have already become old news in California. More than 60 companies currently hold permits to test autonomous vehicles, according to the state’s Department of Motor Vehicles.

But on Friday, California passed a new milestone when it allowed one self-driving car startup, Zoox Inc., to transport passengers for the first time.

Zoox received its permit under a pilot program launched in April by the California Public Utilities Commission, or CPUC.

“This is a really, really significant milestone as we head towards commercial launch, which we have stated is toward the end of 2020,” Bert Kaufman, head of corporate and regulatory affairs at Zoox, told Reuters.

There are a few catches. Zoox can’t charge for the trips, and each autonomous vehicle, or AV, has to have a certified backup driver.

A sister program launched by the commission will eventually allow self-driving cars in California to transport passengers without a backup driver. For now, Zoox is the only company operating under either program.

Self-driving cars could disrupt entire sectors of the economy, according to Sam Schwartz, the former New York City traffic commissioner and author of the book “No One At The Wheel: Driverless Cars and the Road of the Future.”

“I think everybody is expecting fewer drivers, and that’s no surprise,” Schwartz told NPR’s Terry Gross in a recent interview. “But it also means that there are probably going to be fewer repair shops. … AVs lend themselves to fleet operations, especially if they’re going to be offering rides, as opposed to selling maximum vehicles, so car dealerships may disappear.”

He suggested that trucking companies could lose business, but the advertising industry might thrive as riders are increasingly freed up to divert attention from the road to their smart devices.

Meanwhile, critics have raised practical and ethical concerns about the dangers posed by self-driving cars. Earlier this year, a self-driving test vehicle from Uber Technologies struck and killed a woman in Tempe, Ariz. That incident prompted Arizona’s Republican governor, Doug Ducey, to suspend Uber’s test drives.

Some researchers argue that autonomous vehicles can be trained to be safer than human drivers. Other experts say the limited data available from self-driving cars hampers any attempts at comparison.

Either way, self-driving cars are already a growing presence on public roads. The Global Atlas of Autonomous Vehicles in Cities is tracking at least 80 cities that are piloting autonomous vehicles, or are planning to test them. These fleets of vehicles are collecting data and navigating the practical problems of driving in cities. A video from Zoox shows one of its cars surpassing a parked vehicle on a narrow San Francisco street.

Double-parked vehicles (DPVs) are everywhere in San Francisco; classifying and successfully navigating around them in realtime can be a challenge for autonomous vehicles. Check out how Zoox handles them in these examples: pic.twitter.com/iOfCytBeKv

— Zoox (@zoox) December 22, 2018

Google’s parent company, Alphabet, has primarily dominated the self-driving vehicle market, as Reuters reports. The California DMV gave Alphabet’s autonomous vehicle branch, Waymo, a permit to begin driverless testing on public roads in October, according to the company.

Waymo also launched a passenger service in Phoenix earlier this month. The service, Waymo One, charges its customers for fully automated rides. In some cases, the company’s cars are already operating without a backup driver.

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Health December 23, 2018

How Helping Patients Get Good Care At Home Helps Rural Hospitals Survive

Charlotte Potts, who has a history of heart problems, lives within sight of Livingston Regional Hospital. After a recent stint there, she was discharged into the care of a home health agency, and now gets treatment in her apartment for some ailments.

Shalina Chatlania / WPLN


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Shalina Chatlania / WPLN

Rural hospitals close when they don’t have enough paying patients to care for, but they’re also dinged when the same patients show up over and over again. That puts outlying medical facilities in the precarious position of needing to avoid repeat customers.

Charlotte Potts is the type of patient some hospitals try to avoid. She lives in Livingston, Tenn. — a town of 4,000, tucked between rolling hills of the Cumberland Plateau.

“I’ve only had five heart attacks,” Potts says with a laugh. “I’ve had carotid artery surgery. Shall we go on? Just a few minor things.” She jokes that she’s “a walking stent.”

The heart trouble has affected the way Potts deals with her health problems. She spends much of her day in a recliner in her apartment, tethered to a pulsing oxygen machine, and listening to the radio.

