State of the consumer Are U.S. consumers finally tightening the purse strings? That's the main question on the minds of investors as major retailers kick off their quarterly earnings reports this week, starting with Home Depot (HD). The home improvement chain's Q1 results came in below Street expectations, hurt by a delayed start to spring, continued softness in certain larger discretionary projects, and higher mortgage rates.
Dig deeper: Retailer earnings come at a time when consumer sentiment is weakening, amid expectations of stickier inflation for some time to come and a tempered outlook for income growth. Investing Group Leader Bret Jensen believes stagflation is an increasingly likely economic scenario. "Right now, I believe the average American consumer has a better handle on the U.S. economy than the average investor and a better take on the true level of inflation than governmental statistics."
Scott Feiler, consumer sector specialist at Goldman Sachs, said the consumer spending concerns have been driven by updates by bellwethers in the sector, and the notable slowdown seen in April - one of the worst months of the retail quarter. Companies like Wayfair (W) and Whirlpool (WHR) have already warned that consumers are cutting back spending on big-ticket items, while fast-food chains such as McDonald's (MCD) and Starbucks (SBUX) have observed pickier and more value-minded customers. "Consumer cracks are emerging," especially among lower incomes, warned Bank of America analyst Savita Subramanian.
Earnings watch: Walmart (WMT), which will report Q1 results on Thursday, is expected to report modest upside to the consensus U.S. comparable sales estimates, driven by bargain-hunting shoppers. Also keep an eye on other retailers scheduled to report results next week: Lowe's (LOW), Target (TGT), TJX (TJX), and Ross Stores (ROST).
Sustained weight loss Patients who are taking Novo Nordisk's (NVO) blockbuster obesity drug Wegovy have reportedly maintained an average of 10% weight loss four years after starting the treatment. "We see that once the majority of the weight loss is accrued, you don't go back and start to increase weight if you stay on the drug," said Martin Holst Lange, Novo's head of development. The data could help Novo in its efforts to convince insurers and governments to provide coverage for the treatment. The U.K.'s National Health Service provides only two years of Wegovy coverage, while Medicare does not cover the drug. A recent poll showed that many people believe Medicare should cover weight loss drugs. (2 comments)
Resisting takeover Anglo American (OTCQX:AAUKF) has unveiled a major shakeup of the company - which includes divesting its steelmaking coal and nickel businesses - as the British miner aims to stave off BHP's (BHP) takeover bid. Anglo American will demerge Anglo American Platinum (OTCPK:ANGPY), while its diamond business De Beers will either be divested or demerged "to improve strategic flexibility." The overhaul is aimed at sharpening Anglo American's focus on its mainstay assets - copper and premium iron ore. "These actions represent the most radical changes to Anglo American in decades," its CEO Duncan Wanblad said. The plan was announced just a day after the firm rejected BHP's (BHP) new £34B proposal.
Power grid boost The Federal Energy Regulatory Commission approved two new rules Monday that are expected to make it easier to expand the construction of big power lines and bring more renewable energy to U.S. homes and businesses. One rule will require companies that produce and transmit electricity to weigh factors such as supply and demand over at least 20 years; the other addresses the permitting of critical projects in areas that lack adequate transmission capacity. The rule requiring long-term planning is "the biggest single action by the federal government to advance transmission," according to Rob Gramlich, president of power consulting firm Grid Strategies. (46 comments)
Today's Markets
In Asia, Japan +0.5%. Hong Kong -0.2%. China -0.1%. India +0.5%. In Europe, at midday, London +0.1%. Paris -0.1%. Frankfurt -0.2%. Futures at 7:00, Dow flat. S&P -0.1%. Nasdaq -0.1%. Crude flat at $79.10. Gold +0.3% to $2,349.10. Bitcoin -1.5% to $61,690. Ten-year Treasury Yield unchanged at 4.48%.
Today's Economic Calendar
6:00 NFIB Small Business Optimism Index 8:30 Producer Price Index 9:10 Fed’s Cook Speech 10:00 Jerome Powell Speech 8:15 PM Fed's Schmid Speech
Companies reporting earnings today »
What else is happening...
WSB survey results: Derisking and diversifying is still the way to go.
Biden administration raises tariffs steeply on Chinese EVs, chips.
Uber (UBER), Lyft (LYFT) face landmark trial on rideshare drivers.
BYD (OTCPK:BYDDF) sends shockwaves across auto with Seagull.
Biden faces mounting calls to take on grocery price-fixing issue.
HubSpot (HUBS) rises on report of 'compelling' offer from Alphabet.
Wedbush: Apple (AAPL)-OpenAI pact appears to be done deal.
OpenAI unveils new flagship model GPT-4o, available for free to all.
OPEC risks losing market share if it does not start raising output.
ZIM (ZIM) surges as container shipping stocks' momentum continues.

It looks like we made a huge mistake and my wife lost coverage through my employer plan and can't get back on Medicare. It will likely cost her her life.
My wife was diagnosed with kidney failure and went on dialysis in 2021. The kidney clinic suggested it would be cheaper to sign up for Medicare because the premiums would be cheaper than the deductible for my employer group health plan. So we went on Medicare in 2022. I paid premiums but my employer health plan continued to pay claims. When I asked why, they told me the group plan was the 'primary' player and Medicare was 'secondary'.
My wife ended up getting a transplant a few months later luckily. I paid Medicare premiums for another year or so and they never paid any claims. We felt like it was a waste of money. I finally submitted a form to cancel Medicare. This was our critical mistake but didn't realize it at the time.
This year, the employer health plan started denying claims saying: 'Member is eligible for Medicare Part B but does not have Medicare Part B'. I thought it was a mistake and called them. They said, no, my employer plan was primary and to have providers resubmit claims.
Last month, my wife was diagnosed with liver and kidney failure and began dialysis again. She was approved by another hospital for a liver transplant. We waited for 2 weeks for a final go-ahead. The delay was due to insurance we finally found out. In reality. Medicare switched to 'primary' after a 30-month 'coordination period' and the employer plan started denying all claims. since we don't have Medicare Part B. The hospital suggested she enroll in Part B again. We tried. Normally, dialysis is a valid reason for immediate enrollment but because we cancelled last year, we were denied. We continue to appeal to the employer health plan but they just give us the run around. Sometimes they even say they are primary payer again - only to find out that was incorrect later. It's so frustrating.
The rules and process have become more clear now - after many frantic hours of research and phone calls. My wife has continued outpatient dialysis for the last couple of weeks but now that it's clear that she's not covered, she'll probably have quit to go on hospice. I feel so stupid. My wife will pass and we'll be saddled with outrageous bills. This feels like a nightmare I can't wake up from.

