We all hope for some peace and comfort at the end of life. Hospices are designed to make that possible, relieving pain and providing emotional and spiritual support. But two new government studies released Tuesday morning find that the vast majority of hospices have sometimes failed to do that.

And there’s no easy way for consumers to distinguish the good hospices from the bad.

The reports are the government’s first to look at hospice deficiencies nationwide. The Office of the Inspector General in the Department of Health and Human Services found that from 2012 through 2016, health inspectors cited 87% of hospices for deficiencies. And 20% percent of hospices had lapses serious enough to endanger patients.

Deputy Regional Inspector General Katherine Harris cites the case of a patient who had untreated bed sores, or pressure ulcers, on both heels.

“These ulcers rapidly worsened,” says Harris. “The patient developed gangrene and needed a leg amputation.”

In the dry terminology of government reports, this is called “poor care planning.” And having plans of care developed in conjunction with the patient and the patient’s family, Harris says, is a fundamental requirement of hospice,.

“So when we discover that hospices are not doing them, there is reason for concern,” she says.

For example, there’s the case of Karen Bishop Collings and her 85-year-old dad, Dean Bishop. Though Bishop had chronic lung disease, he’d been doing OK and living independently. Then, last winter, he was hospitalized with pneumonia. When he was transferred to a residential care facility to recuperate, he began receiving hospice services. That was a surprise to his daughter.

“We only agreed to pre pre-assessment of his conditions, to even see if he qualified for hospice or palliative care,” she says.

Collings has shared some of her father’s medical records with NPR, and they verify her recollection. The hospice never held a meeting with Bishop or the family to establish a care plan. So Collings was shocked when hospice workers gave her father two new medications: morphine and the anti-anxiety drug Ativan.

“We knew something distressing had happened,” she says. “His whole physicality and mental capacity was completely altered.”

Dean Bishop died a couple of days later.

If this hospice had previously been cited for deficiencies, Collings would have had a hard time finding out. The Centers for Medicare and Medicaid Services, or CMS, doesn’t make that information available on Hospice Compare, its website for consumers, even though the agency has the authority to post at least some of that data.

“We live in a time when we don’t even think about booking a hotel without checking its ratings and reviews,” says Harris. “Why do we demand less for hospices?”

The reports also highlight the the options CMS has for disciplining hospices are few. The agency can drop substandard hospices from the Medicare program altogether. But it lacks the legal authority to assess fines. It would take an act of Congress to give CMS that power.

In response to the Inspector General’s reports, CMS issued a written statement that the agency “has zero tolerance for abuse and mistreatment of any patient.” The statement also says that the agency has added consumer feedback to the Hospice Compare website. Katherine Harris thinks that’s not enough.

“There are a lot of great hospices out there,” Harris says. “There are a lot of highly skilled, committed professionals who are dedicated to helping others leave this life in comfort and with dignity — and the public should know about them.”

The amount of money that Medicare spends on hospice services has roughly doubled since 2006. But Harris says this isn’t just a matter of taxpayer dollars.

You’re only going to die once, she says. It’s important that things go right.

Let’s block ads! (Why?)

Coffee poured. Pillow fluffed. E-book loaded. You’re ready to begin a delightful afternoon on your e-reader when, poof, the book disappears.

Starting in July, Microsoft will be closing its e-book library and erasing all content purchased through the Microsoft e-bookstore from devices. Consumers will receive a refund for every e-book bought.

The company is able to shutter its store – which it launched in 2017 to compete with industry leaders Amazon, Apple and Barnes & Noble – due to a tool called Digital Rights Management or DRM.

DRM allows companies to control content to protect copyright holders and prevent piracy.

“One of the things that I think people don’t realize that’s crucially important is that DRM and related software tools are embedded in all sorts of devices that we buy,” Aaron Perzanowski, the author of The End of Ownership: Personal Property in the Digital Economy, tells NPR’s Lulu Garcia-Navarro.

“Your car, your smart home appliances, your home security system – all of these systems have software that allows for this kind of control over how the devices are used, and I think we’re going to see these same sorts of situations crop up in the context of physical devices that are being used in people’s homes.”

The way DRM is widely employed has been criticized by consumers and earned calls for regulation of Big Tech companies.

“The initial vision for DRM was that it was going to allow for the sale of digital goods online in a way that reduced the risk of copyright infringement,” Perzanowski says.

“As this technology has been deployed what we’ve seen is that the big beneficiaries of DRM have not been copyright holders. They have been technology companies like Amazon, like Microsoft, who are able to control these ecosystems to make it harder for consumers to switch over to new platforms.”