Fortunately, her apartment sits within spitting distance of Livingston Regional Hospital — a 114-bed facility large enough to have a dedicated cardiac unit. But the hospital doesn’t want to see her every time her heart flutters.

So last time she landed in the ER, they helped her connect with a few companies that could provide care at home.

“If I’m going to have certain things going on here in my chest, I call for help, and they’re there,” Potts says of the home care team she chose.

Livingston Regional Hospital has cut readmissions by more than four percent in the last five years — more than any other rural hospital in Tennessee.

Shalin Chatlani / WPLN


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Shalin Chatlani / WPLN

A new era in hospital management

There were days when the hospital might have viewed a home health agency as a competitor. Not anymore.

“When I started this almost 40 years ago, the mission was different,” says Tim McGill, CEO of Livingston Regional. “We wanted patients in the hospital. That was the incentive. We were paid for it. Now you’re not.”

Hospitals used to run on a so-called fee-for-service model with virtually no limit to how many times they could see a patient. But, under pressure from private and government insurance programs, that model is transitioning to one in which hospitals are rewarded for safety and efficiency — which often results in a patient spending less time in the hospital.

Under the Affordable Care Act, Medicare began to ding hospitals if too many patients are readmitted to any hospital within 30 days of discharge. The measure is broadly unpopular with the hospital industry, since so much falls outside a hospital’s control. Medicare has even walked back the rules for safety-net facilities, which tend to treat a sicker population.

The penalty is meant to encourage hospitals to get it right the first time. In Livingston, the hospital operates on the thinnest of margins — just 0.2 percent in the most recent figures. And “readmissions” have been a drag on the bottom line.

One in five patients with heart failure was back within the month. The hospital has paid the maximum penalty in some years — nearly $200,000. So leaders started asking a basic, unifying question of other providers in town, McGill says: “What can we do together so they’ll stay out of the hospital and stay healthier in their home setting? That’s where the work is.”

Collaborating instead of competing

The work took the form of quarterly lunch meetings at the local library.

Mary Ann Stockton, a nurse at the hospital, invites all the home health agencies as well as hospice providers and the leaders of nursing homes.

At one meeting, she applauds the other providers for increasingly meeting patients inside the hospital before they’re discharged. She says it helps patients and families accept these home health workers.

“We know in our area, people don’t like to have a total stranger come into their home,” she says.

The group brainstorms how to generate the same kind of acceptance for hospice care, which — as one doctor in the meeting puts it — some families view as assisted suicide.

And on this day, the groups spends much of its time reviewing the value of flu shots, especially for the staff in nursing homes. Stockton says elderly patients with bad lungs become a hospital emergency room’s “frequent fliers.”

“Flu starts off, goes into pneumonia, COPD exacerbation — and they are a revolving door in our hospital,” Stockton says. “They’re hitting that ER a couple of times a week.”

Advance directives are on the agenda for next time — another way to keep people near the end of life from becoming ER regulars.

Livingston’s parent company, LifePoint Health, is launching this community approach in many of its 80-or-so markets, which are primarily in the Southeast and almost all rural. LifePoint vice president Cindy Chamness helps hospitals find willing partners.

“We were very frustrated for many years,” Chamness says, “because we weren’t able to impact readmissions just working on it by ourselves, as a hospital.”

“Are we saving ourselves right out of business?”

The solution looks different from one town to another. In Lake Havasu, Ariz., paramedics now visit discharged patients to make sure they’re following doctors’ orders. The house calls also cut down on government-funded ambulance rides.

It’s not just rural hospitals — all hospitals can be penalized for readmissions now. And threatening the bottom line in that way does seem to be effective. Readmissions have been falling across the board, according to the latest research.

But rural hospitals, which already treat fewer patients than urban hospitals, wonder if they’ll have enough patients to survive, says Michael Topchik of the Chartis Center for Rural Health.

“[A] CEO from Montana said to me, ‘The problem is, when we do the right thing, are we saving ourselves right out of business?’ ” says Michael Topchik of the Chartis Center for Rural Health.

The focus on cutting readmissions — by definition — cuts overall admissions too, he notes.