It looks like we made a huge mistake and my wife lost coverage through my employer plan and can't get back on Medicare. It will likely cost her her life.
My wife was diagnosed with kidney failure and went on dialysis in 2021. The kidney clinic suggested it would be cheaper to sign up for Medicare because the premiums would be cheaper than the deductible for my employer group health plan. So we went on Medicare in 2022. I paid premiums but my employer health plan continued to pay claims. When I asked why, they told me the group plan was the 'primary' player and Medicare was 'secondary'.
My wife ended up getting a transplant a few months later luckily. I paid Medicare premiums for another year or so and they never paid any claims. We felt like it was a waste of money. I finally submitted a form to cancel Medicare. This was our critical mistake but didn't realize it at the time.
This year, the employer health plan started denying claims saying: 'Member is eligible for Medicare Part B but does not have Medicare Part B'. I thought it was a mistake and called them. They said, no, my employer plan was primary and to have providers resubmit claims.
Last month, my wife was diagnosed with liver and kidney failure and began dialysis again. She was approved by another hospital for a liver transplant. We waited for 2 weeks for a final go-ahead. The delay was due to insurance we finally found out. In reality. Medicare switched to 'primary' after a 30-month 'coordination period' and the employer plan started denying all claims. since we don't have Medicare Part B. The hospital suggested she enroll in Part B again. We tried. Normally, dialysis is a valid reason for immediate enrollment but because we cancelled last year, we were denied. We continue to appeal to the employer health plan but they just give us the run around. Sometimes they even say they are primary payer again - only to find out that was incorrect later. It's so frustrating.
The rules and process have become more clear now - after many frantic hours of research and phone calls. My wife has continued outpatient dialysis for the last couple of weeks but now that it's clear that she's not covered, she'll probably have quit to go on hospice. I feel so stupid. My wife will pass and we'll be saddled with outrageous bills. This feels like a nightmare I can't wake up from.

Hi everyone! 😁
I will preface by saying that it took me many years to find my Dentist and there is no way on Earth that I will go to anyone else. My experiences with dentists have been enough to fill up the Reddit servers and make them crash if I even started to touch upon my experiences of blatant lies and essentially, thievery, most notably perpetrated by their hygienists who are quite OBVIOUSLY financially motivated. I have the best dentist on planet Earth and I have no interest in deviating from him.
I apologize in advance that my post is rather long because I'm blowing off some steam as well. Please don't be angry about that. I'm just upset at the dental insurance world and, particularly, my Dentist's idiot office manager. The bottom line is I need some help figuring out dental insurance companies.
I have had a Humana PPO for quite a few years and my annual maximum cap is $6,000. The premium is a bit ridiculous at about $75 a month but they have historically have paid for most everything so I didn't really blink TOO much about it. HOWEVER, my Dentist stopped accepting/being "in network" of it at the beginning of the year. Most likely because his office manager is something of an idiot who even stopped the office from using CareCredit. I assume that he's trying to shave down his paperwork.
In any event, after having some work done recently I got a bill from my Dentist's office along with the handwritten note from that dingbat office manager stating that, "you are completely responsible for the entirety of this bill as Humana won't pay for anything".
I called Humana immediately and they told me that they DID pay for two of the charges and were never billed for the others and that they paid precisely what they would have been paying if he was in network but I am responsible for the rest. I wrote the dingbat office manager and told him exactly what they paid and what dates and to submit the remaining bills to Humana. He got all defensive. Knowing full well that I'm deaf and cannot handle speaking on the phone (we've discussed the issue of my having gone deaf from cancer treatment a number of times) he told me that I need to call him to discuss it. I once again reiterated that I am deaf in one ear and cannot utilize the phone well because of the reverberations. He wouldn't respond there after. THAT is a complaint that I will take up with my dentist when I see him next. My Dentist nor any of the other people around the Dentist like that office manager but the office manager has been there for 18 years so cannot essentially be let go. The point is that he never resolved anything nor submitted the bills to Humana as I requested. I am spitting nails angry about that.
In the interim I decided that I might want to look at other insurance companies that my Dentist DOES participate in. I cannot understand, unless I've actually grown quite old and senile since the last time I tried to read anything, that they mostly say that they pay a maximum of $1,500 to $2,000 per year. That is total, not per occurrence. I know I'm reading something wrong, RIGHT?
Anyway, to avoid being without any insurance at all while I'm busy canceling my Humana plan, I signed up for the BCBS A1 policy. It's capped at $2,000 per year. In February I simply had a cleaning and a couple of teeth refinished/resurfaced as they had minor erosion and the bill was $978. Humana said that they would covering all but $400 some odd dollars of it but only if their office manager actually submits the damn bills to them. It appears that I have to retrieve the bills myself and submit them because it seems that the office manager is quite adamant about excluding my insurance company as well as CareCredit from his list of daily chores. I wish I had some daily chores to do because I have been out of work due to cancer treatment for over 3 years now and I would LOVE to deal with the miniscule burden of what might be a difficult insurance company or the likes of Synchrony Bank's Carecredit for the sake of my employer's devoted patients.
I am trying to figure out if I have made a good decision by going with BCBS's A1 policy. I have read through the various posts here on Reddit and everybody raves about GEHA. Nobody busy raving about GEHA has ever bothered to respond to anybody inquiring about how to get it so I looked it up for myself and found out that you have to be a postal worker or a military retiree so please don't talk about GEHA. While internet searching for insurance, I made the miserable mistake of typing in my personal information with phone number BUT I back spaced out before pressing the "accept" key which allows agents to contact. Even though I never pressed the "accept" button and back spaced out when I realized that I was submitting information for massive lead share, at 8:01 this morning the freaking phone started ringing and by 9:00 I was so pissed off that I could have bitten somebody's head off if they looked at me wrong. One idiot told me that I had to completely revise my entire health care plan because I have an HMO that includes a dental plan even though no dentist within 400 miles of me participate in it and even if they did I am not leaving my dentist. She told me that I had to completely redo my whole plan anyway in order to get coverage with my dentist and that I could not purchase a standalone plan if I kept my health insurance. She was the biggest idiot I encountered all morning telling me that I can be arrested for having a standalone insurance policy for dental. 🙄 Talk about idiots that really shouldn't have jobs 🙄². I researched and found that I absolutely can purchase my own plan but you cannot comingle plans and benefits. Fine by me because there's not a dentist on the planet that accepts HMO that is worth going to. I asked the stupid idiot just why she thinks I've been paying $74 a month for a separate plan to start with FROM the same company that has my Medicare policy to start with and I've not been arrested in all these years nor is there an APB out for me. I finally got pissed off and told her to have a nice day and hung up on her. She had a whiny 1960s sort of commercial voice to start with that was irritating as hell. As you can tell, she put me in a raunchy mood for the whole rest of the day and I apologize to you that it's coming out in my text. Please accept my very sincere apology.
I know that the very second that I would be without insurance that some big horrible thing would happen so I cannot be without.
Please be kind enough to share your experience in researching and procuring standalone dental plans. I've already signed up for BCBS A1 but I have not remitted the first check yet because I haven't gotten the hard policy in the mail. Other contenders would be Aetna and Cigna.
Thank you VERY MUCH! 🌻 I truly appreciate your help! 🌷

