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A severe workforce shortage for behavioral health and developmental disabilities service providers has left some organizations with vacant positions in 20-50% of their jobs, leading to reductions of critical services they say could be just the tip of the iceberg if state government doesn't step in. “The system’s hanging on by a shoestring right now,” said Matt Bugni, the chief executive officer of AWARE, Inc., an Anaconda-based organization that provides services statewide for children and adults with developmental disabilities and behavioral health needs. (Michels, 8/1)

Caregivers in the "Sandwich Generation" have reported a steep decline in mental health, as did others who had to juggle changes in the amount of caregiving they had to provide to loved ones. Caregivers have struggled with anxiety, depression and PTSD at rates much higher than those without caregiving roles. NPR correspondent Rhitu Chatterjee talks about the study and her reporting with Emily Kwong. (Chatterjee, Kwong, Lu and Hanson, 8/2)

For all the talk about a future of only paying for healthcare using value-based models, the tried-and-true fee-for-service reimbursement system is still the main way that most providers are paid. Brian Esser, associate principal at consulting firm SG2, remembers a healthcare system client in the Midwest that invested heavily in quality and value reimbursement starting around 2011. It was one of the first CMS accountable care organizations, and eventually about 30% of its patients were in a model. “But they quickly realized that they couldn’t sustain it, because they were undercutting so much of their fee-for-service business that they had to pull back,” Esser recalled. “It comes down to, can you make your bond payments? And are you driving enough margin to sustain that legacy business model? That’s a tightrope you have to walk effectively.” (Gillespie, 8/2)

For many people, entering the confinement of an MRI machine can be harrowing: Scans can take hours and patients must lie very still in cramped machines that produce deafening sounds. But a new, high-tech effort aims to ease claustrophobia and deaden the noise to make it less like a scary scan and more like entertainment. (Aguilar, 8/2)

Melissa Fehling’s second child is due Aug. 3. She delivered her first child, River, at the WNC Birth Center in Asheville two years ago, and she said she was looking forward to a similar experience there. But on June 19, she received an email from the center, announcing an indefinite closure on July 20, just two weeks before her due date. (Green, 7/31)

KHN: 12,000 Square Miles Without Obstetrics? It’s A Possibility In West Texas 

The message from Big Bend Regional Medical Center was stark: The only hospital in a sparsely populated region of far West Texas notified local physicians last month that because of a nursing shortage its labor and delivery unit needed to temporarily close its doors and that women in labor should instead be sent to the next closest hospital — an hour’s drive away. That is, unless the baby’s arrival appears imminent, and the hospital’s unit is shut down at that point. In that case, a woman would deliver in the emergency room, said Dr. Jim Luecke, who has practiced 30-plus years in the area. (Huff, 8/2)

Medical bills can be stressful. Some are surprises. Others are intimidatingly large. And many Americans just cannot pay on time. Now, a study in JAMA sheds light on just how much medical debt has been sent for collection in the United States. Researchers used data from a randomly selected group representing 10 percent of all people with TransUnion credit reports — about 40 million individuals — between 2009 and 2020. Though the average amount of medical debt fell to $429 by 2020, 17.8 percent of people had medical bills that were past due. (Blakemore, 7/31)

KHN: At Urgent Care, He Got 5 Stitches And A Big Surprise: A Plastic Surgeon’s Bill For $1,040

It was a Sunday morning in late November when Bryan Keller hopped on a bike for a routine ride to pick up his groceries, cruising with ease in a relatively empty New York City. The surprises came fast and hard: a fall that sent his head into the pavement and left him bleeding profusely and in shock, a trip to an urgent care clinic for five stitches and then a $1,039.50 bill. (Pradhan, 8/2)

KHN: Watch: Cyclist Hits Olympic-Size Medical Bills After Crash 

“CBS This Morning,” in partnership with KHN and NPR, interviews Phil Gaimon, a cyclist who had hoped to be in Tokyo next week as a competitor in the track events on the USA Cycling national team. Instead, a crash on the velodrome track in Pennsylvania in 2019 ended his Olympic dream and left him with huge medical bills — even after his two insurance policies paid portions of the treatment. KHN Editor-in-Chief Elisabeth Rosenthal said Gaimon hit three health care land mines: out-of-network hospitals, out-of-state care and gold-plated charges from the hospitals. Two years after the crash, Gaimon is still fielding calls from collection agencies. (7/31)