“So, this is the real inherent tension and challenge: Hospitals get reimbursed for doing ‘sick care,’ ” Topchik says. “But more and more they’re being asked to do population health, and really focus on ‘wellness.’ “

To make up the volume, the Livingston hospital is expanding its maternity ward and general surgery offerings.

There is also some immediate financial upside to reducing readmissions: Livingston Regional has cut readmissions more than any other rural hospital in Tennessee and even the nation, according to data compiled by Chartis.

As a result, the hospital’s Medicare penalty in the coming year will be reduced to 0.3 percent of its reimbursements — down from the maximum of 3 percent, which was roughly $200,000 a year.

That’s all because patients like Charlotte Potts now can safely stay home.

“I got a real bad tightness in the chest,” Potts recalls about a recent episode. She’d questioned whether to call an ambulance. “I was very uncertain about what was going on.”

But she phoned her home health agency, took a nitroglycerin pill as the agency advised, and instead of going to the ER, was able to get back to sleep.

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Business December 22, 2018

Working The Holidays As An Amazon Worker

NPR’s Michel Martin talks to Vox business reporter Chavie Lieber about what it’s like to work in an Amazon warehouse during the holidays.



MICHEL MARTIN, HOST:

It’s just a couple of more days until Christmas. And if you are like other last-minute shoppers, you may be wondering how on earth you’re going to get those last gifts on time. And if you just cannot stand the thought of a crowded shopping mall – and, frankly, even if you can – you’re probably thinking about turning to Amazon. Amazon is now the 800-pound gorilla of e-commerce, accounting for some 60 percent of purchases on Black Friday, according to the web traffic analyst Hitwise. And, yes, it is an NPR sponsor.

But we were wondering what it’s like to work at an Amazon warehouse during the holidays, so we called Chavie Lieber. She’s written extensively about working conditions at Amazon for Vox, and she’s with us now. Chavie, thanks so much for joining us.

CHAVIE LIEBER: Hi. Thanks for having me. Great to be here.

MARTIN: How much does the workload increase at Amazon during what they call peak, between Thanksgiving and just after Christmas? Can you give us a sense of that? And tell us – as we said, you have sources who speak to you usually without attribution. But what are they telling you about what that’s like?

LIEBER: A lot of the Amazon warehouse workers that reached out to me, they all say that they are grateful for the job. They want the job. It’s really just that it is high-intensity. It is so aggressive. All Amazon warehouses abide by this number called a packing quota. And basically, what that means is every Amazon warehouse worker has a number of boxes that they have to pack per hour. And during the holiday season, when the orders are kind of running in, the managers are trying to get the warehouse workers to pack faster and faster.

So, you know, the average can be, let’s say, 240. But then, during the holiday season, the number of boxes you have to pack per hour can go as high as 400. And basically, if you are slowing down, you’re not keeping up or your productivity levels aren’t as high, workers can get write-ups, and they can also be terminated.

So it just seems like, you know, working under these type of conditions is pretty demeaning. And some employees that I’ve talked to have said, you know, by the end of the holiday season, a lot of people just feel like they can’t make it.

MARTIN: Well, first of all, why do you say it’s demeaning? I mean, I can see that it’s demanding. But why do you say it’s demeaning? Do they say it’s demeaning?

LIEBER: Yeah. Yeah. The line that a lot of people say to me when they talk about, you know, people that are protesting and they’re rallying against Amazon, they want Jeff Bezos and they want Amazon to know that we are not robots.

And basically, it’s this idea that, you know, they want to do the work load. And they want to pack for Amazon. And they want to do this job. But they don’t want to work in this type of environment. And basically, Amazon has this really codified system where it’s not like you can talk to a manager and explain, you know, I’m not feeling well this day or I’m doing this. Like, you know, people describe it as like a well-oiled machine.

MARTIN: So I was going to ask you about that. Are there rules about breaks – how long, how often people are allowed to have them?