My wife and I recently moved in with a family member that has been needing help because of declining health. They have received social security disability, but because of some clerical errors are still waiting on medicaid.
Just last week our family member ended up in the hospital still with no insurance and has been in the hospital and no one is sure if he'll come out.
We were asked to move in to help because they knew their health was getting worse and that we were also looking to buy a house and in their will they have a transfer on death deed that goes to us and in the will we inherit everything since we've been the only family members to help out, but we have the concern that since they still don't have insurance, will medicaid, as they are only in their 50s doesn't qualify until 2 years for Medicare, that this hospital trip could bankrupt him if medicaid doesn't cover claims during the application process since the agent they were working with flipped their name on the application, so it got rejected.
Our question is, if our family member does have to file for bankruptcy or if they pass away before medicaid gets accepted, what are our options for protecting the house because otherwise we need to line up fallback plans.
If this isn't the right sub, if you could point me to a sub or resource that could help us, please let me know.
I'll be happy to answer any questions that I know the answers too.

Hey everybody, quick tax question...
I recently received a DVA gold card, however haven't made any changes to my family's private health insurance as yet. I am guessing I can remove myself from the policy as I have coverage under the gold card?
From the ATO website (https://www.ato.gov.au/individuals-and-families/medicare-and-private-health-insurance/medicare-levy/medicare-levy-exemption/medical-exemption-from-medicare-levy) I can see I am entitled to a HALF exemption from the medicare levy, as my wife does not make above the threshold to pay the levy.
Is anyone else in this situation?

• Is a gold card recognised as full insurance cover for tax purposes?
  
• How do you claim the half exemption from the medicare levy at tax time?
  
• I am guessing medicare levy surcharge doesn't come into it? (High income with no private insurance)
  

Edit: I did call the ATO about this, the person I spoke to couldn’t help me and told me to call Centrelink. The Centrelink person did try to help, but eventually concluded it was an ATO matter…
Thanks in advance

I was talking with someone else on the sub about this, and I felt like it was worthy of further discussion. Everyone on the political spectrum - including Free Speech Libertarians - has co-opted the meaning of the word "Ban."
A public school refusing to stock a book in it's library, even for ideological reasons, has not "banned" the book. If the same school (district) refuses to include a particular book as part of it's curriculum, it likewise has not been "banned." Refusing to provide taxpayer-funded access to a book is no more "banning" the book than the school cafeteria refusing to serve pizza has "banned" pizza.
Remember when Hobby Lobby was accused of "banning" contraceptives because they wouldn't include the abortion pill in their health plan? We knew they were neither "banning" nor even blocking access for the individual. They have simply declined to pay for it. In public terms, If Medicare/Caid does not cover a procedure, the state has not banned your access to it. Since most of us here are Libertarians, you'd think we'd understand this.
The entire "schools are banning books" canard is culture-war catnip at best, and at worst, it's something-something chilling effect. That's not ideal, to be sure. But it doesn't constitute a crisis or an assault on speech or information. Especially when the vast majority of books not made available at school libraries are still available at public libraries. I'd also mention that if a book is prominent enough to be used as a political football, it's probably available for pennies on a reseller site.
We can be against the idea of a public school district refusing to provide a book for political reasons. I am absolutely against this, no matter the book. But I also feel the need to contextualize that with a bare minimum of effort, anyone can still access the book if they wish.
Thank you for attending my TED Talk.