In a University of Pennsylvania Law Review article, Perzanowski found that users are often misled when they click the “Buy Now” button, thinking that they’ve gained permanent ownership of digital content.

Other companies, like Amazon and Walmart, have run into DRM-related troubles in the past, wiping out digital content to the chagrin of consumers.

The e-book and online shopping giant, Amazon, obtained eye rolls when it deleted some George Orwell books from the Kindle’s DRM server, including 1984. Apparently, the company did not understand the irony of erasing a book that famously details the dangers of thought control.

Perzanowski worries that DRM erodes personal property rights and that the scope extends beyond digital media.

“You can go out and buy a car and you think you own the car because it’s parked in your garage,” Perzanowski says. “But in reality – how it functions, who can repair it, what replacement parts are compatible with it – all of that is controlled through software code. And, so I think that line between the physical and the digital is getting increasingly blurry.”

In an explainer posted to its website, Microsoft adds that anyone who wrote notes or marked-up e-books will receive an additional $25 credit. The company has not provided a reason for the closure.

Frank Scardera, a Reddit user, is one of the many Microsoft consumers affected by the e-book purge.

“I was disappointed when Microsoft announced they were shutting the service down…” Scardera says. “In the future, I’ll be buying books from sources that use DRM-free formats, so that if a service is shut down I don’t lose my books or other media.”

NPR’s Peter Breslow and Barrie Hardymon produced and edited this story for broadcast.

Let’s block ads! (Why?)

This article was produced in partnership with MLK50, which is a member of the ProPublica Local Reporting Network.

Methodist Le Bonheur Healthcare, the largest hospital system in Memphis, Tenn., said it has suspended “court collection activities” over unpaid medical bills — just days after an investigation by MLK50 and ProPublica (which also appeared on NPR) detailed its relentless pursuit of debts held by poor people and even its own employees.

“We recognize that we serve a diverse community and we are always thinking about how we can do more and serve our community better,” Methodist said in a written statement. “Over the next 30 days we will be reviewing our policies and procedures to ensure we are doing everything possible to provide the communities we serve with the care and assistance they need. Also, we will immediately suspend any further court collection activities during this period.

“As a learning organization that is committed to continuous quality improvement, we want to be absolutely sure that our practices continue to support our mission and vision of improving every life we touch regardless of ability to pay.”

Methodist dropped more than two dozen cases that were set for initial hearings on Wednesday’s morning docket at Shelby County General Sessions Court.

“Currently, Methodist is in the process of reviewing its collection processes,” R. Alan Pritchard, one of Methodist’s attorneys, told General Sessions Court Judge Deborah M. Henderson.

“You are free to leave,” Henderson told one defendant, who looked puzzled, a purse on her shoulder and a folder full of papers in her hand.

Henderson called the names of other defendants whose cases were on the docket.

Again and again, Pritchard said: “Dropped, please, your honor.”

One of the defendants whose case was dropped is Adrien Johnson, who works for the city of Memphis. Methodist sued him this year for an unpaid hospital bill of more than $900.

Reached by phone, Johnson said he believes the hospital bill was for X-rays he had taken while he was covered by his wife’s insurance. Wednesday was his first court date, and after the hearing, he said he wasn’t clear what the status of his debt was.

“I don’t know what they’re doing,” he said. “I need to find out what’s going on.”

From 2014 through 2018, the hospital system affiliated with the United Methodist Church filed more than 8,300 lawsuits, according to an MLK50-ProPublica analysis of Shelby County General Sessions Court records. That’s more than all but one creditor during that five-year period.

One story by the news organizations chronicled the struggle of Carrie Barrett, who makes $9.05 an hour at Kroger, to pay her 2007 hospital bill for $12,019. The bill has ballooned to more than $33,000 due to interest and attorney’s fees.

Another story detailed how Methodist sues its own employees, some of whom make less than $13 an hour, for unpaid bills related to care delivered at its hospitals. Its health plan doesn’t allow workers to seek care at hospitals with more generous financial assistance policies.

Defendants talked about how the lawsuits upended their lives and left them in a position where they would never be able to pay off their debts, which grew from year to year as interest mounted.

With $2.1 billion in revenue and a health system that includes six hospitals, Methodist leads the market: In 2017, it had the most discharges per year and profits per patient, according to publicly available data analyzed by Definitive Healthcare, an analytics company.

Methodist says it has “a hospital in all four quadrants of the greater Memphis area, unparalleled by any other healthcare provider in our region,” plus more than 150 outpatient centers, clinics and physician practices. The system also said it provides community benefits of more than $226 million annually.