LIEBER: I will tell you what I know about people that are working there full-time, which is, according to federal law, you need to have breaks. And Amazon’s break system is two 15-minute breaks and then a half-hour lunch break. And, you know, some of the complaints that Amazon workers have told me is that these breaks are definitely not enough, especially if some – you know, some of the Amazon warehouse workers in Minneapolis are protesting because a lot of them are Muslim. And they don’t have enough breaks to, you know, eat, drink, get water, go to the bathroom, grab lunch and then also abide by their praying schedule.

So even though, you know, the 30-minute break and then the 15 – and the 15-minute break add up to an hour, which I guess is pretty typical in a lot of workplaces where people are given an hour lunch break, it’s extremely rigid. And if you go over your break time, like, you can get penalized.

MARTIN: What about overtime? Are people expected to work overtime? Are they required to work overtime during peak?

LIEBER: Yeah. During peak season, according to my understanding, overtime is mandatory. Some of the people have told me that their schedules are something like four days a week, 12-hour shifts. And if you try to use vacation time or paid time to call out during peak time, it can be a fireable offense, or it could – it could get you penalized.

MARTIN: If you don’t come, like if you call in sick, for example?

LIEBER: Yeah, exactly.

MARTIN: OK. So you actually alluded to this. There have been various boycotts at Amazon warehouses in – mainly overseas. Would that be accurate?

LIEBER: I think that there definitely are a lot of strikes and walkouts in Amazon fulfillment centers in Europe. We’re definitely seeing a little bit of this movement in the United States. One Amazon warehouse manager that I interviewed had told me that, on Prime Day, the facility that she was working in, people were handing out flyers that they wanted to stage a mass walkout on Prime Day about two years ago and that the managers had been ordered to kind of collect the pamphlets and get rid of them.

You know, the flipside to that is that if people – I think if people were really, really concerned and they heard that these type of conditions were going on, I think that you’d see more boycotts. I think consumers are definitely interested in the story, but I’m not sure if it’s going to stop them from shopping on Amazon.

MARTIN: We know that you’ve heard from a number of disgruntled Amazon employees or employees who say that they found the conditions – well, in some cases, intolerable, but in other cases, tolerable but unpleasant. Have you heard from others? I mean, have other people commented on your stories to say that that’s not the full picture or that they just feel that it’s, you know, for whatever – the good outweighs the bad? Have you heard from other perspectives?

LIEBER: Sure. Sure. Well, I mean, Amazon has reached out to me specifically and have, you know, they’ve told me that these employees that I’ve been speaking to are one-off and it’s not the case all around. Actually, I was able to tour a fulfillment center in Staten Island a few weeks ago and, you know, talked to a few employees there who said that they were, you know, they were happy with the jobs, and they were happy with the wages. They were thrilled with the benefits.

I had a story go up on vox.com about what it was like to work the Black Friday shift. And I had people reach out to me who said that they worked at a warehouse, and this is what the job is. And, you know, they don’t agree with people who complain that it’s high-pressure and that it’s this type of job because the job is the job.

And what I want to say to that is, you know, at a certain point, people have to step back and, you know, wonder, like, what goes on inside these warehouses? What are workers saying? And the bottom line that the warehouse workers want me to tell people is that they are human beings that are packing their boxes, and it’s not always easy for them. And they want the company to kind of step up and listen to their demands.

MARTIN: That’s business reporter Chavie Lieber. She reports on Amazon for Vox, among other subjects that she covers. Chavie Lieber, Thanks so much for talking to us.

LIEBER: Thank you for your time.

MARTIN: We also reached out to Amazon for comment. In a statement, company officials said they work hard to provide a safe, quality work environment for their 250,000 employees across the U.S. They added, quote, “associates are the heart and soul of our operations.”

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.

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Sports December 22, 2018

The Week In Sports: MLB, Cuba Reach Historic Deal

It’s time to reflect on the highlights of the week in sports, including an agreement that would allow Cuban athletes to play Major League Baseball without defecting from their home country.



SCOTT SIMON, HOST:

And now a couple of chestnuts roasting on an open fire (laughter) or, as we say around here, time for sports.

