Blake Farmer, Nashville Public Radio, Author at ��ϳԹ�� News

Can I Opt Out of Having My Doctor Take Notes With AI?

Katherine Ruppelt, Nashville Public Radio — Tue, 07 Apr 2026 09:00:00 +0000

LISTEN: AI scribes are changing medical care. Here’s what to know if the technology shows up at your next doctor’s appointment.

Family physician Eric Boose has been using an artificial intelligence tool to get back to what he calls “old-fashioned medicine” — talking with patients face-to-face, without having to type into a computer at the same time.

“I can really just sit there and engage and just focus on them and listen,” said Boose, who .

Roughly two years ago, he started using an AI notetaker app during patient visits. The tool listens while he talks with patients and then automatically generates a visit summary based on the conversation. The summary is usually ready within seconds after the appointment ends.

“It’s taking care of all that tedious work of charting and taking notes during the visit,” he said. “It’s just freeing up a lot more time to get that done, and I can get home to my family earlier.”

Nearly a third of physician practices are using AI scribes and others are working to add the tool, in an effort to cut down on administrative work.

If your practitioner suggests using an AI scribe at your next appointment, here are three things to keep in mind:

1. Clinicians should ask for your permission.

At the start of an appointment, your doctor might ask something like, “Are you OK if I use an AI scribe to help me take notes during this appointment?” A common practice is to accept verbal, not written, consent from patients before turning the tool on. However, the legal requirements for getting permission to record a patient conversation vary by state.

Boose said you can ask to pause the AI scribe at any point, especially to discuss something sensitive. And if you decline altogether, your practitioner will likely return to taking manual notes on a computer.

2. AI scribes make mistakes too, so check their work.

Like other AI tools, medical scribes can “hallucinate,” or spontaneously add errors into a record. AI scribes can also omit important information or miss context clues within a conversation.

Clinicians are supposed to review and edit the AI-generated visit summaries before adding them to a patient’s record. As a patient, it’s a good practice to carefully review your visit summary and contact your health provider if you notice errors.

3. Yes, the AI company could use your data, with limitations.

Companies and health systems that offer AI scribe tools have access to medical data and are subject to federal standards about how they use and store patient data, under the Health Insurance Portability and Accountability Act, more commonly known as HIPAA.

They may use data from your appointment to help improve their software without informing you, said Darius Tahir, who reports on health technology for ��ϳԹ�� News. “ If information is ‘de-identified,’ which can mean stripping it of identifiers [and] making sure it’s not personally traceable back to people, then it is more free to be used in more ways,” he said. “There are way fewer regulatory requirements.”

If you want to know how your data is being used, ask either your practitioner or medical system for more information. But you might not get a clear answer, Tahir said.

People and Policy

The U.S. health care system will likely continue to integrate AI technology into patient care. The Trump administration strongly supports the development and use of AI, especially in health care. In early 2025, President Donald Trump issued reducing existing regulations on AI to help the U.S. “retain global leadership of artificial intelligence.” In December, the U.S. Department of Health and Human Services released an stating that the department supports “integrating AI to modernize care and public health infrastructure to improve health at the individual and population levels.”

Emily Siner at Nashville Public Radio contributed to this report.

HealthQ is a health series from reporters Cara Anthony and Blake Farmer, approachable guides to an unapproachable health care system. It’s a collaboration between Nashville Public Radio and ��ϳԹ�� News.

��ϳԹ�� News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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Taking a GLP-1? Doctors Say Not To Forget About Movement and Mental Health

Emily Siner, Nashville Public Radio — Thu, 26 Mar 2026 09:00:00 +0000

LISTEN: Taking a GLP-1? Doctors say don’t forget to move your body and tend to your mental health, too.

Severe ankle pain drove Jelon Smart to start taking a weight loss injection a year and a half ago.

Smart was 285 pounds and worked as a caterer in Savannah, Georgia. After she’d been standing on her feet for long hours, her ankles would be “as swollen as a football,” she said. She was walking with a limp. An orthopedic doctor diagnosed her with Achilles tendinitis and recommended losing weight to mitigate the symptoms. Smart began taking the brand-name GLP-1 Ozempic.

The appetite suppression resulted in her shedding pounds quickly, at first.

“I lost 30 pounds initially without changing anything,” said Smart, 48. But then she found herself unable to shed additional pounds.

GLP-1s have quickly become one of the most popular types of weight loss drug in America. Nearly 1 in 5 people have taken them at some point, , a health information nonprofit that includes ��ϳԹ�� News. But doctors say it takes more than a regular shot for patients to achieve their weight goals in the long run.

Here’s what to know.

The Old-School Rules of Weight Loss and Health Still Apply

Regular exercise, smart food choices, plenty of sleep — those basic, healthy lifestyle choices are not only going to help you lose weight on a weight loss drug but also help you keep it off, said Dafina Allen, an obesity medicine physician who runs a clinic in Saginaw, Michigan. For example, some people find that they eat less on a GLP-1, “but they’re not improving their health because they’re not exercising. They’re not improving the quality of the food they’re eating,” Allen said. The path to weight loss is also guided by hormones, metabolism, and genetics.

After her weight loss on Ozempic plateaued, Smart realized she needed to start moving her body, too. “I’m in the gym now six days a week,” she said. “I went from 285 to 175” pounds. The swelling and pain in her ankle went away as well.

Jelon Smart, from Savannah, Georgia, lost 110 pounds after starting on Ozempic — but only after starting an intensive workout regimen, too. (Christopher Smart, Jennifer Davis)

Mental Health Matters, Too

The mind and body are deeply connected. Food and body image can be especially emotional, Allen said. “I can tell you about the patients that I helped lose 50 pounds, that I helped lose 100 pounds, and they still look in the mirror and are not happy.”

The key is seeking help for mental health along the way, said Gerald Onuoha, who practices internal medicine in Nashville, Tennessee. “Making sure that you’re talking to people about your problems, whether it’s a family member or a licensed professional, I think goes a long way,” he said.

Work With a Doctor To Closely Monitor Your Dosage

Onuoha said people can run into serious problems if they increase their GLP-1 dosage too quickly or don’t follow the recommended schedule. He’s seen patients come to the hospital with pancreatitis, gallstones, or acute kidney injury. “I always ask patients that are on GLP-1s: How long have they been on them?” he said. “Are they adhering to the directions? Because those things determine whether or not you’re going to have those complications.”