The number of lawsuits Methodist files isn’t out of proportion to its size, at least compared to competitor Baptist Memorial Health Care and Regional One Health, the county’s public hospital. But Methodist stands out in other respects.

Its financial assistance policy, unlike those of many of its peers around the country, all but ignores patients with any form of health insurance, no matter their out-of-pocket costs. If they are unable to afford their bills, patients then face what experts say is rare: A licensed collection agency owned by the hospital.

Also, after the hospital sues and wins a judgment, it repeatedly tries to garnish patients’ wages, which it does in a far higher share of cases than other nonprofit hospitals in Memphis. A court-ordered garnishment requires that the debtor’s employer send to the court 25% of a worker’s after-tax income, minus basic living expenses and a tiny deduction for children under age 15.

Methodist secured garnishment orders in 46% of cases filed from 2014 through 2018, compared with 36% at Regional One and 20% at Baptist, according to an analysis of court records by MLK50.

Methodist’s announcement was welcomed by some local lawmakers.

“Methodist has been such a great community partner throughout Shelby County that I’m glad to hear they’re reviewing their process over the next 30 days,” said Shelby County Commissioner Mickell Lowery, whose district includes Methodist University Hospital.

U.S. Rep. Steve Cohen, D-Tenn., said: “I was surprised to read about Methodist Le Bonheur’s billing practices, and I’m glad that the company is re-examining them. … I will continue to monitor this situation and look forward to the company’s assessment.”

But the Rev. Anthony Anderson, a United Methodist elder at Faith United Methodist in Memphis, was more reserved.

“I am still heartbroken, and I say that spiritually,” Anderson said. “It breaks my heart to know that a Methodist-related entity, a hospital, would have these types of practices.”

He welcomed the policy review, but only if it leads to the complete erasure of all outstanding patient debt.

“This debt needs to be wiped away,” Anderson said. “That will be the direction I will be pushing towards as a Methodist — that we don’t burden families with these type of financial penalties.”

New data obtained from Shelby County General Sessions Court shows that Methodist has filed more than 600 new lawsuits this year. Its most recent suits were filed on June 21, days before the MLK50-ProPublica stories were published. Its most recent garnishment order was filed on Tuesday.

Wendi C. Thomas is the editor of MLK50: Justice Through Journalism. Email her at wendicthomas@mlk50.com and follow her on Twitter at @wendicthomas.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up for ProPublica’s Big Story newsletter to receive stories like this one in your inbox as soon as they are published.

Let’s block ads! (Why?)

OPEC used to shift world oil markets with a single announcement. These days, the Saudi-led organization needs help from some key partners — most significantly Russia — to exert that kind of influence.

The expanded alliance, which also includes Kazakhstan, Mexico and other nations, is known as “OPEC+.” And on Monday and Tuesday, OPEC+ made its unofficial expansion a little more official.

Member and non-member states have agreed on a “Charter of Cooperation” to formalize their relationship, pending approval from individual governments.

Khalid Al-Falih, the Saudi oil minister, called the move “historic.”

The charter “has created one of history’s strongest producer partnerships, spanning the entire world from east to west,” he said Tuesday. “Our objectives related to market stability are now matched by the horsepower needed to deliver them.”

For many decades, OPEC had that horsepower all on its own: its members controlled a majority of the world’s crude supply.

But the balance of power in the global oil market has changed. A technological revolution unlocked vast quantities of previously tough-to-access crude. The U.S. unexpectedly became the world’s No. 1 oil producer and a significant exporter. OPEC found itself controlling less than half the world’s crude, and watched as oil prices dropped.

So Saudi Arabia looked to a country that, until just a few years ago, had never cooperated with OPEC cuts and was regarded by key OPEC members as an oil rival instead of an ally: Russia. After the U.S. and Saudi Arabia, Russia is the world’s third-largest oil producer.

“There is no question that OPEC’s need to reach out to other large producers like Russia was a direct result of the fact that they were losing their power and influence over the oil market because of the rise in U.S. production and U.S. exports,” says Amy Myers Jaffe, the director of the program on energy security and climate change at the Council on Foreign Relations. “Russia and OPEC decided that they would have to form a partnership or they would lose their influence completely.”

Fortified by Moscow and other cooperating non-members, OPEC+ once again controls most of the world’s crude oil supply. In late 2016, the group agreed on production cuts that are credited with helping stabilize oil prices after their two-year slide. They’ve been extended repeatedly since then.

Building this partnership has not been easy. Iran, a founding member of OPEC, has always been wary of the power its regional rival Saudi Arabia wields within the group, and the new OPEC+ arrangement — which pivots on the partnership between Riyadh and Moscow — gives even more authority to the Saudis.