(SOUNDBITE OF MUSIC)

SIMON: There is a deal on the table between the U.S. and Cuba to allow the best baseball players in Cuba to play in the United States and Canada without having to defect. But it’s not as simple as just letting them sign. Here’s my fellow chestnut, Tom Goldman. How are you, Tom? Happy holidays.

TOM GOLDMAN, BYLINE: Smile when you say that when you call me a chestnut. Good morning.

SIMON: I said a couple of chesnuts. Some of the best baseball players in the world, obviously, are Cuban, but their government has not let them just sign a contract and play wherever in the world they want to – U.S., Japan, any place. What is in this new agreement?

GOLDMAN: Well, Scott, it would allow for easier signing of Cuban ballplayers and safer passage for players from Cuba to the major leagues. As you know, historically, it’s often a harrowing journey. The Cuban government hasn’t allowed players to leave, so they’ve had to defect, leave family behind, take big risks to get to the majors, you know, unscrupulous agents.

SIMON: And not be able to come back and see their family typically in the offseason.

GOLDMAN: Yeah, exactly, and there are unscrupulous agents and criminal elements, you know, waiting to extort players and kidnap them. This agreement, which grew out of more relaxed relations between Cuba and the U.S. during the Obama administration, would let players sign with MLB while they’re in Cuba, come to North America on a work visa and then return to Cuba in the offseason.

SIMON: Do they get to keep their salaries?

GOLDMAN: They do. They do. And this is an interesting point. You know, this is all going to depend on the Trump administration’s approval. And the White House sounds hostile to the idea so far. A statement from a senior administration official criticized the proposal because – and I’m quoting here – “a Cuban body would garnish the wages of hard-working athletes who simply seek to live and compete in a free society.” Now, a source in baseball I spoke to said wages will not be garnished. At most, the source says there will be, like, a 2 percent national tax. But other than that, the agreement guarantees no one’s going to touch the money players get from MLB. Scott, one other thing about money, which is always involved in baseball. Major League clubs that sign Cuban players will have to pay what’s called a release fee to a Cuban – to the Cuban Baseball Federation. There’s concern by our government that the money might end up in the wrong hands – the Cuban government. Now, there are no guarantees some of the money won’t go that way, but baseball officials in this country say while the proposed agreement isn’t perfect, it’ll be a lot better for Cuban players and a lot better for baseball to have this better pipeline to some of the world’s best players.

SIMON: I want to ask you about two American Olympians, both 23 years old, both women, at different points in their career. Mikaela Shiffrin won a slalom today in France, the great skier.

GOLDMAN: Right. Right. Yes, absolutely – breaking news. She won that slalom. It was her 35th slalom victory in her career, ties the women’s all-time record. Also at 23, she’s now the youngest skier ever, women or men, to have 50 World Cup races to have won them in all disciplines. We’ll have to wait till 2022 to watch her do her thing at the next Winter Olympics. But until then, watch her if you can. She’s really special.

SIMON: But there’s a 23-year-old swimmer who’s going to be saying goodbye to professional competition.

GOLDMAN: Yes, Scott, unlike Defense Secretary Mattis, Missy Franklin really is retiring…

SIMON: (Laughter) Yes.

GOLDMAN: …At the ripe old age of 23. Now, you have to go back a couple of Summer Olympics to remember her true greatness in the pool. In London 2012, she won four gold medals, five total, as a 17-year-old. At the World Championships the next year, she won six golds. And at that point, there was talk she was going to be a medal machine like Michael Phelps. She had a bubbly personality to boot. But then it all kind of crashed. Her body betrayed her with injuries. She battled depression. She had surgery on both shoulders last year. And she never could beat the pain. And it turns out, her late teenage years were her heyday, but she is ever-positive. She says she’s choosing to look at retirement as a new beginning, which one can realistically say at 23.

SIMON: Yeah. Well, NPR’s Tom Goldman, thanks. You know, we have run out of time before I could sing (singing) they’re the pride and joy of Illinois, Chicago Bears – bear down.

GOLDMAN: February, Scott, you’ll be celebrating.

SIMON: Oh, really? Tom Goldman, thanks so much.

GOLDMAN: You’re welcome.

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.

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