Part of the issue, Allen said, is that GLP-1s are relatively easy to access — and often much cheaper — through online pharmacies or websites, but those providers may not educate patients about their dosage or side effects. “So they might just go online, find a random company that will ship it to their house, where they don’t even know what dose of the medication they’re taking, or even if the medicine is safe for them as the patient with the medical conditions they have,” she said.

People and Policy

GLP-1 drugs can be costly, and most insurance programs — public or private — don’t cover the medications for weight loss. Medicaid, the government program that covers 69 million Americans, covers GLP-1s for medically accepted conditions like diabetes, but only about a dozen state Medicaid programs cover GLP-1s for obesity treatment, . For older Americans with Medicare, the federal government is planning to allow temporary coverage of GLP-1s for weight loss starting in July.

Katherine Ruppelt at Nashville Public Radio contributed to this report.

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Even With Dental Insurance, You Still Could Face a Large Bill

Blake Farmer, Nashville Public Radio — Mon, 23 Mar 2026 09:00:00 +0000

LISTEN: Your dental insurance might not cover what you expect.

Russell Anthony made eight trips to the dentist last year. The 65-year-old retiree in Nashville, Tennessee, hopes to go less often in 2026, but he’s already made a few visits.

“I had a root canal just last week that was like $500,” he said. “The week before that, I had a crown that cost me several hundred dollars. And as we speak, I have a broken tooth, and I have to go and see the dentist soon.”

In all, Anthony — uncle of HealthQ host Cara Anthony — expects to pay about $2,000 for dental care this year, even though he has dental insurance.

“Trying to weigh the cost of when to go to get dental care and paying for it, versus the other needs that I have, is something that’s very important,” Russell Anthony said.

The American Dental Association reported that had dental insurance in 2021. But that coverage does not necessarily protect against large bills. In fact, 1 in 4 adults with dental insurance reported costs as a barrier to care, according to a by KFF, a health information nonprofit that includes ��ϳԹ�� News.

Here are three things to know to better understand your insurance plan and keep your dental costs as low as possible:

1. Even With Dental Insurance, You’ll Have To Pay for Procedures

Dental plans typically cover routine care in full but pay only a portion of additional work. Benefits vary, but many plans follow the “100/80/50” rule, covering 100% of preventive care like cleanings and exams, 80% of basic procedures like fillings and root canals, and 50% of other major procedures.

Plus, dental plans often have a maximum annual payout, usually between $1,000 and $2,000. Patients are responsible for any costs above that. For example, if your plan maxes out at $1,500 and you need $4,000 of dental treatments, you will be on the hook for the difference of $2,500.

2. Facing a Big Dental Bill? You Have Options

It might feel uncomfortable to talk about finances directly with a dentist, but it’s helpful to be up-front about what you can afford.

Many dentist offices offer financial options to help patients manage the cost of care, including pretreatment estimates and payment plans. If you get an estimate that seems especially high, talk through the items and consider getting a second opinion. It never hurts to ask the office for a discount.

If you need a lower-cost alternative, consider looking into dental schools, which often offer discounted care, or , which use sliding scales based on a patient’s income.

3. Seeing Your Dentist Regularly Can Help Keep Costs Low

Sarah Olim, a general dentist in Katy, Texas, encourages her patients to come in for visits every six months.

“The best thing that you can do to mitigate the cost of going to the dentist is make sure that you are going regularly and trying to take care of things early,” she said.

Olim welcomes patients no matter how long it’s been since their last visit. But she cautioned that patients who wait a few years between visits may find their appointments are more expensive and more uncomfortable.

The reason? Dental problems often don’t resolve on their own. For example, a small cavity that needs a quick filling might cost $200. If left untreated, it could turn into a larger issue requiring a root canal and crown — and cost thousands.

Your dentist will also encourage you to follow the best preventive maintenance: brushing your teeth for two minutes twice a day. Olim tells her patients to use a timer or listen to a favorite song to make sure they brush long enough.

People and Policy

Federal lawmakers have tried to increase children’s access to dental insurance. Under the Affordable Care Act, dental care is considered , so health insurance plans on the individual marketplace must offer dental coverage for those 18 or younger. State Medicaid programs are also for children.

Emily Siner at Nashville Public Radio contributed to this report.

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Is It Worth Your Time and Money To Set Up an HSA?

Blake Farmer, Nashville Public Radio — Mon, 16 Mar 2026 09:00:00 +0000

LISTEN: Is it worth it to set up a health savings account? HealthQ has answers.

When Mike McKee thinks about saving money for the future, he has a few priorities. Maxing out his retirement is one. Building up his kid’s college fund is another.

Opening up a health savings account? Not so much, even though he qualifies because of his high-deductible health plan.

“I’m so frustrated with the system that has anything to do with medical savings,” said McKee, 42, a self-employed musician in Nashville, Tennessee. “I’m just so turned off emotionally that I have to be really careful to be logical about it.”

More Americans are eligible to open an HSA — a kind of tax-free savings account that lets them sock away money for medical expenses — after changes that were part of new legislation last year. But an HSA can be a headache to set up and navigate.

Here’s what to know about how they work and when they’re worth it.

Like a Tax-Free Investment Account for Medical Expenses

With an HSA, you set aside money from your paycheck before taxes, and you can use that money to pay for medical expenses later. , including medications, glasses, orthodontia, and many kinds of therapy.

You have options for the money in the account, including investing it. Some people call HSAs a “triple tax advantage”: There are no taxes on the money that goes in, no taxes on any interest earned, and no taxes on the money that comes out for medical expenses.

Pro tip: An HSA is not the same as an FSA, or flexible spending account, even though it sounds similar. An FSA also lets you put pretax income into an account for medical expenses, but you typically lose unspent money at the end of the calendar year. By contrast, HSA money stays in your account until you spend it. Think F for “forfeit” and H for “hold on to.”

The Admin Work of an HSA Can Be a Real Barrier

First, you have to find out whether your health plan allows for an HSA. Most high-deductible health plans do, but with these plans you might have to spend thousands of dollars before most benefits kick in. Starting this year, plans on the individual Affordable Care Act marketplace that are categorized as “bronze” or “catastrophic” are also eligible. (The easiest way to find out whether you qualify is to call the number on the back of your insurance card and ask.)