Does Medicare cover 100% of anyone's Xolair?
My Disability income went up slightly with Cost of Living and now I have lost my straight Medicare/ straight Medicaid status. I still have Medicare, which covers most of my costs. But now I have a Medicaid Spend Down account which I don't completely understand and Medicaid is retroactively denying the balance of my Xolair shots back to January. ($650/month 😣)
I am trying to figure out my options, maybe there is some way to convince Medicare to cover more now that my situation has changed?
And Medicaid told me I don't have a case worker, so trying to figure this out on my own right now. 🤦‍♀️ Thanks!
Editing to add, it looks like my prescription plan might cover Xolair? I guess this means to do it at home? Which would be okay. Does anyone else do it this way?

I have Medi A and B, if that matters.

My husband is only 50 years old, stage 4 cancer and will be losing employment based Medical insurance plan on Dec 31, 2024.
We were told he does not qualify for Medigap and other policies because he is not retirement age and because of the Cancer diagnosis.

1. We were told no private insurance will take him either.
   
2. Possibly can get Medicare C (advantage Plans) not sure if this is a good route.
   
3. He already has Medicare Part A, will be on Medicare B, but we have no idea where to turn to get a supplemental policy for him that will cover his cancer treatments best.
   

4 He will either go Medicare B part with Medicare Advantage Plan C OR a Marketplace plan. But not sure which is best and most affordable. Im guessing there are separate brokers for Each type?
We live in Ohio (if it matters).
He does not qualify for Medicaid / SSI, Makes too much even on disability income.
Does anyone have any advice on this matter, especially anyone who has been through this same scenario? Marketplace or Medicare B with Advantage Plan.

I have been through so many mattresses with my mother, she has terrible incontinence issues. I thought I solved it by purchasing a Sanisnooze mattress. Well the mattress, within a year, had large wear marks and the vinyl cover cracking so it soaks through, defeated again. We never used any sort of cleaner other than mild soap and water to clean it. Sure, they replace the mattress but, we know it will just happen again. Does anyone have a recommendation for a mattress that won't fall apart for someone who spends a lot of time in the bed, but is also completely sealed and waterproof? She's disabled so maybe I can find another medical supplier through disability, I need some help here. She has medicare and medicaid and we are located in Michigan.

I an a vet (not retired) who is rated 100% T&P
We have Medicare + AARP/UHC
As I understand it: ChampVA is for my spouse ChampVA would be my spouse's Medicare supplemental. ChampVA should be accepted wherever Medicare is accepted.
Questions:
Is there a site / page that compares coverage between ChampVA and AARP/UHC Medicare supplement?
What is the monthly cost for ChampVA for my spouse?
If I predecease from something NOT related to my VA compensation (e.g. heart attack will )will my wife continue to have ChampVA coverage?
We have a part D, can / should we continue? Most of her prescriptions are zero cost on our part D. She is on Farxiga which we get from Canada. Does ChampVA cover Farxiga?

So I've been on SSDI since 2012, with Medicare A since 2013. We declined B at that time as my husband was employed by a large legal firm with excellent group health insurance and we confirmed it would be creditable coverage. Given that I'm chronically and permanently disabled I do need a good deal of medical care. On February 2 DH was unceremoniously and very unexpectedly fired from his job of 26 years which was a truly traumatic time as we dont have a safety net thanks to my life savings having been wiped out by a catastrophic illness in 2006 and my inability to rebuild on my at the time single parent factory income before my forced retirement from meat plant work. On February 10th I submitted my online application for Medicare B under a SEP and also signed up for AARP UHC Medicare D plan. Thankfully D plan was quickly enacted and I've been able to get my medications without too much hassle. But nothing re Medicare B. So some weeks ago I called SS and eventually got a human willing to actually listen who realized that the SEP app I filled out on SS didn't require the form from former employer that's generally required, just copies of my previous insurance card and our W2s. She had my resubmit the application along with the form from his former employer and fax it to my local SS office. And here almost a month later still nothing. I'm not trying to be impatient but geez I would like to know if it's even been looked at. Medicare said call SS of course.
I really need to go to both my PCP who has to see me every so many months if only bc I am on 2 controlled substances but also you know for my health. I'm overdue for my pulmonologist and having serious issues with my chronic GI condition too. I can rustle up the office visit fee but no way I can cover the lab work I will need just for PCP, never mind any specialists. I spent the last 3 years losing 150 lbs and working super hard to get myself as healthy as possible and it's heartbreaking feeling like it's about to fall apart. I intend to go into local SSA office in person next Wednesday to try to ascertain that something's going to happen but I'm losing hope. Does anyone have tips what I can do or say here to get my Medicare B going? My husband has found a new job thank God and had I known I could have gotten insurance there but now I'm in this application process which would be coming soon enough anyway (I turned 63 yesterday) I'm sorry this is so long but it's not a really simple situation or I probably wouldn't be having this problem. I'm fairly bright, husband and adult son who lives with and advocates for me is incredibly intelligent and deals well with people but SS is just like some otherworldly impenetrable entity as far as I can tell. Can I get a caseworker or someone who I can think might be able to be expected to know anything about the situation down the road? Ugh.

How often have you encountered excess charges, and have any/many been over $300? (I keep reading that excess charges, especially large ones, are rare.)
It’s my understanding that, because we live in CT, if we choose to use a medical provider who does not accept Medicare assigned costs (would need to find out in advance), we can switch from a Plan N to a Plan G at any time (with the change taking effect on the 1st of the upcoming month) with no underwriting or fear of refusal, which would then cover any excess charges. And we can also switch back to a Plan N at any time. Is there anyone who has done this?
If you have Plan N, have you ever wished you just signed up for Plan G, and why? (And then why haven’t you switched?)