Meanwhile, Iran also has reason to be worried that the Saudi-Russia partnership could threaten the existing strategic military alliances between Iran and Russia, explains Jaffe.

“Iran is pretty isolated,” she says. “If … Russia feels there’s some benefit to itself from having a tight relationship with Saudi Arabia, then who does Iran go to for any assistance?”

As a result, while Iran has accepted the OPEC+ production cuts, it has spoken out against formalizing the expanded coalition — that is, it accepted the functional reality of the partnership but objected to putting it down in writing. Ahead of the OPEC meeting on Monday, Iran vowed to veto the plans for the charter of cooperation.

Oil minister Bijan Zangeneh went so far as to say that “OPEC might die” as a result of domination by Saudi Arabia and Russia.

But after marathon negotiations on Monday, Iran was persuaded to sign off on the draft text of the charter, which was approved by the participating non-member states on Tuesday.

OPEC+ members welcomed the charter as a tool for strengthening producers’ influence over the oil market.

However, Jaffe notes that even bolstered by the expansion, OPEC+ may not have the ability to move the price of oil as significantly as in the past. Many OPEC members are struggling with involuntary production cuts — from Venezuela’s collapse to U.S. sanctions on Iran. Meanwhile, the U.S. and other non-OPEC producers can ramp up production very quickly, thanks to new drilling technologies.

And if OPEC does push succeed in pushing prices up significantly, Jaffe says, it could backfire — from an oil producer’s standpoint — by pushing the world to more quickly reduce its demand for oil.

“If the price of oil were to go up today … more and more people would be inclined to buy an electric car,” she says. “There are all kinds of features today with new technology that make it actually very dangerous to OPEC’s long-term interest to really jack around the price of oil.”

Let’s block ads! (Why?)

Updated at 5:10 p.m. ET

OPEC and other allied major oil producers have agreed to extend crude oil production cuts for nine months, a move designed to keep oil prices from falling as U.S. production increases and concerns grow about global demand.

Crude oil prices rose after early reports of OPEC’s decision. However, prices are not expected to rise dramatically, as countries that don’t cooperate with OPEC — like the United States — have enough capacity to meet projected growth in demand.

OPEC’s supply cuts, which Russia and several other nonmember countries are also observing, were put in place on a temporary basis at the beginning of 2017. They are credited with helping stop a dramatic multiyear slide in oil prices, and OPEC has opted to extend the cuts repeatedly since then.

Ahead of Monday’s meeting, the organization had been widely expected to extend cuts by at least six months.

The deal technically needs to be approved by participating non-OPEC members in a meeting on Tuesday.

But Russia, by far the most significant non-OPEC partner, has already indicated it is willing to cooperate with production cuts.

Shifting geopolitics

Some of OPEC’s production cuts are outside the cartel’s control.

Iran, a founding member of OPEC, is under pressure from U.S. sanctions after President Trump withdrew from the Iran nuclear deal. As a result, Iran has struggled to export its crude oil.

Venezuela, another OPEC member, has also been hit by U.S. oil sanctions, further contributing to reductions in OPEC production.

More broadly, the agreement to keep cuts in place comes during a period of intense geopolitical tension.

Iran continues to object strongly to the influence of regional rival Saudi Arabia over OPEC decisions, particularly as an alliance between Saudi Arabia and Russia holds growing sway over the cartel.

Since these production cuts were agreed upon in late 2016, non-OPEC members like Russia have bolstered the organization’s ability to influence the global oil market. While OPEC controls less than 50 percent of the world’s crude oil production, the expanded coalition, known as “OPEC+,” controls a majority.

Russia, despite not being an OPEC member, accordingly holds significant sway over OPEC decisions. In fact, Monday’s meeting, originally planned for late June, was rescheduled at Russia’s request — creating some controversy within OPEC’s actual membership.

At the meeting, OPEC agreed to formally recognize the new relationship with these non-OPEC allies through a “Charter of Cooperation.” The charter now needs to be approved by Russia and the other OPEC+ members.

Khalid al-Falih, Saudi Arabia’s minister of energy, called the charter a “historic document.”

“We are bringing a group of producers permanently into a bigger fence … to sort of work together as a bigger family,” he said.

Iran had vowed to veto the charter, given its concerns over the power wielded by Saudi Arabia and Russia. But after lengthy negotiations it ultimately approved the document, which Falih says contained assurances that the new charter would not supersede the original OPEC agreement.