Then, you have to open the HSA on your own through a financial institution — although if you get health insurance through a job, your employer might have preferred institutions. And finally, you have to keep track of your qualified medical expenses. You pay for them using a special debit card or by submitting claims for reimbursement, usually through an online portal. Either way, it’s smart to hold on to receipts.

People and Policy

If you’re living paycheck to paycheck, you may find it difficult to take advantage of the tax savings that come with an HSA. “HSAs, in this way, tend to benefit more the higher-income enrollees, because those are the ones who have the disposable income to set aside at the end of the month,” said Michelle Long, a policy researcher at KFF, a health information nonprofit that includes ��ϳԹ�� News. Plus, people with higher incomes and higher tax brackets have more to gain from getting discounts on their taxes, which is basically what an HSA provides.

Katherine Ruppelt at Nashville Public Radio contributed to this report.

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If You’re Pregnant and Uninsured, Medicaid Might Be Your Answer

Blake Farmer, Nashville Public Radio — Tue, 03 Feb 2026 10:00:00 +0000

LISTEN: If you’re newly pregnant and not able to afford health insurance, you may qualify for Medicaid. Reporters Cara Anthony and Blake Farmer — hosts of the new series “HealthQ” — explain that every state has a program to provide coverage for pregnant people.

When she noticed an unusual craving for hot dogs, Matte’a Brooks suspected her body was telling her something, so she decided to take a pregnancy test. She took two just to be sure. Both were positive.

“I was definitely scared,” said Brooks, 23, who was uninsured. “I was like, OK … I’m pregnant, so where do I go from here?”

Until then she hadn’t thought much about health care, but that changed when she found out that her daughter was on the way.

Brooks got that news last winter. The mix of joy, anxiety, and excitement she felt mirrors what many new parents feel at this time of year. Many Americans find out in January or February that they’re expecting, because in the U.S., August has consistently high birth rates.

A growing body of research shows that prenatal care can make a huge difference to the long-term health of both the parent and baby. This is part of why offers health coverage to pregnant women who meet income requirements and might otherwise go uninsured.

As a result, Medicaid pays for more than 40% of births in the U.S. and an even higher percentage in rural areas, according to KFF. But Medicaid also comes with limitations, and providers may restrict how many Medicaid patients they take, since the payments are than other insurers’.

Here are three things to know about signing up for Medicaid when pregnant.

1. Pregnancy Makes You a Priority

To sign up for government health care, you have to meet a number of requirements that vary widely by state. Most importantly, your income has to be below a certain threshold. In several states, most adults cannot qualify, regardless of income, if they’re not disabled or the parent of a child.

But the math is different for pregnancy. In Tennessee, for example, the eligibility cutoff in pregnancy is the income threshold for some other residents. So if you didn’t qualify for Medicaid previously and are now pregnant, it’s worth double-checking your state’s requirements.

2. Getting Covered Can Be Surprisingly Easy

To apply, you’ll likely proof of income, your Social Security number, and proof of residency. Brooks, an Illinois resident, told HealthQ that she found the sign-up process surprisingly easy. She learned about Medicaid from the provider at her initial prenatal visit.

“They asked if I had insurance. I didn’t know anything at the time,” she said. The nonprofit clinic gave her some phone numbers for the state Medicaid agency. She called and went to an in-person appointment to complete her application. She walked out of the office with coverage. In , pregnancy results in “presumptive eligibility,” which provides immediate coverage — even without confirmation of the pregnancy — while the application goes through the approval process.

3. Coverage Can Go Beyond Standard Medical Care

Medicaid provides all prenatal care at no out-of-pocket cost and usually a of postpartum care. That’s what happened to Brooks: Her appointments, medications, and delivery were free.

States cover dental, vision, and mental health care to varying degrees. Ashley Farrell, who lost her job when she was pregnant and applied to Medicaid in Georgia, said she received “rewards for going to your appointments,” including . Benefits vary by state.

People and Policy

Some maternal health advocates about how Medicaid cuts in the One Big Beautiful Bill Act will affect pregnancy coverage. Though it’s unclear when or how, states might scale back eligibility or offerings for expectant mothers.

Katherine Ruppelt at Nashville Public Radio contributed to this report.

HealthQ is a health series from reporters Cara Anthony and Blake Farmer — approachable guides to an unapproachable health care system. It’s a collaboration between Nashville Public Radio and ��ϳԹ�� News.

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Millions of Americans Are Expected To Drop Their Affordable Care Act Plans. They’re Looking for a Plan B.

Blake Farmer, Nashville Public Radio — Mon, 12 Jan 2026 10:00:00 +0000

Robert Sory feeds a treat to a blind, albino raccoon named Cricket. Russian foxes, African porcupines, emus, bobcats, and goats are also part of his menagerie. (Blake Farmer/WPLN)

It’s feeding time for the animals on this property outside Nashville, Tennessee. An albino raccoon named Cricket reaches through the wires of its cage to grab an animal cracker, an appetizer treat right before the evening meal.

“Cricket is blind,” said Robert Sory, who is trying to open a nonprofit animal sanctuary along with his wife, Emily. “A lot of our animals come to us with issues.”

The menagerie in Thompson’s Station includes Russian foxes, African porcupines, emus, bobcats, and some well-fed goats.

The Sorys are passionate about their pets and seem to put the animals’ needs before their own.

Both Robert and Emily started 2026 without health insurance.

Robert had been covered through a marketplace plan subsidized through the Affordable Care Act. His share of the monthly premiums was $0. When he looked up the rates for 2026, he saw that a barebones “bronze”-level plan would cost him at least $70 a month. He decided to forgo coverage altogether.

“When you don’t have any income coming in, it doesn’t matter how cheap it is,” he said. “It’s not affordable.”

Emily and Robert Sory are trying to open a nonprofit animal sanctuary at their home in Thompson’s Station, Tennessee. They have forgone health insurance this year and are looking for ways to pay for their care without coverage. (Blake Farmer/WPLN)

Dumping Coverage

Marketplace plans from the Affordable Care Act no longer feel very affordable to many people, because Congress did not extend a package of enhanced subsidies that expired at the end of 2025. Last week, the House did pass legislation to extend the expired subsidies, and negotiations have moved to the Senate. Without a deal, an estimated will go without coverage this year.

But even without a health plan, people will still need medical care. Many, like the Sorys, have been thinking through their plan B to maintain their health.