How often have you encountered excess charges, and have any/many been over $300? (I keep reading that excess charges, especially large ones, are rare.)
It’s my understanding that, because we live in CT, if we choose to use a medical provider who does not accept Medicare assigned costs (would need to find out in advance), we can switch from a Plan N to a Plan G at any time (with the change taking effect on the 1st of the upcoming month) with no underwriting or fear of refusal, which would then cover any excess charges. And we can also switch back to a Plan N at any time. Is there anyone who has done this?
If you have Plan N, have you ever wished you just signed up for Plan G, and why? (And then why haven’t you switched?)

Clinical Nurse Specialist References: This looks like the acute care pharmacist role in ICU and ER.
You Tube Nursing Uncharted. The Role of a Clinical Nurse Specialist (CNS) Ep. 06 Highlight Nursing Uncharted
https://www.youtube.com/watch?v=L1_QwTuS3Hc
You Tube Nurse.org. How to Become a Clinical Nurse Specialist (CNS)How to Become a Clinical Nurse Specialist (CNS)
Nurse.org
https://www.youtube.com/watch?v=n8RXYQC0uIo
Nurse.org
How to Become a Clinical Nurse Specialist
https://nurse.org/resources/clinical-nurse-specialist/

What Does a Clinical Nurse Specialist Do?

A clinical nurse specialist's job varies depending on the type of facility they work at and their chosen specialty. However, their primary goal is always to improve outcomes. Therefore, they constantly ask questions like:

• How can I help the nurses at the bedside?
• How can I help these patients on the unit?
• What changes would improve processes throughout the hospital system?

Clinical Nurse Specialist Duties and Responsibilities

According to CNS Andrea Paddock, CNS responsibilities may change daily:
“My day-to-day can transition from being in my office planning for a project. So I'm doing a lot of reading, researching, writing, things like that. Other days, I'm out on the unit helping the nurses, running to codes, running simulations, teaching classes, running meetings, etc. No one day is ever the same.”
In fact, according to the 2020 NACNS survey, CNSs said they spent 26.6 percent of their day providing direct patient care, 22.1 percent consulting with nurses and other staff, 26.5 percent teaching nurses and staff, and 19.7 percent leading evidence-based practice projects. The majority of their time is spent precepting students (32.5%).
Clinical nurse specialists will also perform the following activities according to the survey:

• Assist with evidence-based practice projects
• Assist other nurses/staff with direct patient care (aka act as a resource)
• Assist with research
• Teach patients and families
• Conduct research as the primary investigator
• Teach in the community
• Provide transitional care

In other words, CNSs wear several hats and are valued members of healthcare teams.
What Does a Clinical Nurse Specialist Do? A clinical nurse specialist's job varies depending on the type of facility they work at and their chosen specialty. However, their primary goal is always to improve outcomes. Therefore, they constantly ask questions like: How can I help the nurses at the bedside? How can I help these patients on the unit? What changes would improve processes throughout the hospital system?
Clinical Nurse Specialist Duties and Responsibilities According to CNS Andrea Paddock, CNS responsibilities may change daily: “My day-to-day can transition from being in my office planning for a project. So I'm doing a lot of reading, researching, writing, things like that. Other days, I'm out on the unit helping the nurses, running to codes, running simulations, teaching classes, running meetings, etc. No one day is ever the same.”
In fact, according to the 2020 NACNS survey, CNSs said they spent 26.6 percent of their day providing direct patient care, 22.1 percent consulting with nurses and other staff, 26.5 percent teaching nurses and staff, and 19.7 percent leading evidence-based practice projects. The majority of their time is spent precepting students (32.5%).
Clinical nurse specialists will also perform the following activities according to the survey: Assist with evidence-based practice projects Assist other nurses/staff with direct patient care (aka act as a resource) Assist with research Teach patients and families Conduct research as the primary investigator Teach in the community Provide transitional care In other words, CNSs wear several hats and are valued members of healthcare teams.

CNS Certifications & Specialties

CNS certifications don't cover all specialty areas of nursing like other degrees. Currently, clinical nurse specialists can earn certifications in the following specialties:

• Adult
• Pediatric
• Neonatal
• Geriatric
• Oncology
• Critical Care (Adult, Pediatric & Neonatal)
• Orthopedic
• Perioperative
• Psychiatric-Mental Health (Adult, Adolescent/Child) CNS Certifications & Specialties CNS certifications don't cover all specialty areas of nursing like other degrees. Currently, clinical nurse specialists can earn certifications in the following specialties: Adult Pediatric Neonatal Geriatric Oncology Critical Care (Adult, Pediatric & Neonatal) Orthopedic Perioperative Psychiatric-Mental Health (Adult, Adolescent/Child)

CNS can bill for services and have provider status in many states. Pharmacist do not seem to have this.
NP, CNS, and CNM Services:7 Medicare makes payment for NP, CNS, and CNM services based on the MPFS.
The MPFS is a fee schedule with an individual payment amount for as many as 8,000 different procedure
codes. Section 1833(a)(1)(O) of the Act requires NPs and CNSs to be paid 85% of what Medicare would pay a
physician for the same service or 85% of the MPFS payment amount. Until January 1, 2011, CNMs were paid
65% of the MPFS payment amount. Beginning January 1, 2011, Medicare allows CNMs to be paid 100% of
the MPFS amount. The final section of this paper will posit arguments for changing the statute so that all
APRNs are paid at 100% of the MPFS.
Reference ANA: Medicare Payment for Registered Nurse Services and Care Coordination
https://www.nursingworld.org/~498582/globalassets/practiceandpolicy/health-policy/final_carecoordination.pdf