Meanwhile, the United States — emphatically not a member of OPEC — has been increasing oil production at a rapid clip. The boom in the Permian Basin has made the U.S. the world’s top oil producer.

When OPEC countries cut their production, it boosts the fortunes of members and nonmember partners alike. But it also leaves a larger slice of the market available to others. So when OPEC+ limits production it benefits American producers, albeit unintentionally, helping the U.S. claim a growing share of the global oil market.

Eyeing future demand

Concerns over growing U.S. production are not the only spur for the OPEC+ production cuts. The cartel and its allies are also worried about softening demand growth.

Just last month, OPEC announced it was lowering its expectations for future world oil demand.

The International Energy Agency also projects softening demand growth. The IEA says there are multiple factors, including “a warm winter in Japan, a slowdown in the petrochemicals industry in Europe, and tepid gasoline and diesel demand in the United States.”

But one factor looms large across the world, the IEA says: concerns over the future of global trade.

Economists expect the global economy to slow down over coming months and years. And the tensions between the U.S. and China — among other trade wars — have heightened concerns about an economic cooldown.

Meanwhile, in the long term, changes in transportation — particularly the rise of electric vehicles — and government policies designed to reduce the severity of global climate change could put downward pressure on oil demand.

However, analysts believe demand for oil has not peaked. While demand growth may be slowing down, the global appetite for oil is continuing to increase — just at a slower rate than OPEC and the IEA had previously anticipated.

Let’s block ads! (Why?)

Signs are pointing to a coming U.S. recession, according to an economic indicator that has preceded every recession over the past five decades.

It is known among economists and Wall Street traders as a “yield curve inversion,” and it refers to when long-term interest rates are paying out less than short-term rates.

That curve has been flattening out and sloping down for more than a year, raising worries among some analysts that investors’ long-term view of the market is not positive and that an economic downturn is looming.

But on Sunday, an inauspicious milestone was achieved: The yield curve remained inverted for three months, or an entire quarter, which has for half a century been a clear signal that the economy is heading for recession in the next nine to 18 months, according to Campbell Harvey, a Duke University finance professor who spoke to NPR on Sunday. His research in the mid-1980s first linked yield curve inversions to recessions.

“That has been associated with predicting a recession for the last seven recessions,” Harvey said. “From the 1960s, this indicator has been reliable in terms of foretelling a recession, and also importantly, it has not given any false signals yet.”

In a 1986 dissertation, economist Campbell Harvey identified an economic indicator that would precede the next seven recessions. That indicator, known as “a yield curve inversion,” now forecasts a coming U.S. recession.

Courtesy of Campbell Harvey

hide caption

toggle caption

Courtesy of Campbell Harvey

Still, many economic forecasters do not see a recession on the horizon.

For instance, Randal Quarles, the Federal Reserve’s vice chairman for banking supervision, has said that the gap between short- and long-term interest rates does not mean the U.S. is moving toward a recession.

And then there is a sea of bright economic news setting the backdrop for the yield curve inversion hitting its three-month mark: unemployment is at a near historic low, the stock market is going strong. The S&P 500 is up 17% for the year. And while some economists say the pace of growth may be slowing, the consensus view is that a dramatic economic plunge is not on the horizon.

But Harvey says no single economic predictor has the impressively prescient track record of the yield curve inversion.

“Yes, the economy looks good right now,” Harvey said. “But the yield curve is about the future,” he said. “It captures the expectations of the broad market in terms of what might happen in the future.”

Might a whole quarter of an inverted yield curve become a self-fulfilling prophecy?

“Perhaps,” Harvey said.

Consumers could see the data point as a red flag and pull back on spending, or corporations may view the sloping yield curve and decide not to make investments or hire new employees.

“I look at it more in terms of risk management. This is an important piece of information. It helps people plan,” Harvey said. “It enhances the possibility that we have a soft landing, not a hard landing, like a global financial crisis.”

If the idea of an inverted yield curve remains hard to grasp, Harvey says think of it this way: a yield curve is the difference between a short term cash instrument, like a three-month government bill, compared to a long-term one, such as a 30-year government bond. When the short-term ones are paying out more than the longer-term ones, something is wrong. And economists call it an inverted yield curve.

Or, Harvey said, think of a certificate of deposit at a bank, better known as a CD.

“If you lock your money up for five years, you expect to get a higher rate than, say, locking it up for six months,” he said.

“But in certain rare situations, things get backwards and it turns out the long-term interest rate is lower than the short-term rate, and that’s called an inverted yield curve. That’s exactly the situation we got now, and it is a harbinger of bad news.”

Let’s block ads! (Why?)