The Sorys both lost jobs in November, within days of each other. Robert worked as a farmhand. Emily worked at a staffing firm and lost her insurance along with her position.

“It’s a horrible, horrible market right now. Really tough,” she said.

The first time she had to pay out-of-pocket for her three monthly prescriptions, the cost was $184.

“To equate that to kind of how we think about it, you’re talking about 350 pounds of food for these animals,” Robert said. He pointed to his bobcats, who eat only meat.

A bobcat waits for a meaty meal served by Robert Sory. (Blake Farmer/WPLN)

Workarounds for the Newly Uninsured

To keep kibble in the food bowls, the Sorys are prepping for an uninsured future. They see the same psychiatrist and met with him to make a plan. He was willing to work with them by charging $125 per visit. They’ll have to go every three months to keep their prescriptions current.

And if other medical problems emerge? They’re hoping for the best.

“I’m not somebody who gets sick super often, thank God,” Robert said. “And if I do, generally I go to an emergency room where they’re going to bill me later.” Robert said he would arrange a repayment plan for bills like that.

Emily has costly health conditions and has already taken on substantial medical debt. “It’s just sitting there, and I’ve racked up money,” she said. “But I’ve had to go to the doctor.”

Donated Drugs and Sliding Scales

Hospitals and clinics are of newly uninsured patients. They’re also concerned that people won’t know about alternative ways to get medical care.

“We don’t have marketing dollars, so you’re not going to see big billboards or radio ads,” said , CEO of in Nashville. It’s one of the country’s 1,400 federally qualified health centers, also called FQHCs.

FQHCs are by the federal government. Although they do not usually offer free care, their fees tend to be lower or on a sliding scale.

Uninsured people who get care receive a bill, Beard said, “but the bill will be based on their ability to pay.”

FQHCs often have on-site pharmacies, and some offer prescription medications free of charge through a partnership with the , a Nashville-based nonprofit.

Many hospital pharmacies also partner with the nonprofit, which has donated by pharmaceutical companies to 277 sites in 38 states. must make the medicine available free of charge to people without insurance who have annual incomes below 300% of the federal poverty limit.

The organization primarily sources medications for chronic conditions such as high blood pressure, diabetes, and mental health. Demand is expected to outstrip supply in the new year, according to .

“We’re projecting and engaging with our manufacturers and asking them, ‘Are you willing to help support, for this future status that we are anticipating?’” he said. “By and large,” he said, pharmaceutical companies have said they’re willing to step up.

“It’s a continuous conversation that we’re having,” Cornwell said.

Emily Sory readies the foxes’ supper. (Blake Farmer/WPLN)

A Medicaid ‘Gap’ in 10 States

Hospitals will also have to find a way to care for more patients who cannot pay. Industry groups such as the have been vocal about the threat to hospitals’ financial health and have urged Congress to extend the enhanced subsidies, which take the form of tax credits.

The impact might be most acute in states like Tennessee that have not expanded Medicaid to cover people who work but do not have job-based insurance and cannot afford it on their own.

Ten states have chosen not to expand Medicaid to uninsured, low-income adults — an optional provision of the ACA that is mainly paid for by federal funds.

This Medicaid “gap” is , at the high end of the spectrum, by as much as 65% in Mississippi and by 50% in South Carolina, according to the Urban Institute.

As Emily Sory pets a Russian fox, she admits she is keenly aware that she will soon become part of this growing population. After all, her last job involved health care staffing. Her mother is a nurse.

“I understand the system. And I get it’s people like me that don’t pay their bill are why it suffers. And I feel bad,” she said. “But at the same time, I don’t have the money to pay it.”

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Lice Pose No Health Threat, Yet Some Parents Push Back on Rules To Allow Affected Kids in Class

Blake Farmer, Nashville Public Radio — Wed, 10 Sep 2025 09:00:00 +0000

Any evidence of lice was once a reason for immediate dismissal from school, not to return until the student’s head was lice-free. But what are known as “no-nit” policies have been dropped in favor of “nonexclusion” rules, prioritizing class time over any nuisance caused by parasites the size of sesame seeds. That leniency, of late, is coming back to bite some schools.

Parents in Massachusetts, Texas, Ohio, and Georgia are their districts to revive strict rules on nits and live lice. They blame recent outbreaks on the from the Centers for Disease Control and Prevention that allow students with live lice to remain in class. Before the start of this school year, the Hernando County School District, north of Tampa, Florida, acted to reinstate a policy abandoned in 2022.

“It’s a reinfestation, over and over and over,” said Shannon Rodriguez, who chairs the Hernando school board. In July, she told fellow board members that she’s seen the vicious cycle among families. “What do you do as a parent? Put them back in school with the same kid or kids that are in the classroom who have it? It’s just a never-ending battle.”

Public health officials consider lice a nuisance, not a health threat. Outside of small studies, data collection is scarce. With very little data on infestations, it’s hard to know whether more inclusive policies have anything to do with isolated outbreaks.

The of annual infestations in the U.S. are broad and unreliable since so many cases go unreported. The CDC puts the number between 6 million and 12 million, affecting mostly preschoolers and elementary-age children.

“It really is about education because there are so many myths and so many misunderstandings about lice out there,” said of the chapter in Tennessee. “This isn’t a topic that most people talk about.”

NASN and the American Academy of Pediatrics have supported since at least 2002. But the recommendations were taken more seriously after the covid-19 pandemic affirmed the importance of face-to-face schooling.

“I think that people are starting to realize the value of in-person school and that really anything that takes them out of that should be scrutinized,” pediatrician of told NPR and ��ϳԹ�� News. “Head lice is not a valid reason to keep a kid out of school or be dismissed from school.”

Nolt co-authored the issued by the AAP in 2022, which incorporated new research but largely echoed prior recommendations. It discourages widespread lice checks in schools, as published in the Pediatric Infectious Disease Journal found that lice are frequently misidentified, which leads to unnecessary treatment and isolation of lice-free children.

It takes four to six weeks for lice to go from nits to a full-blown infestation. Only then would a child be seen head-scratching uncontrollably, caused by an allergic reaction to the parasites’ saliva.

“Kicking them out on a Wednesday when they’ve been having it for the past four to six weeks is not going to do anything. But it’s going to take that kid out of school and shame that kid and shame that family,” Nolt said. “I just think that’s not acceptable.”