CNS Independent Practice MapCNS Independent Practice Map

https://www.ncsbn.org/nursing-regulation/practice/aprn/aprn-consensus-implementation-status/cns-independent-practice-map.page
All Nursing Schools:

What You’ll Do as a Clinical Nurse Specialist (CNS Job Description)

https://www.allnursingschools.com/clinical-nurse-specialist/job-description/
https://preview.redd.it/jlk3in7crczc1.png?width=798&format=png&auto=webp&s=f6d55786d31c2eb16c766654faf8c9e0f0a83466
International Council of Nurses. Guidelines for Advance Practice Nursing 2020:
https://www.icn.ch/resources/publications-and-reports/guidelines-advanced-practice-nursing-2020
https://www.icn.ch/sites/default/files/2023-04/ICN_APN%20Report_EN.pdf
https://preview.redd.it/wh0da0a2sczc1.png?width=749&format=png&auto=webp&s=3244c41cae29378b5b16cea0c81450ed7b4014d7
https://preview.redd.it/hljay7v6sczc1.png?width=781&format=png&auto=webp&s=a31841593469f6cbb913a6ab27b064f020a555c1
https://preview.redd.it/4abhhsn9sczc1.png?width=768&format=png&auto=webp&s=cf2d63e1b9b50de0142b2997e1bb42dbf829b598
The role of the nurse is also expanding in Ambulatory care. This looks like the AMCare RPH References:

RN Role Reimagined: How Empowering Registered Nurses Can Improve Primary Care

https://www.chcf.org/publication/rn-role-reimagined-how-empowering-registered-nurses-can-improve-primary-care/
https://improvingprimarycare.org/sites/default/files/topics/RN-Intro1-RN%20Role%20Reimagined-CHCF-Aug2015.pdf
With growing demands on primary care and a shortage of primary care clinicians, safety-net clinics are asking, What is the role of the registered nurse (RN) in primary care?
This report describes how 11 community health centers and county health systems in California, as well as two health centers outside California, are using the following strategies to expand the RN role in primary care:

• Provide RNs with additional training in primary care skills, so they can make more clinical decisions
• Empower RNs to make more clinical decisions, using standardized procedures
• Reduce the triage burden on RNs to free up time for other responsibilities
• Include RNs on care teams, allowing them to focus on their team’s patients
• Implement RN-led new-patient visits to increase patient access to care
• Offer patients co-visits in which RNs conduct most of the visit, with providers joining in at the end
• Deploy RNs as “tactical nurses”
• Provide patients with RN-led chronic care management visits
• Employ RNs’ skills to care-manage patients with complex health care needs
• Train some RNs to take responsibility for specialized functions
• Schedule RNs to perform different roles on different days
• Preserve the traditional RN role and focus on training medical assistants (MAs) and licensed vocational nurses (LVNs) to take on new responsibilities

https://preview.redd.it/1u7knbc8qczc1.png?width=376&format=png&auto=webp&s=50f6048598c3ba69093cfcf77dee5727a7fa0bdf
American Nurse:

Preparing RNs for emerging roles in primary care

https://www.myamericannurse.com/preparing-rns-for-emerging-roles-in-primary-care/

Registered Nurses: Partners in Transforming Primary Care

https://macyfoundation.org/publications/registered-nurses-partners-in-transforming-primary-care
https://macyfoundation.org/assets/reports/publications/macy_monograph_nurses_2016_webpdf.pdf
Registered nurses, the largest health profession in the nation with over 3.5 million
members, are ideally suited to provide the bulk of care for people with chronic
illnesses. In primary care, RNs may assume at least four responsibilities: 1) Engaging
patients with chronic conditions in behavior change and adjusting medications
according to practitioner-written protocols; 2) Leading teams to improve the care
and reduce the costs of high-need, high-cost patients; 3) Coordinating the care
of chronically ill patients between the primary care home and the surrounding
healthcare neighborhood; and 4) Promoting population health, including working
with communities to create healthier spaces for people to live, work, learn, and play.

The Vital Role of Nurses in Delivering Transformative Primary Care

https://www.chenmed.com/blog/vital-role-nurses-delivering-transformative-primary-care
Depending on their level of education and experience, the BMC Health Service Research Article observes, nurses can independently "provide a broad range of patient services, including preventative screening, health education and promotion, chronic disease management, acute episodic care, and a wide variety of therapeutic interventions."
The activation of nurses—under the guidance of MDs, physician assistants, and nurse practitioners—was a hallmark of 30 "high-performing, innovative primary care practices" highlighted in a 2017 study published by the Journal of Ambulatory Care Management. These organizations had "practice-wide standing orders" that directed nurses to "independently conduct preventative visits, manage minor acute illnesses, and provide significant chronic illness care and management" to the patient panels.

Value-Based Care Elevates the Role of the Registered Nurse in Primary Care

https://www.hfma.org/payment-reimbursement-and-managed-care/value-based-payment/54348/
For example, a patient may need to see only the nurse and nurse assistant for one scheduled visit but on another visit needs to be examined by the physician and provided training by the nurse.
Additionally, the patient pathway from appointment preparation to next appointment rescheduling was streamlined to shorten wait time by starting intake procedures from the moment the patient enters the office. Further, the critical handoff between the physician and the nurse is expedited by the needs-based stratification of patients, each associated with evidenced-based care protocol. This expands the role of nurse, allowing them to assume greater responsibility for patient care.
To be successful in such value-based initiatives, healthcare organizations must ensure nurses are working at the top of their license. Progressive providers have increased patient access by conducting new nurse-only patient visits during which registered nurses document patient histories, order lab and other diagnostic tests, and determine patient acuity.
By implementing newly defined standardized procedures, clinics are increasing the registered nurse’s scope of clinical decision making including medication refills and anticoagulant and chronic care management. Nurses also are conducting physical examinations, providing triage, and subsequently presenting patient cases to practitioners—activities that significantly improve overall workflow and efficiency. Moreover, evidence shows nurse-led chronic, complex, and transitional care management results in decreased hospital days and emergency department (ED) admissions.
The Ohio State School of Nursing