Inclusion is the priority, even if it may inconvenience others or sow financial costs. Over-the-counter remedies, such as creams, gels, or shampoos, can add up. Professional treatment, which often involves manually picking out lice and nits, can run into the per person. And sometimes lice hits an entire household.

This summer, a preschool outside Nashville, Tennessee, endured its biggest outbreak yet. Roughly a third of the kids at the ended up with lice.

Owner knew the latest recommendations were to play it cool. So she kept everyone in school, and they faced the dreaded four-letter word together. And then she .

“It’s not as bad as you think it is,” Bryson said. “I mean, yes, we had quite a few kids with it, and it went to parents and siblings. But it’s manageable.”

Among the affected families was Stephanie Buck, who also teaches at the day care. Lice ran through her household, requiring pricey treatments to rid them all of the infestation.

Buck said she’s torn about the best approach to combat lice, balancing the shame and stigma with the practical matter of containing an outbreak.

“Because my daughter was really embarrassed when she found out that she was the first one who got checked and she had it,” Buck said. “It’s hard. You want to protect your babies’ hearts, but you also want to keep them from getting lice.”

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In Tennessee, a Medicaid Mix-Up Might Land You on a ‘Most Wanted’ List

Blake Farmer, Nashville Public Radio — Wed, 22 Feb 2023 10:00:00 +0000

Life was upended for LaShonia Ingram over the past year, and a shadow still follows her around.

Search her name online, and the first result includes the words “fraud” and “most wanted.”

“It was horrible. I couldn’t get a job,” said the 42-year-old mother from Memphis, Tennessee. “All doors were being closed in my face.”

Ingram resorted to selling purses out of her trunk to support her family. She said even DoorDash and Uber wouldn’t allow her to work with a felony charge. Her alleged crime? Fraud.

The state of Tennessee accused Ingram of living in nearby Horn Lake, Mississippi, while still enrolled in the state’s Medicaid program, known as TennCare. It all turned out to be a mix-up, but the damage to her reputation and finances was done.

Every state has to investigate Medicaid fraud committed by doctors and other health care providers, since that’s usually where the most money can be recovered. Few states crack down on patients as Tennessee does. Tennessee posts the names and photos of people arrested for alleged fraud on a government website and social media. Some even wind up on a “most wanted” list.

The list is maintained by Tennessee’s Office of Inspector General. The office was launched in 2005 when most of the cases involved drug diversion: People were accused of using TennCare benefits to acquire massive quantities of narcotics to sell on the street. But as federal rules have slowed the illegal prescription drug market, arrests related to Medicaid are instead sweeping up people accused of moving out of state — often within the same community — without canceling their benefits.

Ingram was one of 28 Medicaid beneficiaries in Tennessee charged in 2022, according to the Tennessee OIG; more than a third of them were accused of not being a Tennessee resident, with many cases originating in the Memphis area, where suburbs extend into Mississippi.

In Ingram’s case, Tennessee announced her arrest in a , which said she eluded authorities for nearly a year. Ingram said she didn’t have a clue about the charges until she got a ticket for not wearing her seat belt.

“They pulled me over, and they said, ‘You have a felony warrant.’ And I said, ‘Quit lying,'” she recalled. “I’ve never been in trouble a day in my life.”

It took $2,000 to bond out of jail and even more to hire an attorney. Not until more than six months later did prosecutors show her the evidence so she could refute the charges and clear her name.

The explanation ended up being pretty straightforward. During the time she was on Tennessee’s Medicaid program and living in Memphis, she filed for divorce from her husband who lived nearby in Mississippi. Ingram said they had been separated for years, but her driver’s license still had the outdated Mississippi address.

After her arrest, Ingram showed her Tennessee lease and electric bills, and the Shelby County district attorney dropped the felony charges.

“We try to apply the law compassionately,” , who leads the TennCare OIG, told KHN.

Other states have fraud investigation units focused on patients, but they don’t necessarily name the accused publicly, which happens in Tennessee. For example, keeps the accused anonymous even after they’ve agreed to reimburse the state.

Holman defends Tennessee’s practice of posting a “most wanted” list for its Medicaid program. He said it’s supposed to be a deterrent: “It’s not to blast anyone or defame anyone. It’s to simply take care of the business that’s at hand, hold people accountable, and do what we’re here to do,” he said.

Chad Holman is Tennessee’s inspector general. Holman views the state’s practice of posting a “most wanted” list for its Medicaid program as a deterrent. “It’s not to blast anyone or defame anyone,” he says. “It’s to simply take care of the business that’s at hand, hold people accountable, and do what we’re here to do.” (Blake Farmer for KHN)

As drug-related cases have diminished, enforcement has increasingly focused on ensuring that people enrolled in TennCare live in the state. In Memphis, 20 of the 27 Medicaid fraud cases since 2019 involved questions of state residency, according to the Shelby County district attorney. And prosecutors have dropped at least a half-dozen of those cases because the evidence was so weak.

Holman said his office won’t overlook low-level offenses.

“This is not murder,” he said. “But the legislature classified it as a felony, and that’s the law that I’m here to enforce.”

Holman acknowledged it costs far more to run the TennCare fraud unit than the office will ever recoup from people on Medicaid, who are usually low-income. Even if the state recovered every dollar from charges brought against beneficiaries in 2022, the total would amount to less than $900,000. The office has a . Since its creation in 2005, the OIG has brought in less than $10 million and charged nearly 3,200 people with fraud, according to its .

The rate of arrests has slowed dramatically. It now arrests fewer people in a year than it previously did in a .

About 1 in 4 Americans are on Medicaid or CHIP — the Children’s Health Insurance Program. The by more than 20 million since early 2020. And for the first time since the start of the pandemic, states will resume and addresses over the next year. Millions of Americans could lose their Medicaid coverage as a result. It’s up to each state to determine who is eligible and how to deal with potential fraud in the program.

, executive director of the Tennessee Justice Center, said policing fraud among TennCare beneficiaries takes time and money that otherwise could be spent on something more helpful.

“It’d be great if our leaders would get out of the ‘gotcha game’ and get into the ‘getting people healthy game,’” she said.

As Medicaid programs restart checks on eligibility, Johnson said, recipients shouldn’t have to worry that a mistake could eventually get them arrested.

Despite her ordeal, Ingram is bouncing back. Still, she has legal bills to pay and has grown more frustrated at being ensnared by the state’s Medicaid dragnet.

“They made a big mistake,” she said.

This story is part of a partnership that includes , , and .

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Doctors Are Disappearing From Emergency Rooms as Hospitals Look to Cut Costs

Brett Kelman — Mon, 13 Feb 2023 10:00:00 +0000

Pregnant and scared, Natasha Valle went to a Tennova Healthcare hospital in Clarksville, Tennessee, in January 2021 because she was bleeding. She didn’t know much about miscarriage, but this seemed like one.

In the emergency room, she was examined then sent home, she said. She went back when her cramping became excruciating. Then home again. It ultimately took three trips to the ER on three consecutive days, generating three separate bills, before she saw a doctor who looked at her bloodwork and confirmed her fears.

“At the time I wasn’t thinking, ‘Oh, I need to see a doctor,'” Valle recalled. “But when you think about it, it’s like, ‘Well — dang — why didn’t I see a doctor?’” It’s unclear whether the repeat visits were due to delays in seeing a physician, but the experience worried her. And she’s still paying the bills.

The hospital declined to discuss Valle’s care, citing patient privacy. But 17 months before her three-day ordeal, Tennova had outsourced its emergency rooms to American Physician Partners, a medical staffing company owned by private equity investors. APP employs fewer doctors in its ERs as one of its cost-saving initiatives to increase earnings, according to .

This staffing strategy has permeated hospitals, and particularly emergency rooms, that seek to reduce their top expense: physician labor. While diagnosing and treating patients was once their domain, doctors are increasingly being replaced by nurse practitioners and physician assistants, collectively known as “midlevel practitioners,” who can perform many of the same duties and generate much of the same revenue for less than half of the pay.

“APP has numerous cost saving initiatives underway as part of the Company’s continual focus on cost optimization,” the document says, including a “shift of staffing” between doctors and midlevel practitioners.

In a statement to KHN, American Physician Partners said this strategy is a way to ensure all ERs remain fully staffed, calling it a “blended model” that allows doctors, nurse practitioners and physician assistants “to provide care to their fullest potential.”

Critics of this strategy say the quest to save money results in treatment meted out by someone with far less training than a physician, leaving patients vulnerable to misdiagnoses, higher medical bills, and inadequate care. And these fears are bolstered by evidence that suggests dropping doctors from ERs may not be good for patients.

A , published in October by the National Bureau of Economic Research, analyzed roughly 1.1 million visits to 44 ERs throughout the Veterans Health Administration, where nurse practitioners can treat patients without oversight from doctors.

Researchers found that treatment by a nurse practitioner resulted on average in a 7% increase in cost of care and an 11% increase in length of stay, extending patients’ time in the ER by minutes for minor visits and hours for longer ones. These gaps widened among patients with more severe diagnoses, the study said, but could be somewhat mitigated by nurse practitioners with more experience.

The study also found that ER patients treated by a nurse practitioner were 20% more likely to be readmitted to the hospital for a preventable reason within 30 days, although the overall risk of readmission remained very small.

Yiqun Chen, who is an assistant professor of economics at the University of Illinois-Chicago and co-authored the study, said these findings are not an indictment of nurse practitioners in the ER. Instead, she said, she hopes the study will guide how to best deploy nurse practitioners: in treatment of simpler patients or circumstances when no doctor is available.

“It’s not just a simple question of if we can substitute physicians with nurse practitioners or not,” Chen said. “It depends on how we use them. If we just use them as independent providers, especially … for relatively complicated patients, it doesn’t seem to be a very good use.”

Chen’s research echoes smaller studies, like one from The Harvey L. Neiman Health Policy Institute that found nonphysician practitioners in ERs were associated with , which could unnecessarily increase bills for patients. Separately, a study at the Hattiesburg Clinic in Mississippi found that midlevel practitioners in primary care — not in the emergency department — increased the out-of-pocket costs to patients while also leading to , including cancer screenings and vaccination rates.

But definitive evidence remains elusive that replacing ER doctors with nonphysicians has a negative impact on patients, said Dr. Cameron Gettel, an assistant professor of emergency medicine at Yale. Private equity investment and the use of midlevel practitioners rose in lockstep in the ER, Gettel said, and in the absence of game-changing research, the pattern will likely continue.

“Worse patient outcomes haven’t really been shown across the board,” he said. “And I think until that is shown, then they will continue to play an increasing role.”

For Private Equity, Dropping ER Docs Is a ‘Simple Equation’

Private equity companies pool money from wealthy investors to buy their way into various industries, often slashing spending and seeking to flip businesses in three to seven years. While this business model is a proven moneymaker on Wall Street, it raises concerns in health care, where critics worry the pressure to turn big profits will influence life-or-death decisions that were once left solely to medical professionals.

Nearly $1 trillion in private equity funds have gone into almost 8,000 health care transactions over the past decade, according to industry tracker PitchBook, including buying into medical staffing companies that many hospitals hire to manage their emergency departments.

Two firms dominate the ER staffing industry: TeamHealth, bought by private equity firm Blackstone in 2016, and Envision Healthcare, bought by KKR in 2018. Trying to undercut these staffing giants is American Physician Partners, a rapidly expanding company that runs ERs in at least 17 states and is 50% owned by private equity firm BBH Capital Partners.

At a two-day company training put on by American Physician Partners in 2020, chief medical officer Dr. Tony Briningstool teaches doctors and nurse practitioners how to safely use sedation in the emergency department. As a money-saving strategy, emergency rooms are employing fewer doctors and relying instead on midlevel practitioners. (Blake Farmer for KHN)

These staffing companies have been among the most aggressive in replacing doctors to cut costs, said Dr. Robert McNamara, a founder of the American Academy of Emergency Medicine and chair of emergency medicine at Temple University.

“It’s a relatively simple equation,” McNamara said. “Their No. 1 expense is the board-certified emergency physician. So they are going to want to keep that expense as low as possible.”

Not everyone sees the trend of private equity in ER staffing in a negative light. Jennifer Orozco, president of the American Academy of Physician Associates, which represents physician assistants, said even if the change — to use more nonphysician providers — is driven by the staffing firms’ desire to make more money, patients are still well served by a team approach that includes nurse practitioners and physician assistants.

“Though I see that shift, it’s not about profits at the end of the day,” Orozco said. “It’s about the patient.”

The “shift” is nearly invisible to patients because hospitals rarely promote branding from their ER staffing firms and there is little public documentation of private equity investments.