Redesigning nursing education to support patients in primary care

https://nursing.osu.edu/news/2020/12/16/redesigning-nursing-education-support-patients-primary-care
https://preview.redd.it/uidu1bhktczc1.png?width=514&format=png&auto=webp&s=0c4b7aaf011e99de7c902915d66da15f7c2e7112
Implementing Nurse-Run Hypertension Clinics
https://www.careinnovations.org/resources/nurse-run-hypertension-care/
https://preview.redd.it/xpcdyccttczc1.png?width=798&format=png&auto=webp&s=67261d97068fd650e07c6e09f27a8ef876243782
https://preview.redd.it/zqwqlyywtczc1.png?width=855&format=png&auto=webp&s=5ea5fd3225bf154d658c8b3424fbc337d1d6e3d4
These tread seems to be international as all countries seem to move toward Value Based Care.

Tension as practice pharmacists ‘encroach’ on nurse duties

https://www.nursingtimes.net/news/primary-care/tension-as-practice-pharmacists-encroach-on-nurse-duties-12-03-2019/

Hospital hires newly qualified pharmacists for wards amid nurse shortage

https://pharmaceutical-journal.com/article/news/hospital-hires-newly-qualified-pharmacists-for-wards-amid-nurse-shortage

I get a lot of prior auth rejections for Medicare patients for their glucose testing supplies because their part D coverage doesn’t cover supplies; part B does.
My question is: can/should the retail pharmacies bill part B for coverage?

I have received a letter from Social Security outlining charges that will be made to my check beginning next month for Medicare when my 65th birthday comes.
I am still covered by good private insurance and drug plan as a dependent by my wife's current employer. I have the forms from her employer showing "credible coverage."
I called the phone number for Social Security that was given on the letter. The hold time was over an hour and I left my contact information for a callback. The letter stated I had sixty days from receipt of the letter to dispute anything. I am not disputing so much as asking for "push back " for benefits.
Does anyone have advice on anything else I should do now ?
Should I write a letter also ? I called the local Social Security office and it was never answered , but a recording said due to increased volume , no service was available and then hung up. Three times.
Any advice appreciated. Thank you

Im trying to figure out insurance that would cover top surgery, and I noticed that the Medicare number I was quoted by a surgeon (31520) isn't on the healthcare.gov.au MBS list of medically necessary breast surgery
does this mean that this number won't be covered by insurance ? or will it be dependent on the plan I go with?

I know Medicare advantage plans cover 100 day Rxs- but does plain Medicare cover 100 day with refill Rxs? Or are my patients going to have a random 10 pill refill?