Dr. Arthur Smolensky, a Tennessee emergency medicine specialist attempting to measure private equity’s intrusion into ERs, said his review of hospital job postings and employment contracts in 14 major metropolitan areas found that 43% of ER patients were seen in ERs staffed by companies with nonphysician owners, nearly all of whom are private equity investors.

Smolensky hopes to publish his full study, expanding to 55 metro areas, later this year. But this research will merely quantify what many doctors already know: The ER has changed. Demoralized by an increased focus on profit, and wary of a looming surplus of emergency medicine residents because there are fewer jobs to fill, many experienced doctors are leaving the ER on their own, he said.

In a lab at Lipscomb University in 2020, nurse practitioners join doctors in practicing how to place a chest tube to fix a collapsed lung by snaking a rubber hose through a rack of pork ribs. The NPs, who work for American Physician Partners, will have to perform the procedure under a doctor’s supervision before being allowed to do it on their own. (Blake Farmer for KHN)

“Most of us didn’t go into medicine to supervise an army of people that are not as well trained as we are,” Smolensky said. “We want to take care of patients.”

‘I Guess We’re the First Guinea Pigs for Our ER’

Joshua Allen, a nurse practitioner at a small Kentucky hospital, snaked a rubber hose through a rack of pork ribs to practice inserting a chest tube to fix a collapsed lung.

It was 2020, and American Physician Partners was restructuring the ER where Allen worked, reducing shifts from two doctors to one. Once Allen had placed 10 tubes under a doctor’s supervision, he would be allowed to do it on his own.

“I guess we’re the first guinea pigs for our ER,” he said. “If we do have a major trauma and multiple victims come in, there’s only one doctor there. … We need to be prepared.”

Allen is one of many midlevel practitioners finding work in emergency departments. Nurse practitioners and physician assistants are among the fastest-growing occupations in the nation, according to the U.S. Bureau of Labor Statistics.

Generally, they have master’s degrees and receive several years of specialized schooling but have significantly less training than doctors. Many are permitted to diagnose patients and prescribe medication with little or no supervision from a doctor, although .

The Neiman Institute found that the share of ER visits in which a midlevel practitioner was the main clinician between 2005 and 2020. Another study, in the Journal of Emergency Medicine, reported that if trends continue there may be in ERs by 2030.

There is little mystery as to why. shows emergency medicine doctors are paid about $310,000 a year on average, while nurse practitioners and physician assistants earn less than $120,000. Generally, hospitals can bill for care by a midlevel practitioner at 85% the rate of a doctor while paying them less than half as much.

Private equity can make millions in the gap.

For example, Envision once encouraged ERs to employ “the least expensive resource” and treat up to 35% of patients with midlevel practitioners, according to a . The presentation drew scorn on social media and disappeared from Envision’s website.

Envision declined a request for a phone interview. In a written statement to KHN, spokesperson Aliese Polk said the company does not direct its physician leaders on how to care for patients and called the presentation a “concept guide” that does not represent current views.

American Physician Partners touted roughly the same staffing strategy in 2021 in response to the , which threatened the company’s profits by outlawing surprise medical bills. In , the company estimated it could cut almost $6 million by shifting more staffing from physicians to midlevel practitioners.

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Some Addiction Treatment Centers Turn Big Profits by Scaling Back Care

Renuka Rayasam — Tue, 31 Jan 2023 10:00:00 +0000

Near the end of his scheduled three-month stay at a rehab center outside Austin, Texas, Daniel McKegney was forced to tell his father in North Carolina that he needed more time and more money, he recently recalled.

His father had already received bills from BRC Recovery totaling about $150,000 to cover McKegney’s treatment for addiction to the powerful opioid fentanyl, according to insurance statements shared with KHN. But McKegney, 20, said he found the program “suffocating” and wasn’t happy with his care.

He was advised against the long-term use of Suboxone, a medication often recommended to treat opioid addiction, because BRC does not consider it a form of abstinence. After an initial five-day detox period last April, McKegney’s care plan mostly included a weekly therapy session and 12-step group meetings, which are free around the country.

McKegney said a BRC staffer recommended he stay a fourth month and even sat in on the call to his dad.

“They used my life and [my] father’s love for me to pull another 20 grand out of him,” said McKegney, who told KHN he began using fentanyl again after the costly stay.

BRC did not respond to specific concerns raised by McKegney. But in an emailed statement, Mandy Baker, president and chief clinical officer of BRC Healthcare, said that many of the complaints patients and former employees shared with KHN are “no longer accurate” or were related to covid safety measures.

But addiction researchers and private equity watchdogs said models like the one used by BRC — charging high patient fees without guaranteeing access to evidence-based care — are common throughout the country’s addiction treatment industry.

The model and growing demand are why addiction treatment has become increasingly attractive to private equity firms looking for big returns. And they’re that predict the market will grow by $10 billion — doubling in size — by the end of the decade as and mount.

“There is a lot of money to be made,” said Eileen O’Grady, research and campaign director at the Private Equity Stakeholder Project, a watchdog nonprofit that tracks private equity investment in health care, housing, and other industries. “But it’s not necessarily dovetailing with high-quality treatment.”

In 2021, 127 mergers and acquisitions took place in the behavioral health sector, which includes treatment for substance use disorders, a rebound after several years of decline, . Private equity investment drove much of the activity in an industry that is highly fragmented and rapidly growing, and has historically had few guardrails to ensure patients get appropriate care.

Roughly dot the country. They’ve proliferated as addiction rates rise and as health insurance plans are required to offer better coverage of drug and alcohol treatment. The treatment options vary widely and are not always consistent with by the federal Substance Abuse and Mental Health Services Administration. While efforts to standardize treatment advance, industry critics say private equity groups are investing in centers with unproven practices and cutting services that, while unprofitable, might support long-term recovery.

Baker said BRC treats people who have been unsuccessful in other facilities and does so with input from both clients and their families.

Private Equity Skimps on the Known Standards

Centers that discourage or prohibit the use of Food and Drug Administration-approved medications for the treatment of substance use disorder are plentiful, but in doing so they do not align with the American Society of Addiction Medicine’s guidelines on how to manage opioid use disorder over the long term.

Suboxone, for example, combines the pain reliever buprenorphine and the opioid-reversal medication naloxone. The drug blocks an overdose while also reducing a patient’s cravings and withdrawal symptoms.