Hello Fellow Apes,
I want to take a quick minute to write a post about Moocao's post regarding CVS Q1 2024 earning.
https://www.reddit.com/Healthcare_Anon/comments/1cjpur9/cvs_q1_2024_earnings_analysis_earnings_call10q/
It is a great post with many implications taken from the perspective of an investor and someone who is on the front line. We're literally seeing CVS' earning unfold in real time. Additionally, I want to juxtapose it with the things that are being written on WSB because comparisons often serve as a good frame of reference.
https://www.reddit.com/wallstreetbets/comments/1ckq8i2/cvs_got_crushed_so_pntg_may_soa?share_id=vWu2IAVOKrdbdYRsz0UOF&utm_content=1&utm_medium=android_app&utm_name=androidcss&utm_source=share&utm_term=1
We often don't know what we're looking at until we have something to compare it to. We're going to start off with Moocao's DD before going to the WSB DD (Sorta)
Starting with Moocao's DD.
CVS reported that their first quarter earnings were negatively impacted by an increase in the use of Medicare Advantage services, which affected their profitability. However, this issue does not stem from the Centers for Medicare and Medicaid Services (CMS). Instead, as a provider of managed care, companies like CVS are responsible for delivering this care to their consumers. The goals of the managed care model include improving cost efficiency, coordinating care, enhancing benefits, promoting preventive care, and managing risk. This model is designed to be cost-effective, focused on preventative care, and capable of delivering high-quality health outcomes. If there is a significant increase in service utilization that is not related to extraordinary circumstances like delayed elective surgeries post-COVID or other exceptional reasons often cited by healthcare companies, it likely indicates a failure in effectively managing the health of the population. In essence, they have reached a point where they must provide necessary care without the ability to further profit by denying services. This situation implies that their management of member health was inadequate, forcing them to address these health issues more intensively now.
CVS reported a revenue growth of 3.7% and an adjusted earnings per share (EPS) of $1.31 for the first quarter of 2024. However, they have revised their EPS forecast for the year downwards to at least $7.00. This adjustment is primarily attributed to higher than expected Medicare utilization. Although these figures appear positive, they don't fully reveal the underlying dynamics affecting the company.
Previously, CVS had forecasted a normalization of service use, building upon an already high baseline from the fourth quarter of 2023. However, they have now observed that the current utilization trends are exceeding those of Q4 2023. This might be the first earnings report this season where a company has reported higher utilization compared to the previous quarter, setting CVS apart from others. Most companies noted an increase in inpatient services in January and February, with a decline in March, but none have reported a higher utilization than in Q4 2023 until now. As mentioned, I believe this is just a consequence of their action, and it is one of the reason why they are desperate for CMS to increase the fee for service rate to be higher than the 3.7% increase they will be getting.
Additionally, CVS has increased its reserves to cover any unprocessed claims resulting from the Change Healthcare cyberattack. Both outpatient services and Medicare supplement utilization have remained high in the first quarter of 2024, surpassing previous projections.
Furthermore, Aetna evaluated the CMS final rate notice for Calendar Year (CY) 2025, along with changes to the Medicare Part D plan as mandated by the Inflation Reduction Act. The company concluded that the reimbursement rates are insufficient (CMS doesn't care and the rules are final). Aetna points out that the lower rate increases specified by CMS will significantly disrupt the level of benefits and the range of options available to seniors nationwide which is another way of saying it will punish the consumers by cutting back on benefits and probably denying the shit out of any claim. Consequently, Aetna plans to reduce benefits and will strategically withdraw from certain markets during the bidding process for CY 2025, a move that is in line with trends seen among other players in the market. My bet is they will start withdrawing from poorer areas where the self-managed care of the population is bad. They will probably still still in more affluent areas where people are managing their own care and has more money. Aetna is focusing on improving its profit margins and has decided not to pursue growth in this market segment in CY 2025.
In response to increased utilization, Aetna has established multidisciplinary teams to analyze claims data for specific conditions, geographic regions, or unusual patterns in service use. It's important to clarify that Aetna is well-equipped to identify the reasons behind this increase. By categorizing and reviewing billing codes, they can easily pinpoint which areas are contributing to higher utilization. CVS has attributed the rise in costs to increased outpatient services and higher drug prices. Prominent factors that typically escalate healthcare expenses include dialysis, diabetes, and drugs for multiple coexisting conditions, which are notoriously expensive and difficult to cut back on. Moreover, this situation is compounded by a deteriorating general health among the population, driven by years of inadequate investment in population health management, leading to a critical point where reversing the trend becomes exceedingly challenging.
Additionally, CVS will be using biosimilar drugs to save money while providing "equivalent clinical care." Biosimilar drugs are a type of medication designed to be highly similar to an already approved biological drug, known as a reference or originator biologic. Unlike generic drugs, which are exact copies of chemically synthesized drugs, biosimilars are derived from living organisms and are not identical replicas but are closely matched in terms of safety, effectiveness, and quality to their reference biologics. Biosimilars are developed to compete with existing biological drugs, offering potentially lower-cost options once the original products' patents expire. This might result in higher claim denials, but slower delivery of care. If this is the case, the issues of population health will just get worse.
In the first quarter of 2024, CVS reported a Medical Benefit Ratio (MBR) of 90.4%, marking an increase of 580 basis points compared to the first quarter of 2023. This rise is attributed to increased utilization of services and a decrease in STARS ratings for the year 2024. Specifically, CVS has observed heightened utilization in outpatient and supplemental benefits, alongside rising pressures on inpatient services. The latter is characterized by seasonal patterns in inpatient admissions that CVS has not encountered since before the pandemic.
In response to these financial pressures, CVS is considering the retirement of certain health plans and the introduction of new plans less impacted by Total Benefit Cost (TBC) thresholds. Additionally, CVS plans to recalibrate the pricing on their existing plans to compensate for the eroded margins.
Moreover, CVS/Aetna is prioritizing pricing strategies aimed at maintaining profit margins rather than expanding membership. Despite these pricing adjustments, CVS does not anticipate a significant loss in membership. This expectation is based on the assumption that similar industry-wide pressures will lead to widespread plan price increases, encouraging members to stay with CVS/Aetna. Concurrently, CVS is exploring reductions in benefits as part of its strategy to improve profit margins. Now... what would happen if there are companies that do not experience similar industry-wide pressure? CVS and similar companies with have real competitions!
The other points Moocao made in the post are self-explanatory and I highly suggest you give it a read. I'm only highlighting keypoints and their implications. I don't see how CVS MCR is going to improve when their population health is so bad that they can't even explain it on an earning calls. We know they know. You can't be a company like CVS and fail at projecting population health. Their profit making caught up to them, and now they have to git gud real fast.
Now for the CVS DD from WSB.
I find the post particularly amusing, and I give the author credit for suggesting that home healthcare would solve CVS' problems. However, he is very wrong in his understanding of healthcare companies and home health. Home health care is a solution and will be the replacement for nursing homes. In is a most cost-effective solution. As for healthcare companies, they will first start cutting cost before they explore introducing another product such as home health care. There are companies such as CLOV that does have a home health care, but CVS doesn't have one and will not be exploring one anytime soon. As for PNTG, the crowd went mild after the recent earning a large part of this is because home health margin isn't that great and the new 80/20 rules for HCBS waivers aren't that great, but we're not going to dive into that here.
I just want to highlight the contrast between Moocao DD and the kind of stuff others such as WSB would post. I know that it may look simple, but there are real nuances to the stuff that we write. For those of you who know how to use census track, you can figure out which geographic areas is causing the most pain for CVS. older, poorer, and less educated seniors are the ones causing the high uptick in utilization. If they really want to reduce the utilization, they need to invest more money into improving access to care and education to improve public health.

UPDATE/QUESTION
I found a Medicare Advantage plan:
AARP Medicare Andvantage from UHC NJ-0004 (PPO) with a $0 monthly premium..... how is this possible? Does this mean the insurance is free to have?
Also... he needs dental ASAP, how can I get him coverage when insurance enrollment periods are not until Oct-Dec?
I am a 28 year old (F) taking care of my father on my own. I desperately need advice.
My father (70) has Medicare part A and part B. In all honesty, I don't think he has stepped foot in a dentist office in 20+ years and he does not have good dental hygiene. I am trying to get him dental insurance so we can have him seen.
I am expecting them to recommend complete extraction and dentures. We do not have money to cover full costs. Please help!!! Thank you.

• Only has medicare part a & b
• Needs dental insurance
• Possible extraction/dentures/major work needed
• Denied medicaid