“It is inconceivable to me that an addiction treatment provider purporting to address opioid use disorder would not offer medications,” said Robert Lubran, a former federal official and chairman of the board at the Danya Institute, a nonprofit that supports states and treatment providers.

Residential inpatient facilities, where patients stay for weeks or months, have a role in addiction treatment but are often overused, said Brendan Saloner, an associate professor of health policy and management at Johns Hopkins Bloomberg School of Public Health.

Many patients return to drug and alcohol use after staying in inpatient settings, but that the use of medications can decrease the relapse rate for certain addictions. McKegney said he now regularly takes Suboxone.

“The last three years of my life were hell,” he said.

Along with access to medications, high-quality addiction treatment usually requires long-term care, according to focused on improving addiction treatment. And, ideally, treatment is customized to the patient. While the “Twelve Steps” program developed by Alcoholics Anonymous may help some patients, others might need different behavioral health therapies.

But, when looking for investments, private equity groups focus on profit, not necessarily how well the program is designed, said Laura Katz Olson, a political science professor at Lehigh University who wrote a book about .

Mitzi Dawn was on staff at Nashville Recovery Center and left after the center was acquired by BRC Recovery and her popular “Sing and Share” event was canceled. She says she worried about her colleagues, since most are in recovery as she is. “You have a perfect breeding ground to be able to take advantage of a lot of really good-hearted, well-intentioned people,” she says. (Blake Farmer for KHN)

With health care companies, investors often cut services and trim staff costs by using fewer and less-trained workers, she said. Commonly, private equity companies buy “a place that does really excellent work, and then cut it down to bare bones,” Olson said. During his stay, McKegney said, outings to movies or a lake abruptly stopped, food went from poke bowls and pork tenderloin to chili that tasted like “dish soap,” and staff turnover was high.

Nearly three years ago, BRC landed backing from , two private equity firms with broad portfolios. Their holdings include a payroll processor, a bridal wear designer, and a doughnut franchise. With the fresh funds, BRC started an expansion push and .

NewSpring Capital and Veronis Suhler Stevenson did not respond to emails and phone calls from KHN.

High Prices and Low Overhead = Big Business

Before the sale to BRC, Nashville Recovery Center co-founder Ryan Cain said, roughly 80% of the center’s offerings were free. Anyone could drop by for 12-step meetings, to meet a sponsor, or just to play pool. But the new owners focused on a new high-end sober living program that cost thousands of dollars per month and relied on staffers who were in recovery themselves.

In 2021, Nanci Milam, 48, emptied her 401(k) retirement fund to go through the sober living program and tackle her alcohol addiction. She had been sober for only six months when she was hired as a house manager, overseeing some of the same residents she had gone through the program with. She had to handle other residents’ medications, which she said she could have abused. Milam said she was fortunate to maintain sobriety.

“I think it served their need. And I was ambitious. But it should not have happened,” said Milam, adding that she left because the company hadn’t helped her start her certification as a drug counselor as promised.

A licensing violation reported to Tennessee regulators in late 2021 involved a staffer who was later fired for having sex with a resident in a storage area. And KHN obtained a copy of a 911 call placed in August 2022 — after a resident drank half a bottle of mouthwash — during which a staffer admitted there was no nurse on-site, which some other states require.

Removing the Burden from Consumers

The regulations of treatment providers largely focus on health and safety rather than clinical guidelines. Only a handful of states, including and Massachusetts, require that licensed addiction treatment centers offer medication for opioid use disorder and follow other best practices.

“We have a huge issue in the field where licensing standards don’t comport with what we know to be the most effective quality-of-care standards,” said Michael Botticelli, former director of the Office of National Drug Control Policy during the Obama administration and a member of a clinical advisory board for private equity-backed Behavioral Health Group. Some organizations, including Shatterproof, toward appropriate care. The federal and state governments to centers that meet clinical quality-of-care standards.

But access to treatment is limited, and desperate patients and their families often don’t know where to turn. State or federal regulators aren’t policing claims from rehab facilities, like the “” touted by BRC.

“We cannot put the burden on patients and their families” to navigate the system, said Johns Hopkins’ Saloner. “My heart really breaks for people who have thrown thousands of their dollars at programs that are bogus.”

When her niece was ready for inpatient rehab in summer 2020, Marina said, sending her to BRC was a “knee-jerk reaction.” Marina, a physician in Southern California, requested to be identified only by her middle name to protect the privacy of her niece, who suffers from alcohol addiction.

She had researched the facility three years earlier but didn’t investigate deeper because she was worried her niece would change her mind. BRC advertised and on

Marina agreed to BRC’s upfront cost of $30,000 a month for a three-month stay in Texas, which she paid for out-of-pocket because her niece lacked insurance. She allowed KHN to review some of her niece’s pharmacy and treatment bills.

Marina said she paid for a fourth month, but said ultimately the program didn’t help her niece, who remains “horribly sick.” She said her niece felt constant guilt and shame at rehab. Marina thought there was inadequate medical oversight, and said the program “nickeled and dimed” her for additional services, like physicians’ visits, that she thought would be included.

“It almost doesn’t matter if you are educated and intelligent,” Marina said. “When it’s your loved one, you are just desperate.”

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Can I Opt Out of Having My Doctor Take Notes With AI?

Blake Farmer, Nashville Public Radio — Tue, 07 Apr 2026 09:00:00 +0000

LISTEN: AI scribes are changing medical care. Here’s what to know if the technology shows up at your next doctor’s appointment.

“I can really just sit there and engage and just focus on them and listen,” said Boose, who .

Nearly a third of physician practices are using AI scribes and others are working to add the tool, in an effort to cut down on administrative work.

If your practitioner suggests using an AI scribe at your next appointment, here are three things to keep in mind:

1. Clinicians should ask for your permission.

2. AI scribes make mistakes too, so check their work.

Like other AI tools, medical scribes can “hallucinate,” or spontaneously add errors into a record. AI scribes can also omit important information or miss context clues within a conversation.

3. Yes, the AI company could use your data, with limitations.

If you want to know how your data is being used, ask either your practitioner or medical system for more information. But you might not get a clear answer, Tahir said.

People and Policy

Emily Siner at Nashville Public Radio contributed to this report.

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Taking a GLP-1? Doctors Say Not To Forget About Movement and Mental Health

Blake Farmer, Nashville Public Radio — Thu, 26 Mar 2026 09:00:00 +0000